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