TOLAC
trail of labor after a c-section
multifetal pregnancy
may cause dysfunctional labor
puerperium
known as postpartum period
-six weeks following childbirth
what is produced before milk?
colostrum
engagement
the first two to three days postpartum, breasts are full but soft
BUBBLE LE
breasts, uterus, bladder, bowels, lochia, episiotomy/laceration site, legs and emotions
REEDA
a mnemonic used to asses the perineal wound healing after childbirth, specifically focusing on the site of an episiotomy or laceration.
REEDA stands for?
redness, edema, ecchymosis, discharge, an approximation
Decent of the uterine fundus
about I centimeter each day; can be displaced by full bladder, should be a firm mass (about the size of a grape fruit)
after pains
similar to menstrual cramps, more intense the more children a female has
after delivery, the vagina will lack tone
will never return to pre-pregnancy state
bulging perineum
patient may feel constant need for bowel movement hematoma puts pressure on rectum- may utilize ice
lochia ruba
red composed mostly of blood
lochia serosa
pinkish composed of blood and mucus
-4 days after birth
lochia alba
clear/ colorless or white composed mostly of mucus and lasts from the 10th day until approx. 6 weeks after birth
women must report any foul smelling lochia, unusually heavy flow, or lochia that returns to rubra after progressing to serosa or alba
(T/F)
true
if lochia rubra to serosa to alba ; what happens?
if it goes back to alba that's BAD!
what happens if patient pad up every 15 minutes?
call the doctor IMMEDIETLY- patient can be hemorrhaging
nursing care with epiecotmy
- ice packs
- topical and systemic meds
- nonpharmalogical (ice packs, siltz bath)
linea nigra
a line that comes down from the umbilicus
melosma
skin hyperpigmentation
Coagulation
clotting factors are higher during pregnancy and 4-6 weeks postpartum
involution
can go back to that pregnancy state
Rhogram fact
if women is RH negative and baby is RH positive (will go by what the dad is to test baby)
what do you do for boggyness ?
massage
rubins phychological changes of the puerperium (after birth)
- phase one- taking in
- phase two- taking hold
- phase three- letting go
postpartum depression
persistent mood of unhappiness
engrossment
stare at the newborn for extended periods of time
stages of grief
- shock and disbelief
- anger
- guilt
- sadness& depression
- gradual resolution of sadness
newborn discharge care
INFANT SAFETY SEATSSS
hypovolemic shock
losing alot of blood
cardigenic shock
not even oxygen reaching the cells
postpartum hemorrhage
blood loss >500ml (vaginal) or 1,000ml (cesarean)
postpartum hemmorhage causes
tone , tissue, trauma, thrombin
risk factors for PPH
- overdistended uterus
- oxytocin use
- obesity
- placenta accerta
early PPH
will occur 24 hours from delivery
late PPH
will occur between 24 Hours and 6 weeks
immediate intervention for hypokalemia
- maintain blood loss
- blood transfusions
- oxygen
- IV fluids
uterine atony
collection of blood within uterus
DIC
can cause clotting factor defects
Oxytocin may be used for what?
to tone the uterus
where is fundal height ?
usually above the umbilicus
Subinvolution of the uterus
the slower than expected or failure of the uterus to return to its normal prepregnant condition.
sub involution of the uterus S/S
fundal height greater than expected
rubra
dark red blood
nursing care for sub involution
women should report fever
D&C
scraping for sub involution of the uterus
anemia
may be advised to continue with iron supplements for several weeks postpartum
hematoma
collection of blood under tissue, vulvar/ vaginal area
hematoma s/s
severe pain, swelling, discoloration, urinary retention,
-monitor vital signs and for shock
small hematoma
ice packs
Large hematoma
surgical evacuation
puerperal infection
infection or septicemia after childbirth
endometritis
common after c-section or prolonged labor
endometritis s/s
fever for 2 days, foul lochia, uterine tenderness.
main sign- foul smelling, lochia with fever