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Amniotic Fluid Embolism
Amniotic Fluid Embolism: Infiltration of amniotic fluid
into maternal circulation, which travels to and obstructs
pulmonary vessels. Leads to respiratory distress and
circulatory collapse.
S&S: Sudden chest pain, dyspnea, cyanosis,
tachycardia, hypotension, bleeding.
Nursing care: Administer 02, IV fluids, blood products
as prescribed. Assist with intubation and mechanical
ventilation as indicated.
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MATERNAL NEWBORN NURSING
Postpartum Fundal Height
- After birth, fundus should be firm , midline, and at
the level of the umbilicus.
- At 12 hours, fundus is 1 cm above the umbilicus.
- Fundus descends 1 - 2cm every 24 hours.
- At day 6 , fundus is 1 /2 way between umblicus and
symphysis pubis.
- At 2 weeks, uterus should not be palpable.
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MATERNAL NEWBORN NURSING
Fundus
Assessment: Assess fundal height, uterine placement, and uterine consistency (firm/boggy) every 8 hours. Nursing care:
- If fundus is displaced laterally, have patient empty bladder! Encourage voiding every 2-3 hours.
- If fundus is boggy, massage fundus in circular motion.
- Administer oxytocin as prescribed to increase uterine contractions and prevent hemorrhage.
- Encourage breastfeeding to stimulate release of oxytocin. i; <
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Lochia
Three stages·
- Lochia rubra : bright red color. Lasts for up to 3 days after delivery.
- Lochia serosa: pink/brown color. Lasts from day 4 to day 10 after delivery.
- Lochia alba: yellow/white color. Lasts from day 11 to 8 weeks after delivery. Abnormal lochia: Excess spurting of blood, saturation of r; ..^ < c a pad in <= 1 Sminutes (indicative of hemorrhage), malodorous lochia (indicative of infection), lochia rubra past day 3. Be sure to check for pooled lochia under patient! ; ..________________________, MATERNAL NEWBORN NURSING
Postpartum care for perineum
- Provide stool softeners to prevent constipation.
- Educate patient about perinea! cleansing: use
squeeze bottle of water and antiseptic solution after
voiding, wipe front to back, blot dry (don't wipe).
- Apply ice packs to perienum to reduce pain and CIO edema. r ..
- Provide sitz baths twice a day (or more).
- Provide pain medication as ordered (NSAIDs, opioid analgesics after C-section, topical anesthetics, witch " @)
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Breasts and Breastfeeding
Colostrum and milk: Colostrum is secreted during
pregnancy and for 2-3 days immediately after delivery.
Rich in antibodies, protein, and fat-soluble vitamins.
Milk produced 3-5 days after delivery.
Patient teaching:
- Make sure baby is latched on correctly (takes in part of i; the areola, not just the tip of the nipple).!
- Breastfeeding produces oxytocin, which helps to contract } the uterus and prevents hemorrhaging.
- Watch for S&S of mastitis: cracked nipples, flu symptoms. ..______________________j "'
f~?ternai-infant bonding
1-------- Signs of ii!]oaired _aonding Ignores infant, disgust with diapers or spit-up, expression of disappointment in infant, apathy when infant cries, does not talk about infant. Nursing interventions:
- Promote skin-to-skin contact.
- Encourage early breastfeeding (and educate mom on infant hunger cues)
- Provide support and praise to mom
- Encourage cuddling, diapering, feeding , bathing.
- Provide information about community resources, and support organizations. r., < ., "O^ c ::0 z ;, 0 3 @ ., .._________________________J °' MATERNAL NEWBORN NURSING
Paternal and sibling adaptation
Signs of paternal-infant bonding: Dad holds infant and maintains eye contact. Dad recognizes infant features that are similar to his own. Dad talks, sings, reads to infant.
- Encourage Dad to take hands-on approach! Adverse sibling adaptation: Regression in toileting or sleeping habits, aggression towards infant, behavior issues intended to gain attention. Education for parents on sibling adaptation:
- Let sibling be one of the first people to see the baby.
- Provide a gift from the infant to the sibling.
