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OB - postpartum
test 2
| Question | Answer |
|---|---|
| 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
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