Postpartum Health Course - NURS 2543 PDF

NURS 2543 Health of Families & Social Groups Week 10: Nursing Care of the Family During Postpartum KRISSY JORDAN, RN, MSCN, PHD CANDIDATE Learning Objectives 1. Describe components of a systematic postpartum assessment and post-partum nursing care. 2. Identify criteria and teaching plan for post...

NURS 2543 Health of Families & Social Groups Week 10: Nursing Care of the Family During Postpartum KRISSY JORDAN, RN, MSCN, PHD CANDIDATE Learning Objectives 1. Describe components of a systematic postpartum assessment and post-partum nursing care. 2. Identify criteria and teaching plan for postpartum discharge. Postpartum Physical Assessments Vital signs Temperature Pulse Respirations Blood pressure Breath sounds Rectal area Vital signs Assessment Normal findings Signs of complications Temperature 36.2- 38’c ≥ 38’c after 24 hrs: infection Pulse 60–100 beats/min Tachycardia: hemorrhage Respirations 12–24 breaths/min Bradypnea Tachypnea Blood Consistent with baseline- Hypertension pressure 120/80 mm hg Hypotension Breath sounds Clear/auscultation Crackles; fluid overload (Keenan-Lindsay et al., 2022) B: Breast & Nipples Breasts Size Shape Firmness Redness and Heat Symmetry Nipples Size Shape Integrity Tenderness 5 B: Breast & Nipples Assessmen Normal Findings Potential Complications t Firmness, heat, pain; Breasts Day 1-2: Soft possible engorgement Redness, heat, pain, fever, Days 2-3: Filling body aches; potential mastitis Days 3-5: Full, softens Redness, heat, pain, fever, with breastfeeding (milk body aches; potential is in) mastitis Redness, bruising, cracks, Skin intact; no soreness fissures, abrasions, blisters Nipples (Keenan-Lindsay et al., 2022) reported (often due to latching U: Uterus Fundus: firm or soft, boggy, higher than expected level? Fundal Height: Where is it in relation to the umbilicus? First 24 hrs @ level of umbilicus; involutes 1- 2cm/day Documentation “1/U = 1 finger above the umbilicus “@ U” = At umbilicus U/1 = 1 finger below the umbilicus Location: Midline or deviated to the left or right? If deviated, it’s usually a sign of a full bladder (Keenan-Lindsay et al., 2022) 7 Nursing Considerations for Maintaining Uterine Tone Stimulation through gentle fundal massage Boggy fundus may be sign of uterine atony  increased risk of PPH Nursing Actions: Perform uterine massage Encourage patient to void Uterotonic medications (Oxytocin) Contact MRP (Keenan-Lindsay et al., 2022) 8 B: Bladder Establish a voiding schedule to prevent bladder distention and urinary stasis Encourage urination prior to breastfeeding Distended bladder causes uterus to be displaced above umbilicus & to one side of the midline abdomen  hemorrhage! Normal findings Able to void spontaneously within 8 hours No bladder distension Able to empty bladder completely No dysuria (painful urination) Diuresis begins within 12 hours after birth Full bladder: fundal height above the umbilicus, shifted away from the midline (Keenan-Lindsay et al., 2022) Nursing Interventions in Preventing Bladder Distinction Empty the bladder as soon as possible Assist/ambulate the patient to promote voiding Pain medications for discomfort during voiding Peri-bottle after each void for hygiene and comfort Intermittent urinary catheter: May be needed if the patient doesn’t void within 6-8 hours of delivery Encourage Kegel exercises to strengthen pelvic floor muscles (Keenan-Lindsay et al., 2022) 10 B: Bowels Passing flatus soon after vaginal birth Bowel movements by day 2 or 3 Active bowel sounds: All four quadrants (especially for C-section) Nursing care in promoting bowel function: Measures to avoid constipation  Ambulating or rocking to stimulate bowel movement  Increasing fibre and fluid intake  Stool softeners as needed (Keenan-Lindsay et al., 2022) 11 L: Lochia Colour Rubra (dark red): birth to 3-4 days Serosa (brownish red or pink) : day 4 to 2-4 weeks Alba (Yellowish white): after 10-14 days Odour “No odour” or “Foul” Amount Scant, Moderate, Heavy Presence of Clots Cherry, Peach or plum or golf size (Keenan-Lindsay et al., 2022) L: Legs Peripheral edema may possibly be present Observe redness, tenderness, pain, venous thromboembolism (VTE) Observe for varicosities (Keenan-Lindsay et al., 2022) 13 E: Episiotomy/Laceration or CS Birth Incision Perineal Area Assessment Check Episiotomy or Areas of Vaginal R: Redness Tearing Look for hematoma formation