OB/Maternity: Postpartum care

Assessment: Bowel and Bladder (Elimination)

-At risk for urinary retention. -Postpartum diuresis 12-24 hrs. -Trauma to tissue/pain can hinder elimination. -Bladder distention will displace uterus. -Perineal care.

Calcium, Phosphorus, Magnesium

-CNS depressant... slows down. -Hi mag: depressants, resp depression. -Check reflexes DTR, stop mag antidote: calcium Gluconate.*** -Lo Mag: Increase activity tremor, seizures... tx: mag infusions. -Common foods: green leafy vegs, pork, beef, chicken, milk, peas.

Risk Factors: Requires Collaborative Interventions.

-Diabetes: Newborn 1 hr after giving birth, breast feed. -Cesarean birth -Preeclampsia: htn, edema, proteinuria. -Retained placents.... -DIC: bleeding cause hypercoagulation, FSP or FDP, depleted, and repleted.... tx: s/s & IV heparin.

Assessment: Breasts (Reproduction)

-Encourage immediate skin to skin attachment and early attempt to breastfeed. -Assess nipple condition, breast fullness, infant latch and position. -Hormones: estrogen, prolactin, oxytocin. -Colostrum is creamy, yellowish: contains proteins, vitamins, and minerals, and antibodies... -After 2-3 days transitional milk... mature milk by day 5.

FVD with Post Op Bleeding

-FVD labs up, HCT?HGB down with bleeding. -Breathing (resp) labored, "C" BP down Pulse tachy weak and thready (UP), CVP down/low, neck veins flat. -Peripheral pulses, skin turgor tenting, fontanels depressed down. -"D" change in mental status. -other s/s: decrease urine, increase sg, dry mouth, no tears, decreased bowels, thirsty -What increases? Sodium, Hematocrit, BUN with normal creatine, SG. -Position: supine or modified T burg, elevate legs... increases venous flow to major organs. -Oxygen -IV: Fluids isotonic NS or LR, PRBC (last).

Maternal Adaptation During Pregnancy

-First trimester: Disbelief and ambivalence. -Second trimester: Quickening; helps mother to view fetus as separate from herself. -Third trimester: Anxiety about labor and birth; nesting occurs.

Potassium

-Foods: raisins, pork, beef, fish, spinach, carrots, potatoes, tomatoes, strawberries, bananas. -LO K: weaK, flat T wave, Uwave, abnormal pulse. -TX: with potassium infusion never IV push. -IV KCL 10 meq/100mL over one hour on pump. -HI K weak, high T wave, Low pulse. -TX: Sodium polystyrene/Katexelate, Sodium Bicarb,Insulin 10units IVP, D50 IVP....First calcium Gluconate to stabilize the heart.

Assessment (Bubble-He)... UTERUS (Reproductive and Perfusion)

-Fundus: top part of the uterus. -Initially at level of umbilicus, descends about 1cm/day... boggy not good. -Should be firm, midline position and size of grapefruit after delivery. -Uterine atony- relaxation of uterine muscle tone.... wanted!!

High Sodium.....

-Hypernatremia -FVD, Cushing.... -Decrease heart function, wek muscles. -Orthostatic with dehydration. -Confusion, agitation seizures with LO Na. -Decreased urine output, increase SG = FVD & blood labs will be up. -Treat: FVD with fluid replacement.

Low Calcium

-Hypocalcemia. -below 8.5 mg -Calcium down PO4 up. -Increase activity twitch, tremor, seizure. -TX: Calcium bolus infusion. -Seizures: padded side rails and suction, oxygen at bedside.

Low Sodium.....

-Hyponatremia. -Weak thready pulses, Resp shallow & weak. -CHF, FVO, Addison. -Confusion, hyperactive bowels. -Seizures with Na under 120: suction, oxygen padded siderails, ** post ictal....sleeepy. -Treat: underlying cause

Assessment of Perineum (Tissue Integrity)

-Lacerations or tears classified in degrees. -First degree:slight tear. -Second degree: through perineum muscle and to the anal sphincter. -Third degree: anal sphincter and perineal muscles are torn. -Fourth degree: throught the anal sphincter and rectum is torn. -Ice for the first 24 hrs, then heat. -May use numb spray for comfort. - always checking for s/s of infection. -Episiotomy: surgical incision of perineum.

PKU and children

-Low protein until age 6, reassess.

Interventions: Medications

-Magnesium Sulfate: -Narcotic agonist --> oxycodone. -Uterotonics: Oxytocin, misoprostol/cytotec: methergine, carboprost.

Sibling Adaptation

-May view baby as a threat to security of their relationships with parents. -Reaction depends on age of siblings. -Preparation for birth is essential.

Paternal Adaptation From Pregnancy Through the Postpartum Period.

-Pregnancy: First trimester *may feel left out or feelings of doubt. *May be confused by his partner's mood changes. *Might resent the attention she receives. Second trimester: Begins to decide which behaviors of own father to imitate or discard. -Third trimester: Anxiety about labor and birth. After Birth: Develops a parent-infant bond, Transitions to fatherhood.

