Professional Documents
Culture Documents
Postpartum
Postpartum or Puerperium
Cardiovascular
Blood
Vital Signs
Abdominal
musculature
Sleeping
Psychological
Postpartum Assessment
BUBBLE-HE
Breasts
Uterus
Bladder
Bowel
Lochia
Episiotomy
Homan Sign
Emotion
Breast Changes
Colostrum secreted from third tri. until
lactation begins
Milk--lactation 3rd pp day
Engorgement from increased vascular and
lymphatic circulation
Decreased/absent placental hormones cause
prolactin to be secreted=lactation
Uterine Changes
Blood vessels contract, uterus shrinks
Involutes at 1cm/day 1cm=1fingerbreadth
Below the symphysis by 10-12 days
Process for involution=autolysis of protein
Bladder Changes
Bladder Changes
edema and hyperemia,extravasation
increased capacity, decreased sensitivity
overdistension with incomplete emptying
urethral trauma may cause dysuria
transient glycosuria, proteinuria, and keytonuria
are normal in immediate postpartum
Bowel Changes
decreased peristalisis
decreased intra abdominal pressure
hemorrhoidal discomfort
perineal discomfort
Lochia
Vaginal
discharge after
delivery, composed of
leukocytes, epithelial cells,
decidua, autolysed protein and
bacteria.
Rubra - delivery to 3rd day
Serosa - days 4-10
Alba -10--several weeks post
delivery
Assessmentcolor,amount,odor,&clots
Episiotomy
Episiotomy--subcuticular sutures
Pain for 24-48 hrs
Episiotomy
First Degree
Vaginal membranes
Second Degree
Third Degree
Fourth Degree
Homans Sign
Emotion
Taking In
Taking Hold
Letting Go
Postpartum Depression
Endocrine Changes
Placental estrogen and progesterone
removed
Prolactin increases, esp in breastfeeding
women
Estrogen begins to increase to follicular
levels at 3-4 wks after delivery
Menstruation returns--6 wks not
breastfeeding, 2-18 mos breastfeeding
BP first then
increases during uterine massage/pain
if PIH may stay elevated
orthostatic hypotension common
Cardiovascular Changes
Blood Changes
Other Changes
Postpartum Chill
Shaking chill due to vasomotor instability
Postpartum diaphoresis
night sweats and increased odor
Fundus @ the
umbilicus
Lochia, moderate,
Rubra with tissue
debris
VSS
Question
A nurse is assessing the vital signs on a postpartum client who delivered
vaginally 10 hours earlier. Findings indicate a temperature of 100, pulse 76
beats/minute, respirations 18/min, and blood pressure 124/70 mmHg. The client
reports feeling sweaty and having to urinate frequently but is otherwise
comfortable. How should the nurse interpret these findings?
a. The client is demonstrating signs and symptoms of hypovolemic
shock indicated by her slow pulse and diaphoresis.
b. The client's elevated temperature and diaphoresis are an indication of
puerperal infection and need to be addressed.
c. The client is bradycardic and the primary care provider should be
notified for further assessment.
d. The client's vital signs and reports of feeling sweaty are normal and
there is no need for intervention at this time.
Question
The nurse knows that subinvolution is most often the
result of:
a. premature separation of the placenta
b. retained placental fragments and infection
c. self-destruction of excess hypertrophied tissue
d. velamentous insertion of the umbilical cord.
Essential Data
Blood Type
Rh Status
Rubella Status
Infant Feeding
Support System
type= O
Rh= Negative
Rubella titer= 1:4
Indirect Coombs= negative
Direct Coombs= negative
Infant Blood Type=O
Breastfeeding
Spouse and extended family in room
Rh Disease
Affects
Rh
Diaphoretic
Breasts- filling
Last BM prior to
delivery
Perineal
pads saturated
Third
Marked
Nursing Considerations
a bath?
Return to work?
Resume sexual intercourse?
Stop talking my vitamins and iron?
Resume exercise?