Assessment & Care of the Postpartum Mother – Flashcards
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Postpartum Period
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The interval between birth and the return of the reproductive tract to its non-pregnant state; lasts approximately 6 weeks
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G-T-P-A_L
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G: # of pregnancies T: # of infants delivered at term P: # of infants delivered prematurely A: # of abortions L: # of living children
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Primigravida
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First pregnancy
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Multigravida
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Multiple pregnancies
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Nullipara
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Never been pregnant
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Attachment
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The process by which the parent and infant come to love and accept each other
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Bonding
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A process by which parents, over time, form an emotional relationship with their infant
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Breast Engorgement
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Swelling of breast tissue caused by increased blood and lymph supply to the breasts as the body produces milk, occurring at about 72 to 96 hours after birth
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Involution
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Return of the uterus to a nonpregnant state after birth
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Peurperium
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The return of the reproductive organs to their normal nonpregnant state
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Subinvolution
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Failure of the uterus to return to a nonpregnant state; the most common causes of subinvolution are retained placental fragments and infection
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Postpartum Assessment
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B-U-B-B-L-E H-E B: Breasts U: Uterine fundus B: Bladder function B: Bowel function L: Lochia E: Episiotomy (Perineum) H: Homan's sign (legs) E: Emotions
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Assessment of Breasts
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Palpate breasts to determine if they are soft or filling Teach to promote milk production & let down, and methods to prevent and treat engorgement Ensure proper bra fit Nipples should be soft, pliable, intact & everted * If mother is NOT breast feeding - DO NOT palpate breasts or assess nipples
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Abnormal Findings (Breasts)
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Redness, heat, pain, cracked, and fissured nipples, inverted nipples, palpable mass, painful, bleeding, bruised, blistered, cracked nipples
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Assessment of Uterine Fundus
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Ensure bladder is empty & lay patient supine Fundus should be firm; if not firm massage until furm Fundal height measured in cm above or below the umbilicus Note: * fundus is 2 cm below the level of the umbilicus immediately after birth; fundus descends approximately 1 cm per day; by the 10th day the fundus should no longer be palpated
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Abnormal Findings (Uterus)
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Fundus is deviated from the midline, boggy consistency, remains above the umbilicus for after 24 hours Note: *If fundus is deviated or elevated above level of umbilicus always rule out DISTENDED BLADDER
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Assessment of Bowel Function
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Assess abdomen for distention, LBM, bowel sounds, hemmorrhoids
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Abnormal Findings (Bowel)
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Constipation, diarrhea, epigastric pain, hemorrhoids
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Assessment of Bladder Function
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Asses last void, rule out urinary retention
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Abnormal Findings (Bladder)
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Inability to void, frequency, urgency, dysuria
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Assessment of Lochia
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Note amount, colour, consistency, odour, presence of clots Note: * amount is assessed in relation to TIME (scant, light, moderate, heavy)
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Abnormal Findings (Lochia)
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Heavy, foul, odour, bright red bleeding
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Types of Lochia
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Rubra (red) - lasts 3 to 5 days Serosa (pink) - lasts 22 to 27 days Alba (white) - continues for 10 to 14 days
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Assessment of Episiotomy (Perineum)
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Assess using REEDAO Asses hemorrhoids ( #, size, other factors) Assess abdominal incision (C-section) Assess knowledge, practice, & effectiveness of self peri-care
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Abnormal Findings (Perineum)
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Pronounced edema, not intact, signs of infection, marked discomfort
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Assessment of Legs
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Assess for edema (peripheral, sacral, dependent), varicose veins, risk factors of thrombophlebitis, Homan's sign
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Abnormal Findings (Legs)
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Positive Homan's sign, painful, reddened area, warmth on posterior aspect of calf
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Assessment of Emotions
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Assess for sleep deprivation, ability to rest, energy level, comfort level, anxiety level, appetite, bonding behaviours, support system
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Postpartum Hemorrhage
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LIFE THREATENING EVENT* Defined as: loss of more than 500 mL of blood after vaginal birth, loss of more than 100 mL of blood after cesarean birth, a 10% change in HCT between admission for labor and postpartum or the need for RBC transfusion Types: 1. Early, Acute, Primary: occurs within 24 hours after birth 2. Late, Secondary: occurs more than 24 hours but less than 6 weeks postpartum
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Assessment of Attachment Behaviour
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Comforting techniques by parents, speaking about the infant in terms of identification, holding the infant, body contact, talking to the infant, affection to the newborn
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Baby Blues
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Characterize by emotional lability, crying, easily and for no apparent reason, a let-down feeling, restlessness, fatigue, insomnia, headache, sadness, anger Symptoms are usually mild and short lived The "blues" are normal
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Postpartum Depression
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An intense and pervasive sadness with severe and labile mood swings; it is more serious and persistent than the baby blues
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Postpartum Psychosis
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Syndrome characterized by depression, delusions, and thoughts by the mother of harming either the infant or herself
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Risk Factors for Postpartum Hemorrhage
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Early: uterine atony (hypotonia of the uterus), lacerations Late: subinvolution of the uterus, endometritis
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Mastitis
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Inflammation of the breasts Almost always unilateral and develops well after the flow of milk has been established Inflammatory edema and engorgement, nipple fissure * If not treatment can progress to BREAST ABCESS
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RhoGam
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Is given to Rh- women who may give or gives birth to an Rh+ infant Supresses antibody formation in Rh - women Given 28 weeks gestation as prophylaxis
