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Name some risk factors for PP complications.
- >24h labor
- Hx of diabetes
- Use of cath
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What are some risk factors for PP hemorrhaging?
- <3hrs labor
- uterine atony (uterine contractility problems)
- operative procedures (c-section, forcepts, etc)
- >3 births closely spaced
- large infant, twins
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What does BUBBLE-EEE stand for?
- Breast
- Uterus
- Bowel
- Bladder
- Episiotomy
- Extremities
- Emotional status
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PP danger signs.
What temperature may indicate infection or dehydration?
Name some danger signs regarding:
temp.
lochia
sensory
LE
Urine characteristics
- 100.4 F
- foul smelling lochia
- blurred vision, headaches
- *calf pain w/ dorsiflexion of the foot (Homen; blood clot in lower legs)
- Swelling, discharge, redness
- Dysuria, burning, urinary retention
- SOB
- Depression/mood swings
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What is the normal range for the PULSE?
For what duration?
40-80 in the first week.
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Nipples.
What do you assess regarding the Pt's nipples
What may the abnormalities indicate? What should you encourage?
flat, inverted, cracked, blistered, bruised, bleeding?
May indicate improper positioning of baby to nipple.
Encourage using different breast feeding positions.
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Breasts.
What does an "engorged" breast mean?
What should you palpate for and what will the abnormality indicate?
Engorged breasts are hard and tender.
Palpate for mass, warmth. If present, may indicate mastitis; a blocked duct.
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What does REEDA stand for? (perineum)
When does healing start and when should it go away?
- R: redness
- E: edema
- E: ecchymosis (bruising)
- D: discharge
- A: approximation of skin edges (p. 784)
C/birth: perineum assessed if twins-1 v and 1 c (e.g.)
Healing begins the first 2 weeks and should heal completely by 4-6 months.
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What is "colostrum"?
What does it contain?
a milky fluid that comes from the breasts of the first few days after giving birth, before true milk appears. It contains carbs, fats, vitamins, minerals, and proteins (antibodies) that fight disease-causing agents such as bacteria and viruses.
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What is "lansinoh" (lanolin)?
A cream that provides relief for sore, cracked, nipples.
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Uterus-involution.
Explain the steps in performing a fundal assessment.
- Put head of bed down.
- One hand on fundus, other on lower uterus.
- Fundus should be @ U (midline on empty bladder)
- (Will shrink to pre-preg size from U @ 1 cm or fingerbreadth/day)
- Cannot be palpated at 10 days.
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What is meant by uterine atony?
What else may prevent uterus contractions?
Uterine atony is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage.
*contractions = coagulation; atony = hemorrhage (soft/boggy/subinvolution)
Remnants of the placenta left in the uterus.
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Review: how do you calculate GTPAL? (gravita para)
- G (gravita): # of pregs (include current)
- T: (term) >37 wks gestation
- P: (pre-term) <37 wks gest.
- A: # of abortions/miscarriages.
- L: # living (excluding pregnancy)
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Lochia.
What should you assess regarding the Lochia?
When is the lochia considered "heavy"?
Amount, color, and odor.
If saturated peri-pad within 1 hr; >1 pad/hr
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Lochia.
Regarding amount, define the range of inches and mL for scant, moderate, and large/heavy.
- Scant: 1-2 in./10 mL
- Light/small: 4 in./10 - 25 mL
- Moderate: 4-6 in./25 - 50 mL
- Heavy: (saturation of a peri pad in an hour.
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Lochia.
According to color, what is the color and # of days each occurs?
How does the odor smell?
- Rubra: (red) 3-5 days
- Serosa: (brownish pink) 5-10 days
- Alba: (yellowish-whitish) 2 - 6 wks.
Odor is earthly like menstrual blood and foul
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Bladder.
What do you want to assess for?
Where should you palpate?
Why must you place the "hat" on the toilet?
Assess for distention & adequate emptying.
Palpate over symphysis pubis.
Place "hat" on toilet to measure initial voids.
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Bowels.
How should you assess bowels?
When do BM usually occur postpartum, why? When do normal patterns return?
Assess for distention & tenderness; auscultate prior to fundal assessment.
Occurs 2-3 days PP d/t decreased muscle tone in the intestine and increased progesterone. Normalcy returns within a week.
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How can you assess the "attachment" behavior between the new born and any individual?
While in the "en face" position, observe the interaction.
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PP comfort measures.
What are some ways to provide comfort if the mother is having difficulty voiding?
When might a cath. be needed?
- Pour warm water over the perineal area.
- Listen to running water.
- Blow bubbles through a straw.
- Warm baths or dip hand in warm water.
*If no results in 4-6 hours.
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Why are PP mothers encouraged to do kegal exercises after birth?
Pregnancy makes the pelvic floor sore and become weak which may lead to incontinence or UTI.
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What is "kangaroo care"?
Immediately after birth, newborn placed skin-to-skin w/ mother.
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