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6 week period of time from delivery of the placenta to the time moms body is back to prepregnancy stage
Early Maternal Assessment
- vaginal birth
- take vitals q15minx4 q30x2 q1h q4-8
- take vitals q30minx4h q1hx3 q4-8h
- can be up tp 100.4 for 24h if over 100.4 infection has occured
- d/t exertion and dehydration.
- Pulse50-70 bpm commonly occur
- d/t elevated stroke volume
- postpartal tachycardia may result from complication, prolonged labor, blood loss, infection.
- Blood pressurecompare BP to BP of first trimester.
- may have some hypotn but should be back to normal
- Resps should remain normal
- Fundus should be halfway between umbilicus and symphysis pubis within a few minutes of pacental birth.
- within one hour fundus should be at level of umbilicus where it remains for one day. there after the undus will descend one fingerbreadth per day in size
- Redness, Edema, Ecchymosis, Drainage and Approximation
- 0-3 points given for each area
Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy(tissue trauma), Homans sign(Legs), Emotions(infant bonding)
Hormones for Changes in Postpartum Mother
- Estrogen:stimulates the formation of additional ducts in breasts and elongation of existing ducts.
- Progesterone:stimulates the formation of lobules the glands that produce milk
Medications used for comfort care
- Stool softeners(Colace, Dulcolax)
- Topicals(Lidocaine)Hemorrhoids(witch hazel Tucks) NSAIDs Ibuprofen, Opiods (darvocet, percocet, tylenol)
- sitz baths, encourage ambulation and administraion of tylenol/motrin etc..should be taken 30 mintues prior to breastfeeding to help with pain relief before uterine contractions
- Involution-the process by which the uterus returns to prepregnancy state.
- - the uterus rapidly contracts to prevent hemorrhage. complete healing takes appox. 6-7 weeks.
- the myometrial cells decrease in size not in number.
- subinvolution=failure of the uterus to return to the nonprgnant state.
- d/t multiple births, infection, hydramnios, prolnged labor or difficult birth, grand multiparity or excessive maternal analgesia.
The uterine fundus is palpated by placing one hand immediately above the symphysis pubis to stablize the uterus and the other hand at the level of the umbilicus
-after pains- are intermittent uterine contractions that occur during the process of involution
primiparous women typically have less pain d/t the uterus' ability to stay contracted
Lochia blood flow from uterus during puerperium.from palcental delivery up to 6-7weeks.
Lochia rubra bright red color lasts for up to 3 days postpartum fleshy odor small clots.
- Lochia serosa pinkish brown color, serosanguous consistency and lasts from day 4-10
- Lochia alba yellowish white creamy texture, fleshy odor.
- scant<25cm light<40 moderate>10 heavy one pad saturated within 2 hours.
- excessive pad saturated in 15min or pooling blood under buttocks.
Interventions for excessive bleeding
first determine cause and tx as prescribed
- excessive bleeding d/t
- cervical/vaginal tear(excessive spurts)
- numerous clots, blood loss(hemorrhage)
- foul odor(infection)
- Lochia rubra>3 days Placental fragments
- Lochia alba and serosa>normal length=endometritis if accompanied with fever pain and abd, tenderness
Episiotomy:surgical incision made by PCP between vaginal opening and the anus
sitz bath, ice pack meds to tx after episiotomy
Homans sign assess for DVT
patients legs should be extended and relaxed with the knees flexed . the examiner dorsiflexs the foot. no pain or discomfort should be present.