Assessment: Pain (Comfort)

-Promote maternal rest. -After-birth pains.... -Non-pharmacological pain releif. -Medications -Resumption of activity. -Physical, Psych, Sexual activity.

Postpartum Assessment: LOCHIA Amount

-Scant: <2.5 cm -Light: <10 cm -Moderate: >10 cm -Heavy: pad saturated within 1 hr. -Excessive: Pad saturated within 15 min.

Maternal Adaptation Phases: Postpartum

-Taking-in Phase: a period of dependent behaviors, occurring during the first 24-48 hours after birth. -Taking-hold Phase: The movement between dependent and independent behaviors, follows the taking-in phase and can last weeks -Letting-go Phase: the movement from independence to the new role of mother, fluid and interchangeable with the taking-hold phase.

Blood Products: PRBS, Platelets, FFPlasma for DIC

-Type and cross match. -Consent -Large bore IV 18 or 19 -Normal saline -FIrst 15 mins.... look for.... --Allergic reaction: hives, wheeze, stridor, and LO BP. -Hemolytic: flank pain/hematuria. -Autologous: febrile...chillds, temp=sepsis/DIC. -FVO: VS up and Lab down.

Assessment: LOCHIA (Reproduction and Perfusion).

-Vaginal discharge following birth. -Contracted uterine muscle compress blood vessels to decrease bleeding. -Locia rubia: 0-3 days --> dark red -Lochia serosa: 3-10 days --> pink -Lochia alba: week 2-5 --> creamy yellow. -Presence of clots??

Nursing Priorities/Plan of Care: Postpartum

-Asseessment postpartum: 2-3 days, VNA, Psych, ICU, Bubble He. -Comfort: Pain meds postpartum post c/s and postop the same. -post op pain med RTC every 4-6 hrs for 48 hrs.. -Safety ABC, complications: SOB/PE, Infection/Sepsis/DIC, Septic shock, FVD = lo BP, pt c/o... -Teaching mothers phsyical, psych, family adjustments.

High Calcium

--8.5-10 mg -Calcium up PO4 down -Decrease activity, ataxia, flaccid. Risk for injury and safety. -TX Fluids and lasix.

Cesarean Section

-33% women in the US get CS... want to decrease this. -Increased risk of infection, wound, UTI and pulmonary DVT. -Increased use of narcotics/sedatives. -Decreased mobility.

Postpartum Period

-Also known as "puerperium" -Starts at birth and lasts 6 weeks: Newborn see MD at 7 days old. -Physical and psychological changes take place, transitioning mom back to pre-pregnant state uterus pelvic organ by 7-10 days, still with lochia red, pink, cream/yellow/alba. -Adjustment to new family dynamics.

Meds For Contraction: Oxytocin

-Also known as pitocin. -For labor titration to increase contractions. -Observe: moms BP and Baby HR. (bby FHR 120-160.. drop under 100 = BAD). -Oxytocin IV infusion after delivery wide open. -Helps stop bleeding after delivery..

At which location would the nurse expect to palpate the fundus of a primiparous patient 6 hours after birth? A.Halfway between the umbilicus and the symphysis pubis B.At the level of the umbilicus C.Just below the level of the umbilicus D.Above the level of the umbilicus

A.Halfway between the umbilicus and the symphysis pubis

A primiparous patient who gave birth vaginally 8 hours ago wishes to take a shower. The nurse anticipates remaining near the client to assess for which problem? A. Fatigue B. Fainting C. Diuresis D. Hygiene needs

B. Fainting

A primagravid patient gave birth vaginally 2 hours ago with no complications. As the nurse plans care for this postpartum client, which postpartum goal would have the highest priority? A. By discharge, the family will bond with the neonate. B. The nurse will demonstrate self-care and infant care by the end of the shift. C. The nurse will state the instructions for discharge during the first postpartum day. D. By the end of the shift, the nurse will describe a safe home environment.

B. The nurse will demonstrate self-care and infant care by the end of the shift.

In response to the nurse's questions about how she is feeling, the patient states that she is fine. She then begins talking to the baby, checking his diaper, and asking infant care questions. The nurse determines the patient is in which phase of maternal adaptation? A.Taking in B.Taking on C.Taking hold D.Letting go

C.Taking hold

At a postpartum checkup 11 days after childbirth, the nurse asks the patient about the color of her lochia. Which color is expected? A.Dark red B.Pink C.Brown D.White

D.White

BUBBLE-HE

•B- Breasts engorgement, pain, presence of milk or colostrum, inversion, cracking, bleeding •U- Uterus location, position of fundus, firmness •B-Bowel last bowel movement, bowel sounds, appetite, medications •B-Bladder difficulty urinating , measure urine when Foley is DC's, bladder distension •L-Lochia type, amount, odor, presence of clots •E-Episiotomy/Laceration Use REEDA Scale: Redness, Edema, Ecchymosis, Drainage, and Approximation •H- Homan's /Hemorrhoids check calves for edema, redness, pain; look for hemorrhoids or hematomas •E-Emotions nutrition, fatigue, pain, adaptation to motherhood, body image issues