Postpartum Physiological Assessments Study Guide PDF

Study guide: Exam 5 **Postpartum Physiological Assessments, Nursing Care, and High-Risk Postpartum Care Study Guide** **1. Postpartum Physiological Assessments and Nursing Care** **a. Assessments and Frequency** - **First Hour:** Assess every 15 minutes x 1 hour - **Next Hour:** Assess ever...

Study guide: Exam 5 **Postpartum Physiological Assessments, Nursing Care, and High-Risk Postpartum Care Study Guide** **1. Postpartum Physiological Assessments and Nursing Care** **a. Assessments and Frequency** - **First Hour:** Assess every 15 minutes x 1 hour - **Next Hour:** Assess every 30 minutes x 1 hour - **Next 22 Hours:** Assess every 4 hours - **After 24 Hours:** Assess every shift **i. Assessing for Hemorrhage and Other Complications** - **Hemorrhage:** Check for signs of DIC (Disseminated Intravascular Coagulation), AFE (Amniotic Fluid Embolism), PE (Pulmonary Embolism), HELLP, or Eclampsia. **1. Vital Signs:** - **Temperature:** Low-grade fever normal, higher suggests infection. - **Blood Pressure (BP):** Hypotension may indicate hemorrhage; hypertension may signal preeclampsia/eclampsia. - **Heart Rate (HR):** Tachycardia can indicate hemorrhage, infection, or PE. - **Respiratory Rate (RR):** Elevated RR may indicate infection, PE, or hemorrhage. - **SpO2:** Drop in O2 saturation could signal PE, hemorrhage, or anaphylaxis. - **Pain:** Document and treat appropriately. **2. Lochia:** - **Color, Amount, and Odor**: - **Rubra:** Bright red, occurs immediately post-delivery (days 1-3). - **Serosa:** Pink to brown, occurs after 3-7 days. - **Alba:** White/yellowish, occurs from 10 days to 6 weeks. - **Check for foul odor** (could indicate infection). **3. Fundus:** - **Best Assessment Position:** Have patient void first, then assess while supine. - **Fundal Height (U):** Should be at or below the umbilicus after delivery. - **Tone:** Should be firm (boggy fundus is concerning for hemorrhage). - **Location:** Should be midline (deviation may indicate a full bladder). **ii. Shift Head-to-Toe Add-Ons** - **BUBBLE-HE:** - **B**reasts, **U**terus, **B**owel, **B**ladder, **L**ochia, **E**pisiotomy (or Laceration), **H**oman's sign (for DVT), **E**motions. - **REEDA (posterior perineum):** Redness, Edema, Ecchymosis, Drainage, Approximation. **b. Critical Findings** **i. Infection:** - **Purulent Discharge:** Check for foul odor, fever, tachycardia, tachypnea, and pain. Could be mastitis, metritis, or wound infection. **ii. Bleeding:** - **Excessive Bleeding:** \>500 mL for vaginal delivery or \>1000 mL for cesarean delivery. - **Signs:** Tachycardia, hypotension, cool/clammy skin, dizziness, pallor. - **Quantitative Blood Loss:** Weigh pads or measure output. **iii. Boggy and Deviated Fundus (Hemorrhage Signs):** - **Intervention:** 1. Have the patient void. 2. Massage fundus until firm. 3. Administer Oxytocin (IV or IM). 4. Reassess every 30 minutes. **iv. Preeclampsia/Eclampsia, HELLP (DIC)** - **Symptoms:** Hypertension (\>160/100), headache, nausea, blurred vision, RUQ pain, edema, bleeding. - **Severe Symptoms:** Petechiae, purpura. **v. Sudden Drop in O2 Saturation:** - **Causes:** Anaphylaxis, PE, or hemorrhage. - **Immediate Action:** Assess, provide O2, and call for assistance. **c. Hemorrhage Management** **i. Fundus should be firm and midline for proper involution.** **ii. Primary (Early) Postpartum Hemorrhage (PPH) (First 24 Hours):** - **Uterine Atony:** - Fundus is boggy, elevated, and deviated. - **Intervention:** Massage fundus, encourage voiding or catheterize for retained urine. - **Laceration:** Bleeding without fundal tone changes (bright red). - **Hematoma:** Painful swelling (normal fundus, ecchymosis, severe pain). **iii. Secondary (Late) Postpartum Hemorrhage (After 24 Hours):** - **Causes:** Retained placental fragments, subinvolution. - **Signs:** Abnormal lochia (odor, change in color), fever. **d. Infection** **i. Mastitis (Breast Infection):** - **Symptoms:** Redness, warmth, fever, pain. - **Management:** Encourage breastfeeding, warm compresses, antibiotics (e.g., Keflex). - **Do not pump or dump breast milk unless pus is present.