Check for hemorrhoids E: Edema The REEDA Scale used for grading the severity of perineal trauma associated with E: Ecchymosis episiotomy or lacerations D: Discharge A: Approximation (Keenan-Lindsay et al., 2022) E: Episiotomy/Laceration or CS Birth Incision Normal Findings Minimal edema Episiotomy or laceration edges approximated C-section incision: Dressing clean and dry, suture line intact Abnormal Findings Pronounced edema, bruising, or hematoma Redness, warmth, and drainage: Possible infection C-section incision: Redness, edema, warmth, drainage – potential infection (Keenan-Lindsay et al., 2022) E: Episiotomy/Laceration or CS Birth Incision Normal Findings Minimal edema Episiotomy or laceration edges approximated C-section incision: Dressing clean and dry, suture line intact Abnormal Findings Pronounced edema, bruising, or hematoma Redness, warmth, and drainage: Possible infection C-section incision: Redness, edema, warmth, drainage – potential infection (Keenan-Lindsay et al., 2022) Nursing Interventions: Episiotomy, Lacerations & Hemorrhoids Cleansing applying - front to back, change pads with each void and stool (at least -4 times/day) Ice pack (first 24 hours) decreasing edema (first 2 hours) anesthetic effect (after 2 hours) Squeeze bottle (peri-bottle) Fill with warm water and instruct the patient to position nozzle between their legs so squirts of water reach the perineum Sitz Bath X2/day for 20 minutes prn Topical applications (Xylocaine) (Keenan-Lindsay et al., 2022) E: Emotional Status Caregiving of self & baby is an indicator of emotional status Note patient’s response to health teaching, affect, eye contact, interests in newborn & adjustment to post partum If concerned, discuss with MRP the need for referral to a Social Worker Psychological assessment Edinburgh Postnatal Depression Scale [EPDS] Patient Health Questionnaire [PHQ-9] 7-item Generalized Anxiety Disorder scale [GAD-7]) (Keenan-Lindsay et al., 2022) 18 E: Emotional Status Postpartum Blues Postpartum Depression Postpartum Psychosis 19 Signs of Postpartum Blues, Depression, Psychosis Condition Signs and Symptoms When to Call Health Care Provider - Sad, anxious, or overwhelmed feelings Call if: Symptoms continue for more Baby Blues - Crying spells than 2 weeks - Loss of appetite - Difficulty sleeping - Persistent symptoms of baby blues Call if: Symptoms worsen, or interfere - Thoughts of self-harm or harm to Postpartum Depression with daily life and ability to care for baby baby or self - Loss of interest in baby - Hallucinations (seeing/hearing things not present) Call immediately if any signs of Postpartum Psychosis - Confusion psychosis appear - Rapid mood swings - Attempts of self-harm or harm to baby Contact a provider for any worsening General Guidance symptoms, inability to function, or thoughts of harm to self or baby (Keenan-Lindsay et al., 2022) Postpartum Blues Affects 50-80% of new mothers and typically begins within days of birth Symptoms: Emotional lability, easy crying, sadness, anxiety, fatigue, restlessness, insomnia, anger, mild depression Peaks around day 5, resolves by day 10 Etiology unknown No treatment is required, but reassurance and support are beneficial Coping Strategies for New Mothers Sleep when baby sleeps Self-Care: Take time for activities you enjoy (e.g., relaxing baths, brief outings) Social Support: Share feelings with partners, seek peer support programs and resources Routine: Plan outings with baby, utilize community childcare when available (Keenan-Lindsay et al., 2022) Postpartum Hemorrhage (PPH) Definition & Incidence Leading cause of maternal death worldwide. Risk for all patients post-birth. Defined as:  Loss of ≥500 mL blood after vaginal birth  Loss of ≥1,000 mL after C-section Often unrecognized until severe symptoms develop Types Primary PPH: Occurs within 24 hours of birth Secondary PPH: Occurs >24 hours to 12 weeks post-birth (e.g., retained placenta, infection) (Keenan-Lindsay et al., 2022) Postpartum Hemorrhage (PPH) Risk Factors & Causes Tone (Uterine Atony): Overdistended uterus, high parity, prolonged labor Trauma: Lacerations, forceps or C-section Tissue: Retained placenta, placenta accreta Thrombin: Coagulopathies (e.g., DIC, thrombocytopenia) Management Immediate assessment & intervention for bleeding control - massage fundus! Oxytocic medications for uterine contraction Surgical intervention may be needed for retained