Postpartum Health

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Information about Postpartum Health

Published on January 15, 2008

Author: Dora


Slide1:  Postpartum Health and Nursing Care by Susan Sienkiewicz FUNDAL HEIGHT AFTER DELIVERY:  FUNDAL HEIGHT AFTER DELIVERY LOCHIA:  LOCHIA SCANT LIGHT MODERATE HEAVY EXAMPLES OF CULTURAL VARIABLES:  EXAMPLES OF CULTURAL VARIABLES African Caribbean - avoid chilling (showers) X 2wks; BF preferred; Chinese - eat “hot” foods X 1 mo; men not present during labor (modesty); FF preferred South Asians - infant washed before handled; postnatal seclusion for mom & infant; BF preferred except colostrum FUNDAL ASSESSMENT:  FUNDAL ASSESSMENT UTERUS DISPLACEMENT D/T BLADDER DISTENTION:  UTERUS DISPLACEMENT D/T BLADDER DISTENTION MANIFESTATIONS OF PPH D/T ATONY:  MANIFESTATIONS OF PPH D/T ATONY  lochia,  clots boggy uterus s/s shock ↓ B/P, ↑ HR, ↓ pulse pressure Thready pulse Cool, clammy skin ↓ U/O PPH TREATMENT: FUNDAL MASSAGE:  PPH TREATMENT: FUNDAL MASSAGE PPH TREATMENT: BIMANUAL COMPRESSION:  PPH TREATMENT: BIMANUAL COMPRESSION CIRCULATORY CARE FOR PPH:  CIRCULATORY CARE FOR PPH Massage uterus  bldg,  bed linen  peripheral pulses  VS, pulse ox  H/H supine position, legs  administer O2 prn FLUID MANAGEMENT FOR PPH:  FLUID MANAGEMENT FOR PPH IVF via lg bore needle Strict I & O Foley – maintain U/O at 30 mL/hr ENERGY MANAGEMENT FOR PPH:  ENERGY MANAGEMENT FOR PPH Cluster care, quiet env Foster bonding Assist OOB  Fe,  protein diet Explain procedures Arrange for home care PELVIC HEMATOMA:  PELVIC HEMATOMA MANIFESTATIONS OF PPH D/T TRAUMA:  MANIFESTATIONS OF PPH D/T TRAUMA Perineal Hematoma severe pain despite analgesia discolored bulging mass Laceration  bright red bldg firm fundus MANIFESTATIONS OF SVT & DVT:  MANIFESTATIONS OF SVT & DVT SVT (in calf:) swelling redness tenderness warmth pain or asymptomatic DVT same plus pedal edema + Homans sign extr cool, pale  pedal pulses CIRCULATORY CARE: SVT & DVT:  CIRCULATORY CARE: SVT & DVT SVT CSM ’s implement medical regime DVT same, plus monitor PT/PTT, INR assess for bldg monitor VS antidotes available protamine sulfate Vitamin K resp assessment PATIENT EDUCATION: SVT & DVT:  PATIENT EDUCATION: SVT & DVT SVT avoid prolonged sitting/stdg support hose reg exercise avoid crossing at knees  fluids stop smoking DVT same, plus don’t rub affected area med regime safety  ETOH avoid pregnancy MANIFESTATIONS OF ENDOMETRITIS:  MANIFESTATIONS OF ENDOMETRITIS Temp > 38 C X 2 on days 2-10 U-distention/subinvolution abdominal pain lethargy, malaise n/v/a foul-smelling, purulent lochia WBC’s > 30K MANIFESTATIONS OF WOUND INFECTION:  MANIFESTATIONS OF WOUND INFECTION  temp edema erythema warmth purulent d/c wound edge separation pain lochia odor, color change MANIFESTATIONS OF UTI:  MANIFESTATIONS OF UTI  temp dysuria frequency urgency bladder distention suprapubic pain hematuria/pyuria chills CVAT/flank pain with pyelonephritis URINARY ELIMINATION MGMT: TEACHING:  URINARY ELIMINATION MGMT: TEACHING Wipe front to back 3L fluids/day acidic fluids void frequently complete course of abx MASTITIS:  MASTITIS MANIFESTATIONS OF MASTITIS:  MANIFESTATIONS OF MASTITIS Fever, chills sudden onset flu-like symptoms unilateral local breast pain warmth, redness, swelling clogged milk ducts MASTITIS: BREASTFEEDING TEACHING:  MASTITIS: BREASTFEEDING TEACHING Proper latch no supplemental fdgs change wet nsg pads avoid tight clothing empty breasts completely manual expression when duct is blocked nipple care (no nipple shields) MANIFESTATIONS OF POSTPARTUM DEPRESSION:  MANIFESTATIONS OF POSTPARTUM DEPRESSION  interest in surroundings  interest in food unable to feel pleasure fatigue health c/o sleep disturbance panic attacks obsessive thinking  hygiene  ability to concentrate odd food cravings irritability rejection of infant PPD: Teaching:  PPD: Teaching relaxation therapy rest & nutrition frequent contact with other adults resource - Depression After Delivery (DAD) 1-800-994-4773 