POSTPARTUM

Blood fragments, deciduas & mucous 6 weeks to completely slough off. RUBRA (RED) 1-3 DAYS SEROSA (PINK, BROWN) 4 10 DAYS ALBA (WHITE) After 10 DAYS
1 2

LOCHIA

Adaptations
Urinary Output 1500 3000 mL/day Blood volume Non-pregnancy level after 2

Adaptations
G. I. Hungary Hemorrhoids from pushing Striae fade in 5 6 months Chloasma & linea nigra fade at end of pregnancy Diastasis recti abdominis Exhaustion Weight loss: Average loss 19 lbs 6 weeks pre- pregnancy weight
3 4

weeks
Vaginal Blood loss 300 500 mL C/S blood loss 500 1000 mL Hgb decreases 1 gm for every 250 mL of blood

loss. Hct 4 points WBC up to 25,000 Fibrinogen still elevated

Adaptations
Oral Temperature Above 100.4 degrees after 24 hrs. febrile Pulse 50-90 bpm Returns to pre-pregnancy in 1 week

Assessment
Review prenatal & L&D documentation Vital signs: Q 15 min. for 1 hr. then q 30 min.

times 2 then q 8 hrs.

General Appearance Breasts Care: Lactating : Warm H2O, Support

bra
Non-lactating BINDER for 72 hrs, support bra, NO BREAST

BP 140/90 or above
Pregnancy Induced Hypertension (PIH) Pitocin will increase BP At risk of orthostatic hypotension
5

STIMULATION
Check for redness or hardness
6

Assessment
Void within 1 hr after delivery Fundus rises or pushed to side if bladder full After voiding check fundus Check for residual Catheterization More than 150 mL leave in catheter At risk of UTI Frequent UTIs Do C&S
7

Assessment
Palpation uterus q 15 min. for the first hr. Fundus at UMBILICUS FIRM, BOGGY. SOFT POSITION & HEIGHT Boggy uterus Excessive bleeding Bladder distension Retained placental fragments
8

Assessment
Lochia Amount , color, presence of clots CONSTANT TRICKLE OR SOAKING 1 PAD AN HOUR IS EXCESSIVE BLEEDING Each pad holds about 50 mL Change pad frequently

Massage uterus IV with Pitocin increased Pitocin 20 30 units added to 1000mL of IV to

INTERVENTIONS

increase uterine contractions

Methergine 0.2 mg IM (Vasoconstrictor) after

delivery of placenta

CHECK BP BEFORE ADMINISTERING HOLD MEDICATION or B/P 140/90 or above Breastfeeding

9 10

EPISIOTOMY
ASSESS FOR ECCHYMOSIS, ERYTHEMA,

EDEMA RML TURN ON RIGHT SIDE TO EXAM Exam hemorrhoids Care of episiotomy Sitz bath Ice pack to perineum first 24 hrs. Sitz bath Encourage Kegal exercise
11

EPISIOTOMY
Topical anesthetics Dermoplast Dibucaine Witch hazal Pain medication Percocet Motrin Acetominophen Sutures are absorbed Complete Healing 4 6 mos
12

PSYCHOLOGICAL CHANGES DURING POSTPARTUM

NEW ROLE!

TAKING IN
PASSIVE

THREE PHASES

13

DEPENDENCE DUE TO DISCOMFORT LOVES TO TALK ABOUT HER PREGNANCY & DELIVERY ENCOURAGE THERAPEUTIC COMMUNICATION NEEDS SLEEP

14

TAKING-HOLD
INITIATE ACTION STRONG INTEREST IN TAKING CARE OF NEWBORN INSECURE BE SUPPORTIVE

LETTING- GO
DEFINES NEW ROLE READJUSTMENT OF RELATIONSHIPS FAMILY RELATIONSHIPS BONDING

EN FACE POSITION; ENGROSSMENT

15

SIBLINGS

16

Major issue of concern

Breast soreness Regaining figure Housework Disappointment

POSTPARTUM OR BABY BLUES

50%-80% FEEL OVERWHELMING

SADNESS
CRYING, ANOREXIA, MOOD SWINGS,

SLEEP DISTURBANCE
NORMAL FINDINGS Support person needs to understand 10-15%% experience postpartum

depression
17 18