Postpartum Care: Comprehensive Guide for New Mothers, Schemes and Mind Maps of Earth Sciences

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Postpartum

Care

Part 1

Priority Vital Signs

Temperature

-Diaphoresis is expected

• Above 100.4 F may indicate infection after the first 24 hours

Blood pressure

-Hypertension: Preeclampsia – watch trend 160/100

-Hypotension: Shock/ volume depletion – watch trend

Heart rate

• Watch the trend: consider hemorrhage, shock, infection, dehydration…

Respiratory rate and oxygen saturation

-Monitor for respiratory depression r/t anesthesia, narcotic pain meds

-Continuous pulse oximeter x 24 Hrs. for spinal anesthesia (long-acting)

Postpartum Assessment

BUBBLE-LE ◦ (^) B reasts ◦ (^) U terus ◦ (^) B owel ◦ (^) B ladder ◦ (^) L ochia ◦ (^) E pisiotomy/ laceration ◦ (^) L ower extremities ◦ (^) E motional Status

Assessment - Breasts

Feeding preference: Breast or bottle

Discomfort: Engorgement, nipple trauma & pain

Milk production & consistency

Size & Shape: underlying factors

Type of nipple: flat, inverted, everted

Proper latching technique

Nursing Care-

Breasts

Breastfeeding Mothers

◦ (^) Assist with latching the infant ◦ (^) Teach latching techniques ◦ (^) Teach breast care ◦ (^) Lanolin ointment ◦ (^) Nutrition education ◦ (^) Referral to lactation consultant ◦ (^) Mild analgesics ◦ (^) Provide encouragement

Mastitis

Infection of the breast, usually unilateral

Infected nipple fissure is usually the initial lesion

Edema & engorgement obstruct milk flow

Mastitis may progress to a breast abscess

Symptoms

◦ (^) Fever & malaise ◦ (^) Breast tenderness to severe pain ◦ (^) Swelling & redness ◦ (^) A hard, palpable mass

Antibiotics are prescribed & emptying the breasts every 2-

hours is encouraged to maintain lactation

Assessment - Uterus

Involution

◦ (^) Consistency: Firm or boggy ◦ (^) Location relative to umbilicus: U, 1/U, U/ ◦ (^) Midline, to the left or right

Abdominal incision (c/s)

Abdominal pain: cramps (afterpains)

or incisional pain

Postpartum Hemorrhage (PPH)

• (^) A leading cause of maternal morbidity & mortality
• (^) Can occur with little warning
• (^) Often goes unrecognized until profound symptoms appear
• (^) Definition:
  • (^) Loss of 500mL or more of blood after a vaginal delivery
  • (^) Loss of 1000mL or more of blood after cesarean delivery
• (^) Classification:
  • (^) Early- within 24 hours of the birth
  • (^) Late- after 24 hours of the birth

• (^) Tone - uterine atony
• (^) Tissue - retained placenta and/or placental pieces, clots, retained products of delivery
• (^) Trauma - vaginal or cervical lacerations, hematomas, uterine rupture or inversion
• (^) Thrombin - missing clotting factors, bleeding disorders

PPH- Uterine Atony

Decreased tone of the uterine muscle

The leading cause of early PPH

Associated factors

◦ (^) High parity (3 or more pregnancies) ◦ (^) A macrosomic fetus ◦ (^) Multifetal gestation ◦ (^) Traumatic birth ◦ (^) Use of magnesium sulfate ◦ (^) Rapid or prolonged labor ◦ (^) Use of Pitocin ◦ (^) History of uterine atony with a previous pregnancy

Medications for Uterine Atony Oxytocin – IV or IM. Contraction of uterus; decreases bleeding. Methylergonovine- IM or IV. Contraction of uterus. Prostaglandin- Deep IM, contraction of uterus. Side effects: diarrhea, HTN, tachycardia Misoprostol- Rectally, contraction of uterus. Side effect: Headache, low grade fever

PPH- Subinvolution of the Uterus Delayed return of the uterus to normal size Associated with late PPH Signs ◦ (^) Prolonged lochia ◦ (^) Irregular or excessive bleeding ◦ (^) Larger than expected uterus If infection is the cause ◦ (^) Uterine stimulant to increase contractions ◦ (^) Antibiotics If retained placenta is the cause ◦ (^) Dilation & curettage to remove the tissue

Endometritis Nursing Care

Antibiotic therapy

Hydration, rest & pain relief

Continue routine assessments

Comfort measures

◦ (^) Cool compresses ◦ (^) Warm blankets ◦ (^) Perineal care ◦ (^) Cool or warm drinks ◦ (^) Vitamin C and protein

Patient education

Assessment - Bowel

Bowel sounds ◦ (^) Listen to all four quadrants ◦ (^) Able to pass gas since delivery? ◦ (^) Date of last bowel movement? Main concern: constipation Nursing care ◦ (^) Increase diet slowly if cesarean section ◦ (^) Encourage high fiber diet and lots of fluids ◦ (^) Ambulation- early & often ◦ (^) Stool softener or gentle laxative ◦ (^) Hemorrhoid medicine or witch hazel compresses ◦ (^) Mylicon and/or suppository for gas pain ◦ (^) Encourage, “Don’t put it off!”