Inter American University of Puerto Rico Metropolitan Campus Carmen Torres de Tiburcio School of Nursing

MATERNAL-NEONATAL CARE-NURS 2141 Prof. Diana M. Cavazos, RN, MSN

Assignment V: Post-Partum Care 1. Define uterine involution. Find the normal values of uterine involution Hours postpartum Level of uterus in centimeters Immediately postpartum 1 hour postpartum 12 hours postpartum daily postpartum 24 hours postpartum 2nd postpartum day 2 weeks postpartum 6 weeks postpartum 1cm 1cm 1cm 1cm 1.5cm 2cm Nonpalpable Nonpalpable Level of uterus in fingerbreadth 1 fingerbreadth below the umbilicus 1 fingerbreadth below the umbilicus 1 fingerbreadth below the umbilicus 1 fingerbreadth below the umbilicus 1to 2 fingerbreadths below the umbilicus 2 fingerbreadths below the umbilicus Uterus has descended into the true pelvis Uterus has descended into the true pelvis

2. On palpation where should the uterus be in the abdomen? What can make this finding deviate? The nurse uses one hand to stabilize the uterus, just above the symphysis and the outer edge of the other hand to locate the fundus. If the uterus is not firm, it is referred to as boggy, and the fundus is massaged gently in a circular motion until the uterus contracts and becomes firm. 3. Name one precaution that must ALWAYS be taken when measuring the postpartum uterus. The nurse must be careful to avoid exerting too much pressure because this may cause the uterus to invert. 4. What may delay uterine involution (8)?

Infection and retained fragments of the placenta are the most common causes. Typical signs include the following: Fundal height is greater than expected for the amount of time since birth, persistence of lochia rubra or slowed progression through the three phases, pelvic pain, heaviness and fatigue. 5. Timetable for postpartum nursing assessment Assessments Evaluate fundal height/consistency Evaluate lochia color/amount Well approximated Assess perineum for hematoma/stressed suture line Assess pulse, respiration, B/P Assess temperature Full Assess for bladder distention Unchanged Assess bowel function Assess breasts for firmness/filling Assess parent-child interaction 6. Define lochia. The maternal discharge of blood, mucus and tissue from the uterus; may last for several weeks after birth. Full, enlarged, soft and warm Nursing Infant Full, tender, soft, warm Infant sent to nursery Full, tender, and warm Infant in nursery Unchanged Unchanged Empty Empty P: 70, R:16 BP: 120/80 99 F Well approximated P: 68, R:18 BP: 110/70 98.6 F Well approximated P: 68, R:18 BP: 108/70 98.8 F 1st hour postpartum Firm 1FU Moderate 2-12 hours postpartum Firm 1FU Moderate 24-48 hours postpartum Firm 1FU Moderate

7. Describe lochia

Lochia Rubra -first 2 hours postpartum

Color Bright-red bloody vaginal discharge

Amount Moderate

Duration First 3 days

Composition Blood, mucus, decidual tissue

-after 2 hours postpartum

Bright-red bloody vaginal discharge

Moderate

First 3 days

Blood, mucus and small clots

Serosa

Watery-pink bloody vaginal discharge

Small

Days 4 to 10 after delivery

Serious fluid, leukocytes, erythrocytes, decidual tissue

Alba

White-yellowish vaginal discharge

Minimal, scanty

Days 10 to 17 after delivery

Leukocytes, deciduous tissue, decreasing fluid content

8. What is considered a normal postpartum blood flow when considering the time a perineal pad takes to fill? Lochia rubra (dark red) saturates perineal pad; no more than one pad per hour, and the woman should not pass large clots. 9. What lab test is performed on the postpartum woman and what is the cut off level. A complete blood count is performed. Leukocyte count may increase during labor up to 25,000/mm, can increase to 30,000/mm during a prolonged labor, and remain elevated for the first two days postpartum. The average count is 14,000 to 16,000/mm. 10. Define postpartum cramps. Describe its cause. Postpartum cramps are caused by uterine contractions, which are the efforts of the uterus to expel blood clots and placental fragments. The contractions are enhanced with oxytocin. 11. Name six nursing intervention for pain related to afterpains or perineal sutures.

1. Assess need for pain medication using a scale from 1 to 10. 2. Give client as prescribed by physician oral NSAIDS, such as Motrin or Ibuprofen, 400-800mg orally every 4-6 hours as needed for pain. 3. Assess perineal site carefully if pain medication do not relieve pains, may indicate a possible perineal hematoma. 4. Suggest client to empty her bladder every hour or so as an effective measure to reduce after pains. 5. Assist client to a sitz bath with warm water or moist heat to reduce discomfort in perineal or episiotomy area. 6. Suggest client to lie on her abdomen with a pillow against her lower abdomen because this creates pressure that keeps the uterus contracted.

Translated to English M. Bou/ 2-2003 A. Piazza, R. Caballero, R. Rodriguez/ 2-2002 D. CAVAZOS, RN,MSN 8/2011