The postpartum body removes excess fluid accumulated during pregnancy by diuresis. In addition, women frequently experience excessive perspiration (diaphoresis), which also releases accumulated fluid during the postpartum period. After delivery, the diaphragm descends and postpartum women’s respirations normally return to the prepregnant state. After delivery, relaxin levels subside and the pelvic ligaments and joints return to their prepregnant state. However, the joints of the feet remain altered, and many women notice a permanent increase in shoe size. The abdominal wall is weakened and the muscle tone of the abdomen is diminished after pregnancy. Patients should be instructed to begin abdominal exercises anytime following a vaginal delivery and after abdominal tenderness resolves following a cesarean section, generally in four weeks. Show
Postpartum Psychological ChangesBonding, sometimes referred to as attachment, between mothers and infants is affected by a multitude of factors, including socioeconomic status, family history, role models, support systems, disturbed sleep, cultural factors, and birth experiences.
Postpartum assessment of attachment should begin immediately after delivery and continue throughout the infant’s first year of life. Most women positively attach to their newborn infants. However, there are some who do not form attachments appropriately. Malattachment behaviors vary and can include:
If malattachment is noted, providers should immediately report the observation and continue to monitor both the mother and infant. Postpartum depression is a serious and debilitating depression that affects many women throughout the world. Postpartum depression occurs in 8% to 15% of women after delivery. Various screening tools are available. Routine Postpartum Assessment and Patient EducationPrimary responsibilities of nurses in postpartum settings are to assess postpartum patients, provide care and teaching, and if necessary, report any significant findings. It is imperative for nurses to distinguish between normal and abnormal findings and to have a clear understanding of the nursing care necessary to promote patients’ health and well-being. BUBBLE-LE BBreastsUUterusBBowel functionBBladderLLochiaEEpisiotomy/perineumLLower extremitiesEEmotionsBREASTSThe breasts are assessed for:
UTERUSThe fundus is assessed for:
In addition, patients are assessed for uterine cramping and treated for pain as needed. BOWELAssessment of the bowel is important in all postpartum patients. It is especially vital for patients following C-sections. The bowel is assessed for:
Prescribed stool softeners or laxatives are administered as needed to treat constipation and ease perineal discomfort during defecation. BLADDERAssessment of urination and bladder function includes:
The bladder should be nonpalpable above the symphysis pubis. LOCHIALochia is assessed during the postpartum period:
It is important to note that patients who had a C-section will typically have less lochia than patients who delivered vaginally; however, some lochia should be present. EPISIOTOMY/PERINEUMThe acronym REEDA is often used to assess an episiotomy or laceration of the perineum. REEDA stands for: REEDA RRednessEEdemaEEcchymosisDDischargeAApproximationRedness is considered normal with episiotomies and lacerations; however, if there is significant pain present, further assessment is necessary. The use of ice packs during the immediate postpartum period is generally indicated. There should be an absence of discharge from the episiotomy or laceration, and the wound edges should be well approximated. Perineal pain must be assessed and treated. LOWER EXTREMITIESTo assess for deep vein thrombosis (DVT), the lower extremities are examined for the presence of hot, red, painful, and/or edematous areas. An elevated temperature may also be present. The legs for assessed for adequate circulation by checking the pedal pulses and noting temperature and color. In addition, the lower extremities are assessed for edema. EMOTIONSEmotions are an essential element of the postpartum assessment. Postpartum women typically exhibit symptoms of the “baby blues” or “postpartum blues,” demonstrated by tearfulness, irritability, and sometimes insomnia. The postpartum blues are caused by a multitude of factors, including hormonal fluctuations, physical exhaustion, and maternal role adjustment. This is a normal part of the postpartum experience. If symptoms last longer than a few weeks or if the postpartum patient becomes nonfunctional or expresses a desire to harm herself or her infant, she should be instructed to report this to her certified nurse-midwife or physician immediately.
