.....................................................Medications used during the postpartum period
• stool softener (docusate sodium)- lowers surface
... [Show More] tension of feces, water INTO stool)
• Motrin (ibuprofen), acetaminophen
• perineum pain
▪ lidocaine spray
▪ tucks- witch hazel pads
▪ ice w/i first 24 hours then sitz bath after first 24 hours
• pre-eclampsia, seizure prevention
▪ magnesium sulfate
• incisional pain, perineal pain
▪ vicodin, percocet
• hemorrhage
▪ Oxytocin, methergine, hemabate
• hypertension
▪ do NOT use methergine
▪ CAN use mag sulfate, hydralazine, labetalol, nifedipine
• What infection risks present for the mom in the postpartum period?
o uterine infection r/t lochia
▪ episiotomy increases risk
▪ leads to peritonitis, septicemia
• Group B strep, staph, E Coli
• endometritis (c-section, chorioamnionitis)
• rupture of membranes more than 24 hours before birth
• refrained placental fragments in uterus
• PP hemorrhage- pre existing anemia
• prolonged & difficult labor, instrumental births (lacerations, tissue trauma)
• internal FHM electrode
• local vaginal infection present at time of birth
• uterus explored after birth
• Mastitis
• infection of the breast introduced through cracked nipples
• Symptoms
• unilateral usually but can be bilateral, scant breast milk production
• affected breast is painful, red, swollen, tender to touch, & fever is present initially
• malaise & flu like symptoms
• Management
• antibiotics, continue BFing or express milk manually, cold or ice compress, good supportive bra, wet compress, increase fluid intake
• Differentiate between mastitis and blocked milk duct
o blocked duct: same symptoms as mastitis but LOCAL, fever not involved. Hard nodules
present in the breast- should resolve after infant feeds.
• Rooming in: promotes bonding, BFing
• Postpartum Preeclampsia:
o Symptoms
▪ increase in HTN severity over first few days
▪ proteinuria, edema
▪ d/t refrained placental fragment
▪ seizure risk (6-24 h after birth)
• Nursing care/management
▪ taken for D&C to remove retained placental fragments
▪ bed rest, quiet atmosphere, freq vitals, I&O
▪ admin magnesium sulfate, antihypertensives
▪ seizure precautions
• Be able to evaluate behaviors that demonstrate maternal/infant bonding
o taking in / dependent phase: first 24-48 hrs (1-3 days)
▪ rely on others for assistance, wants to relive birth experience, excitement
• taking hold / independent phase: day 2 / 3 & lasts 10 days - couple weeks
▪ seeks acceptance, takes charge of care for infant, eager to learn & practice
▪ could be w/i first few hours for women w/o anesthesia
• letting go / interdependent phase: resumes role as an individual, family
functions as a unit
• Bonding
▪ face to face & eye contact, positive views of infant, compares infant features to family members, naming infant, touching, seeking immediate proximity, feeding, changing, responding to cries, smiling, talks to infant
▪ Concerning behaviors: apathy, disgust when voids, spits up, expression of disappointment, turning away, no proximity, no talking, rough handling, or
ignoring altogether.
• Interventions
▪ skin to skin contact, rooming in, quiet environment, early initiation of BFing, helping as needed, encourage intervention for readiness cues, infant care teaching to promote maternal confidence
• Recognize indications of postpartum depression.
• Symptoms: anxiety, feeling of loss
o overwhelming sadness or grief that interferes with BFing, child care, returning to
work
o helplessness, worthlessness, loss of control
o excessive worry, forgetfulness, inability to focus, anxiety or panic attacks, OCD behaviors
o feeling disconnected from infant
o tired but can’t fall asleep
o thoughts of harming self or baby
• Occurs 1-12 months after birth
• Interventions
o Refer the client for a psychological evaluation by the primary care provider, psychologist, psychiatrist, psychiatric RN, counselor or social worker (particularly one trained in special needs of women with PPD.
o Reassure the client she’s not alone and that what she’s feeling is real.
o Encourage the client to ask for help with the baby, housework, and meals.
o Teach the client how to maximize sleep.
o Refer the client to a public health nurse to assess the baby at home and provide follow-up care, as appropriate
• Activity modifications after delivery:
• When can mom return to work: 6 weeks PP
• When can mom resume sexual intercourse: 3-4 weeks after birth or when lochia ceases (Dr. Morse said 6 weeks b/c that's when the mom sees her provider) [Show Less]