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Uncomplicated Postpartum Assessment & Care
OB HESI
57
Nursing
Undergraduate 3
06/05/2011

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Cards

Term
Involution
Definition
reduction is size of uterus after delivery to prepregnant size caused by uterine contractions that constrict and occlude underlying blood vessels at placental site
Term
Puerperium
Definition
the 6-week period after delivery
Term
Fundus
Definition
Top portion of uterus; a palpable indicator of involution
Term
Boggy uterus
Definition
interrupted uterine contractions cause uterus to be soft and relaxed and is likely to cause hemorrhage 
Term
Lochia
Definition
Discharge of blood and debris following delivery
Term
Lochia Rubra
Definition

  • blood with small amounts of mucus, shreds of decidua, epithelial cells, leukocytes; may contain fetal meconium, lanugo, or vernix caseosa 
  • dark red, boody; fleshy, musty, stale odor that is nonoffensive; may have clots smaller than a nickle
  • occurrence 1-3 days postpartum 

Term
Lochia Serosa
Definition

  • composed of serum, erythrocytes, shreds of degenerating decidua, leukocytes, cervical mucus, numerous bacteria
  • pink or brownish; watery; odorless
  • occurs 4-10 days postpartum

Term
Lochia Alba
Definition

  • Composed of leukocytes, decidual cels, epithelial cells, fat, cervical mucus, cholesterol, bacteria
  • yellow to white; may have slightly stale odor
  • occurs 11-21 days postpartum; may persist to 6 weeks in lactating women 

Term
Total volume of lochia, that gradually decreases is ___mL
Definition
240-270 mL
Term
amount of lochia may be increased by this
Definition
exertion or breast-feeding
Term
Afterpains
Definition

caused by intermittent uterine contractions following delivery

* more painful in multiparous and breast-feeding women

Term
Postpartum changes of Cervix
Definition

  • soft, irregular, and edematous; may appear bruised with multiple small lacerations
  • closes to 2-3cm after several days, admits a fingertip after 1 wk
  • shape permanently changes to lateral slit-like os of multiparous woman

Term
Postpartum changes of Vagina
Definition

  • smooth walls, edematous with multiple small lacerations
  • client should be free from perineal pain within 2 wks
  • Low estrogen levels postpartum lead to decreased vaginal lubrication and vasocongestion for 6-10 wks, resulting in painful intercourse

Term
Postpartum changes of abdominal wall
Definition

 

  • soft and flabby with decreased muscle tone
  • striae (silver in white woman, dark in dark women)
  • Diastasis recti

 

Term
Postpartum cardiovascular changes
Definition

  • returns to pre-pregnant state within 2 wks
  • 40% blood volume increase is eliminated by diuresis
  • First 48 hrs pose greatest risk of complications for clients with heart disease
  • BP should remain consistent with pregnancy baseline
  • Bradycardia of 50-70bpm common during first 6-10 days
  • Increased WBC count up to 30,000/mm3 (increase > 30% in 6hrs indicates pathology)
  • Decreased Hgb r/t amount of blood loss during delivery; returns to prelabor value in 2-6 wks
  • Hct increases by 3-5 days r/t diuresis; drop indicates abnormal blood loss 

Term
Postpartum urinary changes
Definition

  • increased bladder capacity and decreased bladder tone lead to decreased sensation and increased r/f urinary retention & infection
  • diuresis of 2-3,000mL increases output in first 12-24hrs after delivery and accounts for 5-Ib weight loss
  • Increased glomerular filtration rate assists in diuresis
  • full bladder displaces uterus, increasing risk of uterine atony and hemorrhage 
  • Fluids lost through diaphoresis (night)

Term
Postpartum GI changes
Definition

  • hunger and thirst
  • risk for constipation r/t decreased peristalsis, use of narcotic analgesics, dehydration and decreased mobility during labor, and fear of pain from having BM
  • Risk for hemorrhoids increases because of pressure from pushing during second stage of labor

Term
Postpartum endocrine changes
Definition

 

