Postpartum

Question 1

Vaginal birth hospital stay

Answer 1

24-48 hrs

Question 2

C-Section hospital stay

Answer 2

96 hrs (4 days)- longer if complications

Question 3

Involution Process

Answer 3

Return of uterus to nonpregnant state

Question 4

When will Uterus reach nonpregnant size?

Answer 4

5-6 weeks but we can only feel the uterus up to 2 weeks postpartum.

Question 5

When checking fundal height moms uterus, how should she be positioned?

Answer 5

Mom should be no more than 30 degrees when checking fundal height

Question 6

Postpartum

Answer 6

4th stage of labor

Question 7

What does the placental site start to do at delivery and why?

Answer 7

At delivery, placental site starts constricting so it doesn’t bleed and cause hemorrhage.

Question 8

What does the uterus feel like after delivery?

Answer 8

Irregular, modular, and it is raised.

Question 9

Lochia

Answer 9

Uterine discharge

Question 10

Rubra

Answer 10

Blood and debris (red) about 1-4 days

Question 11

Serosa

Answer 11

Old blood and debris (pink or brown) about 4-10 days after delivery

Question 12

Alba

Answer 12

Debris, serum, and bacteria (yellow or white) about 10 days to 6 weeks

Question 13

When does regeneration happen?

Answer 13

By 30 weeks postpartum there is a regeneration of the endometrium except at the placental site-that takes 6 weeks

Question 14

What should you do first if uterus is boggy and shifted to the side?

Answer 14

Empty the bladder. A full bladder can cause a boggy uterus and can make it shift to the side. UO should be 30-60 mLs/hour

Question 15

What is considered a hemorrhage?

Answer 15

> 500 mL of blood loss for a vaginal birth is considered a postpartum hemorrhagic mother
1000 mL of blood loss for a C-Section is considered a postpartum hemorrhagic mother
Soaks 1 pad in 15 minutes or 2 pads in 30 minutes is also considered a postpartum hemorrhagic mother
10% or more drop in hematocrit is also considered a postpartum hemorrhagic mother

Question 16

Subinvolution of Uterus: Define, causes, S/S

Answer 16

Slower than expected return
Causes: hemorrhage, retained placental fragments, pelvic infection
S/S: prolonged lochial discharge, irregular or excessive bleeding

Question 17

Causes of sub volition/hemorrhage

Answer 17

If they had an overextended uterus (big baby, lots of fluid, twins, triplets, etc.), >5 pregnancies, previous C-Section and now a Vback, baby came to fast, previous postpartum hemorrhage, placenta précis, infection, any clotting disorders

Question 18

S/ of postpartum hemorrhage

Answer 18

Hard to find uterus, soft and boggy uterus, firms up with massage but the min. You stop massaging it it goes back to soft and boggy, the funds is at an unexpected level, excessive lochia

Question 19

Things to do for a postpartum hemorrhage.

Answer 19

Massage uterus to try and firm it up, replace fluids (LR), may give whole blood or PRBCs, may be given plasma extenders, pack the uterus, can add up to 40 units of oxytocin, last course of action is a historectomy

Question 20

Oxytocin

Answer 20

As soon as the placenta releases they put 10-20 units IV of oxytocin to help the uterus get its tone.

Question 21

Methergen

Answer 21

If mom is breast feeding only give in emergency otherwise should not be given if breast feeding.
200-400 much q6-12 he. Up to 7 doses. IM or IV 200 mcg q5hrs. Up to 5 doses.
This is given if mom was induced and the uterus isn’t responding to oxytocin anymore.

Question 22

Hemabait

Answer 22

250 mcg IM repeat 15-90 min. W/ max of 2 mg
CAN ONLY BE GIVEN IN THE HOSPITAL
only given if merger hen and oxytocin don’t work. If this doesn’t work then mom will go to surgery.

