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OB Exam 2
Ch 15 Postpartum Adaptations
| Question | Answer |
|---|---|
| striae and linea lighten but | do not go away |
| summary of postpartum changes | psychological: PPD vital signs integumentary/endocrine: thyroid GU/GI: diuresis, constipation cardiovascular: blood volume and components reproductive: uterus/lochia, perineum, breasts |
| diuresis begins | post delivery with vaginal with vacuum or c section |
| Physiological Changes: Reproductive System | uterine involution cervix vagina perineum |
| uterine involution | the natural process where the uterus shrinks and returns to its pre-pregnancy size and shape after childbirth |
| uterine involution: afterpains | can be comparable to birthing pains the more births, the higher the pain |
| uterine involution with multiple fetus | need to contract harder |
| placenta delivery does not include | all placental lining which is why there is bleeding bleeding at spot where the uterus was |
| uterus decreases in size | every day postpartum |
| uterus can contract more quickly when | mom is breast feeding because sucking triggers oxytocin release |
| uterine involution: lochia | shredding of endometrial lining lochia means red |
| cervix before and after birth | when there had been a previous birth or early abortion, the os becomes more slit like if this is the first birth, the os is more circular and there is no slit |
| at first, the cervix is | bruised and edematous |
| when does the cervix return to more normal appearance | by 6th week pp, tends to look more normal, pink/glistening/red |
| after birth, the os | is never the same! |
| vagina returns to approximate pre-pregnancy size by | 6-8 weeks pp |
| perineum usually | suffers the worst! |
| how long for the perineum to completely heal | 4-6 months |
| uterine involution is the | Retrogressive changes that return uterus to pre-pregnancy size |
| how should uterus descend | moving back into uterine cavity, descends from umbilicus 1cm/day |
| what day is the uterus half way to pre pregnancy size | day 6 |
| what day is the uterus finished with it's complete descent | day 10, back into pelvic cavity |
| unlike cervix, the uterus | returns to pear like size |
| when are you able to palpate fundus | until it gets close to the linea terminalis |
| uterine involution process is | sequential |
| subinvolution | Failure of uterus to return to nonpregnant state |
| what does subinvolution result from | ineffective uterine contractions, something prevented them from happening |
| most common causes of subinvolution | any part of placenta retained, either of the membranes contribute to subinvolution infection from RoM polyhydramnios and multiple fetuses |
| what to make sure of the placenta when it's delivered | make sure everything is intact because if something is missing then, its retained and there will be subinvolution |
| Involution involves more | contractions aka afterpains |
| primary mechanism for preventing hemorrhage | Constriction of myometrial blood vessels |
| inadequate contractions will result in | uterine atony which will cause bleeding |
| pain management for afterpains include | ibuprofen, acetaminophen if due to infections, broad spectrum abx |
| full bladder and afterpains | a full bladder can also contribute, so ask when they last voided |
| if uterus is tilted towards the R and not midline, then | there is bleeding |
| lochia is | Vaginal discharge that occurs after birth for 4 – 6 weeks PP |
| lochia results from | involution |
| lochia decreases | progressive lightening of color and amount, there are 3 stages |
| what does lochia color changing result from | changing composition of tissue sloughed off in endometrial restoration |
| c sections have less lochia because | uterine debris is manually removed (suctioned) |
| 3 stages of lochia | lochia rubra lochia serosa lochia alba |
| lochia rubra | bright red, days 1-3 |
| lochia serosa | pinkish/brown/rust like, days 4-10 |
| lochia alba | whitish/yellow, days 10-14/4-6 weeks pretty much clear |
| lochial bleeding | Trickle from vagina May also gush during uterine massage Dark color suggests pooling |
| lochial bleeding pooling | as they flood with blood, under neath the cervix will pool a lot of times |
| non lochial bleeding | Bleeding from vagina when uterus is not contracted, uterus feels boggy Excessive and bright red |
| when bleeding and the fundus doesn't contract, | have them void |
| vagina can experience | dryness |
| episiotomies/lacerations | take time to heal generally don't do episiotomies anymore |
| hemorrhoids because | constipation and strain to push |
| pelvic muscular support | pelvic muscles are sling like and if pressure is on them, can function unwell and not support the uterus which leads to a poorer quality of life |