  • estrogen and progesterone levels drop rapidly after placental delivery
  • menstruation resumes 7-9wks for nonlactating women with 90% experiencing menstrual period by 12 wks; 1st cycle usually anovulatory
  • Ovulation & menstruation return time prolonged in lactating women (may very from 2-18 months
  • lactation

 

Term
Lactation
Definition
nipple stimulation leads to release of oxytocin from pituitary gland; this stimulates release of prolactin from pituitary gland, causing milk production
Term
Let-down reflex
Definition
release of milk by contractions of alveoli of breast
Term
Colostrum 
Definition
first milk secreted and is rich in protein & immunoglobulins 
Term
Primary Engorgement
Definition
occurs on 2nd or 3rd day as supply of blood and lymph in breast is increased and transitional milk is produces
Term
Mature milk
Definition
produced after 2 wks and appears watery and slightly bluish in color, similar to skim milk
Term
Phases of maternal adjustment
Definition

  1. taking-in phase
  2. taking-hold phase
  3. letting-go phase

Term
Taking-in phase
Definition

  • first 3 days postpartum; needs to discuss L&D
  • preoccupied with own needs; passive and dependent
  • touches and explores infant

Term
Taking-hold Phase
Definition

  • 3rd-10th day postpartum
  • obsessed with body functions
  • rapid mood swings
  • anticipatory guidance most effective now

Term
Letting-go Phase
Definition

  • 10 days-6 wks postpartum
  • mothering functions established
  • sees infant as a unique person

Term
Bonding (attachment)
Definition

 

  • process by which parents form emotional relationship with their infant over time
  • mother explores infant first with fingertips, then palms, and finally enfolding NB with whole hands and arms
  • Holds infant in en face position
  • uses a soft, high-pitched tone of voice
  • engrossment

 

Term
en face position
Definition
face-to-face, about 20 cm apart and on same plane
Term
Engrossment
Definition
father's absorption, preoccupation, and interest in infant shortly after birth, which can be stimulated by witnessing birth 
Term
Postpartum Blues
Definition

  • maternal adjustment reaction
  • transient depression usually occurs btw 2nd & 3rd day and/or within first 2 wks
  • r/t changes in hormone levels, fatigue, and psychological stress r/t infant dependency
  • mood swings, anger, tearfulness, feeling let down, anorexia, and insomnia
  • usually resolves spontaneously, but may lead to postpartum depression

Term
Postpartum V/S
Definition

  • temp > 100.4 may indicate infection; may be elevated initially after delivery r/t dehydration
  • Pulse: 50-80 bpm; report if >100
  • Resp: 16-24 bpm
  • BP: assess for orthostatic hypotension

Term
BUBBLE-HEB (nine components of postpartum assessment)
Definition

  1. B: breasts
  2. U: uterus
  3. B: bladder
  4. B: bowel
  5. L: lochia
  6. E: episiotomy or perineal lacerations
  7. H: homan's sign
  8. E: emotional status
  9. B: bonding

Term
Postpartum Breast assessment
Definition

  • determine method of feeding
  • palpate for engorgement or tenderness
  • inspect nipples for redness, cracks, erectility

Term
Postpartum uterine assessment
Definition

  • palpate top of fundus with dominate hand
  • determine firmness, height, & position in relation to midline of abdomen
  • correlate fundal location with expected descent of 1 cm per day
  • Inspect abdominal incisions, episiotomy, and lacerations for REEDA

Term
REEDA
Definition

  • R: redness
  • E: edema
  • E: ecchymosis
  • D: discharge
  • A: approximation of skin edges

Term
Postpartum bladder assessment
Definition

  • void within 6-8 hrs post-delivery
  • assess frequency, burning, or urgency (UTI)
  • evaluate ability to completely empty bladder
  • Palpate for bladder distention if assessment is questionable 

Term
Postpartum bowel assessment
Definition

  • assess for passage of flatus
  • inspect for signs of distention
  • auscultate bowel sounds x4 for postoperative clients

