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postpartal
MCN postpartal adaptation
Question | Answer |
---|---|
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 |