Postpartum OB exam 2
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. What would you like to do?
What is the defiition of maternal mortality
the death of a woman while pregnant or within 42 days of termination of a pregnancy
What are common causes of maternal mortality?
What is the nursing care for the first hour after delivery?
- Check fundus, lochia vital signs (Bp, T, HR, RR,)
- Bonding ( skin to skin, feeding)
Whats does BUBBLEHE +P Stand for?
- Episiotomy or incision
- Homan's signs
- Emotional state
How do you assess the breasts according to the bubllehe assessment? What is the care of the breasts if bottle feeding? breast feeding?
- Soft, filling or firm? (ask mom)
- Colostrum, milk
- Bottle feeding: no nipple stimulation (let shower water hit back) supportive bra without under wire; for engorgement, ice packs, pain meds, green cabbage leaves; DO NOT empty them; usually resolves 24-48 hours
- Breast feeding: assess nipples, may wear supportive bra; for sore nipples lanolin cream (wool allergy?) air dry, no soap on nipples. milk usually comes in 2-5days
How do you assess the uterus according to the bubblehe assessment?
- It should be firm not boggy
- how many finger breaths from umbilicus? (1 away/day)
- Should be midline not displaced
- the uterus usually cramps, the more children a women has the more cramping
How do you assess the Bowel and bladder according to the bubblehe assessment?
- Bladder: Should be emptying comletely; assess for buring or pain upon voiding(UTI? episiotomy) measure first void; I&O after C-section
- Bowel: Assess bowel sounds, for BM after delivery, for hemorrhoids, assess diet and explain to increase fiber and ambulate (raw fruits and veggies; oatmeal, whole grain breads, increase fluids)
How do you assess the Lochia according to the bubblehe assessment?
- Color: Rubra- 1st 3 days (dark red) Serosa- 3rd-10th day (pink) Alba- 10th-21st day (clear, colorless, whitish)
- Amount: Scant, light or moderate; heavy is 1 pad/hour; excessive is 1 pad/15 minutes; small clots are normal; increases with breast feeding and activity; c-section birth has less lochia; no lochia is not normal, possible retained clots
How do you assess the Episiotomy/ incision according to the bubblehe assessment?
- Episiotomy: (see it by having her ly on one sidenot as common, usually midline, mediolateral) tell her to squeeze buttcheeks the sit and not just sit on one cheek)
- Lceration: 1st - 4th degree (3rd and 4th are into rectum)
- C-birth: ( classical, low transverse)
- Care of incision: keep it clean and dry; dressing changes, assess for "REEDA" which is redness, edema, erythema, discharge and approximation)
How do you assess the Homan's sign according to the bubblehe assessment?
assessing for DVT or PE; not the most valid way of checking; ask if the patient has leg or chest pain (where is the pain? back of calf is most concerning) look at leg for redness, warmth and check pedal pulses, check with doppler; assess lungs sounds;
How do you assess the emotional state according to the bubblehe assessment?
Ask questing like: how are you feeling, how are things with the baby...) listen to how she reacs to baby, does she call the baby by name or refer to "it" Observe her; do not specifically ask "how is your emotional state" assess bonding, for postpartum blues, depression, psychosis
What are the types of pain in postpartum? what is the non-pharm management? pharm management?
- Types: uterine, perineum, generalized
- non pharm: ice, sitz bath, body mechanics, position change
- Pharm: ibuprofen, narcotics
How is pain assessed?
Pain scale (rated by client), objective and subjective observations, reassess in 30-60 minutes; document pain assessment before and after intervention
Why is Rho Gam given? when is the first dose given? how many hours before birth is it given?
- when mom is Rh negative and baby is Rh positive; it is given to prevent the development of antibodies in the mothers body against Rh positive erythrocytes; given to protect future pregnancies
- first dose given at 28 weeks
- an aditional dose may given during pregnancy if damage to the placenta is suspected (abruption, abdominal trauma, amniocentesis)
- given within 72 hours of birth
Rubella titer is taken during pregnancy, what indicates immunity? When is vaccine offered if she is non immune?
titer of 1:8 or greater indicates immuity; if non-immune, vaccine is given after delivery and should avoid pregnancy for 4 weeks
When is the Hep B vaccine given?
When is the varicella vaccine given?
When is the flu vaccine given?
When does transition to parenthood begin? What is it encouraged/hindered by?
- at the discovery of pregnancy; the transition is a major life event;
- Impacted by: previous life experience, relationship between partners, finances, education, support system, desire to be a parent, age
What are some importnat factors to becoming a mother? father? adolescent parents?
When does bonding being? What is attachment?
- They are the emotional feelings that begin in pregnancy or shortly after birth; it is unidirectinal from parents to infants (babies attach not "bond")
- Attachment: emotional connections between infant and parents; bidirectional between infant and parents; lifelong impact on person
What are the expected assessment findings of bonding?
Holding the infant close, refer infant by name or gender, respond to infants needs, speak positively about infant, interested in learning about infant, ask appropriate questions about care, appear comfortable holding and caring for infant
What are the maladaptive assessment findings of bonding?
referring to infant as "it" avoiding eye contact with infant (but this may be cultural); does not respond to infant cry, emotionally unavailable to infant, allows others to care for infant, show no interest in infant (may also be cultural), poor feeding techniques (propping bottle), irritable or uncomfortable brestfeeding
How can you promote bonding?
- early and prolonged contact with infant
- rooming in
- couplet care (nurse cares for mom and baby)
- positive reinforcement of parenteral care of infant
- encourage parents to talk about birth and feelings of parenthood
- encourage breast feeding
- if infant is in nicu: x
- take pictures of infant
- assist mother to nicu
- involve parent in care of infant
- provide parent with phone number of NICU and encourage them to call
- family rooms in nicu
when does discharge planning begin? What does it include?
- begins with initial prenatal visit; teach self and infant care; follow up care for self and baby ( 6 week check for mom; 1 week or sooner for infant); can resume sexual IC/ birth control when bleeding stops and she feels comfortable
- well balanced diet
What are the danger signs that foster the need to notify HCP immediately?
- persistent lochia
- foul smelling lochia
- bright red bleeding
- prolonged afterpains, pelvic or abdominal pains, constant backache
- s/s of UTI
- pain, redness of tenderness of calf
- localized breast tenderness or redness
- discharge, pain, redness or separating of suture line
- prolonged and pervasive feelings of depression or being let down/ generally not enjoying life.
What is benzocaine topical anesthetic (dermoplast)?
What is oxycodone and acetaminophen?
What would you like to do?
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