What are components of a postpartum assessment?
-ask questions
-vital signs
-fundal checks
-auscultate heart, lung, and bowel sounds
How frequent are postpartum assessments performed?
-q15 mins for 1-2 hrs
-q4hrs for 24 hrs
-q8hrs after 24 hrs
What are common cardiovascular changes postpartum?
-increased cardiac output for 24 hrs
-bradycardia common first week
-hypercoagulable
-temp up to 38C (100F)
What are some postpartum danger signs?
-temp 38C
-foul smelling lochia
-large blood clots/ saturated peripad w/in 1 hr
-HA
-blurred vision
-dizzy
What are the components of a postpartum exam?
-Breasts
-Uterus
-Bladder
-Bowel
-Lochia
-Episiotomy
-Hemorrhoids
-Extremities
-Emotional Status
What do we assess for postpartum on extremities?
-DVT
-edema
-Deep Tendon Reflex
-Clonus (dorsiflexion rxn)
What are postpartum breast changes?
-colostrum first few days
-engorgement
If lactating, how do you tx engorgement?
-breastfeed
-express breast milk
-warm compress
-ice
-green cabbage leaf
If not lactating, how do we tx engorgement?
-ice packs
-firm bra
will dry up w/in week
How does breastfeeding stimulate production?
stimulates pituitary gland to release prolactin and oxytocin
How do you use cabbage leaves to tx engorgement?
-rinse chilled leaves
-pat dry
-wrap breast w/ exposed nipples
-leave in place (bra opt) until leaves are warm
-repeat until relief
What are postpartum changes to lochia?
-Rubra (1-3 days)
-Serosa (3-10 days)
-Alba (10+ days)
What are postpartum vaginal/perineal changes?
-dryness
-dyspareunia (sex pain)
-edema
-errythema
-stretched/atonic pelvic floor
What are nursing education topics r/t to vaginal/perineal postpartum changes?
-kegels 10x10 TID
-no intercourse for 6 weeks
-water-soluble lube
What are postpartum urinary changes?
-diuresis
-decreased bladder tone
-increased bladder capacity
-increased risk for retention/infection
-uterine atony
-increased lochia
How can a full bladder impact the uterus postpartum?
displaces uterus, typically to right
When can we expect the first postpartum void?
w/in 6 hrs
How can we encourage postpartum urination?
-privacy
-running water
-hand in warm water
-slow exhale
-blow through fist
-peppermint oil
-catheterize PRN
What are some postpartum GI changes?
-increased hunger and thirst
-may not have BM for 2-3 days
-risk for constipation
-risk for hemorrhoids
How can promote comfort in the perineal area?
-ice
-sitz bat for 20 min PRN
-contract butt before sitting
-peri care: peri bottle, pat dry, peri meds
How do you promote comfort for post cesarian (C/S)?
-gentle fundal checks
(have pt inhale and press down w/ 1-2 fingers while exhaling)
-teach exhale when turning
-position baby to avoid abd pressure
-assist to lift baby out of crib
What are postpartum menstruation return timelines?
-lactating: 3-18 mo
-nonlactating: 7-9 weeks
ovulation may occur before menstruation
How do you promote RhoGAM maternal safety?
-anti-D immune globulin given to block immune response and prevent maternal sensitization
-indicated for RH negative mom and RH positive baby
-administer w/in 72 hrs of birth in deltoid IM
