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OB - postpartum

test 2

puerperium period of recovery from childbirth. lasts about 6 weeks. return of body systems to non-pregnant state.
phases of postpartum - immediate 1st 24 hours. mother's body has prepared itself for this delivery, so she has 2x blood volume. able to withstand this loss of blood (but she can still hemorrhage).
phases of postpartum - early 1st week. go home, breastmilk comes on day 4-5. engorgement, moodswings. make sure attachment/bonding is occuring. mental status: how are her moods? how is she adapting?
phases of postpartum - late 2nd-6th week. watch moods.
involution process in which uterus returns to pre-pregnant state. contraction of uterine muscles. autolysis.
autolysis. self digestion, protein materials are broke down, absorbed, and cast off.
involution: postpartum (right after birth) uterus 2 fingerbreaths below U. will stay like this for 8-10 hours. feels like big grapefruit.
involution: 8-10hr postpartum pitocin starts to leave system, uterus comes back to U, can be 1 fingerbreath above. will decreased to 1-2 below the U until it is back in the pelvis and no longer palpable.
involution process compression of intramyometrial bloow vessels. muscle contraction rather than platelet aggregation & clot formation. uterus should remain firm & well contracted. pitocin after expulsion of placenta. mathergine IM or PO may be used.
mathergine wrks more precisely than pitocin by constricting the blood vessels. increases BP. not the drug of choice for mother's with high BP.
after pains period of relaxation & vigorous contraction. more intense in multipara, mother of multiples, retained clots, breastfeeding moms.
placental site vascular constriction & thrombosis/irregular nodular & elevated area. upward growth of endometrium caues sloughing of necrotic tissue. prevents scar formation. regeneration of placenta site - 6 weeks
lochia postchildbirth uterine discharge.
lochia rubra delivery to 3 days. pink to red. more noted with vaginal than C/S. rule of thumb: no intercouse until lochia has stopped.
lochia serosa 3-10 days. pink to brown.
lochia alba 10 days + up to 6 weeks. yellow to white.
cervix soft immediately after birth. by 18hrs, shortens, firms, and regained form.
ectocervix fragile, bruised, small laceration.
endocrine system changes dramatic decrease in estrogen (depression), progesterone (depression), human clacental lactogen, human chronic gonatrophin. pacental enzyme insulinase (reverses the diabetogenic effects of pregnancy).
prolactin levels decreased in non-lactating moms. increased in lactating women (into the 6th week in response to infant sucking, suppresses ovulation. NOT a birthcontrol method!).
urinary system increased renal function, steroid related.mild proteinurine, related to autolysis. postaprtal diuresis & diaphoresis. urethra & bladder may have birth induced trauma. difficulty urinating, distensions, bladder tone restored 5-7 days.
gastrointestinal system appetite returns quickly. vaginal can eat right away. C/S - wait for bowel sounds to return.
breast bresatfeeding: colostrum from 24-48 hours THEN breastmilk. milk continues until weaned. engorgement.
cardiovascular system blood volume almost 2x by delivery (estrogen causes this). can loose up to 1000cc w/o shock.
vital signs 15 min x2, Q 1hr x2, Q4 up to Q8.
hematologic changes blood loss (300-400 vaginal; 1000 c/s). leukocytosis (WBC 15-20,000. normal 5-10,000). RBC decrease gradually. extracellular fluid may increase hematocrit and hgb.
Hct UP. 38-40. dont want this to go down. means there is hemorrhage.
Hgb UP. 18. don't want this to go down.
recurrance of ovulation and menses nonbreastfeeding, 6-8 weeks. breastfeed, 12 weeks after delivery.
1st hour PP Recovery vital signs Q 1 5 mins. assess uterus firmness, location. assess bleeding. skin. leg movement if epidural. bladder (1st voiding). IV fluids, meds, etc.
BUBBLE HEE Breast (tender, engorged, nippled). Uterus (position, contractility). Bladder (distention). Bowels (constipation, hemorrhoids). Lochia (type, amount). Epistomy (swelling). Hemorrhoids. Extremities (redness, Homan's sign).
nursing implications. postpartum assessment. aseptic technique. adequate fluids & diet. supportive. education - self & infant. Rh factors. rubella vaccine.
Rhogam must be given by 24-72 hours PP. kills antigens, stops body from building antigens. wont work after 72 hours (she has already built the antibodies).
Rh factor mom Rh-, dad Rh+, baby Rh+ delivery, placenta comes out, blood supplies meet, positive can get inside moms blood, her body builds imunity against Rh, bad for subsequent pregnancies.
checking episiotmy - REEDA Reness. Edema. Ecchymosis. Discharge. Approximation.
signs/symptoms of infection takes 48-72 hr to set in. fever (≥101). malaise. purulent discharge. foul lochia. pain. rapid pulse. chills.
PP Complications hemorrhage. hematoma. subinvolution. infection (endometritis). thrombosis. mastitis. UTI, cystitis, pyelonephritis. psychosis, PP depression.
hemorrhage: predisposing factoris older age. high parity. rapid labor. prolonged 1st & 2nds stage. forceps delivery. induced delivery. heavy meds. previous uterus atony. placenta abruption/previa. pre-eclampsia/eclampsia. over-distention of uterus.
1st stage of labor dilation. true contractions to dilation of 10 cm. 1st time mom = up to 15 hours.
2nd stage labor pushing stage. up to 2 hours. >2hrs, uterus will be exhausted. more bleedings.
pre-eclampsia and eclampsia r/t a disease process. young teen mothers and older moms. thought of as being a immune-type process. body sees preg as foreign object, tries to get rid of it. Pre = s/sx, no seizure. eclampsia = seizure.
uterine atony have pt void first to be sure the catheter is draining well. massage fundus until firm. hemorrhage may be slow or sudden. monitor vitals. oxygen. bimanual uterine compression.
subinvolution uterus doesn't decreased in size. presistent lochia/fresh bleeding. poor tone.
subinvolution risk factors long labor, anestesia, full bladder, difficult delivery, retained placenta, infection.
PP Hemorrhage. early: uterine atony or laceration of genital tract, 1st hour. late: after 1st hr. retained placental fragements or abnormal involution. lochia doesn't progress through normal stages
Tx of hemorrhage IV fluids/blood replacement. D&C or repair of laceratiom. pitocin/methagine (watch HTN. dont give w/ preeclampsia). antibiotics. pad count. massage uterus. hysterectomy if uterine atony not controlled.
puerperal infection infection of the genital tract. delivery to 10 days PP. most common site: endometrium in uterine cavity. placental site excellent culture medium. tx: fluids & abx.
S/Sx of depression (2 weeks PP) tearfulness, mood swings, insomnia/loss of appetite, social withdrawal, despondency/loss of interest. impaired memory. inability to concentrate. ambivalence about motherhood.
Created by: malysab14