MANIFESTATIONS OF POSTPARTUM PSYCHOSIS:  MANIFESTATIONS OF POSTPARTUM PSYCHOSIS depression s/s manic s/s auditory hallucinations delusions guilt worthlessness Slide28:  A gravida 5 postpartum client is complaining of intermittent uterine cramping while breastfeeding. The nurse knows that these symptoms are most likely due to: a. Endometritis b. Uterine atony c. Uterine involution d. Retained placental fragments Slide29:  A postpartum client has saturated 4 perineal pads with bright red blood during a 1-hour period. Vital signs are stable, uterus is well-contracted. The bleeding is most likely due to: a. Subinvolution r/t retained placental products b. Endometritis c. Uterine atony d. Cervical laceration Slide30:  Where should the nurse expect the level of the fundus to be 2 hours after a normal vaginal delivery? a. At the level of the symphysis pubis b. Midway between the umbilicus and the symphysis c. At the level of the umbilicus d. At the level of the xyphoid process Slide31:  The nurse is aware that the most common sign of a perineal hematoma is: a. Excessive blood loss b. Severe pain c. Uterine atony d. hypotension Slide32:  When caring for a traditional Latina postpartum woman, which individual has the greatest influence on her health care decisions? a. Her sister b. Her husband c. Her mother d. The nurse Slide33:  A nurse assesses a traditional Chinese postpartum mother for bonding behaviors. Which of the following may indicate a maladaptive maternal response? a. Refusal to breastfeed b. Not wanting the husband in the room c. Showing little concern when the infant cries d. Dependence on her grandmother for help Slide34:  A behavior that illustrates engrossment would be: Father is sitting in a rocking chair holding his new baby boy, touching his toes, and making eye contact. Mother tells her friends that her baby’s eyes and nose are just like hers. Mother picks up and cuddles her baby girl when when she begins to cry. Grandmother holds her grandson in the “en face” position. Slide35:  A woman expresses a need to review her labor and birth experience with the nurse who cared for her while she was in labor. This behavior is most characteristic of which phase of maternal postpartum adjustment? Taking-hold phase Taking-in phase Letting-go phase Announcement phase Slide36:  Which action would be least effective in facilitating parental attachment to their new infant? Referring the couple to a lactation consultant to ensure continuing success with breastfeeding Extending visiting hours for the significant other as desired Providing guidance and support as the parents care for their baby Keeping the baby in the nursery as much as possible in the first 24 hours to promote maternal rest Slide37:  A postpartum woman in the fourth stage of labor received Hemabate 0.25 mg IM. The expected outcome of this medication is: Relief from the pain of uterine cramping Prevention of intrauterine cramping Limitation of excessive blood loss that is occurring after birth Reduction in the blood’s ability to clot Slide38:  The nurse responsible for the care of postpartum women should recognize that the first sign of puerperal infection would most likely be: Fever > 38° C on postpartum day 2 WBC’s 25,000/mm3 Foul-smelling, profuse lochia Bradycardia Slide39:  Nursing care of a postpartum woman during the acute stage of DVT includes: Teaching her to use the breast pump until anticoagulation therapy is completed at which point she can resume breastfeeding Administration of oral warfarin Maintaining bedrest and elevation of the affected extremity Application of elastic stockings so she can exercise her legs Slide40:  A priority question to ask a woman experiencing postpartum depression would be: Have you thought about hurting yourself? Does it seem like your mind is filled with cobwebs? Have you been feeling insecure, fragile, or vulnerable? Does the responsibility of mother seem overwhelming? Slide41:  THE END

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