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MCN postpartal adaptation

puerperium postpartal period, woman readjusts, physically and psychologically, from pregnancy and birth. occurs immediately after birth until approx 6wks.
reproductive changes involution of uterus, cervical changes, vaginal changes, perineal changes, recurrence of ovulation and menstruation.
cervical changes cervix is flabby, formless, and may appear bruised. shape of external os is permanently changed, closes slowly takes about a week.
involution of uterus rapid reduction in size and return of the uterus to nonpregnant state. decidua is irregular, jagged, & varied in thickness. outer most layer becomes necrotic and sloughed off in lochia. exfoliation occurs.
exfoliation of placental site heals the placental site. very important aspect of involution, if healing leaves scar the area for future implantation is limited, as is the # of possible pregnancies.
changes in fundal position immediately after birth contracts to size of large grapefruit,within 6-12h rises to umbilicus because of blood and clots in uterus. boggy uterus is no good. decreases 1 finger breadth per day
boggy uterus soft, spongy assoc. with excessive uterine bleeding.
subinvolution and slowing of descent of fundus. caused by infection, fever, tachycardia, oversized uterus
lochia rid of uterus debris. classified according to color.
lochia ruba dark red. first 2-3 days, epithelial cells, RBC, WBC, shreds of decidua, occasionally meconium, lanugo, and vernix. few small clots common.
lochia serosa pinkish color. days 3-10. same as ruba plus, serous exudate, microorganisms
lochia alba persists a week or two. WBC, RBC, decidua, fat, cervical mucus, cholesterol crystals, and bacteria
vaginal changes appears edematous and may be bruised, small lacerations may be evident, vagina decreases and rugae return within 3-4wks
perineal changes appear edematous and bruised, episiomoty or lacertation edges should be drawn together. healing occurs 2-3wks after birth. complete healing may take 4-6mths
recurrence of ovulation and menstruation varies, nonbreatfeedig 6-8wks, breastfeeding 3months(assoc. w/ rise in estrogen levels, breastfeeding alters GnRH
abdominal wall loose and flabby, stretched, responds to exercise in 2-3months, diastasis recti abdominis (separation of muscles)striae present
lactation breast development in preparation for lactation results from influence of estrogen and progesterone. after birth interplay of maternal hormones lead to milk production. increase 2/3 level
GI system hunger and thirst proceed birth. bowels sluggish due to lingering progesterone, decrease ab tone, and bowel evacuation assoc w/ labor
urinary tract increased bladder capacity, swelling and bruising of tissue, decreased sensation of bladder, risk for overdistention. puerperal diuresis
vital signs fever 38C after 24h should be concerned, BP stable, if decrease may be hemmorhage
blood values I coagulation and immobility @ risk DVT, I WBC, blood loss 250-500mL, C section 1000mL
weight loss wt loss 10-12 lbs from birth, diuresis additional 5lbs, 6-8wks to reach prepregnant wt. if gained average wt. of 25-30lbs
postpartal chill common with trauma, blood loss, hard work of delivery, placental separation, reaction to epidural, vasomotor changes
postpartal diaphoresis caused by elimination of excess fluid and waste via skin produced increased perspiration. night sweats, protect mom from chilling
taking-in passive, dependent, follows decisions, hesitates making decisions, food and sleep are major needs.
taking-hold worry about techniques, failures, feels unsure or tentative, requires assurance that shes doing well, good time to teach
maternal role attainment woman learns mothering behaviors and become comfortable with her identity, form relationship w/ child, binds in to the infant
4 stages of maternal role attainment anticipatory stage(during pregnancy), formal stage(begins at birth), informal stage(mom makes choices), personal stage("mother")
postpartum blues few days in 70%,1-2wk transient, mood swings, anger, weepiness, anorexia. caused by changing hormones, psychologic adjustments, insecurity
social support family relationships important, talk more w/ other parents, support groups are helpful for lack of support system
urinary output blader should be non-palpable and non-distended. high output 2000-3000ml, takes 2-3 days to get rid of. void q4-6h of 150mL
breasts get bra size one size too large
latch milk takes 2-3days to come in. breasts will be soft,filling,full,or engorged. milk everted, falt, or inverted. intact or cracked
tx of engorged breasts ice, cabbage, bra 24/7, binder, tylenol, no meds work
lower extremities risk DVT, watch for pain, redness, and warmth. assess Homans sign
nutrition and fluid extra 500k/cal per day for breastfeeding
sleep daily rest periods, sleep when baby sleep
activity sex 4-6wks, fatigue may consist for months, depends on culture, use support for household chores
immobility and muscle strain encourage early ambulation, watch orhtostatic hypotension, feed and give fluids prior to walking
alterations in body image hardest for the adolescent parents
rubella vaccine 1st postpartal visit, needs MMR and cant get pregnant for 3 months if levels less than 1-10
RHIgG-RHOGAM RH+ baby and RH- mom, 72h w/in birth to pretect next pregnancy
promotion of well being after C-section pain mamagement(duramorph work 24h), mobility w/in 24h, s/s of deression, teach(full 6wk recovery, incision care)
follow-up care mom-1-2wks on phone, 6wk check-up, baby 2days-2wks
discharge vaginal-48hours, C-section 96h
infertility cannot get pregnant for a year of having sex without contraception, 40%male, 40%female, 20%other reasons
tests of womens fertility BBT, endometrial biopsy, hormonal assessment, transvaginal u/s, cervical factors, uterine factors
BBT check temp daily for ovulations, occurs when 0.5-1F increase
endometrial biopsy check progesterone levels after 10-12 days ovulation
hormonal assessment FSH,LH,progesterone,TSH,prolactin,androgen
transvaginal u/s follicular monitor, time of ovulation
cervical changes ferning, spinbarkite-clear, stringy, and sticky, means ovulation , looks like egg white
uterine factors HSG-radiopaque to see problems in uterus, hysteroscopy, laproscopy(rule out endometriosis)
test of mans infertility semen analysis-sperm count, motility, quality (morphology)
managing infertility pharmacologic agents, therapeutic donor insemination, assisted reproductive technique, embryo cryopreservation, IVF w/ donor oocytes, gestational carrier, surrogate mother, adoption
Created by: gudknecht