The Family after Birth

(Ch 12, 19)

FOCUSED ASSESSMENT

 4th

stage of labor: 15 min x 4 30minx 2 hourly x 2 q4h

Lochia: Discharge from placental site

Rubra:

red blood, fleshy odor small clots okay (1st 3rd day) Serosa: pinkish brown, blood/mucous (4th to 10th day) Alba: yellowish white (11th-21st day)
Amt: heavy (1 pad q2h), moderate, light, scant
4

Lochia

Flow:

Normal:

gush of lochia first few days Gently massage fundus Incr. when first ambulates Abnormal Excess spurting of bright red blood Numerous clots

Inversion

Foul odor Lochia rubra past 3 days From serosa to rubra, from alba to serosa

Uterus
Involution Subinvolution

Uterine
Oxytotics Firm

Cxr

Breastfeeding

fundus Empty bladder q2-3 hr!

6

 Oxytocin

(Pitocin) IV/IM Endogenous oxytocin breastfeeding

Analgesia Incr.

AFTER breastfeeding

Methergine,

Ergonate IM, PO F

B/P

Prostaglandin
Hemabate

 Lacerations
Vaginal

(perineal or cervical)

bleeding w/firm fundus Continuous slow trickle

Hematoma
Severe

perineal or rectal pain/pressure Difficulty voiding due to pressure Urge to deficate

 Post

episiotomy/laceration Cold packs (first 24-48 hrs) Heat (after cold packs) Topical & systemic medications Sitz bath Peribottle (warm water, front to back

10

 Hemorrhoids Constipation
increase

fluid and fiber intake Increase activity, such as walking

Stool

Softeners
Colace

Surfak,

Laxative Witch

Hazel compresses (Tucks)

hemorrhoids

11

 Assess

urine retention (d/t loss of bladder tone) Signs of distended bladder Fundal height above umbilicus Fundus displaced from midline to side Excess lochia Residual urine may promote UTI Excessive diuresis (3,000 mL/day) w/i 23 days

12

Afterpains
Intermittent,

w/i 48 hr More common with: Multiparas, breastfeeding

13

 Sexual
When

Intercourse

bleeding stops/episiotomy heals, lochia alba May need water-soluble lubricant Use protection
Kegel
10

Exercises

x in a row, 8 times a day

14

 Cardiac

volume

output and blood Chills

Vasomotor

Hypotension Diuresis/diaphoresis Normal blood loss Coagulation 500 mL: Vaginal Dyspnea/tachypnea 1000 mL: C-Section hallmark signs of PE Homans sign Thrombosis - clot (red, tender, edema)
15

Orthostatic

response

 Assess

At Risk for: Infection Complications of anesthesia Thromboembolism Pain

for: Respiratory depression IV fluids for 24 hrs. Assess bowel sounds (Mylicon drops) Medicate for pruritis N/V Leave foley for 24 hrs. (Duramorph) Assess abdominal incision Have Narcan ready TED hose 16

 Early:

within 24 hours Late: 24 - 6 weeks Major risk is hypovolemic shock

S/S:
Tachycardia

1st

systolic bp Pale, cold, clammy skin Mental status changes Decreased urinary output

17

EARLY CAUSES/RISKS
Atony (flaccid after massage) Lacerations Hematomas (PAIN vs. bleeding) Precipitous delivery Magnesium Sulfate

notify PCP

LATE CAUSES/RISKS
Retention of placental Subinvolution

fragments

18

 Causes
Venous

Dont

stasis Pressure behind knees if legs are in stirrups

S/S

of PE:

Dyspnea Coughing Chest

cross legs (impedes blood flow) Avoid pressure behind knee Early ambulation Anti-embolic stockings

pain

19

 RhoGAM
RhoGAM

(IM) given within 72 hrs to Rh-neg moms with Rh-pos infants

20

 Rubella
CANT

vaccine (german measles) prior to d/c if not immune (SQ in deltoid)

get pregnant for next 3 months CANT give if mother is sensitive to neomycin (abx in topical ointments)

Component in Rubella vaccine

21

 Therapeutic
Shock Anger Guilt Sadness

communication Stages of the grief process

and disbelief

and depression Gradual resolution

May

be dt death, abnormality, altered expectation

22

 Postpartum

Blues vs. Postpartum Depression Factors influencing bonding

23

 Infection/septicemia
fever

after childbirth

of 38 C (100.4 F) after the 1st postpartum day

Risks
Tissue

trauma Open wound at the placental insertion site Surgical incision Cracks in the nipples Endometritis (inflammation of the lining of the uterus) Retained placenta or blood clots

WASH HANDS!!
24

 Begins Severe

~ 2-5th day

cramping/pelvic pn, fever Purulent lochia

25

 Colostrum
Hindmilk Foremilk Alternate

first few days Feed 15-20 min on each breast

After

feeding, apply small amt of breast milk to nipple (toughens) 500 additional calories from pre-pregnancy

26

 Cold

compresses Cabbage leaves (lactating and non-lactating engorgement)

27

 Infection

usually d/t staph - milk stasis, cracked nipples, poor latching on, poor hygeine S/S:
Redness/heat

in the breast Tenderness, Edema/heaviness Fever, chills An abscess may form

28

 Abx,

mild analgesics Continue to breastfeed q 2-4 hr (or pump)

Unaffected

breast 1st letdown reflex weaning can lead to engorgement and stasis of milk
Warm

shower before, ice packs after Fluid intake Well-fitted bra Emotional support

29

 Chills,

fever > 100.4 for 2+ days Boggy uterus Large clots darkening/increasing amt of lochia Abdominal/pelvic pn Foul smelling discharge Calf or breast pain Urination with burning Postpartum depression
30