Postpartum Questions and Answers 100% Pass

Postpartum Questions and Answers 100% Pass What period of time is postpartum referred to? 4th stage of labor - Women adjusts physically and psychologically to the process of childbirth - Begins immediately after birth and continues for approximately six weeks, or until the body has returned to a near pre-pregnant state Rubella vaccine - SubQ - Can still breastfeed - Can't get pregnant for one month Tdap For Pertussis - Given to mom, dad and anyone close to baby to hopefully prevent baby from getting it - Given after every pregnancy Rh isoimmunization All moms that are Rh- get Rogan shot at 28 weeks- if baby is Rh+ have 72 hours to give mom another shot Ibuprofen, naproxone Given for "after pains" caused by uterine contractions after feeding - Do not exceed 3,200 mg in 24 hours Postpartum Exam B- breast U- uterus B- bladder B- bowel L- locia E- episiotomy/laceration H- Homan's/hemorrhoids E- Emotional B- breast - Enlarged nipple - Breast enlargement and engorgement with milk - Can be uncomfortable - Primary engorgement lasts about 24-28 hours - Mastis- infection/inflammation of breast U- uterus - Involution- process when uterus returns to pre-pregnancy state and location- occurs through uterine contractions and atrophy - After the third stage of labor, assess the uterus every 15 minutes for an hour; every 30 minutes for the 2nd hour; every 4 hours for the next 24 hours; then once a shift or more frequently if findings are not WNL - Have women empty bladder before assessing- uterus becomes displaced and deviated to the right when the bladder is full- can cause hemorrhage ** - Provide privacy - Lower head of bed to supine, flat position - Locate fundus - Determine tone of fundus- should be firm and rock hard - Measure distance between the fundus and umbilicus with your finger- each finger is 1 cm - Determine position of fundus B- bladder - Puerperal diuresis - Bladder distention- incomplete emptying r/t anesthesia, swelling of perineum - Cystitis- bladder infection- any difficulty/painful/burning urination - Assess voiding amounts during the first 24 hours post birth - Assess for frequency, urgency and burning on urination- signs of infection - Assist the woman to the bathroom and encourage her to void within 6 hours of birth or if experiences signs of bladder distention- call when getting out of bed; should be voiding 150 ml - Instruct the woman to increase fluid intake of at least 8 glasses per day - Instruct the woman on kegal exercises- 80 kegals a day to be effective B- bowel - Constipation- iron; prenatal vitamins; pain meds; progesterone collage, stay hydrated, ambulation, high fiber - Flatulence- gas pain- heat/ice; lay in left lateral sims with right leg up - Appetite- clear liquids when you hear bowel sounds; wait about an hour to make sure out of the woods for c-section patients - Weight loss- weight of baby and placenta, blood/fluid inside placenta L- lochia - Vaginal bleeding where placenta detached- if goes back to previous color- sign of possible hemorrhage - When flow stops- means cervix is closed- takes about 6 weeks to close- nothing up vagina until then - Average drainage about 225 cc- greater in AM and increased during breastfeeding; if saturating a pad an hour- call 911- hemorrhaging E- episiotomy/laceration - Assess for REEDA - Redness, edema, ecchymosis, discharge, approximation of edges of episiotomy or laceration (can be 1st, 2nd, 3rd, 4th degree) - Asses for discomfort- pain scale - Provide comfort measures- ice packs to prevent edema - Reduce risk for infection H- Homan's/hemorrhoids - Homan's sign- 3-6 weeks postpartum- DVT/blood clot- support under knew- dorsiflex foot- look for redness, pain, tenderness - Hemorrhoids- don't push back in- could perforate bowel- itch, burn, sting- preparation H; hydrocortisone cream, sitz baths- towel in tub with warm water 3 times a day for 20 minutes- will increase circulation E- Emotional Postpartum blues Stages of milk - Colostrum- present at 1st pp week; thick and yellow; increase in volume in parous women - Transitional milk- present 7 to 10 days pp; not as yellow in color - Mature milk- present after first 2 weeks pp; whiter and thinner than transitional milk Discharge teaching for breastfeeding mom - Assess breasts for primary engorgement - Asses nipples for irritation and tissue breakdown - Asses for mastis - Redness, irritation, tenderness of breast - Wash hands - 8, 8 oz. glasses of water a day Discharge teaching for non-breastfeeding mom - Assess breasts for primary engorgement - Ice 20 mins on, 20 mins off - Supportive bra - Analgesics Discharge teaching for all moms Weight loss- 6 months post partum will be 3/4 lbs above pre-pregnancy weight Relief of emotional stress - Emotional liability- explain mood swings, tearfulness, postpartum blues - Coping with feelings about birth - Coping with feelings about infant - Ability to care for self and infant- ask about family support system, previous depression (would