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PP Ch. 17

Study guide- PP physiologic adaptations

Describe PP changes in uterine muscle Stretched uterine muscle fibers contract & gradually regain former size & contour
Describe PP changes in uterine muscle cells # of uterine cells remains the same, but each cell decreases in size through catabolism
Describe PP changes in uterine lining outer area of endometrium(decidua) is expelled w/ placenta. Remaining decidua separates into 2 layers: Superficial layer is shed in lochia & basal layer regenerates new epithelium
contains blood, mucus & bits of decidua, is red or red-brown color & has a duration of approximately 3 days Rubra
Contains serous exudate, erythrocytes, leukocytes & cervical mucus, is pinkish or brown-tinged, duration from day 4- day 10 Serosa
Contains leukocytes, decidual cells, epithelial cells, fat, mucus & bacteria, is white, yellow or cream color & duration is from day 11 & can last 3-6wks PP Alba
Describe effects of BF on uterine involution BF stimulates oxytocin from pituitary gland which intensifies afterpains, bt also maintains better uterine contraction which facilitates uterine involution
Describe effects of BF on sexaul intercourse Lactation suppresses ovulation & estrogen secretion, causing more vaginal dryness than nonlactating moms have. May cause pain during intercourse unless a lubricant is added
What is significance of bradycardia during early PP period? Normal. Blood volume & cardiac output increase as blood from uteroplacental unit returns to central ciruclation & as excess extracellular fluid enters vascular compartment for excretion. Because stroke volume increases, pulse decreases
What makes any pregant or PP woman at risk for bentous thrombosis & what factors increase risk? higer fibrenogen levels increase ability to form clots, but factors that break down clots are not increased. Vericose veins, hx of thrombophlebitis or C/S birth have additional risks above baseline
How does leukocyte level change during early PP period & how would this leve be interpreted for nonpregnant woman? Leukocytes(WBC) increase up to 30,000, with an avg of 14-16,000. In a nonpregnant women the level is 5-10,000 so the higher level would indicate infection
Explain how a full bladder shortly after birth can lead to PPH. Full bladder moves uterus from normal position & interferes with uterus ability to contract firmly & occlude open vessels at placental sites, allowing them to bleed freely. (it allows uterine atony)
Why are PP women at risk for UTI? Increased bladder capacity & decreased bladder tone along w/ rapid diuresis may cause urinary retention. Stasis of urine increases risk of bacterial growth.
When can women expect their menses to resume if they are BF? If not planning to breastfeed?? BF moms may not resume menses for 12wks-18mths, depending on length & frequency of BF, but lactation is not a good form of contraception. Formula feed will prob begin menses between 7-9wks PP.
Describe influence of hormones on lactation Estrogen & progesterone prep the breasts for lactation, Porlactin initiates milk production in alveolis, Oxytocin causes milk ejection from alveoli into lactiferous ducts
What RN measures help suppress lactation & manage discomfort of breast engorgement? Tell mom to wear well-fitting bra/sports bra 24h/day. Ice & analgesics reduce discomfort & need to avoid actions that stimulate milk production such as spraying with warm water during showers or pumping/massaging breasts
Describe proper technique to massage a soft fundus. How should the nurse expel clots? NONDOMINANT hand above symphysis pubis, massage fundus with DOMINANT hand until firm. When firm, press firmly to expel clots. DO NOT EXPEL CLOTS BEFORE FIRM. (see pg. 403 table 17-1)
What teaching should you provide the PP woman to prevent constipation? Increase activity progressively, drink adequate fluids(min 8 glasses water/day, add dietary fiber(fruits, veggies,whot grains, bread & pasta) to prevent constipation. Prunes are a natural laxative
What S/S should the PP woman repot to MD/midwife? Fever, localized area of redness, sweling or in pain in breast unrelieved by support/analgesics, presistent abd tenderness or feelings of pelvic fullness/pressure, persistent perineal pain, s/s uti, change in lochia(full list pg 418)
PP Assessment Look over pgs 400-406
Created by: L.moore