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Update Your Discharge Teaching (Part 2)

Newborn throwback!

Happy week!

Is the summer flying by for anyone else? I looked at the calendar and it’s nearly JULY. Seriously ya’ll, where does the time fly?

I’m excited about next month though – I’m headed to my first conference in a few years (the postpartum support international conference in New Orleans!) If you’re going to be there, send me an email or DM to meet up! Otherwise, I’m excited to get even more goodies to go into the postpartum templates that are headed your way.

In the meantime, here’s the second half of the postpartum education I put on my discharge notes. You can catch the basic discharge info from last week here.

This week’s info I add only if it’s pertinent to the mama, i.e., she had chronic hypertension, pre-eclampsia or gestational hypertension, gestational diabetes, thyroid disease or a c-section.

So I use the stuff from part 1’s post, then add this as needed.

Remember, this is only a template, but I have found that the patient is not the only one who benefits from this kind of language. The postpartum nurses also appreciate the language and find the discharge teaching a little easier.

I’d love to hear what you guys use as well…or anything that could be added too! And let me know if you like the note templates (I may have more to share – and these were definitely things that weren’t provided to me when I went back to school…).

Check out the teaching below and share with colleagues as desired.

xoxo, Jamie

1 year ago on the blog…The 16 Week Visit

2 years ago on the blog…Friday Five (#22)


***Chronic hypertension discharge information:***

Although you had chronic hypertension during the pregnancy, you do not need to have your blood pressure checked postpartum because your blood pressures did not require medical management with medicine. You may stop taking your baby aspirin. You are still at risk to have pre-eclampsia, even in the postpartum period and should present for evaluation for any of the following symptoms:

* Severe headache (especially when not resolved with Tylenol 1000mg)

* Changes in your vision

* Severe right upper quadrant pain in your abdomen

Please present to the emergency room for any of these symptoms during your postpartum period.

***Pre-eclampsia or gestational hypertension discharge education:***

During your pregnancy or labor course you were diagnosed with high blood pressure as a result of pregnancy. Though the cause of this is treated with delivery, women are still at risk of complications for six weeks after delivery. Please be sure that you return to the Women’s Health Clinic (or Labor and Delivery) for a blood pressure check 3 days after delivery and 2 weeks after delivery. Please contact us to be seen if you develop new/persistent headaches, vision changes, chest pain/shortness of breath, pain in the right upper part of your stomach, or a notable increase in swelling.

Having had blood pressure issues in pregnancy does increase your risk for heart disease later in life. Please be sure to report this as part of your medical history during your annual health appointments.

***Diabetes education***

– During your pregnancy you were diagnosed with gestational diabetes. While the majority of women will clear this after pregnancy, 30% will not and will develop regular (Type 2) diabetes. 

– To ensure that you do not continue to have diabetes, please go to the lab 1-2 days before your 8 week postpartum appointment to perform a 2-hour glucose tolerance test. By going before your appointment the results will be available to review when you see your provider.

– Having had diabetes in pregnancy does increase your risk for developing this later in life. Please be sure to report this as part of your medical history during your annual health appointments.

– Please contact diabetes services for follow-up questions regarding your diabetes management at (insert a phone number here).

***Thyroid disease***

– Now that you have delivered we will return to your pre-pregnancy dose of Synthroid (if you did not have your dose adjusted in pregnancy, continue taking the same dose). We will retest you thyroid level at your postpartum visit. We do not recheck your thyroid level prior to this visit or change you medication.

***C-Section:***

– Postoperatively, you should expect significant abdominal soreness following a c-section. We will provide oral pain medications, typically an anti-inflammatory (ibuprofen), acetaminophen (Tylenol), and an oral narcotic (oxycodone or roxycodone). It is recommended to take the anti-inflammatory medication three times daily with food or milk, using the Tylenol as needed in addition, and the narcotic only if pain is not controlled with the other medications. 

– You should plan to rest plenty in the next 2-4 weeks; however, you should not be on bed rest. Getting up and moving around is good for your recovery. When you feel up to it (usually shortly after going home) you can take short 10-15 minute walks inside or outside. If you have stairs in your house limit the number of times you go up and down for the first several days and take them slowly, one at a time. You should not start working out until 6 weeks after surgery. You should not do any lifting of greater than your baby in his/her carrier for the first 6 weeks. Avoiding activities that cause you to strain your abdominal cavity (such as straining for a bowel movement, lifting heavy items, deep knee bends/squats, or heavy pushing) is important to prevent poor healing.

If you were given an abdominal binder you may wear this as long as needed. It is recommended that you take it off for a few hours each day to ensure your incision is exposed to air and does not stay moist.

– Bathing: You can shower with your incision. Allow the soapy water to run over your incision and rinse with water. Do not scrub your incision. Gently pat dry with a towel. You should not take tub baths for the first 6 weeks after surgery.

– Driving: No driving for at least 2 weeks or while taking narcotics or phenergan (an anti-nausea medication) if taking for longer than 2 weeks. You need to be able to slam on the brakes and turn the wheel sharply without hesitation.

– Vaginal Bleeding: Lochia (vaginal bleeding after delivery) generally slows and stops within a few weeks after delivery, but it can be normal through six weeks after delivery. It is not unusual for bleeding to stop, then have a brief return or increase 1-2 weeks later. This is called placental site involution and is caused by healing of the area in the uterus where the placenta attached. Generally, bleeding should steadily decrease after delivery but may include clots. Bleeding should not become so heavy as to saturate a pad an hour for 2 hours or more.

– Wound Care:

Your skin incisions are closed with stitches (sutures) under the skin which will dissolve over time and do not need to be removed. They are covered with _____ (insert steristrips, dermabond, prevena…)

– Steristrips:

steristrips, which are similar to small band-aids. These are in place to assist with optimal healing by keeping tension off of the incision. Please remove these 7 days after your surgery. It is alright to shower with these in place. No special care is needed otherwise for your wound. Do not scrub or use harsh soaps, peroxide, disinfectants or lotions on the incision. You can just put soap suds on the incision and allow water to gently wash over it while you shower.

– Dermabond:

This is a surgical skin glue used to optimize healing by keeping the edges of the incision together and decreasing tension across it. You may shower with the glue in place. No special care is needed otherwise for your wound. Do not scrub or use soap, peroxide, disinfectants or lotions on the incision. You can just allow water to gently wash over it while you shower. The dermabond will gradually begin to peel/fall off over the next few weeks. After two weeks you can assist the removal by gently peeling off glue if it has not already fallen off.

– Prevena:

You have a Prevena Wound Care System in place over your incision. This helps to optimize healing by providing constant light suction to the wound, keeping the incision clean, and preventing fluid buildup underneath the incision. This dressing needs to be removed on or around day 7 after your surgery, or when it stops working. Please go to the Women’s Health Clinic or Labor and Delivery at this time to have the dressing removed and the incision inspected.

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