increased risk for post-partum depression - Talk with father or baby/husband to make sure depression resolves Postpartal diaphoresis Occurs in the first few days in response to decreased estrogen levels - Profuse sweating often occurs at night - Don't have fever, usually bodies way of getting rid of excess fluid - Assist patient with shower, linen and clothes change, reassure this is normal Puerperal diuresis Decrease in estrogen and oxytocin (usually over 12 hours)- a lot of urine After pains Occur after feeding- uterus contracts because of oxytocin - Give ibuprofen or naproxen- 3,200 mg/24 hours Vitals signs and labs for postpartum woman - VS should remain stable - Blood loss- 400-500 cc- vaginal delivery- over 500 hemorrhaging; 1,000 cc- c-section - Orthostatic hypotension - Hgb/Hct- decrease due to blood loss- anything below 10 is anemia - Temperature- if above 100.4- infection - Fall risk because of orthostatic hypotension - Increased risk for venous thrombosis 2-3 weeks pp due to increased fibrous tissue - WBC- can be elevated up to 20,000 Rubin's stages of postpartum adjustment - Taking in- 1-2 days after delivery- sorting reality from fantasy in birth experience; tends to be passive, focused more on her own needs; wants everything brought to them Taking hold- 2-3 days after delivery- ready to resume control over life Bonding/attachment phases - Acquaintance phase - Phase of mutual regulation - Reciprocity Acquaintance phase - Finger tip exploration, response verbally to sounds of infant - Hand baby to mom, they explore baby - En face position Phase of mutual regulation - Adjustment between needs of mother and needs of infant Reciprocity - Mutually gratifying integration among mother, infant, and father - 6 weeks Factors that influence attachment - Personal characteristics (maybe baby reminds them of someone she hated—if she got raped) - Involvement with the family (if you have close relations with family it helps to bond with baby) - Relationships (is there a father) - Communication patterns - Degree of nurturing received as a child Reactive affective disorder If bonding does not occur- can develop this disorder Perineal care and comfort measures - Use REEDA scale - Edema may still be present after 24 hours - Use ice pad (to help with pain and inflammation) - Warm bath for soreness Nursing interventions to help decrease perineal edema and promote healing while reducing risk for infection - Avoid wiping from anal to vagina- big way to prevent infection - After each elimination need to cleanse perineum - Wash hands before and after changing periods or performing pericare Postpartum blues Transeint period of depression- occurs during first few days after delivery, resolves without intervention in 10-14 days - Tearfulness, anorexia, difficulty sleeping, feeling of let down - Caused by changing hormone levels, physiologic adjustments, unsupportive environment, insecurity, fatigue, discomfort, overstimulation - 80% of women experience this - Cluster nursing care; explain mood swings; help them cope with new experiences Promoting family bonding in newborn Social setting can influence attachments - Open visiting hours - Rooming in - Siblings can participle in care in developmentally appropriate ways - Father can make an attachment by feeding Postpartal chills - Due to vascular instability- blood loss - Cold, shake uncontrollably - Provide warm blankets Stages of Lochia - Bright red at birth - Rubra- dark red- first three days - Serosa- pink- 4-10 days - Alba- creamy white or light yellowish - Clear Where should the funds of the uterus be located in relation to time from the delivery of the placenta - Should be midline - Takes 6-12 hours to get to umbilicus- if located above after 12 hours- sign of hemorrhage - Descends 1 cm a day until day 10- should be non-palapable at symphysis pubis - 24 hours after delivery- 1 cm below umbilicus..etc. Effects of epidural anesthesia postpartally - Bladder distention- straight cath - Orthostatic hypotension - Diminished lower body nerve sensation- risk for falls Caloric requirement of lactating women Increase caloric intake by 200 when breastfeeding- and when pregnant increased by 300- so 500 total Caloric requirement of non-lactating women 200 cals per day Lactating women resuming menstrual period Return depends on length of time breastfeeding and frequency of breastfeeding- usually 7 weeks-6 months - Breastfeeding is not method of contraception- can't take birth control pills while breastfeeding Non-lactating women resuming menstrual period Usually returns 6-10 weeks Nursing interventions for boggy uterus -Uterus is not in a contracted state - Risk for hemorrhage - Immediate action is to massage the uterus* - If uterus does not respond to massage, follow with standing order for oxytocin IV and notify the physician Nursing interventions for displaced uterus - Displaced to right- think bladder distention- need to void/straight cath - Hemorrhaging would be suspected if uterus is above the umbilicus