NR327 - Postpartum Assessment, Exams of Advanced Education

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NR327 - Postpartum Assessment

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• 2024/ - NR - Nr

What is the main goal of the Postpartum period? Preventing postpartum hemorrhage -Other goals include assisting in Pt's recovery, identifying deviations in the expected recovery process, providing comfort measures and pharmacological pain relief, providing Pt education about newborn and self-care, and providing baby-friendly activities to promote infant/family bonding Phases of maternal role Attainment Dependent Dependent-independent Interdependent Describe the Dependent Phase "Taking-in phase" -First 24-48 hr -Focus on meeting personal needs -Rely on others for assistance (nurse, CNA, mom, partner, father, gma) -Excited, talkative -Need to review birth experience w/ others Describe Dependent-Independent Phase (Taking-hold phase) -Begins on day 2 or 3 -Lasts 10 days to several weeks -Focus on baby care and improving caregiving competency -Want to take charge but need acceptance from others -Want to learn and practice -Dealing w/ physical and emotional discomforts, can experience "baby blues"

Describe Creating the role of the involved father phase (Co-parent transition) Decides to become actively involved in the care of the infant Describe Reaping rewards phase (Co-parent transition) Rewards include infant smiles and a sense of completeness and meaning Which of the following behaviors by the client indicates a need for the nurse to intervene? A. Mother views newborn's behavior as uncooperative during diaper change B. Father maintains close physical proximity with newborn C. Mother identifies newborn's characteristics to those of her mother D. Father interprets newborn's behaviors as a way of expressing her needs A - Postpartum assessments immediately following delivery include: -Monitoring VS -Uterine firmness and its location in relation to the umbilicus -Uterine position in relation to the midline of the abdomen -The Amount of vaginal bleeding Acronym for the postpartum assessment B. U. B. B. L. E. H. E. R.

BUBBLE HER is an assessment checklist acronym. What should you check? Breasts Uterus Bowel Bladder Lochia Episiotomy Hemorroids / Homan's sign Emotions RhoGam / Rubella B. U. B. B. L. E. H. E. R. Breasts Uterus (fundal height, uterine placement, and consistency [soft → firm]) Bowel and GI function Bladder function Lochia (discharge after delivery; color, odor, consistency, and amount [COCA]) Episiotomy (redness, edema, ecchymosis, discharge, approximation [REEDA]) Hemorrhoids / Homan's sign (for DVT; not done anymore) Emotions RhoGam / Rubella

What are ways to stop the lactation of mom's who do not want to breastfeed? -Tight bras, breast binders -Ice pack or cabbage leaves can be applied Optimal Latch for breastfeeding has nipple and areola Assessment of the Uterus Assess fundal height, uterine placement, and uterine consistency at least q8hr -Assess relation of fundus to umbilicus (should be at the level of umbilicus, everyday after it lowers 1 cm.) -Assess position: Left, right, Midline (midline is optimal, full bladder is the cause if displaced laterally) -Assess Firmness: Firm vs. Boggy (Firm is optimal [rock]; Boggy = massage needed) Nursing consideration for C-sections Pts -still need to check fundus -Need to know if fundus is bleeding Normal QBL for vaginal birth

0-500 mL Normal QBL for C-section 0-1000 mL Causes of Boggy Uterus -Uterine Atony (not firm) -Retained pieces of placenta (Dr removes or performs D&C) What should the nurse do if a Boggy uterus is palpated? Massage the uterus to make it contract -if the fundus is boggy (not firm), lightly massage the fundus in a circular motion What could cause the uterus to be displaced laterally? a full bladder Describe Involution Fundus descending and uterus returning to pre-pregnancy size -Occurs w/ contractions of the uterine smooth muscle, whereby the uterus returns to its prepregnant state. Describe the Process of Involution

1. At end of 3rd stage of labor, Uterus should be palpable at midline and 2cm below umbilicus.

-Cytotec ALL of these Control PPH by uterine stimulation Contraindication for Hemabate asthma Contraindication for Methergine HTN Adverse reactions of Pitocin -Lightheadedness -N/V -Seizures -Coma -Death Adverse reactions of Methergine Do not administer to Pts w/ HTN -HTN -N/V -headache

