[Jan RN]

I am an RN considering taking a job in couplet care. I have worked just nursery before, but not postpartum. I'm a little nervous about p.p. What are the main pt.complications/emergencies that can occur on the postpartum unit and how should the nurse react? What skills does the RN need? Thanks..jan

[GrumpyRN63]

My first job was postpartum, it was fun. The worst thing I have seen was pp hemorrhage, because anyone at all sick went to Maternal Special Care. Lots of teaching, breastfeeding, infant care, we really didn't even deal with mom's who had fetal demise's, they went to gyn floor, its a nice place to work, better than just nursery, have fun !! BTW, you may want to post this on the pp/maternity/OB forum (something like that)

[jhhrn68]

The thing about postpartum is that you are mostly dealing with a young healthy population. Because of the increase in c-sections, you will need to know some post-op care. And there will be the 14 year old and the 41 year old and the smokers and some drug users. But mostly, you are looking at people who take care of themselves, do not have chronic diseases and who are there by choice.

[SmilingBluEyes]

What was said above is great. Post partum is a great transiton for any prior nurse. I think you would enjoy it. Good luck!

[l&drocks]

Scariest pp problem: PP hemorrhage
Funniest: I don't know how to breastfeed
Rareist: Death

[NurseNora]

If you enjoy teaching, couplet care is a wonderful place. It can be busy and stressful, but most of the patients are young and healthy. PP hemmorhage is probably the most frequent life threatening problem you'll encounter, although it is most common in the first hour after delivery. Perineal and vaginal hematomas sometimes don't show up until the patient is in the PP unit. A preeclamptic patient (even an undiagnosed one) can have a siezure and become eclamptic for 24 hrs after delivery. Pregnant/newly delivered women are at increased risk for thrombophlebitis and pulmonary embolism. Urinary retention can be a problem especially for women who have had epidural anesthesia for labor or epidural/spinal narcotics for C/S.

You already have most of the skills you need. You will learn to assess a fundus. How high is it and how firm? If it's high and off to the side, have her get up and void and check it again (a full bladder pushes it up and can be the cause of increased bleeding). If it's still high and it's not firm, learn to express clots. These are things you'll be taught as part of your orientation and aren't difficult to learn.

If she can't void, you'll learn tricks to help her. Or you may need to cath her. You'll learn through observation how much perineal discomfort is "normal" and what a PP perineum looks like. Pain much greater than "normal" and swelling may be signs of a hematoma.

You'll also learn how to assess for the S/S of preeclampsia and what to do if the patient does sieze (very rare). In nursing school you learned about thrombophlebitis and pulmonary embolism. You also learned about diabetes and how to deal with low blood sugar.

One of the most irritating things about PP to me is that many of the patients are very needy and cranky. But this is a normal thing. You often have to "mother the mother before she can mother her baby". So I learned to get over my irritation and deal with it. That old axiom is true. It's amazing how a little cossiting and some sleep can help an exhausted women turn herself into a mother.

I think you'll like couplet care. You get to deal with your patients in a more holistic way than just taking care of just half of the mother baby dyad.

[LKG6]

Originally Posted by Jan RN

I am an RN considering taking a job in couplet care. I have worked just nursery before, but not postpartum. I'm a little nervous about p.p. What are the main pt.complications/emergencies that can occur on the postpartum unit and how should the nurse react? What skills does the RN need? Thanks..jan

I work on a routine pp floor so we don't have many complications or emergencies. But here are some that I can think of now:
hemorrhage, large clots that look like jello, fainting and hitting head into objects, seizures, uncontrolled pain after c-section or BTL, bleeding at section site or opening of wound, different infections needing IV antibiotics, low crits needing blood, lots of teaching. And there can be some issues with babies that you already know.

[Italian RN]

In the very short amount of time I have been on the floor on my own ( I am a new grad) I have had at least:

-Two PP Hemorrhages
-Several fainting episodes due to low H&H (unrelated to PP Hemorrhages)that lead to Blood Transfusions
-Just this past week one of my patients had two Grand Mal Seizures and also Coded on me, she went to ICU. Was back the next night on my shift and I took care of her again and she was fine but a very scary situation.

come to think of it I dont think I have had a regular couplet assignment that wasnt complicated by one thing or another. I definitely wouldn't get into PP if you want a slower paced career or patients that are perfectly healthy... at least that has been my experience and of course it is probably MUCH different at other hospitals...

That reminds me I really must say thank you to all of you experienced nurses...

[Chloe'sinNYNow]

Originally Posted by Italian RN

In the very short amount of time I have been on the floor on my own ( I am a new grad) I have had at least:

-Two PP Hemorrhages
-Several fainting episodes due to low H&H (unrelated to PP Hemorrhages)that lead to Blood Transfusions
-Just this past week one of my patients had two Grand Mal Seizures and also Coded on me, she went to ICU. Was back the next night on my shift and I took care of her again and she was fine but a very scary situation.

come to think of it I dont think I have had a regular couplet assignment that wasnt complicated by one thing or another. I definitely wouldn't get into PP if you want a slower paced career or patients that are perfectly healthy... at least that has been my experience and of course it is probably MUCH different at other hospitals...

That reminds me I really must say thank you to all of you experienced nurses...

Not at all different from my own experience. And turns out I couldn't handle it. Buh-bye OB!!

And to you all experienced nurses who helped me, G-d bless and thank you all. To my idiot Internet shopping, every other baby feeding letting my own new admits starve,and helping all others while watching me struggle 5 couplets on my own without direction or hands-on help, you know who you are and SHAME ON YOU!!

Moving on to LTC!

Chloe