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17 Cards in this Set
- Front
- Back
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the postpartum fundus
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assess for firmness. Palpate > delivery.
Remains @ umbilicus X 24 hrs. Soft aka “boggy” - danger of hemorrhage when palpating support lower uterus to prevent eversion. Full bladder gives false fundal height, Breast feeding increases the decrease of fundus height! |
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Delays in uterine involution include?
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retained placenta/clots
multiparous pt. [grand multip ] exhaustion multi-fetuses. C/S involutes slower; d/t surgery & less initiation of breast feeding > delivery. |
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About post partum lochia
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Placenta separates from spongy layer of uterus - decidua BASALIS
1st 3 days = rubra =”red” [blood] >3 days = serosa = “pink” 10th day – alba - “white” [up to 3 wks] Total flow lasts about 4-5 wks Should not be bright red; could be PP hemorrhage |
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the post patrum cervix
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Neck; remains slightly opened & contracts > delivery.
In 7 days, opening narrow as pencil. Os remains slit-like |
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the post patrum vagina
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Slightly distended after birth. Kegel exercises ^muscle tone and strength. Important for lacerations.
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the post patrum perineum
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Can be edematous/ecchymotic
Ice x 24 hrs. then heat [Sitz] Topical anesthetics creams/sprays apply for comfort. Perineal massage relaxes perineum before delivery. May prevent episiotomy /laceration. Teach Kegels |
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What are complications of the perineum?
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Hematmas
area of swelling on 1 side (if small apply ice) If large bleed go to OR for packing |
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care for sore perineum
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Use warm water
wipe from front to back |
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about Lacerations post partum?
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size of baby, timing of delivery, tension on perineum.
Sutured & treated as episiotomies. Analgesics, ice, topical creams, Sitz bath. 1st degree = from base of vagina to base of labia minora. 2nd “ = from base of vagina to mid perineum 3rd = entire perineum to anal sphincter 4th = entire perineum through anal sphincter & some rectal tissue. |
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how should you treat a patient with bad lacerations post partum?
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Nothing into rectum - no rectal temps., suppositories, or enemas with 4th degree to avoid further damage.
Colace TID, ^ po fluids to promote BM. Ice X 24 hrs., Sitz baths TID; topicals. KEGELS! |
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How are hormones affected post partum?
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Pregnancy hormones decrease w. delivery of placenta.
HCG & HPL disappear by 24 hrs. FSH rises 12 days - to begin new menstrual cycle. Menses resumes by 4-5 wks. if not Br. Fdg |
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HOw does the urinary system change in the Post partum period?
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Loss of bladder tone
Hydronephrosis decreased bladder sensitivity increased risk for bladder inf. |
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Expected blood loss for nvd and C/S
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NVD:300
c/s: 500 |
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who is at high risk for DVT?
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c/s mothers
overweight mothers Advanced age SMokers Diabetes Varicose veins |
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what are the expected bowel sounds post partum
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vaginally: BS right away
C/S: bowel sounds hypoactive for first 8 hours |
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Bathroom expectations for postpartum patient?
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BM - difficult/painful d/t lacerations/hemmorhoids.
C/S - BM 3rd - 4th day. GI activity slowed d/t surgery. Can go home without BM if + flatus |
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about when should patients return to eating?
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Epidural/spinal: po clears after delivery, advance diet if +BS.
General anesthesia: usually NPO for ~ 6-8 hrs. Duramorph/astromorph can cause N/V up to 12 hrs. antiemetic meds. |