Adverse reactions of Hemabate Do not administer to Pts w/ Asthma -Fever -Explosive diarrhea -N/V Adverse reactions of Cytotec -N/V -Diarrhea -HA -Cramping How do you evaluate the effectiveness of PPH meds? -the fundus should be firming up and the bleeding should be slowed/stopped Postpartum Bladder Assessment -Assess for Retention and Distention -Assess ability to void -Assess voiding Pattern (excess diuresis (>3000 mL/day) is normal w/in the 1st 2- days after delivery) -Assess voiding Adequately -Assess for evidence of a distended bladder -Freq. voiding of less than 150ml indicates urinary retention w/ overflow

-Pericare: Have to change pad every time they use bathroom; Ice packs at least first 24 hr -s/s UTI: freq, burning, dysuria -Bladder training / Kegel exercise Physical changes in the GI system -Increased appetite following delivery -Constipation -Hemorroids Postpartum Bowel Assessment -Assess for reports of Hunger (expect good appetite) -Assess for bowel sounds and the return of normal bowel function (want Bowel movement w/in 2-3 days) -Assess for discomfort w/ defecation d/t perineal tenderness, episiotomy, lacerations, or hemorrhoids -Assess rectal area for hemorrhoids Pt education for Bowel -Comfort measures (↑ fluids, IVs) -Early ambulation -Diet/Nutrition (↑ high fiber foods) -constipation (Stool softener) define Lochia Post-birth uterine discharge that contains blood, mucus, and uterine tissue

-Amount of lochia is similar to a heavy menstrual period about 2 hr after delivery, then decreases gradually at a consistent rate What are the 3 stages of Lochia? Lochia Rubra Lochia Serosa Lochia Alba Describe Lochia Rubra Dark red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. -Lasts 1-3 days after delivery Dark red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. -Lasts 1-3 days after delivery Lochia Rubra Describe Lochia Serosa Pinkish brown color -Serosanguineous consistency -Can contain small clots and leukocytes -Lasts from approx. day 4 to day 10 after delivery Pinkish brown color -Serosanguineous consistency

-Discharge teaching: use of Pads vs. Tampons (no tampons!) -Assessment of bleeding (amount should decrease, should lighten in color, could bleed up to 8 wks) -Changes of Lochia -Time frame (up to 8 wks) -s/s of Infection How to assess Episiotomy or Laceration repair -Place Pt in the lateral position and ask Pt to bend/flex one leg up -Nurse looks into perineal area from the Pt's posterior; this gives the best view Assessment of Episiotomy, Laceration, Incision REEDA Redness Edema Ecchymosis (bruising) Discharge (not lochia; infection discharge) Approximation REEDA Redness Edema Ecchymosis (bruising) Discharge (not lochia; infection discharge) Approximation

REEDA applies to ______ Episiotomy, Lacerations, & Incisions Pt education about Episiotomy, Laceration, Incision -Perineal Care (how to change pads, how to use water bottle when cleaning -Incisional Care --s/s of infection (redness, swelling, discharge, fever, warmth) -Comfort measures: --Ice (for at least first 24hr) --Topical Assessment of Hemorrhoids -Assess size -Number of Hemorroids present -Pain -Teach the Pt comfort measures (ibuprofen, sitz bath) Homan's Sign -not performed on anyone postpartum Why are postpartum women more at risk for DVT? -↓ ambulation -Epidural / C/S -Bedrest

-Decreased interactions w/ others -Lack of communication -Crying -Fatigue -HA -Anxious manifestations of Postpartum depression -Guilt -Anxiety -Fatigue -feeling of loss -Loss of appetite -persistently sad -intense mood swings -insomnia -lack of sleep -flat affect -Rejection of baby Describe Postpartum Psychosis -Develops w/in the first 2-3 weeks -will have disorientation, hallucination, paranoia -May harm themselves or baby Pt education r/ t Postpartum Emotions -Teach Normalcy of postpartum blues

-Instructions on when to notify MD of persistent thoughts of harm or injury What is RhoGam? Given to Pts who are Rh- in pregnancy -Given at 28 wks When do we give RhoGam? at 28 weeks pregnant and 72 hours after birth How do we know we do not have antibody to Rubella? -Titers (bloodwork) -If comes back non-immune → Pt needs vaccine (MMR) Range of Rubella? 1.0 = immune <0.7 = non-immune MMR vaccine Pt teaching -Pt should not get pregnant for at least 4 weeks after -It is okay to breastfeed baby Which area of health teaching will a new mother be most responsive to during the taking in phase of the postpartum period? a)Family planning