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FAMILY EXAM #2
PostPartum Maternal Assessment
| Question | Answer |
|---|---|
| A second degree episiotomy | extends through the perineal muscles |
| A third degree episiotomy | extends through the anal spinchter muscle |
| A first degree episiotomy | extends through the skin and superficial structures above the perineal muscle |
| Lochia Rubra | is deep red mixture of mucus, tissue debris, and blood that occurs for the first 3-4 days after birth |
| Lochia Alba | is creamy or light brown discharge that consists of leukocytes, decidual tissue, and reduced fluid content. It occurs from 10-14 days postpartum but can last up to 3-6 weeks in some |
| Lochia Serosa | is pinkish brown and is expelled from the uterus from days 3-14 postpartum. it contains primarily leukocytes, decidual tissue, RBC, and serous fluid |
| Convection | Air currents blow over the infants body |
| Radiation | Cold object close to the infant, but not touching them |
| Conduction | Body heat transfers to a cold object, such as placing a baby on a cold scale |
| Evaporation | Wet skin dries and evaporates |
| Maternal Postpartum Assessment | Assess every 15 minutes in the first hour, every 30 minutes in the second hour, every 4 hours for the next 24 hours, and after 24 hours assess every 8 hours |
| Maternal Postpartum Vital Signs | Pulse should be between 60-80 bpm at rest, however bradycardia is common. BP should reamin about the same but should be lower than 140/90 and higher than 85/60. Respirations should be between 12-20 breaths per minute, and pain should be premedicated rather than waiting. |
| BUBBLE-EE | An easy way to temember the maternal postpartum assessment which includes breasts, uterus, bowels, bladder, lochia, episiotomy (perineum, epidural site), extemities, and emotions. |
| Maternal Postpartum Breast Assessment | Contour, symmetry, engorgement, or erythema, nipple cracks, redness, fissues, bleeding, erectness, flat, inverted |
| Maternal Postpartum Uterus Assessment | Assess fundus, palpate to remove clots. Have patient empty bladder. Use two hands and feel for the top of the fundus with one hand on the fundus, and one on the lower segment. Should be midline and firm |
| Maternal Postpartum Bladder Assessment | Many do not feel the need for void even when bladder is full, leading to distension and displacement of uterus upward and to the side. This prevents uterine muscles from contracting properly and can lead to excessive bleeding. Urinary retention is the inability to empty the bladder within 6 hours of birth |
| Maternal Postpartum Bowel Assessment | Auscultate bowel sounds PRIOR TO FUNDUS PALPATION. Spontaneous bowel movements will occur within 1-3 days postpartum. Bowel sounds should be present in all quadrants. The abdomen should be soft, nontender, and nondistended. |
| Maternal Postpartum Perineum Assessment | Should be assessed with the patient on her side with top leg flexed upward at the knee and drawn toward her waist. Assess for irritation, ecchymosis, tenderness, or hematomas and hemorrhoids. No redness or edema should be present, but there may be some red on the skin surrounding perineum. A white line running through the length indicates an infection. Perineal discolaration indicates hematoma. |
| Scant Lochia | 1-2 inch stain on a pad, approximately 10 ml |
| Light or Small Lochia | 4 inch stain on a pad, approximately 10-25 ml |
| Moderate Lochia | 4-6 inch stain on a pad, approximately 25-50 ml |
| Large or Heavy Lochia | The pad is saturated within 1 hour, you can ring it out |
| Maternal Postpartum Epidural Site Assessment | Assess for itching, nausea, vomiting, or urinary retention. Visual inspection of site, and accurate documentation of intake and output are essential |
| Maternal Postpartum Extremity Assessment | Hypercoaguability increases the patients risk for clots. Monitor extremities for signs of DVT and PE |
| Maternal Postpartum Danger Signs | Fever over 100.4, foul smelling lochia, large blood clots, or saturating a pad within an hour. Severe headaches or blurry vision. Calf pain with dorsiflexion of the foot. Swelling redness, or discharge at episiotomy, epidural, or abdominal sites. Dysuria, burning, or incomplete emptying of the bladder. SOB, dyspnea without exertion. Depression or extreme mood swings. |
| LACTATION | Secretion of milk by the breasts. Brough on by progesterone, estrogen, prolactin, and oxytocin. Typically appears within 4-5 days of childbirth |
| COLOSTRUM | Contains proteins and carbs, but no milk fat. Present at birth, for the first few days before milk supply comes in |
| LACTOGENESIS | Onset of milk secretion. Initially triggered by the delivery of the placenta. |
| ESTROGEN | Decreased levels stimulates breast engorgement and diuresis of excess extracellular fluid accumulation during pregnancy. Also stimulates the growth of milk collection in the ductal system. At its lowest 1 week after birth, and stays low if breastfeeding – if not it begins to increase again by week 2 |
