Post Partum...

nicolebutterfly · Apr 9, 2007

Hello, I student nurse presently in post partum and OB. A typical day usually involves checking the patient's v/s, hygeine, c-section incision (if needed), help mom with breast-feeding tips, we also assess her pain (if any) and help mom get used to this new baby or babies. We will escort the baby back and forth from the nursery, help teach her bathing tips for the baby. If it is the first day post partum we will make sure she is ambulating and voiding normally and well. I hope this helps..now I need some sleep to get ready to care for some post partums tomorrow morning:smilecoffeecup: , good luck!

Nicole

texasnursingstudent · Apr 13, 2007

one of the really important things to do when the mom is in the postpartum unit is to check the uterus for the fundus height. the fundus should be firm and placed in the middle of the mom's abdomen, or at the umbilicus. the fundus should not be boggy or squishy feeling, nor should it be deviated from the middle of the abdomen. it's really really important to check this frequently because a boggy fundus means that hemorrhaging is/can be starting. a fundus that is deviated to the side can often be corrected after the mom gets up to urinate. have her do so, and help her of course, and then check a few minutes later. lastly, a boggy fundus can be massaged to help make it more firm. check your textbook for more information on this as well as how quickly the fundus should start to descend after the mom has given birth. from what i understand the fundus height is checked regardless of whether the birth was lady partsl or C-section. hope this helps!!!

SmilingBluEyes · Apr 13, 2007

teaching

teaching moms and their loved ones how to care for themselves, babies, and adjust to new parenthood.

SO IMPORTANT.

mstigerlily · Apr 13, 2007

I was just wondering, what all do you do in a days time while working postpartum...in regards to either mom and/or mom&baby.

Depends on the hospital and unit, management, policies and the nurse herself, but at my hospital the duties are as follows:

Admit, assess, discharge up to four couplets at a time. Some of these may include overflow gyn surgeries, low risk antepartum patients or moms whose babies are in LII nursery. Refer to lactation, social services, dietary as necessary. Check MAR, administer meds, hang IVs, chart checks. Not very often but we can start or bolus mag and push other cardiac meds, more often we maintain and discontinue mag patients if they are transferred that way. We also hang blood if they need it. Lots of IV antibiotics and IV push meds. Vital signs q4h first 24 hrs for mom and baby and q8h after that. Empty catheters, change pads, assist to bathroom, all personal needs. Order and review labs for moms/babies as needed. PKU tests, hearing tests and other lab draws for mom and baby may be your responsibility as well. Weigh babies nightly, record I&O for moms, sometimes for babies. Teach and assist parents to care for themselves and for babies: diapering, sore nipple management, pumping, breastfeeding, nipple shields, supplemental feeding systems, burping, swaddling, breastfeeding, discharge teaching. Rent pumps, discharge teaching and paperwork for discharge. Call housekeeping, security and maintenance to address any patient concerns with their rooms. Many psychosocial issues, lots of teaching. In my opinion it would be best for a very hands-on type of nurse who is comfortable with babies, is comfortable with lots of family members being around all the time, and is tactful, professional, kind, friendly but firm.

Sometimes we float to L&D to recover patients which includes assisting with cleaning, sending and/or disposing of instruments and sharps, placenta, cord blood, transitioning, bathing baby with vital signs on both mom and baby. Giving the vit K injection, sometimes Hep B injections, the eye ointment. Assisting doctor with any repair, cleaning up mom and getting her ready to move to postpartum room.

Sometimes nurses take turns in the well baby nursery where they care for up to 8 babies who may be on phototherapy and staying in, all new c-section admissions, baths, transitions and care, plus babysitting and doing vitals for for any babies staying for awhile while mom rests. Assist with circumcisions, care for circs afterwards. In some postpartum units in my area (not mine), nurses will maintain and hang antibiotics for the babies, care for "feeders and growers" who need to just remain on an IV or monitor for a bit before discharge, give gavage feeds.

Since we have four couplets that's 8 charts so LOTS of charting, supplemental care plans, PPOCs, referrals, nursing assessment forms, computer charting. There may be a huge difference in responsibilities at different hospitals in my area, there may be techs, CNAs and LVNs to assist with care. At our hospital lab does the PKU and all other lab draws on moms and babies but at many hospitals this is the RN's responsibility.

MIA-RN1, RN · Apr 14, 2007

1. Assess mother--breasts, uterus, bleeding, bottom, legs, edema, homan's sign and epidural. Also vital signs since our techs are mostly (but not all) SLOW. Treat pain. Give meds as ordered. TEACH TEACH TEACH. Assist with breastfeeding, teaching diaper changes etc. Soothe them when they cry, laugh with them when they laugh. Ambulate them, d/c foleys and saline locks as ordered. All of this, q4 or bid, depending on type of birth and how many hours since.

