Week 2 Postpartum, Complications, & Newborn Care Flashcards
Physiological changes: fundus & uterus
•involution = fundus descends back into the pelvis
•Fundal height decreases about 1 cm per day **
• a boggy fundus indicates uterine atony (massage until firm**)
Describe the 3 stages of bleeding after birth
•Lochia Rubra (3-4 days of dark red blood, like a heavy menstrual period, may have small clots)
•lochia Serosa (4-12 days of pinkish/brownish discharge, flow is moderate to small amount)
•Lochia Alba (12 days-3weeks postpartum, yellowish-white discharge, gradual disappearance)
Can smell like normal menstrual blood to musty smell (onion-like)
Ovarian function & menstruation postpartum
•period resumes 1-2 months in non-breast feeding mothers
•period resumes when breastfeeding mother starts weaning baby.
•Breastfeeding is not a form of birth control**
Refrain from vaginal activity for 6 weeks (sex, tampons, menstrual cups)
If c-section 8 weeks 👆🏻bc of abdominal trauma
Breast milk production
•continue to secrete Colostrum for 48-72 hours after birth
•a decrease in estrogen & progesterone stimulate prolactin = milk production*
•Oxytocin hormone = milk ejection*
How to stimulate vs stop making breast milk
Stimulate: not wearing a bra, warm compress
Stop: tight bra, cold compress, cabbage leaves
Causes of urinary retention
•loss of elasticity, tone, sensation d/t birth, meds, anesthesia, lack of privacy (embarrassment), pain from tears or lacerations
-Diuresis begins within the first 12 hours (get momma up & to the bathroom even if she doesn’t feel like she needs to go).
Changes to the GI Tract (mom)
•Patients are usually very hungry after birth.
•Hemorrhoids are very common internal and external. External looks like grape cluster
(Tuck pads w/witch hazel to relieve pain)
Postpartum vital signs
•Temp: can be up to 100.4 and be fine as long as there isn’t a source of infection
•HR over 100 may indicate excessive blood loss (shock: heart is trying to compensate, mom may be in pain and is getting anxious)
•BP & RR unchanged is everything is normal
•Elevated WBC in response to trauma & inflammation (below 20,000 for test purposes is normal) however if it was combined with a fever obviously something else is going on
Maternal Assessment
“BUBBLE HE”
Breast-size=shape, firmness, redness, symmetry, breastfeeding?
Uterus-fundus, fundal height, deviation? (Bladder may be full, get them to pee)
Bowel=last bowel movement?, stool softener education (lots of fluids & colace- is not a laxative!)
Bladder=voiding?, education on pain interventions (peri bottle), assess foley, I/O (1st two voids)
Lochia=color, odor, amount
Episiotomy-REEDA, hemorrhoids?, hematoma (very painful, may need surgical repair)
Homan’s Sign=assess for DVT, prevention, ambulation/sequentials in place?
Emotional Status-bonding patterns (taking-in, taking-hold, letting-go), Hx of Postpartum depression
Explain Bonding patterns postpartum
Taking in: all about mom, she’s in pain, she’s tired, she’s hungry
Taking hold: most receptive to education and advice from nurse. Breastfeeding, asking questions, wanting to do everything about the baby
Letting go: she’s independent and confident and feels okay without the nurse.
Explain 1-4 degree Tears
1st degree most mild. Involves skin
2nd degree deeper into fatty tissue
3rd degree involves muscle
4th degree…all the way through to rectum and it’s one giant hole from vagina to anus….🫣
Postpartum discomforts and What exacerbates uterine contractions postpartum?
•oxytocin expels milk for breastfeeding however it also starts contractions and can make it very uncomfortable.
•Cramping = Motrin 600mg, tears= norco
•ice packs, warm sitz bath to relieve itchiness from sutures
•constipation = fiber, fluids, colace
•NBFM = cold showers and bra
•BFM = warm showers, no bra
Breastfeeding assessment /things to remember
•Put the newborn skin-to-skin as soon as both are stable
•Stay with the patient while breastfeeding until she feels secure and confident
Assess LATCH (audible swallow, type of nipple, comfort of mother)
• Engorgement=feed frequently, apply warm packs before feeding, massage breast
•breast hygiene (wash with water only, air dry, try not to wear bra)
• Cracked nipples=air dry for 10-20mins after feeding, rotate positions, check latch
• Calories should be increased by 200-500/day, take Prenatal vitamins
• Educate on newborn diapers/normal stool color- Avoid gas producing food
• Oral contraception=no estrogen(will dry milk supply) take progestin-only pills
Complications- Cystitis
Cystitis = Bladder infection. Happens because mom is in pain and not cleaning well. They need to drink lots of fluid and go to the bathroom frequently & change their pad every time.
Interventions: (Hydration, encourage frequent emptying of the bladder, antibiotics, pain medication.)