| PROGESTERONE | Stimulates the growth of the milk production system |
| PROLACTIN | Triggers the synthesis and secretion of milk after the women gives birth |
| OXYTOCIN | Acts so that milk can be ejected from the alveoli to the nipple |
| Maternal Postpartum Uterus Adaptations | Returns to normal size through a gradual process of involution (the retrogressive changes that return it to its non-pregnant size). Within 12 hours of birth the fundus is located at the level of the umbilicus. Over the next few days, it descends about 1 cm per day. By approximately 1 week, it shrinks by 50%. By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis |
| Maternal Postpartum Cervix Adaptations | Extends into the vagina immediate after birth, and remains partly dilated, bruised, and edematous. Typically returns to prepregnant state by 6 weeks postpartum. Gradually closes, but never regains prepregnant shape and appearance. – It is no longer shaped like a circle; it is now like a jagged-slit-like opening |
| Maternal Postpartum Vagina Adaptations | Mucosa is edematous, relaxed, thin, with few rugae, shortly after birth. Ovarian function returns and estrogen production resumes. Mucosa thickens and rugae return in approximately 3 weeks. By 3-4 weeks the edema and vascularity have decreased. Returns to approximate prepregnant size 6-8 weeks postpartum but may always be slightly larger. Localized dryness and coital discomfort (dyspareunia) plague many women until menstruation returns |
| Maternal Postpartum Perineum Adaptations | Often edematous, and bruised for the first day or two after birth. If there was an episiotomy laceration, complete healing may take as long as 4-6 months. Muscle tone may or may not return to normal. Perineal lacerations may extend into the anus and cause considerable discomfort for mother when attempting to ambulate or defecate. Presence of swollen hemorrhoids may also heighten discomfort. |
| Maternal Postpartum Pelvic Floor Adaptations | Supportive tissues are stretched during birth, and restoring their tone may take 6 months. Pelvic relaxation can occur in any women who gives birth vaginally and it is the most common complications of vaginal childbirth |
| Maternal Postpartum Cardiac Output Adapatations | Remains high for the first few days postpartum. Gradually declines to nonpregnant values by 3 months |
| Maternal Postpartum Blood Volume Adapatations | Drops rapidly after birth, returning to normal within 4 weeks. Further reduced through diuresis between days 2 and 5 |
| Maternal Postpartum RBC Adapatations | production ceases, causing mean hemoglobin and hematocrit levels to slightly decrease in the first 24 hours. During the next 2 weeks, both levels should rise slowly |
| Maternal Postpartum WBC Adapatations | count increases in labor, and remains elevated for the first 4-6 days after birth, but then falls within normal levels |
| Maternal Postpartum Pulse Adapatations | Bradycardia may occur (40-60 bpm) for the first 2 weeks. If tachycardia occurs (over 100 bpm) further investigation is required, as it may mean hemorrhage, hypovolemia, or dehydration |
| Maternal Postpartum Coagulation Adapatations | usually returns to prepregnant levels after 3 weeks postpartum |
| Maternal Postpartum Urinary Adapatations | GFR and renal plasma flow decrease to normal by 6 weeks. Gradual return of bladder tone and normal size and function of the bladder, ureters, and renal pelvis. All which were dilated |
| Maternal Postpartum GI Adapatations | Due to fetus no longer filling abdominal cavity the GI system quickly returns to normal. Progesterone levels decline reversing the diminished bowel tone. Appetite returns to normal immediately after birth |
| Maternal Postpartum Musculoskeletal Adapatations | Hormones RELAXIN, ESTROGEN, AND PREGESTERONE levels decline resulting in a return of ALL JOINTS to prepregnant state. EXCEPT FOR THE FEET. Parous women may note permanent increase in shoe size |
| Maternal Postpartum Respiratory Adapatations | The rate typically remains the same, the diaphragm returns to its usual position, shortness of breath and rib aches are relieved. Tidal volume, Vital Capacity, and Functional Residual Capacity return to prepregnant values within 1-3 weeks |
| Maternal Postpartum Endocrine Adapatations | Rapid Clearance of Placenta Hormones. Levels of progesterone drop quickly, undetectable within 3 days. & production is reestablished with the first menses. hCG is nonexistent at the end of the first week. Prolactin is a hormone secreted by the anterior pituitary gland involved with lactation and reproduction, it declines within 2 weeks for those not breastfeeding, and remains elevated in those that are |
| Maternal Postpartum BP Adapatations | falls in the first 2 days, then increases 3-7 days after childbirth and should return to prepregnant levels by 6 weeks |
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