placenta or severe hemorrhage Prevention Early recognition & prompt treatment to reduce maternal mortality (Keenan-Lindsay et al., 2022) Hypovolemic Shock Signs & Symptoms Rapid bleeding (pad soaked in 15 min) Weakness, lightheadedness, nausea, “seeing stars” Anxious, reluctant to hold baby, “air hunger” Ashen/grey skin, cool/clammy feel Increased pulse and respirations, decreased urine output Declining BP (may not occur initially due to compensatory mechanisms) Immediate Actions Notify Provider Uterine Intervention: Massage and administer uterotonics (e.g., oxytocin) Oxygen: 8–10 L/min Position: Tilt or elevate legs 30° IV Support: Maintain fluids; add second line if needed Further Measures: Blood transfusion, urinary catheter, prepare for surgery (Keenan-Lindsay et al., 2022) Breastfeeding Promotion Early Initiation: Skin-to-skin contact & breastfeeding within 1-2 hours after birth Health Benefits: Aids uterine contraction, reduces PPH risk Support: Assess latch, provide education on cue-based feeding Community Resources: Peer support, IBCLC referrals for ongoing guidance Suppression Indications: Not breastfeeding or infant loss Wear a supportive bra for 72 hours Avoid stimulation (no warm water, baby suckling) May experience severe breast engorgement @ 72-96 hours post birth Manage discomfort with ice packs, mild analgesics, frozen cabbage leaves (Keenan-Lindsay et al., 2022) Health Promotion for Future Pregnancies Rubella Vaccination Administer MMR vaccine if rubella non-immune Given postpartum to prevent rubella in future pregnancies Safe for breastfeeding; avoid in immunocompromised individuals Delay pregnancy for 4 weeks after vaccination Informed consent and contraception for 1-month post-vaccine Prevention of Rh Isoimmunization Standard Dosage: 300 mcg of Rh immune globulin (Rhig) for Rh-negative women  Antepartum prevention @ 26-28 weeks gestation  Within 72 hours postpartum if baby is positive Large Fetomaternal Transfusion: Dosage determined by Kleihauer-Betke test (Keenan-Lindsay et al., 2022) Postpartum Self-Care: Key Essentials Nutrition Balanced diet & hydration: Essential for energy and lactation Continue PNV for 6+ weeks or longer if BF; additional iron may be needed for low hemoglobin levels Exercise Gentle walking and stretching; gradually increase activity after 6-week checkup Kegel exercises aid recovery and bladder control Medications NSAIDs or stool softeners for perineal/C-section recovery Clear guidance on dosage, timing, and side effects; ensure written instructions at discharge Family Planning Contraception: Discuss options pre-discharge, including non-hormonal and lactation-safe methods Sexual activity: Generally safe to resume after 2–4 weeks if comfortable; consider additional lubrication if breastfeeding (Keenan-Lindsay et al., 2022) Postpartum Warning Signs Physical Warning Signs Heavy Bleeding: Soaking more than 1 pad/hour or passing large clots Severe Abdominal Pain: Persistent pain not relieved by medication Fever: Temperature over 100.4°F (38°C) with chills Severe Headache: With vision changes, nausea, or swelling Leg Swelling/Pain: Redness, swelling, or tenderness in calf Wound Infection: Increased redness, swelling, or discharge Painful Urination: Blood or pain during urination Shortness of Breath/Chest Pain: Seek immediate care Psychological Warning Signs Postpartum Depression: Sadness, hopelessness, or difficulty bonding Suicidal Thoughts: Immediate professional help needed Breastfeeding Concerns Engorgement/Infection: Pain, redness, or fever Latching Issues: Persistent difficulty breastfeeding (Keenan-Lindsay et al., 2022) Postpartum Follow-up After Discharge Routine Checkups Mother: 6-week visit (or 2 weeks for CS/complications) Newborn: 3-5 days after birth or 48-72 hours post-discharge Home Visits Community health nurses assess mother, baby, and environment Benefits: Reduce ER visits, support breastfeeding, provide education Telephone Follow-Up Postpartum calls for health checks, teaching, and support Outcomes: Better breastfeeding, reduced depression, higher satisfaction Warm Lines (Help-Lines or Consultation Services) Non-crisis support for feeding, crying, etc. Support Groups Peer connections through in-person or virtual meetings Community Resources Referrals to local/national services tailored to family needs (Keenan-Lindsay et al., 2022) Summary, Education/Anticipatory Guidance (Keenan-Lindsay et al., 2022)