** **ii. Metritis (Infection of the Uterus):** - **Symptoms:** Fever, foul-smelling lochia, abdominal tenderness. - **Management:** Antibiotics (often broad-spectrum). **iii. Wound Infection (C/S, Laceration):** - **Risk Factors:** DM, obesity, immunocompromised, poor hygiene. - **Symptoms:** Redness, swelling, pain. - **Management:** Wound care, antibiotics, monitor for signs of systemic infection. **iv. Urinary Tract Infection (UTI):** - **Risk Factors:** Foley catheter, operative vaginal birth, dehydration. - **Symptoms:** Dysuria, frequency, urgency, fever. - **Management:** Antibiotics. **e. Other Complications** **i. Disseminated Intravascular Coagulation (DIC):** - **Signs:** Excessive bleeding, bruising, petechiae, and purpura. **ii. Anaphylaxis:** - **Symptoms:** Swelling, rash, difficulty breathing. - **Management:** Administer epinephrine, call for emergency support. **iii. VTE/DVT/PE:** - **Symptoms:** Swelling, redness, pain in one leg, sudden shortness of breath, chest pain. - **Management:** Anticoagulation therapy, supportive care, monitoring. **f. Psychological Disorders** **i. Baby Blues:** - **Timeframe:** 1-2 weeks postpartum. - **Symptoms:** Mood swings, irritability, anxiety, fatigue. - **Care:** Reassure and provide emotional support. **ii. Postpartum Depression (MDD):** - **Symptoms:** Persistent sadness, fatigue, difficulty bonding with baby. - **Timeframe:** First year postpartum. - **Care:** Referral for counseling, antidepressants. **iii. Postpartum Psychosis (Bipolar I Disorder):** - **Symptoms:** Delusions, hallucinations, suicidal thoughts. - **Immediate Action:** Admit to psychiatric care, never leave the patient alone with the baby. **iv. Paternal Postnatal Depression:** - **Symptoms:** Irritability, fatigue, low mood. - **Management:** Therapy, medication, support groups. **g. Discharge Teaching** **i. Normal vs. Abnormal Postpartum Findings:** - **Lochia:** Normal (rubra, serosa, alba); foul odor or heavy bleeding is abnormal. - **Involution and Afterpains:** Can be more intense in multiparas and during breastfeeding. **ii. Postpartum Depression and Recognizing Symptoms.** **iii. Recognizing and Preventing Postpartum Hemorrhage (PPH).** **iv. Contraception and Resuming Sexual Activity:** - **Ovulation occurs before menses, so contraception may be needed early.** **2. Transition to Parenthood** **a. Teaching:** - **Ensure needs (pain, positioning, etc.) are met before teaching.** - **Evaluate understanding before progressing.** **b. Support:** - **Promote bonding, monitor for communication, and clarify expectations.** **c. Loss:** - **Provide support, avoid retraumatization, and promote successful grieving (DABDA).** **3. The Neonate** **a. Transition to Extrauterine Life** **Normal Assessment:** - **Tone:** Flexed. - **Head:** Fontanels flat, symmetrical, no abnormal findings. - **Chest:** Normal respirations (30-60 breaths/min), slightly irregular HR (110-160). - **Abdomen:** Soft, round, umbilical cord with AVA (artery, vein, artery). - **Genitalia:** Swollen labia in females, check male for both testes. - **Limbs:** Symmetrical movements, no hip clicks. **Critical Findings in Neonatal and Maternal Care: Comprehensive Review** **1. Neonatal Critical Findings** **i. Jaundice** - **Pathologic Jaundice** (occurs within first 24 hours): **Risk of neuro damage**. - **Treatment:** **Phototherapy (bili lights)**; cover eyes. - **Cause:** Typically, due to **hemolytic disease**, **infections**, or **metabolic disorders**. **ii. Pallor, Dusky, Cyanosis** - **Possible causes**: Anemia, hypoxia, respiratory distress, or congenital heart defects. - **Immediate Actions:** Assess oxygen levels, check for respiratory distress, and administer O2 if needed. **iii. Hypotonia (weakness), Seizures** - **Sign of:** Neurological issues, hypoxia, infection, or metabolic disturbances. - **Action:** Immediate assessment and neurological evaluation. **iv. Fontanel Changes** - **Bulging Fontanel:** Can indicate **increased intracranial pressure (ICP)**. - **Sunken Fontanel:** Suggestive of **dehydration**. - **Low-set Ears or Clefts:** Could indicate **genetic syndromes** or **craniofacial anomalies**. **v. Abnormal Breathing Patterns** - **See-saw or Paradoxical Breathing:** **Respiratory distress** (due to respiratory failure or severe lung disease). - **Tachycardia (\>180 bpm) or Bradycardia (\60 breaths/min)** may indicate **respiratory distress syndrome (RDS)**, **infection**, or **cardiac anomalies**. **vi. Gastrointestinal Signs** - **Distension, Decreased Bowel Sounds:** Possible **NEC (Necrotizing Enterocolitis)** or **intestinal obstruction**. - **No Meconium by 48 hours:** Suspect **Hirschsprung\'s disease** or **meconium ileus**. - **No Urine Output by 24 hours:** Indicates possible **renal failure**, **dehydration**, or **obstruction**. - **Bright Green or Bloody Stool:** **NEC**, **intestinal perforation**, or **sepsis**. **vii. Vital Signs Abnormalities** - **Temperature:** - **\100.4°F**: Indicates **hypothermia** or **infection**. - **Heart Rate (HR):** - **\180 bpm:** Could indicate **fever**, **infection**, or **tachycardia**. - **Respiratory Rate (RR):** - **\60 breaths/min**: Indicative of **tachypnea** (possibly from **RDS**, **infection**, or **metabolic acidosis**). - **Apnea for \>15 seconds**: **Emergency**; may indicate **immaturity** (especially in premature infants). - **Oxygen Saturation (SpO2):** - **\