Postpartum Assessment Flashcards Preview

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Flashcards in Postpartum Assessment Deck (16)
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1
Q

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B- Breast assessment

A

Should be soft 1-2 days after delivery, milk on day 3

Nipples should be everted, can be red/cracked/sore = ointment safe for baby too

2
Q

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U- Uterine assessment

A

Fundal height/tone defends 1cm/day

Should be firm (fist) and at midline (umbilicus)

3
Q

If uterus is above umbilicus what might that indicate

A

Full bladder cause deviation may need cath

Encourage void first

4
Q

Fundal check

A

Supine knees flexed or straight
One hand symphysis pubis (prevents prolapse)
Feel for funds with flat part of fingers
Note position and observe perineum for blood flow/clots
GET RN/instructor if BOGGY (should be firm; massage to get firm)

5
Q

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L- Lochia assessment

A

Color, amount, and clots
Bleeding after birth is normal should be rubra (bright red) day 1-3 then serosa 4-10 days then alba 10-21
Small clots normal (measure and chart)
Shouldn’t have bad odor but smells “fleshy”
Moderate flow NOT heavy

6
Q

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B- Bladder assessment

A

Should NOT be palpable (only feel if distended)
Void 6-8 hours after delivery (300-400ml/void)
Urine should be clear/yellow
Note & measure clots (blood or placenta?)

7
Q

1 reason for hemorrhage

A

Atonic uterus (not contracting due to distended bladder)

8
Q

What signs distended bladder

A

Excessive lochia, fundus displaces above midline, bulge of bladder above symphysis, freq voids of less than 150 ml

9
Q

Bladder condition immediately postpartum

A

Bladder and urethra edematous, hypotonic bladder (this why don’t push with foley in)

Produce diuresis > 3000ml 24-48 hrs after giving birth

10
Q

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B- Bowel assessment

A

Soft abdomen, + bowel sounds/flatus (depends on when last ate), check for hemorrhoids, date last BM, note discomfort/pain, prevent constipation

Nausea/vomit common remind to slow down while eating

11
Q

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E- episiotomy
How to assess episiotomy

A

Lay on side and lift upper buttock to see perineum

Look for REEDA 
R- redness
E- edema
E- ecomosis (bruising/hematoma)
D- drainage (incision shouldn't) 
A- approximation
12
Q

Help with episiotomy/hemorrhoids

A
Sits bath, ticks pads for hemorrhoids 
Peri bottle (warm water spraying from back) 
Ice perineum first 24 hours 
Analgesia 
Topicals
13
Q

Degrees of episiotomy lacerations

A

First- superficial
Second- skin to muscle
Third- to anal sphincter
Fourth- through anal sphincter to rectal mucosa

14
Q

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E- extremities

A
DVT signs (unilateral edema, warmth, redness) 
Pedal pulses 
Deep tendon reflexes 
Sensation/motion
Orthostatic hypotension 
Varicose veins
15
Q

Immediate postpartum SN actions

A
Vitals every 15 min for first 1-2 hours
Temp at least once in first 1 hr
Shaking/chattering teeth (hormonal) 
Fundus/lochia checks every 15 mins then 30 mins then 2-3 hrs, 4 hrs, 8hrs
Assess pain, sensation of extremities
16
Q

Bubble assessment

A
Breast 
Uterus
Bladder
Bowel
Lochia
Episiotomy, emotional, extremities, education