[19] MIDTERMS | POSTPARTUM P1 Flashcards
1
Q
Six week period after childbirth
A
POSTPARTUM
2
Q
“4th trimester of pregnancy”
A
PUERPERIUM
3
Q
PUERPERIUM
- Latin word
- ____ - “child”
- ____ - “to bring forth”
A
PUERPERIUM
- Latin word
- Puer - “child”
- Parere - “to bring forth”
4
Q
PSYCHOLOGICAL CHANGES OF THE POSTPARTAL PERIOD
- “childless or “parents of one”
- new role as parents (parenthood)
A
TRANSITION PHASE
5
Q
PHASES OF THE PURPERIUM
- “time of reflection”
- passive
- dependent
- “birth experience”
A
TAKING IN PHASE
6
Q
PHASES OF THE PURPERIUM
- initiates action
- Greater independence
- ideal for teaching
A
TAKING HOLD
7
Q
PHASES OF THE PURPERIUM
- Giving up:
old role
previous lifestyle
ideal birth experience - Readjustment of relationships
A
LETTING GO
8
Q
MATERNAL CONCERNS & FEELINGS IN THE POSTPARTAL PERIOD
- feeling abandoned & less important after giving birth
A
ABANDONMENT
9
Q
MATERNAL CONCERNS & FEELINGS IN THE POSTPARTAL PERIOD
___ in the baby in terms of the baby’s sex, size or look may be experienced by parents or partners
A
DISAPPOINTMENT
10
Q
- conflicting feelings of joy & emotional letdown during first few weeks after birth
- evidenced by tearfulness, feelings of inadequacy, mood lability, anorexia & sleep disturbance
A
POSTPARTUM BLUES OR BABY BLUES
11
Q
POSTPARTUM BLUES OR BABY BLUES
MOOD ELATION / DEPRESSION
- Fluctuating ____
- response to dependence & low self-esteem ____
- being away from home
- physical discomfort
- ____ engendered by assuming a new role
- Not having support from the partner
A
MOOD ELATION / DEPRESSION
- Fluctuating hormones
- response to dependence & low self-esteem exhaustion
- being away from home
- physical discomfort
- tension engendered by assuming a new role
- Not having support from the partner
12
Q
PSYCHOLOGICAL ADJUSTMENT- Maternal Role Attainment
- Occurs during pregnancy
- Woman looks to role models, especially her mother
- How to mother
A
(1) ANTICIPATORY STAGE
13
Q
PSYCHOLOGICAL ADJUSTMENT- Maternal Role Attainment
- Begins when the child is born
- Woman is still influenced by the guidance of others
- Tries to act as she believes others expect her to act
A
(2) FORMAL STAGE
14
Q
PSYCHOLOGICAL ADJUSTMENT- Maternal Role Attainment
- Begins when the mother begins to make her own choices about mothering
- Begins to develop her own style of mothering and finds ways of functioning that work well for her
A
(3) INFORMAL STAGE
15
Q
PSYCHOLOGICAL ADJUSTMENT- Maternal Role Attainment
- Final stage of maternal role attainment
- When woman reaches this stage, she is comfortable with the notion of herself as a mother
A
PERSONAL STAGE
16
Q
INFLUENCING FACTORS
- S____
- A____
- P____
- M____ relationships
- A____
- Previous ____
- S____ status
A
INFLUENCING FACTORS
- Social support
- Age
- Personality traits
- Marital relationships
- Anxiety / Depression
- Previous child care skills
- Temperament of infant
- Socio-economic status
17
Q
CHALLENGES OF THE POSTPARTAL WOMEN
- Finding ____ for themselves
- Feelings of ____
- F____
- Feeling of ____
- Finding time for their ____
- ____ behavior
A
- Finding time for themselves
- Feelings of incompetence
- Fatigue
- Feeling of responsibility
- Finding time for their older children
- Infant’s behavior
18
Q
PHYSIOLOGIC CHANGES
- reduction in size & return of uterus to a nonpregnant state
A
INVOLUTION
19
Q
TWO MAIN PROCESSES INVOLVED IN INVOLUTION
- Sealing of ____
- Reduction of organ to approximate ____ size
A
- Sealing of placenta site
- Reduction of organ to approximate pregestational size
20
Q
PHYSIOLOGIC CHANGES
WEIGHT OF THE UTERUS
- ____ - immediately after birth
- ____ - at the end of the first week
- ____ - complete involution (6 weeks) (similar to prepregnant weight)
A
WEIGHT OF THE UTERUS
- 1000g - immediately after birth
- 500g - at the end of the first week
- 50g - complete involution (6 weeks) (similar to prepregnant weight)
21
Q
PHYSIOLOGIC CHANGES
FUNDAL HEIGHT
- 1 hr later: fundus on level of ____, where it remains for approximately the next 24 hours.
