Postpartum Care
Vital Signs
Fundal Assessment
Lochia Assessment
Periniuem Assessment
Early Maternal Assessment
Encourage early ambulation promotes BM and gas release
rest, temp, diet, cultural considerations
water, high fiber foods, urinary void within 6 hrs, be within 2-3 days
Temp >100.4 x 48 hrs poss endometriosis, 101.6 in first 24 hrs. 102.2 (suspect sepsis)
Endometriosis can occur up to 4 weeks after abortion, delievry, termination
Leading cause of maternal death
Post partum hemmorhage
Early<24hr
Late 24hr-1 week
Nipples:flat, everted, inverted
Breast tissue: soft, filling, firm
Temp, Color
Postpartum breast assessment
Sitz bath, NSAIDS, hot/cold, witch hazel pads
Non pharmacological interventions for pain
“Taking in”
”Taking Hold”
”Letting Go”
Rubins maternal tasks
interruptions to tasks include
money, living situation, lack of family support, substance abuse, domestic violence, nurse should
assess for interference, refer to social worker as needed
4 T‘s:tone, trauma, tissue, thrombin
Uterine atony
uterus should be midline (may be deviated)
firm, firm w/massage, boggy
Tachycardia, 15% drop BP, O2 sat<95% (within 24 hr
delivery)
Early signs of postpartum hemorrhage
First milk, rich in immunoglobulin, golden colored
Colostrum
Priority nursing intervention for unilateral leg cramping
Contact provider *risk for DVT
Assess: pulses:pain, varicosities, warmth, edema, sensation
Don’t forget risk for PE-SOB, chest pain
Mak e sure to evaluate risks for blood clots such as smoking, advanced maternal age, genetic disorders (factor 5)
highest risk for PE is first three weeks postpartum due to hypercoagulable state
American Academy of Pediatrics recommendation for breastfeeding duration
6 months
COLA
Bladder/Bowel assessment
Color, odor, last void/BM, and amount
unrepaired laceration of vaginal canal/perineum-continuous trickle of bright red blood
Hematoma of perineal area-complaint of unrelieved pressure, pain
Major causes of early maternal hemorrhage
Ice packs, bind breasts, don’t milk breasts
Nursing education for mother who are not breastfeeding
Hematology/metabolic- decreased blood volume/decreased estrogen/progesterone/prolactin
renal/fluid/electrolytes, natriuresis/diuresis
respiratory-decreased intrathoracic pressure
integumentary-stretch marks
cardiovascular-decreased CO, diuresis
immune-elevated WBC, rhogam, MMR, Tdap
reproductive-return of menustration
musculoskeletal:diastasis rectus abdominus
Physiological post partum changes
A new mother is diagnosed with mastitis and requires ABX, what does the provider need to ask the mother when deciding appropriate prescription?
Are you breastfeeding?
REEDA
Episiotomy Perineal Assessment
redness, edema, ecchymosis, discharge, apporoximation
Oxytocin
methergine (check BP)
prostaglandins-cytotec
Medications for postpartum hemmorhage
Benefits of breastfeeding for mother and baby
Mother:
decreased risk of ovarian, endometrial, breast CA
increased wt loss, decreased risk DM II, decreased risk osteoporosis, increased infant bonding
Infant: decreased ear infections, increased immune ability, decreased SIDS, decreased childhood obesity, jaw development
Stages of milk development:stage 1 (after placental delivery) stage 2 (colostrum) stage 3 at 4 days
Supportive bra, does not bind axilla
15-20 min feed (<5min, infant may not get hindmilk)
warm cloth/shower b/f feed to encourage let down
ice after feed to decrease edema
Nursing considerations for engorgment
Check I & O
6-8 wet diaper
Yellow mustard seed BM
back to birth weight within a week
law of supply and demand, the more a mother nurses/pumps, increased stimuli will trigger increased milk production
Name the parts of BUBBLE assessment
Breasts
Uterus
Bladder
Bowel
Locia
Episiotomy
Emotional Status
Uterine Atony most common cause
retained placental fragments
nurse must check for placental fragments in lochia
Late postpartum hemorrhage (24 hr-1week)
HIV+, medications (chemo/antiepileptic), active TB, active HSV lesion of breast, exposure to radiation are all contraindications
Breastfeeding
Breast care for breastfeeding mother
Cabbage
water, no soap, lanolin no longer recommended
air dry/10-15 min sunlight
express milk and put on tender nipples
don’t over pump
feeding 10-15 min each side, until breast is soft
assure correct latch
afterpains x 1 week, esp those who are multipara
Formula fed babies
“Fed is best”
sterilize baby bottles before feeding
formula should never be diluted
water from a tested source