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Hormonal changes occur secondary to what in the PP period Delivery of the placenta (and hormones) Change in prolactin secretion
Prolactin ant. pituitary, suppressed by estrogen in pregnancy Increases immediately after delivery - peaks at 3 hours PP Stimulated by suckling - stimulates alveolar cells to produce milk. In non-lactating women - falls to non-pregnant levels at 7-14 days
Oxytocin Produced in hypothalamus, stored and secreted by posterior pituitary Causes myoepithelial cell contraction leading to milk ejection Responsible for contraction and involution of the uterus
Oxytocin release is inhibited by: Fear, anxiety, embarrassment
Oxytocin release is enhanced by: Relaxation, orgasm, baby cry, breast stimulation
Estrogen Decreases rapidly PP with removal of placenta estradiol reaches <2% preg val by 24 h aiding in initiation of lactation
Progesterone 24-48 h: level similar to luteal phase 3-7 d: level = fallicular phase decrease aids in lactation
HPO axis Suppressed in pregnancy Estrogen and progesterone slowly increase and pituitary function resume at 4-6 weeks pp.
Hemoglobin and HCT are affected PP by: Hydration, fluids retained in labor and reduction in blood volume
9 predisposing factors for thromboembolic disease in the PP woman Venous stasis from dilation of vein and compression of uterus Prolonged bed rest Lack of activity or ambulation Hypercoagulation disorders Instrument assisted and cesarean birth Hemorrhage Sepsis Multiparity Advanced maternal age
Blood loss: - 1 pt drop in HCT = - 1 pt drop in HGB = HCT - 250 ml HGB - 500 ml
Renal pelves and ureters return to normal by: 4th PP week
Bladder is edematous and hypotonic immediately PP resulting in: Over distention and incomplete emptying - encourage periodic voicing
What % of women have non-pathologic proteinuria up to 2nd day PP? 40%
Diuresis begins______ _______ _______ and lasts up to the ___ PP day? Shortly after delivery 5th
Urine output may equal _______mL/D PP 3000 mL
Urinary incontinence may persist up to _____ postpartum 6 months
What are the 3 processes to uterine regeneration? What speeds up the process? Contractions, autolysis, and placental site regeneration Breastfeeding
Immediately following delivery uterus is at?________ at 1-2 hours uterus is at?________ Uterus descends __ finger breadth/d? At 2 weeks uterus is approximately __ week size. Uterus is at the non-pregnant size at ____ to ____ weeks PP? 2/3 btw pubis and umbilicus umbilicus or 1 fb below 1 12 week 4-6 weeks
Endometrium takes ___ weeks to regenerate? Placental site takes ___ weeks to regenerate? 3 weeks 6 weeks
Lochia arises from the? Superficial layer of the uterine decidua
Lochia rubra lasts___ days Color? Contains mostly? 4 days Bright red Blood
Lochia Serosa lasts __ days Color? Composed of? 22 days pink serous fluid, decidual tissue, leukocytes and erythrocytes
Lochia Alba lasts ___ days Color Contains: 7 days Whitish erythrocytes and decidua
Mean duration of lochia is __ days but can last up to __ days 33 days 60 days
Engorgement may occur btw the __ and ___ PP day and resolves in _______ hours 2nd and 4th 24-48
Resumption of ovulation is associated with a rise in? Plasma progesterone
Initial menses following delivery is anovulatory in 75% of women
Breastfeeding - prolactin Secreted by: Influence in PP State Anterior pituitary Stimulated alveolar cells to produce milk; initiates lactation with suckling; inverse relationship btw catecholamines and PRL
Breastfeeding - Prolactin inhibiting factor Secreted by: Influence PP: Hypothalamus Suppresses release of prolactin
Breastfeeding - Oxytocin Secreted by: Influence in PP Posterior pituitary "Milk ejection" reflex
Breastfeeding - Estrogen Secreted by: Influence PP: Ovary and placenta Blood levels decrease and initiation of lactation associated
Breastfeeding - Progesterone Secreted by: Influence PP: Ovary and placenta Blood levels decrease and initiation of lactation associated
Breastfeeding - ACTH Secreted by: Influence PP Anterior pituitary High level believed necessary for maintaining lactation (milk synthesis and release)
Breastfeeding - HPL Secreted by: Influence on PP Placenta Not applicable to PP but stimulated mammary growth of alveoli in non pregnant/pregnant state
Breastfeeding - Thyroxine Secreted by: Influence on PP Thyroid Important in maintaining lactation by control of metabolism; direct effect on mammary glands
Breastfeeding - thyroid releasing hormone Secreted by: Influence on PP Hypothalamus Stimulates release of PRL; can be used to maintain lactation
Breastfeeding - Growth hormone Secreted by: Influence on PP Anterior Pituitary may act with prl in initiation of lactation May act with thyroxine to potentate milk yield; most important in maintaining lactation
PP PE Breasts Observe presence of engorgement, lumps, red streaks Observe integrity of nipples Check presence of colostrum or milk BF women will have glandular hypertrophy Hyperpigmentation may be permanent
PP PE Uterus Assess position of uterus in relation to pp day If enlarged or displaced, reevaluate after void Assess tenderness, and fundus for firmness
PP PE Perineum Lie on side for visualization Inspect laceration/epis, integrity of sutures,hemorrhoids/hematoma Perineum edematous and bruise at dx - returns to nl at 2 weeks pp - may remain tender to palpation suture visible at 6 weeks Encourage perineal hygiene.
