Assessment
These 8 things must be assessed during the postpartum period.
What is BUBBLE-HE? Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy, Homan's Sign (legs) and Emotional State
This is most commonly caused by uterine atony or a full bladder.
What is postpartum hemorrhage?
(During delivery, oxytocin causes the uterine muscles to contract, which compresses blood vessels in the area where the placenta was attached. If the uterus doesn't contract enough, these blood vessels can bleed freely, causing a steady loss of blood)
This first-line medication is used to stimulate uterine contractions to control bleeding.
What is Pitocin?
(Causes the uterus to contract and put pressure on the vessels where the placenta was attached to help close them off)
This is what's best for babies.
What is breastfeeding?
(Passage of antibodies to help with fighting infection)
Which of the following patients should be the priority for the social worker to see on Monday morning?
A. Room 37: Postpartum day 2, 31 y/o, G2P2, feeling extremely tired and overwhelmed.
B. Room 41: Postpartum day 1, 23 y/o, G1P1, having trouble breastfeeding
C. Room 47: Postpartum day 2, 16 y/o, G1P1, patient's mom is with her and states she is going to go live with her after discharge
What is C?
An adolescent mom should always take priority because they are going through multiple life changes.
During your PP assessment you find that the uterus is 2cm below the umbilicus shifted to the right. It is soft and boggy. What intervention will you complete immediately?
What is have mom empty her bladder?
(Uterus should be firm and midline. A shifted, boggy uterus is a sign of a full bladder and places mom at high risk for hemorrhage.)
Blood loss of 1178ml during delivery
What is postpartum hemorrhage?
Vaginal Birth: 500ml (in your book)
C-Section Delivery: 1000ml
AWHONN and ACOG now defines PPH as 1000ml regardless of delivery type
This medication should be avoided (if possible) for patients with hypersensitivity to the medication or asthma.
What is Hemabate?
(Hemabate is a bronchoconstrictor)
Your patient tells you she is experiencing sharp pains while she breastfeeds her baby as well as sore bruised nipples. You inform her that she is experiencing this.
What is ineffective latch?
(Breastfeeding should never be painful. If a baby is only latching on the nipple, this will be painful, cause bruising, flatten the top or bottom of the nipple and make your nipples extremely sore. You should instruct the patient to make sure the baby gets more breast tissue in their mouth during feeds)
All of the following are important for discharge education for the postpartum mom except:
A. Signs/Symptoms of infection
B. Call the doctor is you experience signs of preeclampsia or increased bleeding
C. Your baby should eat every 5-6 hours.
What is C?
(Mom's should be instructed to feed their baby every 2-3 hours and make sure baby has 6-8 wet diapers a day)
During your assessment, your patient states she has increased discomfort in her perineum. She asks what you recommend to help alleviate the pain without taking medication. This is what you would suggest.
What are sitz bath, ice packs, numbing spray and spray water bottles?
Discoloration of the perineum, perineal pain, edema, rectal pressure and rectal bleeding are all signs up this postpartum complication.
What is hematoma?
(Notify physician for possible surgical management. Strict pericare can help as well)
Your patient is receiving Dinoprostone (Prosin E2) for postpartum hemorrhage. This is an important assessment to keep an eye on.
What is Blood Pressure?
This medication is known to cause hypotension
Your breastfeeding patient explains she is experiencing extreme cramps and some bleeding during breastfeeding. You explain that this is...
What is normal response to breastfeeding?
Breastfeeding will cause release of oxytocin which causes uterine contractions. The bleeding, due to uterine contractions, is normal lochia and expected over the first few days postpartum.
This is the main difference between "Baby Blues" and Postpartum Depression.
What is the inability to take care of one self and others.
(Sadness, anxiety and fatigue is normal after birth. Hormones are shifting and moms are up with the baby. When this becomes excessive and they are no longer showering, eating/drinking, oversleeping or not sleeping it is a sign that mom might need more help)
While checking for lochia, you find a pad that has red blood (about 1/3 of the pad), some mucous and it smells musky. You should do this after your assessment.
What is nothing?
This is normal for the first few days postpartum. If your patient begins soaking a pad in under an hour or passing clots the size of a golfball, then you should notify your physician.
Calf tenderness, leg pain, swelling, redness and heat are all signs of this postpartum complication.
What is Thrombosis?
(Diagnostic tests include: D-dimer, doppler, VQ Scan and MRI. Management with medications (NSAIDS/Heparin), rest, elevation, compression stockings and increased fluids)
Your patient is bleeding after delivery and her blood pressure is 180/96. This medication should be avoided during treatment of the hemorrhage.
What is Methergine?
(Methergine frequently causes hypertension sometimes leading to seizures. You should use other treatment options for the patient with pre eclampsia, eclampsia or HBP)
The following statement shows that your education to non-breastfeeding moms was successful.
What is bind my breasts, not stimulate or squeeze my nipples and use ice packs to help with inflammation.
(Stimulation and oxytocin initiates milk release so moms who do not want to breastfeed should prevent it).
This disorder appears after three months and is manifested by delirium, hallucinations, and mania?
What is Postpartum Psychosis?
(This is a true emergency and the patient needs to be seen immediately. Treatments include medications, ECT, therapy and inpatient treatment.)
This is how you assess for Homan's Sign.
What is have patient sit on the side of the bed, straighten the leg (flexed knee) with dorsiflexion of the foot?
(Positive sign is pain in the calf muscle. This is checking for DVT)
These are risk factors for postpartum thrombosis.
What are intrauterine fetal growth restriction, preeclampsia, cesarean section, postpartum hemorrhage, and immobility?
(Others include cesarean section, maternal age >35, varicose veins and chorioamnionitis)
This medication is given rectally during a hemorrhage and binds to the myometrial cell wall to cause myometrial contractions to expel tissue (it is also used off label to ripen the cervix)
What is Misoprostol (Cytotec)?
(Prostaglandin analogue)
This is characterized by fever, malaise, flu like symptoms, painful breasts and is usually localized to one breast.
What is mastitis?
Nursing interventions: warm compress, encourage frequent pumping or breastfeeding to help keep breast soft, stress the importance of finishing all the antibiotics, NSAIDs and wearing loose clothing
Birth control (pill, patch, implant, ring), condom, IUD and tubal ligations are all examples of
What are contraceptive planning upon discharge?
(It's important to remind families that people have and do get pregnant while breastfeeding so this should not be a primary source of birth control)