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, What actions are appropriate if the PP mom has an elevated temp?
< 100.4 F= encourage fluids (64 oz./day) and rest
>100.4 F= same as above + notify physician and anticipate antibiotics
What is the difference between a midline and a mediolateral episiotomy?
- midline: heals quicker and causes less pain, but increases risk for developing a 4th degree tear
- mediolateral: improved protection against creating a 4th degree tear, but more painful and increased
risk for complications after healing
What are Rubens phases?
- Taking in phase: in first 24-48 hours mom focuses on her own personal comfort and healing, adjusts to
physiological changes, depends on others, and has decreased decision making capabilities
- Taking hold phase: maternal focus shifts towards infant, independence, decision making, learning
about infant's cues and needs, and becoming a "mother"; may exhibit feelings of inadequacy and
requires reassurance; baby blues and fatigue are common
- Letting go phase: mother begins grieving her "old life" and letting go of old behaviors, incorporated
infant into her life, accepts infant, lets go of what could have been, regains independence and may
return to work or school; may have feelings of guilt, grief, or anxiety; this is when relationship with
partner can grow
What are some things that can alter how a mom progresses through the maternal phases?
- mag sulfate or complications in labor
- PPD or PPP
- c section
- culture, life experiences, how they were parented, support, infants characteristics
What are some common alterations in the urinary system in the PP pariod?
, - transient stress incontinence (up to 6 weeks)
- bladder distention related to IV fluids, decreased sensation, urethral edema, lacerations, operative
vaginal delivery, bladder trauma
- urine output up to 3000 mL/day due to diuresis
- cystitis= bladder inflammation or infection
What are some nursing interventions for PP bladder care?
- assist w/ voiding 2-4 hours post birth
- assess
- measure output (minimum of 300 mL 2-4 hr after delivery)
- catheterization if unable to void spontaneously
- admin antibiotics, fluids, and rest for cystitis
What are some endocrine changes associated with the PP period?
- estrogen drop immediately PP but rises within 1 week PP (may cause diaphoresis in that first week)
- progesterone decreases (thickens uterine lining to prep for new pregnancy)
- prolactin decreases immediately after placental delivery but increases with breastfeeding which can
suppress menses and ovulation but is not a reliable form of birth control (ovulation/menses usually
returns 17 weeks PP)
- for nonlactating women, they should see their first menses in 7-9 weeks
What are some muscular/nervous system changes in the PP period?
- diastasis recti= normal finding and should resolve without intervention
- mild muscle soreness (treat with heat, cold, and analgesics)
- post epidural diminished nerve sensation in lower body (NO ambulation until FULL SENSATION returns)
- headache could indicate pre-e (up to 12 weeks PP) or post-epidural spinal headache
- may experience fatigue (encourage rest while baby is sleeping and focus on self care)
What are some common GI findings in the PP period?
- decrease motility post birth until end of 2nd week PP
- constipation (slowly resolves but may need stool softeners, 3000 mL fluids daily, ambulation, and
increased fiber)
- hemorrhoids (slowly resolve but can be painful, educate to avoid sitting for long times, use tucks and
sitz baths)
