test 2
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| puerperium | period of recovery from childbirth. lasts about 6 weeks. return of body systems to non-pregnant state.
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| phases of postpartum - immediate | 1st 24 hours. mother's body has prepared itself for this delivery, so she has 2x blood volume. able to withstand this loss of blood (but she can still hemorrhage).
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| phases of postpartum - early | 1st week. go home, breastmilk comes on day 4-5. engorgement, moodswings. make sure attachment/bonding is occuring. mental status: how are her moods? how is she adapting?
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| phases of postpartum - late | 2nd-6th week. watch moods.
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| involution | process in which uterus returns to pre-pregnant state. contraction of uterine muscles. autolysis.
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| autolysis. | self digestion, protein materials are broke down, absorbed, and cast off.
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| involution: postpartum (right after birth) | uterus 2 fingerbreaths below U. will stay like this for 8-10 hours. feels like big grapefruit.
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| involution: 8-10hr postpartum | pitocin starts to leave system, uterus comes back to U, can be 1 fingerbreath above. will decreased to 1-2 below the U until it is back in the pelvis and no longer palpable.
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| involution process | compression of intramyometrial bloow vessels. muscle contraction rather than platelet aggregation & clot formation. uterus should remain firm & well contracted. pitocin after expulsion of placenta. mathergine IM or PO may be used.
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| mathergine | wrks more precisely than pitocin by constricting the blood vessels. increases BP. not the drug of choice for mother's with high BP.
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| after pains | period of relaxation & vigorous contraction. more intense in multipara, mother of multiples, retained clots, breastfeeding moms.
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| placental site | vascular constriction & thrombosis/irregular nodular & elevated area. upward growth of endometrium caues sloughing of necrotic tissue. prevents scar formation. regeneration of placenta site - 6 weeks
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| lochia | postchildbirth uterine discharge.
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| lochia rubra | delivery to 3 days. pink to red. more noted with vaginal than C/S. rule of thumb: no intercouse until lochia has stopped.
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| lochia serosa | 3-10 days. pink to brown.
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| lochia alba | 10 days + up to 6 weeks. yellow to white.
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| cervix | soft immediately after birth. by 18hrs, shortens, firms, and regained form.
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| ectocervix | fragile, bruised, small laceration.
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| endocrine system changes | dramatic decrease in estrogen (depression), progesterone (depression), human clacental lactogen, human chronic gonatrophin. pacental enzyme insulinase (reverses the diabetogenic effects of pregnancy).
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| prolactin levels | decreased in non-lactating moms. increased in lactating women (into the 6th week in response to infant sucking, suppresses ovulation. NOT a birthcontrol method!).
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| urinary system | increased renal function, steroid related.mild proteinurine, related to autolysis. postaprtal diuresis & diaphoresis. urethra & bladder may have birth induced trauma. difficulty urinating, distensions, bladder tone restored 5-7 days.
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| gastrointestinal system | appetite returns quickly. vaginal can eat right away. C/S - wait for bowel sounds to return.
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| breast | bresatfeeding: colostrum from 24-48 hours THEN breastmilk. milk continues until weaned. engorgement.
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| cardiovascular system | blood volume almost 2x by delivery (estrogen causes this). can loose up to 1000cc w/o shock.
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| vital signs | 15 min x2, Q 1hr x2, Q4 up to Q8.
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| hematologic changes | blood loss (300-400 vaginal; 1000 c/s). leukocytosis (WBC 15-20,000. normal 5-10,000). RBC decrease gradually. extracellular fluid may increase hematocrit and hgb.
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| Hct | UP. 38-40. dont want this to go down. means there is hemorrhage.
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| Hgb | UP. 18. don't want this to go down.
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| recurrance of ovulation and menses | nonbreastfeeding, 6-8 weeks. breastfeed, 12 weeks after delivery.
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| 1st hour PP Recovery | vital signs Q 1 5 mins. assess uterus firmness, location. assess bleeding. skin. leg movement if epidural. bladder (1st voiding). IV fluids, meds, etc.
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| BUBBLE HEE | Breast (tender, engorged, nippled). Uterus (position, contractility). Bladder (distention). Bowels (constipation, hemorrhoids). Lochia (type, amount). Epistomy (swelling). Hemorrhoids. Extremities (redness, Homan's sign).
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| nursing implications. | postpartum assessment. aseptic technique. adequate fluids & diet. supportive. education - self & infant. Rh factors. rubella vaccine.
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| Rhogam | must be given by 24-72 hours PP. kills antigens, stops body from building antigens. wont work after 72 hours (she has already built the antibodies).
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| Rh factor | mom Rh-, dad Rh+, baby Rh+ delivery, placenta comes out, blood supplies meet, positive can get inside moms blood, her body builds imunity against Rh, bad for subsequent pregnancies.
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| checking episiotmy - REEDA | Reness. Edema. Ecchymosis. Discharge. Approximation.
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| signs/symptoms of infection | takes 48-72 hr to set in. fever (≥101). malaise. purulent discharge. foul lochia. pain. rapid pulse. chills.
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| PP Complications | hemorrhage. hematoma. subinvolution. infection (endometritis). thrombosis. mastitis. UTI, cystitis, pyelonephritis. psychosis, PP depression.
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| hemorrhage: predisposing factoris | older age. high parity. rapid labor. prolonged 1st & 2nds stage. forceps delivery. induced delivery. heavy meds. previous uterus atony. placenta abruption/previa. pre-eclampsia/eclampsia. over-distention of uterus.
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| 1st stage of labor | dilation. true contractions to dilation of 10 cm. 1st time mom = up to 15 hours.
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| 2nd stage labor | pushing stage. up to 2 hours. >2hrs, uterus will be exhausted. more bleedings.
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| pre-eclampsia and eclampsia | r/t a disease process. young teen mothers and older moms. thought of as being a immune-type process. body sees preg as foreign object, tries to get rid of it. Pre = s/sx, no seizure. eclampsia = seizure.
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| uterine atony | have pt void first to be sure the catheter is draining well. massage fundus until firm. hemorrhage may be slow or sudden. monitor vitals. oxygen. bimanual uterine compression.
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| subinvolution | uterus doesn't decreased in size. presistent lochia/fresh bleeding. poor tone.
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| subinvolution risk factors | long labor, anestesia, full bladder, difficult delivery, retained placenta, infection.
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| PP Hemorrhage. | early: uterine atony or laceration of genital tract, 1st hour. late: after 1st hr. retained placental fragements or abnormal involution. lochia doesn't progress through normal stages
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| Tx of hemorrhage | IV fluids/blood replacement. D&C or repair of laceratiom. pitocin/methagine (watch HTN. dont give w/ preeclampsia). antibiotics. pad count. massage uterus. hysterectomy if uterine atony not controlled.
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| puerperal infection | infection of the genital tract. delivery to 10 days PP. most common site: endometrium in uterine cavity. placental site excellent culture medium. tx: fluids & abx.
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| S/Sx of depression (2 weeks PP) | tearfulness, mood swings, insomnia/loss of appetite, social withdrawal, despondency/loss of interest. impaired memory. inability to concentrate. ambivalence about motherhood.
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