REEDA is Redness, Edema, Ecchymosis, DIscharge, approximation
PP PE Lochia Assess amt, color and odor Signs of possible problem: lochia malodorous, becomes heavier and bright red; associated with abdominal pain or fever Bleeding may increase temp. with activity
PP PE Bladder Assess UO, dysuria, ability to void and edema r/t lacerations birth related trauma usually resolves within 24 hours Cath may be necessary for distention, increased bleeding or edema interfering with voiding
PP PE Extremities (exam of legs) Place foot flat and knees slightly bent Palpate both sides of legs for varicosities, calf tenderness and heat Inspect for edema, redness Homan's sign
PP PE Vital Signs BP and Pulse Q 15 min X 2 hours after delivery Temp: slight increase; normal w/i 24 h Pulse - Normal (>100 indicates infection or hemorrhage) Resp: Normal 12-20/min BP: transient rise but should resolve to pre-preg over a few days
Rubella immunization If prenatal titer <1:10 (non immune) 0.5 mL subcutaneously
RhoGAM administered to: Rh negative mom if: Infant Rh positive Mother not sensitized to Hr D antibodies Infant has a negative direct autoagglutination test -Administer within 72 hours
Perineal pain management Ice packs prn x 24-48 h Topical anesthetic prn Witch hazel Stiz bath, cold or hot Analgesia (Ibuprofen, acetaminophen, tylenol 3 or percocet)
Constipation managment Common after extended labor and NPO or fear d/t extensive laceration Docusate sodium 50-100 mg oral qd or bid increase fluids and fiber
Afterbirth pain management and cause Cause: continuing contraction and relaxation of uterus More common with increased parity Triggered by oxytocin Keep bladder empty Ibuprofen (anti-inflammatory)
Non-lactating breast care: Pharmacologic agents not recommended by FDA Moderate to severe pain Tight fitting bra or ace wrap Ice Avoid nipple stimulation Discourage expression of milk Mild analgesics Cabbage leaves
Sore nipples Presentation and management Pink, burning nipples related to nipple stretching, peaks at 3-4 d pp. Air dry, correct positioning/breaking of suction, apply EBM/colostrum, treat thrush, least sore side first, ice for engorgement/pain relief, apap 30 min before feeding.
Cracked nipples Presentation and management Blistered, scabbed, cracked d/t trauma Air dry, correct position/breaking of suction, apply ebm/colostrum, treat thrush, least sore side 1st, Ice, apap 30 min prior to feed.
Engorgement Presentation and management Usually temporary, tight, red, shiny skin; occasional fever up to 101, usually pp day 3-5, pain. Use good bra, facilitate drainage, anti-inflammatory, heat before bf, cold after bf, feed q2h, cool cabbage leaves pump to reduce milk buildup.
Low milk supply Presentation and management infant wt loss >7%, infant with concentrated urine, dry hard stools, lethargy, dry MM extra feeds/pumps/pump after feed, skin to skin during pump, stop smoking, evaluate mom for endocrine abnormalities, reglan protocol, acupuncture, fenugreek.
Created by: 1012021766



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