BC3-nursing, postpartum assessment
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| puerperium | the postpartal pperiod, to last 6 weeks after birth. physical and psychological adjustment of mom. body returns to prepregnant state
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| Uterus involution | return of uterus size and location. back to 30 to 60 grams, fundus is unable to be palpated above symphisis by 10 days
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| subinvolution | failure of uterus to return to normal prepregnat size
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| fundus | top of uterus, size of large grapefruit immediately pp
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| location of fundus | pp located midway between symphisis and umbilicus, birth to 6 hours
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| location of fundus pp | by 6-12 hours, fundus rises to umbilicus and decreases 1 fingerbreadth/day until 10 days
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| boggy fundus | hemorrhage
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| fundus high and deviated | full bladder
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| breastfeeding facilitates | involution ( the return of uterus to preppregnant state)
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| Lochia | menstural like discharge postpartum
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| Rubra | dark red lochia days 1-3, contains epithelial cells, erythrocytes, leukocytes, shreds of deciduas
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| serosa | pinkish lochia days 3-10, more serous
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| alba | creamy colored lochia yellowish, lasts 1-2 weeks
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| character of lochia | never absent, foul smelling, or full of large clots, never reverse itself
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| cervical changes | Os closes by 7 days, only admits a finger. Cervical lacerations usually heal if not too extensive.
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| severly lacerated cervix | pp hemorrhage
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| vagina pp | size decreases and rugae return within 3 weeks
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| kegels | ppp exercises to improve tone and contractility of vagina. can do any time, should do often.
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| return of menses | in non-nursing women by 6=10 weeks
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| breastfeeding return of menses | get periods within 30-36 weeks, ovulate in 17 to 28 weeks not a form of birth control
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| perineum pp | swelling and edema may occur, episiotomy may be present, external hemorrhoids may be present related to L &D, bruising can occur.
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| perineum care pp | ice first 24 hours then heat (sitz bath)
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| prolactin and oxytocin | hormones that cause milk production
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| Colostrum | thick creamy substance, before milk comes in, high iin fat, protein, fat soluable vitamins and high level antibodies and immunoglobulins
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| how long is colostrum available | at delivery and for the first 2-4 days
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| transitional milk | replaces colostrum, in breast first 2 weeks of life. contains lactose, water soluable vitamins, elevated levels of fat, more calories than colostrum
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| mature milk | thin apperance, high % of water, protein is lower in breast milk than formula higher in carbohydrates
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| abdomen pp | tone will return in 2-3 months with exercise, stretch marks fade over time
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| GI system pp | sluggish bowel d/t lingering effects of Relaxin (hormone) of if mom had c section
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| Urinary tract pp | at risk for overdistension r/t increased bladder capacity, swelling around urethra, and dec. sensitivity to pressure (epidural)
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| urination pp | needs to void frequently and shouldnt let go beyond 4-6 hours without voiding. Diuresis occurs, increasing urine output and returning blood volume to normal rapidly
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| vital signs pp | postpartum infection suggested by 38C any 2 episodes after 24 hours(100.4 F)
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| BP pp | should remain stable, elevations may be indicative of PIHand decrease may indicate hemorrhage
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| pulse | normal pulse is 60-90, immediately after delivery there may be an increase in pulse, then days 1-6pp, the pulse is a normal bradycardia
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| pp leukocytosis | 15,000-20,000 normal
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| pp HGB | usually drops 2 pts related to blood loss (normal HGB is 12-15)
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| ppH+H | return to normal with reduction of blood volume
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| weight loss pp | 10-12 lbs at birth, return to normal with reduction of blood volume
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| physiologic pp chill | related to vasomotor changes andnervous response to delivery
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| diaphoresis pp | elimination of excess fluid and waste products via perspiration, night sweats often occur
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| Afterpains pp | intermittent uterine contractions, they are more painful in multips. May occur with breastfeeding or administration of methergine
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| taking -in phase | mom- more passive, dependent, needs care for her needs , still focused inward, starting to move out. may need to talk about L& D experience
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| taking-hold phase | after day 2-3 Mother resumes control of her life and body functions. wants to take care of her newborn, seeks information about baby care. may need reassurance
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| postpartum blues | transient period of depression occuring first week or so ppp. related to shift in horemones, exhaustion, discomfort
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| BUBBLE HE HA | Breasts, Uterus, BOwels, Bladder, Lochia, Episiotomy, Homans sign, edema, hemorrhoids, attachment
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| Postpartum infection | any clinical infection infection of the genital canal which occurs within 28 days after childbirth or abortion
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| sites of pp infection | episiotomy, lacerations of vagina or cervix, placental site, c section incision
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| chorioamnionitis | may be a result of PROM it is inflammatory reaction of fetal membranes in response to bacteria/ viruses in amniotic fluid
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| endometritis | usually at placental site, permits the start of the infection. If not treated, and prevented from spreading, it can travel along genital tract, become more extensive and serious
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| symptoms of pp infection | temp of 100.4 or higher on 2 successive days, not counting first 24 hours of birth, accompanied by fatigue, lethargy, lack of appitite, chills, perineal discomfort, lower abdominal paiin, nausea, foul profuse lochia
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| treatment of pp infection | prevention, most effective and cheapest method. fluids and broad spectrum antibiotics breastfeedig may continue
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| mastitis | infection of breasts
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| mastitis symptoms | painful breasts, high fever, chills, low BP
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| mastitis lab findings | entric gram neg. bacteria, usually staph aureus, from the newborns mouth
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| treatment of mastitis | antibiotics, good bra support of breasts, local heat or cold, and analgesics. Encourage continued breastfeeding or pumping breasts
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