n326-maternity-final-exam-study-guide
Postpartum
• Postpartum : after delivery for 6 weeks
• Involution: return of the uterus to pre-pregnant state
• Lochia: Shed uterine epithelial cells
• Rubra: d1-3, bloody
• Serosa: d 4-10, pink or pinkish brown
• Alba: d 11-21, white or crea...
,
,Postpartum
• Postpartum : after delivery for 6 weeks
• Involution: return of the uterus to pre-pregnant state
• Lochia: Shed uterine epithelial cells
• Rubra: d1-3, bloody
• Serosa: d 4-10, pink or pinkish brown
• Alba: d 11-21, white or cream
colored How often to assess?
• First hour: Every 15 minutes
• Second hour: Every 30 minutes
• First 24 hours: Every 4 hours
• After 24 hours: Every 8 hours
• Always on indication!
Vital Signs
• Vital signs rarely altered
• Temperature sometimes slightly elevated in the first 24 hours because of dehydration
o
WBC increase normal for initial PP period
o
Normal leukocytosis ( ave 12, 000- 20,000 )
o
Temp > 100.4 x 2 in 24 hrs needs evaluation
• Pulse (50 – 70 bpm)
• Respirations (16-20 breaths per minute)
• Blood Pressure
o BP > 140/90 = DANGER SIGN
• Pain – zero to 10
Breast
Inspect the breast tissue
o
Size, shape, contour
o
Nipples: cracks, redness, bleeding
o
Are the nipples inverted or everted?
o
Palpate the breasts for soft, filling, engorged
o
Palpate for nodules, masses, clogged ducts
o
Colostrum: clear yellow “ early milk”
o
Engorgement / mastitis
Important to know how they will be feeding the baby
Lactation
o
Secretion of milk from the breasts
o
“There's nothing there”
▪ Reassure the mom, her breasts will fill
▪ Colostrum, rich, thick early milk
Not breastfeeding
o
Risk for engorgement
▪ Occurs 3- 4 days PP : resolves in 1-2 days AFTER milk comes in
o
Breasts become full, hard, red, tender
o
Frequent emptying will resolve engorgement but can become cyclical
o
Relief measures:
▪ Tight bra
▪ Cool compresses
▪ Don't stimulate the breasts
▪ Cabbage leaves
, Uterus
Assess the uterus
o
Fundal Height
▪ At the umbilicus, 1 FB below umbilicus, 1 FB above umbilicus etc
o
Determine involution
o
Midline & firm after delivery
o
If the uterus is displaced up and to the right it could be that she needs to void
o
Boggy uterus indicates uterine atony
o
Atony leads to postpartum hemorrhage
o
Life threatening!
o
Massage the fundus
Uterine Involution
o
Uterine involution: return to non pregnant state
o
Myometrium contractions: after pains
▪ Due to high oxytocin levels
▪ Continue to occur w/ BF
•
Especially for multipara
o
1 – 2 cm/day
o
What do we expect to find?
▪ Immediate postpartum FF@U
▪ Day 1 FF @ U-1
▪ Day 2 FF @ U-2
▪ 6 weeks back to nonpregnant size
Postpartum Hemorrhage
Risk factors for postpartum hemorrhage
• Grand multiparity
• Overdistension of uterus
• Precipitous labor – baby came out quickly
• Prolonged labor
• Retained placenta
• Placenta previa or abruptio placentae
• Induction or augmentation of labor
• Administration of tocolytics to stop contractions
• Operative procedures (cesarean birth, vacuum extraction, forceps)
• UTERINE ATONY = #1 Cause
• The uterus fails to contract after the delivery of the baby, and it can lead to
a potentially life-threatening condition known as postpartum hemorrhage.
Leading cause of maternal mortality
Causes (4t's tone, tissue, trauma, thrombus)
o
Tone – uterine atony uterus stretches and doesn't go back
o
Tissue – retained product of conception
o
Trauma – traumatic delivery
o
Thrombus – clot
Uterine atony - uterus gets boggy and bleeding (massage uterus until firm)
o
Firm uterus (but still bleeding means laceration) vs. non-firm (then it's the uterus)
Laceration of vagina
Laceration of cervix
Hematoma - could be bleeding under the skin patient will explain extreme perineum pain
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