- Decreases ____ per day
A
FUNDAL HEIGHT
- 1 hr later: fundus on level of umbilicus, where it remains for approximately the next 24 hours.
- Decreases one fingerbreadth per day
22
Q
PHYSIOLOGIC CHANGES
- The uterus in the 1st hour postpartum is boggy (soft or flabby)
- Abnormal; failure of the uterus to contract adequately after delivery
- Allows hemorrhage to flow into the uterus
A
UTERINE ATONY
23
Q
PHYSIOLOGIC CHANGES
- Contraction of the uterus after birth “intermittent cramping”
A
AFTER PAINS
24
Q
PHYSIOLOGIC CHANGES
AFTER PAINS
Noticed most by:
- M____
- Those who gave birth to ____ or ____ births
A
AFTER PAINS
Noticed most by:
- Multiparas
- Those who gave birth to large babies or multiple births
25
* Vaginal discharge after giving birth, containing blood, mucus, and uterine tissue
LOCHIA
26
# **TYPE OF LOCHIA**
* **Color**: Red
* **Duration**: 1-3 days
* **Composition**: Blood fragments of decidua, mucus
LOCHIA RUBRA
27
# **TYPE OF LOCHIA**
**LOCHIA RUBRA**
* **Color**: ____
* **Duration**: ____ days
* **Composition**: Blood fragments of ____, mucus
**LOCHIA RUBRA**
* **Color**: Red
* **Duration**: 1-3 days
* **Composition**: Blood fragments of decidua, mucus
28
# **TYPE OF LOCHIA**
* **Color**: Pink
* **Duration**: 3-10 days
* **Composition**: Blood, mucus, and leukocytes
LOCHIA SEROSA
29
# **TYPE OF LOCHIA**
**LOCHIA SEROSA**
* **Color**: ____
* **Duration**: ____ days
* **Composition**: Blood, mucus, and ____
**LOCHIA SEROSA**
* **Color**: Pink
* **Duration**: 3-10 days
* **Composition**: Blood, mucus, and leukocytes
30
# **TYPE OF LOCHIA**
* **Color**: White
* **Duration**: 10-14 days (or up to 6 weeks)
* **Composition**: Largely mucus
LOCHIA ALBA
31
# **TYPE OF LOCHIA**
**LOCHIA ALBA**
* **Color**: ____
* **Duration**: ____ days (or up to ____ weeks)
* **Composition**: Largely ____
**LOCHIA ALBA**
* **Color**: White
* **Duration**: 10-14 days (or up to 6 weeks)
* **Composition**: Largely mucus
32
# **LOCHIA**
**HEAVY AMOUNT**
* Stain larger than ____ inches in length within 1 hour
* ____ to ____ ml
**HEAVY AMOUNT**
* Stain larger than **6 inches** in length within 1 hour
* **50 to 80 ml**
33
# **LOCHIA**
**MODERATE AMOUNT**
* stain ____ inches in length within 1 hour
* ____ ml
**MODERATE AMOUNT**
* stain **< 6 inches** in length within 1 hour
* **25-50 ml**
34
# **LOCHIA**
**SMALL AMOUNT**
* stain less than ____ inches in length after 1 hour
* ____ to ____ ml
**SMALL AMOUNT**
* stain less than **4 inches** in length after 1 hour
* **10 to 25 ml**
35
# **LOCHIA**
**SCANT AMOUNT**
* stain less than ____ inch in length after 1 hour
* only on tissue when the woman wipes
**SCANT AMOUNT**
* stain less than **1 inch** in length after 1 hour
* only on tissue when the woman wipes
36
# **THE CERVIX**
DURING NSD:
* SOFT & MALLEABLE
* ____ & ____ are open
* External os size of a ____ opening (end of 7 days)
* appears slitlike or ____ (star shaped)
DURING NSD:
* SOFT & MALLEABLE
* **internal & external** os are open
* External os size of a **pencil** opening (end of 7days)
* appears slitlike or **stellate** (star shaped)
37
# **THE VAGINA**
After vaginal birth:
* soft, with few ____
* Diameter greater than normal
* ____ PERMANENTLY TORN
* “____" to heal vagina
After vaginal birth:
* soft, with few **rugae**
* Diameter greater than normal
* **HYMEN** PERMANENTLY TORN
* “**KEGEL EXERCISE**" to heal vagina
38
# **HORMONAL SYSTEMS**
* Decrease in ____ as soon as placental is delivered
* By ____: Progestin, Estrogen, and Estradiol revert back to prepregnancy levels
* Decrease in ____ and ____ - almost negligible by 24 hours
* Decrease in ____ (12 days), then begins to as as a new menstrual cycle is initiated
* Decrease in **pregnancy hormones** as soon as placental is delivered
* By **Week 1**: Progestin, Estrogen, and Estradiol revert back to prepregnancy levels
* Decrease in **hCG and hPL** - almost negligible by 24 hours
* Decrease in **FSH** (12 days), then begins to as as a new menstrual cycle is initiated
39
