Chapter Period (((postpartum Clinical Record – Flashcards

---------Vital Signs: ---Temperature: slight elevation during first 24 hours; normal afterwards ---Pulse: relative bradycardia; returns to prepregnancy levels within 10 days ---Respirations: 16 to 20 breaths/minute ---Blood pressure: within usual range ---Pain: goal between 0 to 2 on pain scale ((((VS Q 5-15 minutes initially (first hour q15 min, generally) in 4th stage dependent on events in labour and birth. ie) PPH Then Q30 min x 1hour, then Q1 hour x 2, then Q 4-8 hours. Relative bradycardia - due to the decrease in blood volume and cardiac output after delivery. May range from 50-70 bpm as the body adapts to the changes. Pulse usually returns to prepregnant levels 10 days after birth. BP normal unless significant events in labour led to hemodynamic instability. Usually SAMP for pain. Can use voltaren supps. (respirations should stay the same ---resps increase cause of pain and so on) (blood pressure is normal unless significant loss of blood) (pain 0-2 on painscale) (women using voltaren take out ibropefen)))))

-Breasts (size, contour, engorgement) -Uterus (height of fundus, firmness) -Bladder (voiding, bladder emptying) -Bowels (bowel sounds, distention) -Lochia (amount, colour, odour) -Episiotomy and perineum (lacerations, hematoma) -Extremities -Emotional status

Breasts -erect, flat or inverted nipples, discharge, cracks, blisters, soreness, redness, inflammation (mastitis) Uterus - watch for a boggy uterus. Descent by 1cm or 1 finger/day. Bladder - difficulties with urination, pain, incontinence, signs of infection.. Watch for low urine output especially with a woman on oxytocin during labour (antidiuretic properties of oxytocin). A full bladder increases the risk of PPH Bowels - BM may not occur for 2-3 days due to decrease in muscle tone and peristalsis during labour or because they had a BM during birth. Women with perineal trauma may have difficulties having a BM, Provide stool softeners. Should have good BS and passing gas, non-distended. Lochia - measures as scant (1-2 inch staining), light or small (4 inch staining), moderate (4-6 inch staining), large or heavy (pad is saturated within one hour Each ml of blood loss equals 1g in weight. c/s will have less lochia. Ensure frequent pad changing and good handwashing to decrease infection risk. Episiotomy - or tears 1st degree involves skin and superficial tissue, 2nd through perineal muscles, 3rd extends through the anal sphincter to 4th degree - through the anterior rectal wall. Check Q8 hours for signs of infection, hematomas. Apply ice. Extremeties - women are at an increased risk of thromboembolitic disorders (DVT, PE) Look for edema, redness, pain. Women at an increased risk (C/S). Emotional - how does she interact with her family, her baby, her level of independence, energy levels, eye contact with family and infant, posture and comfort level when holding infant, and sleep and rest periods. Watch for mood swings, irritability and crying episodes (if nipples are bleeding—don't stop baby from breastfeeding) (inproper latch---has blister) (mastitis—within day one or two---no because takes longer no milk just colostrum) (watch for boggy uterus—means hemorrhage) (landmark---feeling for uterus---umbilicus) (some difficulty in urination---get a catheter) (listen to bowel sounds) (women should not be inclined to push) especially if have trauma down there and so on --- Docusate -100 mg tablets to be in pack (good bowel sounds, abd distended and passing gas) (women who had c-section will most likely have bowel sounds but might be slightly hypoactive) (start with icechips) Lochia---rubera(red)---serousa(pink)---alba(browny/whity) Each ml equals 1 gram C-section will have less lochia--- not as much as vaginal Episiotomy --- first degree involves skin 1,2,3,4 degree ----through rectal wall- check that for any hemotomas forming—apply ice to decrease inflamation ---DVT at risk, edema, redness, pain C-section more at risk for DVT Emotional bit how she is interacting with baby and so on Does she have eye contact with family and infant Starting with the blues---postpartum depression

True Rationale: Some women experience a slight elevation in temperature during the first 24 hours postpartum; this may be the result of dehydration secondary to fluid loss during labour.

--Bonding and attachment --Transition to parenthood -------Stages -------Factors affecting attachment: parent's background, infant, care practices --Critical attributes of attachment: proximity, reciprocity, commitment --Positive and negative attachment behaviours (see Table 16.1)

-Providing optimal cultural care (see Box 16.3) -Promoting comfort ----Cold and heat applications ----Topical preparations ----Analgesics -Assisting with elimination ----Promoting voiding ----Promoting bowel elimination (Providing optimal cultural care - page 479. Read on your own.)

Promoting activity, rest, and exercise ---Early ambulation --------Rest periods --------Exercise program; recommended exercises; Kegel exercises (see Teaching Guidelines 16.3) --------Assisting with self-care measures ---Ensuring safety ---Counselling about sexuality and contraception

Promoting nutrition ---General recommendations (Canada's Food Guide) ---Needs for the breastfeeding woman Supporting choice of newborn feeding method Assistance with breastfeeding ---(Baby-Friendly Hospital Initiative) ---Assistance with bottle-feeding

False Rationale: To meet the needs for milk production, breastfeeding women require an extra two or three Canada Food Guide servings per day.

-Teaching about breast care ----Breast assessment ----Measures to alleviate breast engorgement -------------Breastfeeding woman ------------Bottle-feeding woman (lactation suppression) ----Promoting family adjustment and well-being -------------Parental roles ------------Sibling roles ------------Grandparent roles

C. 6 months Rationale: Exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life. Breastfeeding for the first 6 months of life and up to 2 years of age or older is optimal.

-Teaching about postpartum blues -Preparing for discharge (criteria) -Providing immunizations -Ensuring follow-up care -----Telephone follow-up -----Outpatient follow-up -----Home visit follow-up