Nursing Concepts: Fundus and Hemorrhoids

Fundus Assessment

• A boggy fundus indicates a lack of firmness, often signifying hemorrhage due to uterine atony.
• Interventions include fundal massage, administering Pitocin, or encouraging breastfeeding to firm the uterus.

Hemorrhoid Care

• Recommend lying on the side and tightening buttocks while sitting to reduce perineal pressure.
• Advise maintaining a high-fiber diet and fluid intake, along with moderate exercise like walking.

Postpartum Weight Loss

• Expect an initial weight loss of 10-12 lbs from the infant, placenta, and fluids, with an additional loss of 5 lbs due to postpartum diuresis.

Assessing Placental Healing

• Full healing of placental site can take 6-7 weeks, primarily through exfoliation.
• Monitor lochia for type, amount, and consistency, noting the progression from lochia rubra to serosa and finally to alba.

Homan's Sign

• A clinical sign indicating the potential presence of thrombosis, characterized by pain at the back of the knee or calf during dorsiflexion of the ankle.

Uterine Positioning

• A fundus that is not midline suggests a full bladder, indicated by bulging lower abdomen and spongy mass below the fundus.
• A full bladder can hinder uterine contraction and potentially cause postpartum hemorrhage; encourage the patient to void.

Steady Trickling of Blood

• A consistent trickle of blood may indicate lacerations that require suturing.

Rubella Vaccination

• Rubella vaccine is advised early postpartum and should be administered immediately after childbirth.

RhoGAM Usage

• RhoGAM is a vaccine used to prevent Rh-negative mothers from developing antibodies against Rh-positive babies, essential to be given before discharge.

Breastfeeding Interventions

• Breastfeeding requirements include 140-160 ml/kg/day and caloric needs of 100-115 kcal/kg/day.
• Regular assessments of breastfeeding technique, infant weight, and feeding history are necessary; provide breast pump instructions as needed.

Managing Engorgement

• Engorgement results from inadequate breast emptying, leading to painful swelling and potential complications like mastitis.
• Treatment includes applying moist heat, using cold compresses, wearing a supportive bra, and possibly needing antibiotics if infection occurs.

Contraception for Breastfeeding Mothers

• Pregnancy can occur before the first postpartum menstruation; recommend progestin-only contraceptives to avoid decreasing milk production.

Normal Vital Signs for Newborns

• Respiratory rate: 30-60 breaths per minute.
• Heart rate: 120-160 beats per minute.
• Blood pressure: systolic 70-100, diastolic 50-65.
• Normal weight: 4.5-7 lbs.
• Temperature range: 97.7-98.9°F.

Heat Loss Prevention in Newborns

• Common heat loss occurs through radiation; preventive measures include maintaining a warm environment and minimizing exposure to cooler surfaces.
• Other heat loss types: convection (cool air currents), evaporation (water turning to vapor), and conduction (direct skin contact with cool surfaces).

Hyperbilirubinemia Overview

• Hyperbilirubinemia involves accelerated destruction of fetal red blood cells and inefficiency in bilirubin conjugation and elimination.
• Bilirubin aids in fat digestion and is processed by the liver; jaundice develops when the liver fails to efficiently manage bilirubin levels.