# **URINARY SYSTEM**
* NSD: UO of ____ ml/day (diaphoresis & diuresis)
* Transient loss of ____ and ____ of bladder decreases sense to void
* Increase possibility of ____ and ____
* NSD: UO of **3,000 ml/day** (diaphoresis & diuresis)
* Transient loss of **tone** and **edema** of bladder decreases sense to void
* Increase possibility of **urinary stasis and UTI**
40
# **CIRCULATORY SYSTEM**
* Decrease in blood volume
Amount of blood:
* ____ ml in VSD
* ____ ml in CS
* Decrease in blood volume
Amount of blood:
* **300 - 500 ml** in VSD
* **500 - 1,000 ml** in CS
41
# **GASTROINTESTINAL SYSTEM**
* Mother is usually hungry after giving birth
* NSD: ____
* CS: NPO; ____ must occur before DAT
* Replace fluid loss
* Diet is a case-to-case basis, as ordered by doctor
* The occurence of ____ due to consistent pushing during labor
* Decreased ____
* Mother is usually hungry after giving birth
* NSD: **DAT**
* CS: NPO; **Flatulence** must occur before DAT
* Replace fluid loss
* Diet is a case-to-case basis, as ordered by doctor
* The occurence of **hemorrhoids** due to consistent pushing during labor
* Decreased **abdominal muscle tone**
42
# **INTEGUMENTARY SYSTEM**
* Rectus muscle tone is not regained; ____
* ____ appear reddened and will fade in time
* ____ strengthens abdominal muscles and returns abdominal support
* Linea nigra and chloasma becomes barely detectable in ____ time
* Rectus muscle tone is not regained; **DIASTASIS**
* **Stretch marks** appear reddened and will fade in time
* **Modified sit-ups** strengthens abdominal muscles and returns abdominal support
* Linea nigra and chloasma becomes barely detectable in **6 weeks** time
43
# **RETROGRESSIVE CHNAGES OF THE PUERPERIUM**
* ____ after labor
* Sleep hunger
* ____ - return to prepregnant weight
* **Exhaustion** after labor
* Sleep hunger
* **Weight loss** - return to prepregnant weight
44
# **TEMPERATURE**
* Slight ____ of temperature during first 24 hours after birth (due to dehydration that occured during labor)
* If ____ during first 24 hours, temp returns to normal
* Oral temp above ____ C (febrile), may indicate postpartal infection
* Slight **increase** of temperature during first 24 hours after birth (due to dehydration that occured during labor)
* If **adequate fluid** during first 24 hours, temp returns to normal
* Oral temp above **38** C (febrile), may indicate postpartal infection
45
# **PULSE**
* Rapid or thready pulse is a sign of ____
* Rapid or thready pulse is a sign of **hemorrhage**
46
# **BLOOD PRESSURE**
* Decrease in BP may indicate ____
* ____ mmHg systolic or ____ mmHg diastolic may indicate postpartal hypertension
* ____ - occurs on standing due to lack of adequate blood volume to maintain nourishment of brain cells
* Decrease in BP may indicate **bleeding**
* **140 mmHg systolic or 90 mmHg diastolic** may indicate postpartal hypertension
* **Orthostatic hypotension** - occurs on standing due to lack of adequate blood volume to maintain nourishment of brain cells
47
# PROGRESSIVE CHANGES OF THE PUERPERIUM
* ____ hormone is responsible for milk production
* ____ is responsible for the let-down reflex, allowing breastmilk to flow
* Breast ____ may increase body temperature
* Proper attachment of baby to breast must occur to avoid ____
* Increase ____ to ensure proper breastfeeding
* **Prolactin** hormone is responsible for milk production
* **Oxytocin** is responsible for the let-down reflex, allowing breastmilk to flow
* Breast **engorgement** may increase body temperature
* Proper attachment of baby to breast must occur to avoid **mastitis**
* Increase **fluid intake** to ensure proper breastfeeding
48
# MESTRUAL CYCLE
* If not exclusively breastfeeding, menstrual cycle resumes ____ after birth
* If breastfeeding, menstrual cycle resumes in ____ (**lactational ammenorrhea**)
* If not exclusively breastfeeding, menstrual cycle resumes **6-10 weeks** after birth
* If breastfeeding, menstrual cycle resumes in **3 or 4 months** (**lactational ammenorrhea**)
