Postpartum & Postpartum At Risk Flashcards
(28 cards)
What post-birth warning signs should the nurse teach the postpartum mother? (9)
1) Severe headaches
2) Pain in the legs (DVT)
3) Excessive bleeding
4) Trouble breathing.
5) Soaking a pad in less than an hour
6) Passing a clot bigger than an egg
7) Visual disturbances
8) Epigastric pain
9) Severe N/V
If a postpartum mother had preeclampsia during pregnancy, what BP readings should she report to provider?
systolic blood pressure of 160 or greater and/or diastolic pressure of 110 or greater
If a home-health nurse assessed their postpartum patient and found signs of severe preeclampsia, she should contact the provider and anticipate what?
that the patient would have to go to the hospital for admission & the administration of magnesium sulfate
Who cannot breastfeed? (4)
1) those on antipsychotics (antidepressants are mostly fine)
2) those with HIV
3) babies with galactosemia
4) those wearing contraceptive patch
Explain the stages of lochia
Rubra → bright red discharge in the first 1-2 days
Serosa → pink/ brownish discharge (like end of your period)
Alba → white or creamy discharge at the end
when assessing episiotomy, we do not want to see anything that might look like a _______ ________
perineal hematoma
Normal findings for episiotomy (6)
1) NO redness on incision
2) should NOT have new ecchymosis
3) NO edema
4) NO drainage (esp foul smelling)
5) should ALWAYS have approximated edges
6) should look like it is closing a little more everyday
what are abnormal findings regarding lochia? (5)
1) Soaking pad <1 hour
2) Soaking pad in 15 minutes
3) Passing egg-sized clot
4) Bad smell
5) Color goes back and forth from bright red to some other color and then back to bright red
Taking in Stage:
1) when does it occur & how long?
2) how is mom acting?
3) is teaching ok?
4) what does mom need?
5) nurses role?
1) occurs immediately after birth & lasts typically 24-48 hrs
2) mom is overwhelmed, focused on herself; wants to talk about birth and replays it in her mind to process it
3) not yet receptive to learning
4) needs support from others
5) nurse should assist with newborn care and self-care for mom; keep teaching short, realistic, & supportive; patience is key
Taking Hold Stage:
1) when does it occur?
2) how is mom acting?
3) ideal time for what?
1) usually occurs around day 2 but may take longer
2) she begins adjusting to motherhood and accepting the new reality, starts focusing on baby and self-care, and is full of questions like “is this normal?” and will need guidance
3) Ideal time for teaching → this is where most teaching will take place
Letting go Phase:
1) when does it occur?
2) how does mom act?
3) nurses role?
1) usually occurs after the first month, often by 6 wk checkup
2) she fully assumes motherhood role, gains confidence in her identity as a mother and begins to feel more at ease with the role
3) continue to provide support but more in the background, as mom becomes more independent in her new role
List the risk factors for postpartum hemorrhage (11)
1) Past History of PPH (doubles risk)
2) Overdistention of uterus
3) Grand multiparity
4) Preeclampsia
5) Medications that relax smooth muscle
6) Obesity
7) Asian or Latina heritage
8) Oxytocin
9) Operative vaginal delivery
10) Cesarean section
11) Prolonged/dysfunctional labor
what postpartum infection is most common in post-cesarean pts?
endometritis
List the risk factors for endometritis (5)
1) PROM
2) Multiple vaginal exams in labor
3) Compromised health status, low SES
4) Instrumental deliveries
5) cesarean delivery
The most accurate way to determine blood loss is weighing the pads.
1) expected blood loss for vaginal delivery?
2) expected blood loss for ceserean?
1) 200-500 mL
2) 500-1000 mL
what is the first line med for PPH? what other meds can be used?
first-line tx → oxytocin
other meds
1) methylergonovine (methergine)
2) misoprostol (cytotec)
3) Carboprost (Hemabate)
what does methylergonovine (methergine) do for PPH?
works very quickly to tone up the uterus & constrict the blood vessel
what MUST be done before administering methylergonovine (methergine) and why?
check BP first!!
bc it can cause hypertension and potential risk for hypertensive crisis
high BP is contraindication
what PPH med is the same thing used for an induction (cervical ripening)? what is different in this situation?
misoprostol
Used in larger doses than for cervical ripening or labor induction (800-1000 micrograms).
who is carboprost (hemabate) contraindicated in?
pts with asthma
What causes uterine atony? (3)
1) Overdistended uterus (twins, macrosomia, polyhydramnios)
2) Full bladder preventing contraction
3) Clots inside uterus
what causes retained placenta fragments?
Body continues perfusing placenta site & inhibits contraction
how does retained placenta fragments present? what is critical to prevent it from causing PPH?
pt may have “trailing membranes”
placental inspection post-delivery is critical
When trauma is the reason for PPH, what causes this? (2)
1) Unrepaired lacerations → cervical, vaginal, perineal
2) Perineal hematomas → Collection of blood under tissue; can hold 250–500 mL