Postpartum ComplicationsCESAREAN SECTION ISSUESMother care after a C-section has some additional assessment needs during the postpartum period, including incision status, pain, respirations, and lung and bowel sounds. POSTPARTUM HEMORRHAGE (PPH)Postpartum hemorrhage is one of the leading causes of death among postpartum women. PPH refers to a blood loss of at least 500 mL after a vaginal birth and at least 1000 mL after a C-section. Postpartum hemorrhage is categorized as early or late. Early refers to a hemorrhage occurring within the first 24 hours after birth, while late refers to a hemorrhage occurring 24 hours to 12 weeks after delivery. Early postpartum hemorrhage is often caused by uterine atony, or a failure of the uterine muscles to contract properly, thereby inhibiting the healing of blood vessels at the site of placental attachment. The blood vessels continue to bleed until the uterine muscles contract. Signs of uterine atony include a boggy uterus, a fundus that is higher than expected upon palpation, and excessive lochia. The nurse must report a PPH immediately and prepare for the insertion of a large-bore intravenous catheter, if one is not already present, and the administration of intravenous fluids and oxygen. HYPOVOLEMIC SHOCKA sequelae of PPH is hypovolemic shock. In the presence of a PPH, hypovolemic shock can occur and cause severe organ damage and even death if untreated. These patients will also require oxygen (usually 8–10 L via face mask), IV fluids, and possibly blood products. This is a very serious situation, and nurses must be prepared to assist in this life-threatening emergency. THROMBOPHLEBITISWomen can suffer from thrombophlebitis as a result of venous stasis and the normal hypercoagulability state of the postpartum period. Thrombophlebitis is an inflammation of the blood vessel wall in which a blood clot forms and causes problems in the superficial or deep veins of the lower extremities or pelvis. All postpartum women are at risk. However, certain risk factors predispose some women to developing thrombophlebitis. These risk factors include:
The blood clot that develops in thrombophlebitis can lead to a life-threatening pulmonary embolism as a result of the clot detaching from the vein wall and blocking the pulmonary artery. The major signs of pulmonary embolism include dyspnea and chest pain. POSTPARTUM INFECTIONSPostpartum infections are infections accompanied by a temperature of 38 °C or higher on two separate occasions during the first 10 days postpartum, exclusive of the first 24 hours. Postpartum patients are carefully monitored for signs and symptoms of infection during this period. Common infections that may occur during the postpartum period include:
HEMORRHOIDS AND INCONTINENCE AFTER CHILDBIRTHHemorrhoids are common in late pregnancy (7.8%). Symptomatic hemorrhoids may be treated with local anesthetics, topical astringents/protectants, bulk-forming laxatives, stool softeners, topical corticosteroids, or topical vasoactive agents. Sign up for our newsletter email list and like us on Facebook and Instagram to be among the first to know about all our special discounts and offers! About Wild Iris Medical Education:Wild Iris Medical Education, Inc., is a privately held, woman-owned company providing online healthcare continuing education. In 1998, we began offering online ANCC-accredited nursing continuing education courses and since then have expanded to provide CEUs for occupational therapists, physical therapists, paramedics, EMTs, and other healthcare professionals. Accredited and Approved Nationwide. Join Our More Than 750,000 Satisfied Customers Now!High-quality, accredited, evidenced-based continuing education courses in an easy-to-use format designed for learning, from Wild Iris Medical Education. We’ve been providing online CE since 1998. Which action does the nurse implement to enhance client comfort due to an episiotomy immediately after childbirth?To relieve pain or discomfort: Ask your nurse to apply ice packs right after the birth. Using ice packs in the first 24 hours after birth decreases the swelling and helps with pain. Take warm baths but wait until 24 hours after you have given birth.
When discharging a new mother which instruction would the nurse give to help prevent postpartum infection?Shower as often as you like, but avoid tub baths or swimming until after your postpartum checkup. There should be nothing placed in the vagina until after your postpartum checkup. This means no tampons, douching or intercourse (sex). Make your follow-up appointment for about six weeks after delivery.
What appearance does the nurse anticipate the Lochia will have on the second postpartum day?It will be bright red or brownish for the first few days, and then may change to pink or yellowish white. Lochia may last for up to six weeks.
How can the nurse best manage a client's care during the transition phase of labor?Transition Phase. Inform patient on progress of her labor.. Assist patient with pant-blow breathing.. Monitor maternal vital signs and fetal heart rate every 30 minutes -1 hour, or depending on the doctor's order. Contraction monitoring is also continued.. When perineal bulging is noticeable, prepare for delivery.. |