N113 - Postpartum Assessment & Care
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| What is postpartum? | show 🗑
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| show | the process by which the uterus returns to its normal size.
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| What is evidence of satisfactory involution? | show 🗑
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| What is the normal rate of descent of the uterus? | show 🗑
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| show | A prolonged labor, general anesthesia, difficult delivery, multiple pregnancies, full bladder, infection, retention of placental fragments.
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| show | Hemorrhage
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| What are S/S of hemorrhage? | show 🗑
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| show | Hb <5.0g/dl & Hct of <20%, hemoglobin will decrease 1 to 1.5 g/dl & hematocrit will decrease 2-4% per 500 ml of blood loss
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| show | blood loss greater than 500 ml in first 24 hrs caused by uterine atony, laceration of the genital tract, retained placenta, adherent placenta.
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| show | Retained placenta and infection are the most common causes.
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| show | the decidua (lining) which is cast off down to myometrium, a new endometrium is formed
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| show | Bright red, tends to clot, serosanguineous, becoming more serous and less bloody - last 1-3 days.
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| What is lochia serosa and how long does it last? | show 🗑
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| What is lochi alba and how long does it last? | show 🗑
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| show | separation of the rectus abdominis muscles may occur leaving part of abdominal wall with no support except skin, subcutaneous fat, fascia & peritoneum.
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| Why is bathing so important? | show 🗑
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| show | A surgical incision of the perineal body - assess using REEDA - redness, edema, echymosis, discharge, approximation
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| show | A tear in the perineal body which occurs in varying degrees.
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| show | tear through skin & structures that are superficial to muscle
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| show | extends through perineal muscles - much like an episiotomy
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| 3rd degree laceration | show 🗑
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| show | involves anterior rectal wall
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| Sulcus tear | show 🗑
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| show | Pt should void within 6-8 hours following delivery, check for bladder distention if less than adequate amount voided - retention with overflow
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| What can cause bowel dysfunction? | show 🗑
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| Are there any dietary restrictions following delivery? | show 🗑
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| How ofter should vitals be checked after delivery? | show 🗑
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| What are considered the standard vital signs? | show 🗑
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| What does BUBBLE HE stand for? | show 🗑
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| show | Are they soft, firm or filling? Any discharge - type & amount, Nipples cracked/lesions? Unusual contour?
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| How is the uterus assessed? | show 🗑
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| show | Assess for position and size. Teach S/S of infection, teach proper pericare
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| show | Check for flatus/bowel sounds, rectal pressure. Teach need for extra fluids, fiber
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| How is lochia assessed? | show 🗑
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| How is an episiotomy or laceration assessed? | show 🗑
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| What is assessed in regards to emotional status? | show 🗑
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| show | The time between conception and onset of labor, used interchangeably with prenatal
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| show | The time between the beginning of labor and the birth of the infant.
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| What does puerperium or postpartum mean? | show 🗑
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| show | The number of pregnancies in which the fetus has reached 20 or more weeks gestation when they are born regardless of live or still born.
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| show | Birth that occurs prior to the 20 weeks, either selective or spontaneous. Therapeutic - done to save mother or non-viable fetus.
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| show | Labor that occurs after 20 weeks but before completion of 37 weeks.
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| What is considered a term pregnancy? | show 🗑
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| What does TPAL stand for? | show 🗑
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| show | A baby born dead at 20 or more weeks gestation.
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| What is a neonate? | show 🗑
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| show | Capacity to live outside the uterus - about 22-25 weeks gestation.
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| show | Slight penetration of placenta into the myometrium
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| show | Deep penetration of the placenta into the myometrium
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| What is placenta percreta? | show 🗑
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| show | Hydraminos is too much amnionic fluid, macrosomia is a large baby. Both stretch the uterus more than normal and make it hard for the uterus to contract after birth.
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| How are hematomas related to delivery? | show 🗑
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| show | Vulvar - most common & most can be seen, Upper vaginal - difficulty voiding due to pressure on urethra or meatus, Upward - severe lateral uterine pain, flank pain, abdominal distention. May have S/S of shock without blood loss & a well contracted uterus.
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| show | Presence of a fever of 100.4
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| show | Leading cause of newborn sepsis & meningitis, infant infected through vaginal birth, can lead to death or severe neurological damage. Routine screening done at 32-36 weeks. Ampicillin or gentamycin can be given during labor.
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| What is metritis? | show 🗑
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| show | Infection at the placental site
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| What is parametritis? | show 🗑
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| show | Infection of the tubes & ovaries.
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| What is thrombophelpitis? | show 🗑
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| show | Sudden onset of SOB, chest pain, tachypnea, dyspnea, apprehension, cough, hempotysis, diaphoresis, fever, circumoral cyanosis.
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| What causes an amniotic fluid embolism? | show 🗑
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| What is disseminated intravascular coagulation? | show 🗑
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| What are the psychological adjustment stages? | show 🗑
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| What are the characteristics of the taking in phase? | show 🗑
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| What are the characteristics of the taking hold phase? | show 🗑
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| show | Accept and realize the physical separation of infant and relinquish role of childless individual. Challenge - extreme exhaustion of night time care and sleep deprivation, anticipatory guidance needed regarding the realities of motherhood.
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| show | Can occur 1-2 weeks after birth, often peaks around 5th day and subsides by 10th day - believed to be related to hormone levels. Exhaustion is rated as one of the top causes.
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| show | Symptoms persist longer than 2 weeks and intensify.
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| show | A temp elevated to 100.4* in the 1st 24 hours post delivery can be due to exertion & dehydration.
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| show | An infection of the breast tissue. More common in breast feeding mothers.
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