NURS 306 Chapter 12 Postpartum Physiological Assessments and Nursing Care
when to assess the uterus
Q15 min every hr Q30 min 2nd hr Q4 hrs next 22 hrs every shift next 24 hrs
what is lochia?
a bloody discharge from the uterus that contains sloughed off necrotic tissue and goes through
what is a boggy uterus?
a sign that the uterus is NOT in a contracted site.
what is a boggy uterus?
a sign that the uterus is NOT in a contracted state.
nursing actions
asess uterus for location, position, and tone of fundus
why are uterine contractions so important?
b/c it helps constrict blood vessels to prevent blood loss. WE NEED THEM TO HAVE UTERINE CONTRACTIONS.
purpose of assessing uterus
b/c of possibilities of postpartum hemorrhage
difference between clots for lochia
clots are common for lochia if small, chart it. if large, then you must weigh it and notify MD. if it's 10 mL then it interferes with uterine contractions.
expected findings for uterus
descends 1cm per day and by day 14 the fundus has descended into the pelvis and is NOT palpable.
what is a patient teaching for a client getting oxytocin through an infusion pump?
ensure to tell them it could cause uterine cramping
women are at risk for......
hemorrhage and infection
if a client has a boggy uterus, what does it pose a risk for?
hemorrhaging and blood loss.
what is the a/e of oxytocin?
if used IV, it can cause coma, seizures, hypotension and water intoxication.
what does a distended bladder indicate?
it can indicate the fundus is to the side and interferes with uterine contractibility THEREFORE LEADING TO HEMORRHAGING
what happens to the endometrium after birth?
it exfoliates and regenerates through the process of necrosis.
what is oxytocin?
it's used for postpartum control of bleeding. it stimulates uterine smooth muscle to produce uterine contractions.
nursing action for a boggy uterus
massage the fundus with the palm of your hand in a circular motion until firm. THEN REEVALUATE WITHIN 30 MIN.
what is afterpains?
moderate to severe cramp like pains that are r/t uterus working harder to remain contracted and/or to the increase of oxytocin is released in response to infant suckling.
nursing considerations for oxytocin
monitor VS assess water intoxication such as headache, drowsiness, anuria.
who are at risk for developing "afterpains"?
multiparous women or women who are breastfeeding. multiparous: women who have given birth more than once.
what is involution
process that happens after delivery of the placenta. it's when the uterus returns to a pre-pregnant size, shape and location. The placental site heals.
best advice for assessing uterine
tell her to void first and assist her to restroom. then REASSESS UTERUS
what happens if the boggy uterus doesn't respond to the massaging?
then you have to follow the standing order for oxytocin and notify MD or midwife.
how does involution occur?
this happens by uterine contractions, atrophy of the uterine muscle and a decrease in size of uterine cells.
purpose of nursing assessment after postpartum
to reduce risks of hemorrhages and infection
the reproductive system
uterus, cervic, vagina, perineum. all in which have changes 6 weeks after giving birth.
when is the best time to assess the lochia?
whenever the uterus is assessed. this allows us to notice any early signs of bleeding.
what time poses a great risk for postpartum hemorrhaging?
within the first hour following delivery
purpose of postpartum care
-assess early signs of complications -health and family promotion
how long is the postpartum period?
6 months after childbirth
