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Post partum

Involution Rapid reduction in size and the return of the uterus to a non pregnant state. within 48-72 hrs after birth.
Factors that retard uterine involution Prolonged labor, anesthesia, multiparity, full bladder, incomplete expulsion of placenta, infection, overdistention of bladder.
Fundal position Immediately after delivery of placenta-top of fundus is midline and halfway between the symphysis pubis and umbilicus. 6-12 hrs postbirth, fundus will be at the level of umbilicus, and then decreases about one finger breadth each day.
Sub involution Slowing of descent
Lochia Rubra-first 2 to 3 days Serosa- day 3-10 Alba-addtl week or two
Diastasis recti abdominis Separation of the abdominal muscle may occur with pregnancy, especially in women with poor abdominal muscle.
Hematologic changes -postpartum Hct rises, WBC elevated (12000-25000)
Nursing plans and interventions A. monitor VS Q4hrs x24hrs then Q8hrs B. Check fundal height and firmness C. Assess and doc. lochia
Common cause of uterine atony after the first post partum day Retained placental fragments.
RhoGAM Prevention of Rh isoimmunization with next pregnancy. Given to Rh neg women. Given postpartally when fetus is Rh pos. Must be given within 72hrs IM. Given at 28weeks gestation to Rh neg mothers with a neg antibody titer.
What does a boggy uterus that is displaced above and to the right of the umbilicus mean, what nsg action is needed? Bladder distention is detected, perform fundal massage.
After pain is more common in which clients Breast feeding women, multiparas and women with over distention of the uterus.
Common cause of uterine atony in the first 24 hrs Full bladder
Three signs of positive bonding between parents and new born Calling infant by name, exploring newborn head to toe, using en face positon.
Differentiate cystitis from pylonephritis Pylonephritis has the same symptoms as cystitis (dysuria, frequency and urgency) with the addition of flank pain, fever and pain at costovertebral angle.
Signs of endometritis Subinvolution(boggy high uterus), lochia returning to rubra with foul smell, temp-100.4 or higher, unusual fundal tenderness.
Nursing action taken during post partum hemorrhage Fundal massage, notify MD if massage does not firm fundus, count pads to estimate blood loss, assess and record vital signs, increase IV fluids and administer oxytocin
Nursing interventions for post partum infection encourage early ambulation, change peripads frequently, provide adequate nutrition and fluids, monitor for sings of infection, admin antibiotics if ordered
Nursing interventions for post partum depression Encourage verbalization of feelings, assess potential for suicide, support groups
Created by: roseiv2014