Question 23

Cytotec

Answer 23

200 mcg suppository

Question 24

Trauma

Answer 24

Increased HR, decreased BP
Trauma to birth canal 2nd most common cause of early postpartum hemorrhage (Lacerations, Hematomas)
Uterus is nice and firm
SEVERE PAIN UNRELIEVED BY PAIN MEDICATION
Says she has a lot of pressure and she feels anxious
With a hematoma they may do an US to see where it is located. Then they will go into surgery and do an I&D (incision and drainage of hematoma)

Question 25

Pain postpartum

Answer 25

Pain scale 0-10 (5th VS) Pain control: change positions every 1-2 hours, position for comfort, distraction, WALK in room or hall, GET MOM UP AND MOVING

Question 26

After pains

Answer 26

Contractions or after pains:compression of intramyometial vessels Oxytocin: released by pituitary strengthens and coordinates contractions Pitocin (oxytocin) is administered IM or IV Breastfeeding and Pitocin stimulate uterine contractions After 48 hours they have decreased a LOT and they are usually gone after 3-4 days For nursing mom Medicate 30 minutes prior to feeding baby

Question 27

Cervix postpartum

Answer 27

Soft immediately following birth Ectocervix cervix (portion in vagina): bruised with small lacerations (optimal condition for development of infection) OS gradually closes over 2 weeks- never regains pre pregnancy appearance

Question 28

Vagina postpartum

Answer 28

Regarding absent, may be permanently flattened Initially bruised and edema toys Localized dryness until ovarian function returns (estrogen) If breastfeeding estrogen is decreased which causes the vagina to dry up, delayed ovarian function

Question 29

Abdominal wall postpartum

Answer 29

0-6 weeks it is relaxed | 6 weeks it returns to prep regnant state

Question 30

Diastasis recti abdominis

Answer 30

Abdominal separation due to a large fetus or multifetal gestation

Question 31

Urinary system postpartum

Answer 31

Postpartum diuretics: within 12 hrs of delivery, excess tissue fluid BUN level increases as uterus involuted +1 proteinuria for a couple days Kidney function: 1 month

Question 32

GI system postpartum

Answer 32

Appetite: usually very thirsty and hungry following birth BM: usually delayed 2-3 days (decreased muscle tone of intestines) but usually 8-14 days for bowel pattern to be back to normal Always listen to bowel sounds and note if they are passing gas

Question 33

Nipples and Breasts

Answer 33

Help relieves breast feeding pain: cocoanut oil, he'll pass, let breast milk air dry on nipple Always look at breasts: are they engorged, red, filling, warm

Question 34

Colostrum

Answer 34

Starts to produce @ 7 months gestation Do not throw away, really healthy for baby, protects baby Gives premature babies some immunity High in immunoglobulins, protein, and exactly what baby needs 2-3 days

Question 35

Breast Abcess

Answer 35

Plugged milk duct KEEP NURSING OR PUMPING THAT SIDE TO UNPLUG IT Warm painful lump, may itch, red, change in nipple

Question 36

Postpartum Physical Assessment

Answer 36

``` Need to monitor how mom is bonding with baby and her emotional status. Skin to skin for mom and baby FIRST HR postpartum check VS q15min, EVERY 30 MIN for the next hour, then check VS q HR for TWO hours. After 4 HRS its checking VS every shift unless it's a C-section then it's q4hrs for 48 hrs. Breast (nipples) Uterus Bladder Bowels Lochia Extra Homan's Emotional ```

Question 37

Postpartum Testing

Answer 37

H&H drawn AM after delivery Drop in hgb is expected- >4 point drop is considered postpartum hemorrhage Rubella immunization if not immune Rhogam If drop in hct or breastfeeding keep taking prenatal vitamins

Question 38

Postpartum mood disorders

Answer 38

Baby blues Postpartum depression Postpartum psychosis Postpartum depression can happen up to a year after delivery but usually happens around 3 months May need antidepressants: Paxil, Zoloft, Primalar, Abentyl Whose at risk for PP depression:

Question 39

How can we tell if mom has the emotional attachment to baby?

Answer 39

Leaving baby in crib Letting everyone else take care of baby Calling baby it Nurses can facilitate bonding and that is our role, to help the family work as a unit

Question 40

How can we tell if baby is bonding to parent?

Answer 40

Baby looking at them Move toward the sound of their voice They track the parent

Question 41

When does placental scab pass?

Answer 41

10-14 days post delivery