Week 3 ~ Overview Slides

4th stage of labor _ First 1 to 2 hours after birth _ Breastfeeding is recommended to begin _ Assessment: PP assessment focusing on CV and reproductive systems _ Post-anesthesia recovery: _ Regardless of obstetric status, no woman should be discharged from recovery area until completely recovered from anesthesia POST PARTUM HEMORRHAGE (PPH) Early: usually due to uterine atony (relaxed, uncontracted uterus) Intervention for this#1: Massage the uterus! (Items in red are always on tests). Breastfeed Woman may need a med to help uterus stay contracted: Pitocin IV or IM, Methergine (IM/IV or PO) (unless B/P is elevatedthis med can increase it further) Hemabate (IM) or Cytotec (prostaglandin may be given in the vaginal fornix or even rectally PPH: LATE Late (days or weeks after delivery): usually due to retained placental fragments Intervention: SIGNS OF POTENTIAL COMPLICATIONS See the Nursing Process box (Postpartum Physical Concerns). To safely discharge, all of the following should be within acceptable limits: V/S Contracted uterus without hemorrhage Normal lochia Recovering perineum Negative Homans sign Breasts WNL, and baby latching on well Appetite WNL Elimination WNL Neuro intact Mom is able to rest and sleep, feels confident about her ability to care for baby. RESUMPTION OF SEXUAL ACTIVITY AND CONTRACEPTION See Teaching for Self Care on pg. 503. Which contraceptives are appropriate for PP women planning to breastfeed? (Read my comments on this in the overview). If not breastfeeding, women can use a contraceptive containing estrogen, since the drying up of lactation that occurs with this hormone will not be a problem. If a woman is well established in lactation, estrogen may have little effect on amount of milk production.