OB - Postpartum - POSTPARTUM Initial Postpartal Assessment...

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Unformatted text preview: POSTPARTUM Initial Postpartal Assessment BUBBLE-HE 0. B reasts 1. U terus: location & firmness of fundus 2. B ladder: presence of catheter or fullness from overdistention 3. B owel: time & amt of last void 4. L ochia 5. E pisiotomy 6. H omans sign: DVT check 7. E motions-------------------------------------------------------------------------------------------------------------------- 8. These check-ups are usually done: o 1 st hour: assess Q 15 mins o 2 nd hour: assess Q 30 mins o 1 st 24 hours after that: Q 4 hours o after 1 st 24 hours: assess Q 8 hours-------------------------------------------------------------------------------------------------------------------- Chart Review 9. To determine if factors present that increase risk of complications: gravida, parity, delivery time & type, medications, history, allergies, infant feeding method, condition of baby, need for RhoGam, rubella, risk factors for hemorrhage and infection. Other risk factors to look for include whether forceps were used during delivery and whether internal monitors were used.-------------------------------------------------------------------------------------------------------------------- UTERINE ADAPTATION 10.Puerperium: period from end of childbirth to involution of uterus. About 6 wks. 11. Involution retrogressive changes that return the reproductive organs (uterus) to pre-pregnancy state. Takes 6 wks. 12. Afterpains : cramping pain following childbirth caused by alternate relaxation & contraction of uterine muscles. Particularly severe during breastfeeding, when OCT (released from PP to stimulate milk-ejection reflex) also stimulates strong uterine contractions. These pains rapidly decrease 1 after 48 hours after childbirth. More common in overextended uterus. Fundal Descent 13. PP, uterus is size of grapefruit & fundus palpated between symph pubis & umbilicus. 14.About 12 hours after birth, fundus is about 1 cm above umbilicus 15.After 24 hours, begins to descend at approximately 1 cm, or 1 fingerbreadth, per day CONTINUED NEXT PAGE 16. By 10 th day, it is in pelvic cavity and can no longer be palpated abdominally. 17. Usually takes 6 wks to completely involute. 18. Descent documented in relation to U (umbilicus) MEASURING FUNDAL DESCENT Day 1 - U Day 2 - U-1 Day 3 - U-2 Etc o Fundus should be firmly contracted o If difficult to locate or boggy (soft, not contracted), then massage to stimulate. Like kneading bread. Massage is not necessary if uterus is contracted. o The non dominant hand must support and anchor the lower uterine segment if massaging an uncontracted uterus.massaging an uncontracted uterus....
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OB - Postpartum - POSTPARTUM Initial Postpartal Assessment...

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