Postpartum

Question 1

Postpartum

Answer 1

After delivery for 6 wks

Question 2

Involution

Answer 2

Return of the uterus to pre-pregnant state

Question 3

Lochia

Answer 3

Shed uterine epithelial cells

vag bleeding

Question 4

Lochia

Rubra

Answer 4

Dark red and consists mainly of blood and trophoblastic debris; Bloody, dy 1-3

norm

Question 5

Lochia

Serosa

Answer 5

consists of old blood, serum, leukocytes, and tissue debris; Pinkish/brown, dy 4-10

Question 6

Lochia

Alba

Answer 6

Lochia alba consists of leukocytes,
decidua, epithelial cells, mucus, serum, and bacteria. White/Cream, dy 11-21

Question 7

Amount of Lochia

Scant

Answer 7

< 2.5 cm

Question 8

Amount of Lochia

Light

Answer 8

< 10 cm

Question 9

Amount of Lochia

Moderate

Answer 9

> 10 cm

Question 10

Amount of Lochia

Heavy

Answer 10

1 pad w/in 2hrs

Question 11

Amount of Lochia

Excessive

Answer 11

pad is saturated in 15 mins

Question 12

What will we assess?

Answer 12

VS
Pain
Breast
Uterus
Bladder
Bowel
Lochia
DVT
Episiotomy
Emo. Attach
Bonding
Feeding

BUBBLEDEP

Question 13

How often do we assess?

Answer 13

Q15 mins: 1st hour
Q30 mins: 2nd hour
Q4 hrs: first 24 hours
Q8 hrs: after 2 hours
Always on indication !, temp may be elevated ( > 100.4) 1st 24 hrs (dehyration), BP >= 140/90 = danger sign

Question 14

PP Immunizations

Answer 14

Rho GAM (- mom, + baby)
Tdap ( if not gotten in 2 yrs)
Rubella, Varicella in non-immune

Question 15

Maternal Adaptation

Answer 15

Taking In: dependent on others ( 24-48hrs, desires sleep, needs nurturing)
Taking Hold: Increasing autonomy ( confidence in infant care, may feel inadequate, don’t take over, praise effort)
Letting Go: adapts to new parenthood (separation of newborn form self, confidence in caretaking)

Promote early skin to skin + rooming in

Question 16

Newborn Attachment

Answer 16

prolonged eye contact, mutual gazing
tracking parent face
holding fingers
“enterainment” - dancing w/ voice
synchrony - infant cues + parent respone

Question 17

Family Adaptions: Pospaturm Blues

Answer 17

Normal, occur 1-2 wks pp
unexplained tearfulness, feeling down, decrease appetite
self- limiting

Question 18

Family Adaption: Postpartum Depression

Answer 18

Irritablity
Extreme sadness
Lack of desire to care for baby
Last longer than ( 6-10 weeks)
Require intervention
* OB visit
* Meds ( SSRI)

Most patient risk factors: H/x of Depression , Single mothers, Multipara moms

Question 19

PP Psychological changes: Postpartum Psychosis

Answer 19

Medical Emergency
Psych admission for treatment
Self harm/ infant harm risk
Admission to psychiatric unit for treatment

Question 20

PP Depression

Answer 20

Requires intervention
Therapy, meds, diet, exercise, sleep,
Zulresso: expensive, 60 hrs IV dose

Question 21

Discharge Education

Answer 21

Increase fluids, fiber, stool softeners
rest periods
no heavy lifting
no tampons, no douching, no tub for 6 wks
no sex 6 wks
flu appt: 6 wks ( 1 wks for c/s)
* newborn visit w/in 1-2 days

S/S DVT

Question 22

Breasts

Answer 22

Inspect
colostrum: early milk -> mature milk by about 72 - 96 hours after birth
Engorgement/ Mastitis
* relief: tight bra, cool compress, no stim, cabbage

Question 23

Not Breastfeeding ?

Answer 23

Risk for engorgement
* occurs 3-4 day PP, resolves in 1-2 days AFTER milk comes

Question 24

Uterus

Answer 24

Funal Height, firm, midline
* @ umbilicus after delivery, 1 FB above the umbilicus, etc
* 1-2 cm/dy
Displaced up + right = void
Boggy = uterine atony = PPH
* life threatening, massage fundus
Myometrium contractions: After pains
* d/t increase oxytocin

Question 25

**Postpartum Hemorrhage**

Answer 25

**Risk Factors**: Grandmulti, overdistention of uterus, precipitous labor, prolonged labor, retained placenta, placenta previa/abruptio, operative procedures **PPH= leading causes of maternal mortality** **Causes**: ( 4 T's = Tone, Tissue, Trauma, Thrombus) Uterine atony, vag. lac, Cervix lac., Hematoma, retained placental fragment, full bladder **90% PPH due to uterine atony** Blood loss greater than * **500 cc vag birth, or 1000 cc c/s** **Early PPH**: 1st 24hrs **Late PPH**: 24 HRS -> 12 wks

Question 26

**S/S of Postpartum Hemorrhage**

Answer 26

boggy uterus, blood gushm > 1 pad/ 15 mins, severe perineal pain, tachycardic **CALL MD IF UTERUS DOES NOT FIRM UP**

Question 27

**PPH Meds**

Answer 27

1. **Oxytocin** 20 units IM/IV 2. **Methylergomovine Maleate** 0.2 mg IM, follwed by tablets ever 4-6 hours ( Preeclampsia or BP !!! > 140/90, hold call MD) 3. **Hembate**, prostin 15 M 250 mg IM ( contra: Asthma, keep in fridge) | Side Effect of Meth: stomach upset/ diarrhea/ nausea Med are given after

Question 28

**Bladder**

Answer 28

**Diuresis occurs: 3000 cc/dy** Encourage freg emptying + fluids Assess for lower extremity edema **Diaphoresis common @ night** **S/S Bladder Distention** * Fundus above baseline + displaced from midline * Excessive lochia * Discomfort , bulging bladder * Freq voiding < 150 cc

Question 29

**Bowels**

Answer 29

May take 3 days, normal pattern in 8-14 dys ask about passing gas, inspect distention auscultate x4 Assess hemorrhoids **Stool Softners ! Colace, Ducolax, Senakot**

Question 30

**Perineum**

Answer 30

Lacerations * **1st**: Superficial * **2nd**: Vag. Muscosa * **3rd**: 2nd + anal sphincter * **4th**: to rectal muscosa Episiotomy = 2nd degree lac **REEDA** * Redness, Edema, Ecchymosis, Drainage, Analgesia

Question 31

**SKIN TO SKIN**

Answer 31

Glycemic control, 1 hr min