Post Partum Care
ID Breast needs for Breastfeeding vs NonBreastfeeding pt
BF: hydration, baby cues, wets and dirty diapers, on demand-frequent nursing on baby's cues, correct latch
NBF: avoid stimulation, cool showers, cabbage leaves, supportive bra, use cold packs
Oxytocin
Causes uterine contractions
Given during labor to induce or augment labor
Give post partum to prevent PP hemorrhage->to prevent uterine atony
ID PP Baby Blues
-emotional lability, irritability, broken sleep-MOST women experience this!
-resolves within 2wks
-mom remains able to care for self and baby
-no intervention is usually needed
APGAR Score sheet
PLEASE know the chart and how to obtain a score
PP involution
why is it important?
Who is more likely to experience more painful cramps? --> mom who is on her baby #3, 4, 5...first time moms usually have very mild involution pains
ID Perineum care PP
Know normal:edges approximated, mild edema, minor ecchymosis, mild-moderate pain, AVOID CONSTIPATION
Helpful: ice, sitz bath, pain medication, stool softener Severe pain should be investigated
Vitamin K
given to newborn babies within 1hr after delivery to assist with blood clotting (to avoid hemorrhage in newborn due to lack of mature clotting factors)
ID PP depression
-usually 6-12 months after delivery; can occur earlier
-DEBILITATING -Needs help/intervention
-LISTEN/give hope and connect with provider/do not judge or threaten to take baby away
Gestational Aging
assessment of NEUROMUSCULAR and PHYSICAL Maturity of baby
ID some characteristics of preterm baby vs post term baby: soles/skin/genitalia
ID normal newborn VS
RR, HR, temperature: know parameters please
*If VS are stable; action is to support bonding, encourage breastfeeding, keep dry and warm, monitor VS
ID Badder care PP
Diminished sensation, edematous and hypotonic
IMPORTANT to empty regularly to prevent hemorrhage d/t uterine atony
Increased diuresis postpartum to excrete extra fluid volume
Erythromycin Ointment
Given to newborns within 1hr after delivery to prevent blindness due to STIs
ID stages of lochia
Lochia Rubra-
Lochia Serosa-
Lochia Alba-
know when to expect, what color, consistency
Reflexes
Sucking/Rooting/Moro/Stepping/Tonic-neck/Babinski/Palmer Grasp
Are they normal?? (yes)
able to ID reflexes if described
What's a mongolian spot?
normal discoloration of skin in dark skin ethnic groups-resolves on it's own
Uterus PP
Know expected location of fundal assessment post delivery and 1-2 days after. Know warning s&s: deviation (likely d/t full bladder), elevation
Notify provider for elevated (above U) fundal assessment, clots, excessive bleeding-give oxytocin/pitocin
HEMABATE-can be helpful with PP hemorrhage: DO NOT GIVEN TO ASTHMA pts
Methergin-can be helpful with PP hemorrhage: DO NOT GIVE TO pts with elevated BPs (hypertension, PreE)
Narcan (Naloxone)
Medication helpful in reversing respiratory depression due to narcotic use
Can be used for babies after delivery if mother had narcotic like Fentanyl close to delivery
Bonding and attachment
What is Engrossment?
Taking-in Phases (know each one)
Cold Stress in Newborns/hypothermia
Know mechanisms of heat exchange: Convection/Evaporation/Conduction/Radiation
How to prevent each type.
What is brown fat?
Can lead to hypoglycemia and respiratory distress
When does fertility return??
Breastfeeding mother after 8 weeks
NonBreastfeeding mother as soon as 2 WEEKS
ID Cardiovascular changes PP
Average blood loss-300 for vaginal delivery
PP hemorrhage >500 vag >1000 c/s
Thrombosis risk d/t clotting factors, vessel damage, decreased mobility
Antibiotic use for GBS+ mothers
Usually penicillin (clindamycin or vancomycin-can be used if mother has allergy) to prevent newborn GBS sepsis
*Prevent GBS sepsis* HOW?? Give antibiotic, monitor baby for 24-48hrs in GBS+ mothers
Prolonged membrane ruptures, internal monitors increases newborn risk
Caput Seccudaneum vs Cephalohematoma
Know the difference!
Which one crosses the suture line? When will it resolve? Does it place baby at risk of jaundice?
Physiological vs Pathologic Jaundice
ID each
When does it likely to occur? What are the levels mg/dl of each? How is it resolved? Does it need treatment? If not treated what happens?
Rhogam
who needs rhogam post partum??
-Rh NEGATIVE mothers who have Rh POSITIVE baby
1st dose given at 28wks to all Rh negative mothers
2nd dose is given IF baby is Rh positive