2. Assess baby: Vitals, skin color for jaundice, umbilicus, circ if applicable, general color and tone, pain. Check and change diaper. Keep track of all feeds and diapers. Help latch on. Heelstick bg's as indicated. Baby baths. Blood draws as indicated/ordered. PKU's. Assist with circ if indicated. Again, q4 or bid, depending. We have 'transitional care' now too, which means taking care of babies who need abx but are stable--remember to take them to special care nursery for meds. Sometimes we give meds to babies too---usually oral prophylactic abx for hydronephrosis.

3. Chart. and chart. Oh, and don't forget chart!

4. Misc: We also get antepartums who need monitoring and meds and usually fetal heart tones q4h. Give blood to hemorrhaging mothers. Monitor hourly vitals and reflexes for pts on Mag Sulfate. Collect 24h urines. Comfort mothers with FDIU and also do post-mortem on fetus.

And then sometimes we get gyn surgeries---hysterectomies for the most part.

LuvofNursing, BSN, MSN, RN · Aug 18, 2009

A few questions from a newbie postpartum nurse....

What is PPOC? And how often do you encounter complications? What types of complications do you see most often? Do you get much experience with IV's? Do you in and out cath very often?

I was hired into couplet care, any advice for this type of unit?

thank you.

justiceforjoy · Aug 20, 2009

Things I learned that my nurses failed to do for me after going to nursing school, haha: emotional status checks. (I showed no interest in my daughter for quite a while after she was born,) and letting me know that there was a shower on the floor. (I was there for three days... Ew.)

Throwing those up there as simple things that get overlooked. Also, while palpating the fundus, be sure to remember to support the base of the uterus by placing one of your hands just above the pubic bone while your other hand palpates the fundus.

NurseNora, BSN, RN · Aug 21, 2009

Some complications to be on the lookout for:

lady partsl or labial hematoma. You can see the swelling with a labial hematoma, but often with a lady partsl hematoma it's inside and cant' be seen. Signs would be swelling, bruising, and pain not relieved by the usual meds. The swelling can get to be very hard as the blood collects in the labia, so if you're not sure, touch it. In a lady partsl hamatoma that doesn't show, the most outstanding symptoms will be extreme pain and often rectal pressure. If it goes on long enough, you'll see a change in VS as a result of blood loss--you want to find it before that happens.

Pulmonary embolism is more common PP than you would expect in healthy young women. Pregnancy is a time of hypercoagulation and someone who's been on bedrest or in stirrups is much more likely to develop a clot and through it into the lungs.

Eclampsia usually occurs during pregnancy, but can show up anytime in the first 6 weeks post partum. So keep an eye on those vital signs and outputs. Your patient should start diuresing sometime in the first 24 hours. Keep asking the headache, visual changes, epigastric pain questions even post partum.

Spinal headaches; even if the patient had an epidural, there could have been a tiny hole resulting in some loss of CSF. A blood patch works like magic to cure it. Spinal headache usually goes away when the patient lies flat is starts when sitting or standing. A pereclamptic headach is severe and the position of the patient doesn't matter and usual medication doesn't help.

Post partum hemmorhage. If you suspect your patient is bleeding too much, start weighting her pads. She shouldn't saturate a pad in an hour, she shouldn't be passing clots. Your report to the doctor will carry much more weight if you can say "I've been weighing her pads and she's lost over 650gms over the last hour" rather than, "I think she's bleeding too much"

A patient who has had epidural or spinal narcotic can have a respiratory arrest. Many places have orders for continuous pulse ox &/or hourly respiration checks for the first 24 hours. Do you know where the nearest Ambu bag is?

Problems with breastfeeding: sore, chapped, blistered nipples. Get mom and baby skin to skin and be sure of good latch. One of my favorite sites for breastfeeding information is: http://breastfeedingtaskforla.org . It's the Los Angeles county breast feeding task force and has downloadable info sheets in both English and Spanish. The one I use most often is the one in Spanish that is titled "Breastfed Babies Don't Need Formula".

You don't start too many IVs on PP because the patient often comes with a saline lock from L&D and you don't remove it until you're pretty sure you won't need to restart an IV. You'll do more removals than starts, but you'll need to start a few from time to time.

A few in & out caths, but usually L&D has gotten the patient to void. If a patient can't void and her perineum is very swollen, you might suggest to the doc to put in a foley till the swelling goes down a little. I work nights, so the mom usually appreciates being able to sleep the night without worrying about voiding. During the day shift, she may prefer straight caths. You'll figure out what works best for you and your patients.

This is what comes to mind. Complications are the exception rather than the rule, it's always a surprize when one does occur. You just have to be on the lookout and ready to respond appropriatly if one does happen.