Chapter 15 Postpartum Adaptations Flashcards
1) Examine the systemic physiologic changes occurring in the woman after childbirth 2) Integrate dimensions of postpartum care for the multicultural family 3) Determine the psychological changes that occur in women in the postpartum period 4) Plan postpartum nursing care w/interventions to foster mother-baby bonding 5) Assess the phases of maternal role adjustment & accompanying behaviors 6) Analyze the psychological adaptations occurring in the mother's partner after childbirth
Puerperium Period
AKA Postpartum
Begins after the delivery of the placenta & lasts~6 weeks
During this period, the woman’s body begins to return to its prepregnant state
- These changes usually resolve by 6 weeks
She also begins to adapt into her maternal role
The 4th Trimester
Up to 9-12 months post delivery
Cultural Considerations for the Postpartum Woman
Nurses must be sensitive to how people respond when being touched & should refrain from touching if it elicits a negative response from the client
Touching, placing patients in close proximity to each other, & taking away personal belongings-> reduce client’s sense of security & heighten anxiety
Some cultures view the birthing process as a solely female process
Uterine Involution
A natural, gradual process in which the uterus return to its nonpregnant size & condition through retrogressive changes
Reproductive System Adaptations: Uterine Involution
Uterus Involution
- Contracting of muscle fibers-> go back to normal size
Catabolism
Regeneration of epithelial lining
- 9-10 months of uterine lining must slough off
Complications
Placental fragments, or amniotic sac remnants-> can’t contract ATONY (uterus is boggy, not firm)
- Empty bladder first
Infection
Overdistention
Full bladder
Birth Trauma
Anesthesia
Hemorrhage
Uterine Interventions
Support & massage fundus often & routinely (depends on hospital policy)
Empty bladder
Lochia
Necrosis of the decidua basalis
Vaginal discharge occurring 4-8 weeks
Lochia rubia
Deep-red, mixture of mucus, tissue debris, & blood
- Bright red means active bleeding
Will last 3-4 days
Locha Serosa
Pinkish-brown
Lochia Alba
Creamy white or brown, days
Lochia Assessment
Amount (how many pads has she used in the last 1-2 hours)
○ Consider size of pads
- Scant: 2-inch stain (10mL)
- Small: 4-inch stain (10-25mL)
- Moderate: 6-inch stain (25-50 mL)
- Large: >6-inch stain (50-80 mL)
Color
Odor (musky scent)
Change with activity and time
Reposition patient!!!!!
- Assess back (see if bleeding is going up their back)
Lochia Complications
Reappearance of bright red bleeding
Clots larger than golf ball (fist size): Weigh the clot (quantitative blood loss)
- Massage fundus: See if it is displaced, firmness
Infection
○ Foul smelling discharge
Hemorrhage
Lochia: Vaginal vs C-Section Delivery
Vaginal deliveries will typically have heavier/longer lochia
C-Section patients can still experience bleeding for up to 6 weeks