- Give preschoolers a doll to care for, and/or allow older siblings to help provide care to the baby. r "' < ., "O^ c ::0 z ;, 0 3 @ ., .._________________________J O> MATERNAL NEWBORN NURSING
Breast care
Discharge teaching: Wash hands before breastfeeding, wear supportive bra, drink lots of fluids, apply breastmilk to sore nipples and allow to air dry, report signs of mastitis to provider (cracked/sore nipples, flu-like symptoms). Breast engorgement: Empty breasts with each feeding (until breasts soften), apply cool compresses after feedings, apply warm compresses (or take warm shower) prior to breastfeeding. Apply fresh cold cabbage leaves to breasts. [ 2 Suppression of lact~tion: '!'Jear suppo~ive bra for first 72 hours, avoid breast st1mulat1on, and avoid warm water over breasts. Use mild analgesics as needed. Apply fresh cold cabbage leaves to breasts.
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Postpartum teaching: sexual intercourse
- Avoid sexual intercourse until vaginal discharge is
white (lochia alba) and episiotomy is healed -
around 2-4 weeks.
- Physical reaction to sexual stimulation may be
diminished for first three months after delivery.
- Use of a OTC lubricant may be needed to prevent
discomfort. ,
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- Ovulation may occur as early as 1 month after
delivery. Pregnancy can occur while breastfeeding
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(even if menses has not returned). Discuss use of :
contraception.
MATERNAL NEWBORN NURSING
Deep vein thrombosis
S&S: Unilateral leg pain, swelling, warmth, redness. Prevention: Ambulate early and frequently, avoid prolonged immobility, elevate legs when sitting, a~oid crossing legs, drink 2-3L of fluid per day, no smoking , wear antiembolic stockings. Nursing care of DVT:.
- Bed rest and elevation of affected extremity above heart.
- No pillows or knee gatch under knees!
- Apply warm moist compresses.
- Do NOT massage legs.
- Administer analgesics, anticoagulants (heparin, warfarin) as prescribed. Implement bleeding precautions. MATERNAL NEWBORN NURSING
Pulmonary Embolism
PE: Complication of DVT where the embolus moves into the pulmonary vasculature, occluding the vessel and obstructing blood flow to the lungs. S&S: Dyspnea, chest pain, tachypnea , hypotension, hypoxia, peripheral edema, bloody sputum. Treatment of PE:
- Place patient in semi-Fowler's position.
- Administer 02
- Administer thrombolytic meds as prescribed (alteplase, streptokinase ).
- Implement bleeding precautions. N co r .. < .. 't) c z "^0 3 @ N co ,- '
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Mastitis
Mastitis: Breast infection, usually involving S. aureus. Risk factors: Blocked duct, nipple trauma from poor breastfeeding technique, inadequate hand hygiene. S&S: Painful, reddened, hard area on one breast, flu-like symptoms (fever, body aches), fatigue, elevated WBCs. Nursing care:
- Administer antibiotics.
- Provide education to mom: Wash hands before breastfeeding. Allow nipples to air-dry. Make sure infant takes in nipple AND areola, empty breasts completely with each feeding, breastfeed frequently. Use breast Cl)^ I"" < Cl)
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UTI
Risk factors : Postpartum hypotonic bladder, urinary catheterization, frequent pelvic examinations, c-section. S&S: Urinary urgency, frequency, pain. Fever, chills, malaise, cloudy/malodorous urine, suprapubic pain, urinalysis positive for bacteria, WBCs, and RBCs. Nursing care:
- Obtain urine sample.
- Administer antibiotics.
- Provide education : wipe front to back, increase fluid intake (3Uday), drink cranberry juice. I"" QI < QI
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Postpartum Mental Health
Postpartum blues: Lasts <= 1 O days. Symptoms: crying, insomnia, decreased appetite, feeling of "letdown". Resolves without intervention. Postpartum depression: Occurs within 6 months of delivery. Symptoms: persistent feelings of sadness, intense mood swings, lack of appetite, rejection of infant, flat affect, anxiety/panic attacks. Typically requires intervention. i
Postpartum psychosis: Occurs within 2-3 weeks. History of 2
bipolar disease is key risk factor. Symptoms: confusion, } hallucinations, delusions, paranoia. Patient and/or infant is at risk for harm. (^) 0 ... L----------------------..J co