-usually caused by swelling, trauma, urinary retention, foley.
Complications: Hematoma
Localized collection of blood, involving the vaginal sulcus or vulva.
risk for this: Large babies, traumatic birth, just cause..
Symptoms:
Vaginal or rectal pressure*
Shock symptoms they’re bleeding internally
Severe pain not relieved with medication
Bulging mass with discolored skin
Inability to void
Complications: Boggy uterus
Boggy uterus that does not contract, causing excess bleeding at the site where the placenta was attached.
ALWAYS massage fundus until firm, empty bladder, call dr.
Unresolved leads to:
1. Bakri balloon and direct pressure inside and out of uterus
2. Last resort is surgery, take out uterus if mom is hemorrhaging
Hemorrhage & shock
Vaginal = 500ml
C-section = 1,000 ml
10% drop in H&H from admin is concerning
4 T’s = Tone (atony), trauma (laceration), Tissue (placenta retention causes bleeding), Thrombin (mom run out of clotting factors/ low platelets)
Who is at risk? = mom who has many kids, preg with multiple babies, blood clotting disorders, preeclampsia
5 Meds for postpartum
meds are generally used in this order
Oxytocin = IV/IM, prophylactic to prevent hemorrhage
Cytotec = Rectal pill, for postpartum hemorrhage
Methergine = IM thigh, causes High BP (if Pt’s systolic is over 160 or has a Hx of HTN, do not give).
Hemabate = IM, stops bleeding, causes explosive diarrhea, Contraindication: asthma
Tranexamic Acid (TXA) = IV, given rapidly, stops bleeding
Complications: Mastitis
•Inflammation D/t Blocked milk duct & infection. Typically occurs 2-3 weeks after delivery
•Early signs-Presents with localized swelling, heat, redness, pain on one area of the breast.
•Late signs-fever and flu-like symptoms
•Patient can continue to breastfeed during
Complications: DVT -> PE
•Cause: mom is more sedentary
•venous stasis, hyper-coagulation, endothelial damage during pregnancy & delivery
•S/S: SOB, tachycardia, cough, crackles, feeling of impending doom/anxiety
•Interventions: 02, IV fluids, anticoagulants
Perinatal loss
•Miscarriage = before 20 weeks, Under 20 weeks is considered “product of conception” 🤬
•over 20 weeks is considered actual fetal loss
Initial assessment for newborn
What do we do at birth?
Starts at minute one- start timer*
•Tactile stimulation (drying fast!!)
•Maintain temperature (keep them from losing heat very important *)
•Suction if needed, mouth-nose (aspiration precaution)
•Vitals HR, RR, Temperature Identify •mother to baby with bands
•Separation only if necessary (CPR, mom needs surgery)
APGAR scoring
•Appearance, pulse, grimace, activity, respirations.
•Assessment done at 1 minute and 5 minute after birth (common score is 8 for 1min, 9 for 5 min)
A) is the baby blue (0), blue extremities pink body (1, common first 24hrs), body is fully pink (2)
P) absent (0, CPR), <100 Bpm (1), >100 (2) {babies CPR starts when HR drops below 60)}
G) no response/floppy (0), grimace/aggressive stimulation(1), cry on stimulation (2)
A) none (0), flexion(1), active flexion against resistance (2)
R) absent (0), weak/irregular (1), strong crying (2)
Initial causes of respirations
Surfactant: lipoproteins that reduce surface tension in the alveoli preventing collapse;
- Produced 34-36 weeks gestation
Tx for pre-term: Betamethasone/dexamethasone
*Hormone shot given in two doses 24 hours apart. It stimulates surfactant in baby to mature lungs. If born early they’re given a fighting chance.
Vitals for newborn
always assess for 1 full minute when doing first time assessments
•Do HR & RR FIRST before they start crying
•HR 110-160 (Auscultate the 4th intercostal space midclavicular line to detect abnormalities).
RR: 30-60
Axillary Temp: 97.7-100.3
Length: 18-22 inches
Weight: 2500-4000g
Head Circumference: 33-35 cm
What is molding?
All normal findings:
Soft spots on head. Bones shift to fit vaginal canal and overlap. Can feel like a lump or ledge. (Cone head, goes away in first 24-48 hrs)
newborn head injuries
•Cephalohematoma (24-48 hours after birth) collection of blood under the periosteum of skull. Subgaleal hemorrhage = bleeding between the scalp & the skull often from suction use during delivery.
•Caput succedaneum (edema - crosses sutures) very common. Collection of bloody fluid beneath the skin caused by pressure of the head on dilating cervix
Newborn Eye Assessment
•Swollen eyelids
•Cross eyes are not uncommon
•Eyelids symmetrical
•Sclera clear or sub-conjunctival hemorrhage
•Pupils equal and reactive
Newborn Ear assessment
•Normal shape, patent
•Even with eyes (low set ears may indicate congenital abnormalities)