Term
Lochia assessment
Definition

  • inspect type, quantity, amount, and odor
  • correlate findings with expected bleeding
  • cesarean-delivered women may have less lochia

Term
Episiotomy or perineal laceration assessment
Definition

  • inspect perineum for REEDA
  • inspect for hemorrhoids 

Term
Homan's sign
Definition

  • pain in calf upon dorsiflexion of foot is recorded as + sign and may indicate thrombophlebitis
  • inspect for pedal edema, redness, or warmth; if abnormal changes are present, assess pedal pulse

Term
Prevention of postpartum hemorrhage
Definition

 

  • assess risk factors
  • keep bladder empty
  • gently massage uterus if boggy
  • administer oxytocic meds as ordered 
  • monitor for side effects of meds (hypotension with rapid IV bolus of Pitocin; hypertension with Methergine and Ergotrate)

 

Term
Client should apply ice to perineum for __min on and ___min off for the first __hours
Definition
20 min on, 10 min off for first 24 hours
Term
Warm or cool sitz baths should be encouraged for the first ___hrs
Definition
12-24hrs
Term
Topical anesthetics for perineal area
Definition

  • Dermaplast
  • Americaine Spray
  • witch hazel compresses (Tucks)

Term
Analgesics used for postpartum comfort
Definition

  • acetaminophen (Tylenol)
  • NSAIDs (ibuprofen) 
  • narcotics (codeine, hydrocodone, oxycodone)
  • PCA pump (morphine epidural) for c-section

Term
Adverse effects of morphine epidural
Definition

  • late-onset respiratory depression (8-12 hrs)
  • N&V (4-7 hrs)
  • itching (w/in 3 and up to 10 hrs)
  • urinary retention
  • somnolence 

Term
Promotion of postpartum bowel elimination
Definition

  • early and frequent ambulation
  • increased fluids and fiber
  • stool softeners as ordered
  • avoid straining; normal bowel pattern returns in 2-3 wks

Term
Postpartum contraindication of suppositories 
Definition
3rd or 4th degree lacerations involving rectum
Term
Postpartum promotion of urinary elimination
Definition

  • voiding q2-3 hrs even if no urge is felt
  • catheterize as ordered for urinary retention
  • Foley catheter for 12-24 hrs after c-section

Term
Breast feeding time
Definition
10-15 min on one side and until infant lets go on the second side; alternate first breast used and rotate positions 
Term
Promotion of suppression of lactation and successful bottle feeding
Definition

  • utilize snug bra or breast binder continuously for 5-7 days to prevent engorgement
  • avoid heat and stimulation of breasts
  • apply ice packs for 20 min qid if engorgement occurs
  • encourage demand feedings q3-4hr, awakening during day and allowing to sleep at night

Term
Increased lochia or pain may indicate _____
Definition
overexertion 
Term
Promotion of adequate nutritional intake for breast feeding mothers
Definition

  • add 500 kcal/day
  • fluid intake of 2,000 mL/day
  • continue prenatal vits and iron

Term
Resuming sexual activity postpartum
Definition

  • after episiotomy has healed and lochia has stopped (about 3 weeks post-delivery)
  • use water-soluble lubricant PRN
  • inform that breast milk may be released with orgasm 

Term
Postpartum warning signs
Definition

  • bright red bleeding saturating more than 1 pad per hour or passing large clots
  • temp > 100.4F
  • chills
  • excessive pain
  • reddened or warm areas of breast
  • reddened or gaping episiotomy, foul-smelling lochia
  • inability to urinate; burning, frequency, or urgency with urination
  • calf pain, tenderness, redness, or swelling

Term
Postpartum Rubella vaccination
Definition

  • titer of < 1:8 (not immune)
  • KNDA to neomycin
  • admin 0.5 mL subQ prior to discharge
  • delay vaccine at least 6 wks, and preferably 3 months, to avoid drug interaction and reduced rubella immunity if RhoGAM is indicated 
  • Avoid pregnancy for at least 3 months because vaccine contains live virus and can adversely effect fetus 

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