| kegel exercises | way to strengthen the pelvic muscles you hold when you have to void so you build up more muscle there |
| breasts/lactation | Secretion of milk by the breasts Brought on by hormones (estrogen, progesterone, prolactin, oxytocin) |
| colostrum appears | first and is liquid gold! |
| when does breast milk come in around | 4-5 days PP |
| suppression of lactation | no universal guideline, risk is engorgement |
| engorgement | postnatal physiologic painful condition in which distention and swelling of the breast tissue occur as a result of an increase in blood and lymph supply as a precursor to lactation |
| support for mom not breast feeding | wearing a tight-fitting bra, apply ice to breast, relieve engorgement with warmth/shower, avoid stimulation |
| sequence of breast feeding | newborn sucking on breasts stimulates the pituitary gland causing the release of prolactin causing the synthesis and release of breast milk and oxytocin which causes contraction of the smooth muscle in the uterus and around the alveoli cells in the breast |
| when estrogen and progesterone are decreasing, | oxytocin and prolactin are increasing |
| colostrum appearance | thick and yellow, as additional milk enters the breast it turns to breast milk |
| best intervention for engorgement | move milk out with pump or have baby suck as well as can because engorgement makes baby not able to latch |
| Cardiovascular Changes | dramatic changes occur after birth (just as in pregnancy) CO gradually decreases Varicosities regress |
| postpartum mothers will have | more night sweats to get volume down |
| blood components | hgb/hct: hgb has a small drop but is not significant WBC clotting factors significantly increase so impact of blood loss isn't so significant |
| average blood loss for c section | 1000mL |
| urinary system changes | Immediately after birth, risk for incomplete emptying, bladder distention, difficulty voiding, and urinary retention |
| remind mom to void | q2-3 hrs pp |
| postpartum diuresis begins | within 12 hrs pp and lasts through 1 week |
| postpartum moms can have | stress incontinence |
| GI changes | constipation is a problem even though progesterone is decreasing, due to hormonal changes/not eating/decreased bowel sounds with epidural and spinal |
| what to do for client with GI changes | Client will need food & hydration to begin to replenish body Give fiber, IVF, med/laxative |
| musculoskeletal changes | Joints return to pre-pregnancy size except for feet Women are fatigued and activity intolerant for a few weeks --- connect to teaching needs Abd. Muscle tone diminished |
| Integumentary changes | Hyperpigmentation fades as hormone levels return to prepreg states Postpartum hair loss may be experienced Stretch marks fade to silvery lines Sweating is one of the most noticeable adaptations - way to get fluid out |
| Endocrine System changes | Estrogen & progesterone drop quickly Placental hormones decline Prolactin levels decline w/in 2 weeks if not breastfeeding |
| ovulation and return of menstruation differs between | breastfeeding & non-breastfeeding women |
| ovulation and return of menstruation in nonlactating moms | takes 6-8 weeks to have something like a period |
| ovulation and return of menstruation in lactating moms | takes several months to get ovulatory pattern back |
| Ovulation may occur before menstruation, therefore | breastfeeding is not a totally reliable method of contraception have this convo PRIOR to d/c!! |
| HR | decreases to normal range 60-80 |
| BP | WNL, orthostatic hypotension |
| RR | WNL |
| temp | slight elevation in 1st 24 hours bc increase in WBC 100.4 |
| Nursing Theory: Maternal Role Attainment (Rubin) | 1. taking in 2. taking hold 3. letting go |
| first step: taking in | moms are dependent on support! Time immediately after birth when client needs others to meet her needs & relives the birth process |
| second step: taking hold | Dependent at first and transitions into independent maternal behavior |
| third step: letting go | Reestablishes her relationships with others as mom moves forward with pp, you can d/c |
| pp psychosocial assessment | interactions with others level of independence energy eye contact with infant posture and comfort level with infant sleep and rest patterns mood/affect |
| partner adaptations | Time of great change Influenced by many factors Nurses can promote degree of involvement & encourage active participation Engrossment |
| Engrossment | partner's developing time with newborn – time of intense absorption, preoccupation, & interest |
| 3-Stage Role Development Process: | 1. Expectations 2. Reality 3. Transition to Mastery |
Created by:
leh195