Chapter 20 Flashcards by Brina Quintanilla Reyes

What does postpartum mean?

Is the period interval between birth and return of the reproductive organs to their non pregnant state

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Post partum is also referred to what other two terms?

Puerperium
Fourth trimester of pregnancy

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What does involution mean?

The return of uterus to non pregnant state

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Right after delivery ( baby and placenta ) the fundus is palpated at what?

Uterus -2

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How do measure this?

Starting from the umbilicus
Two fingers below
( where you’d feel the uterus right after delivery )

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After you feel the initial state of the uterus which is U -2, which means literally 2 finger breasts below the umbilical , the uterus should ___?

Rise to U or U+1

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What are some common deviations of uterus measurement right after delivery that can alter the results?

A full bladder

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Why do we encourage emptying of the bladder in order to properly measure?

Because bladder will cause distention and misplace the proper uterus height

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What is the patho behind emptying the bladder in order for the uterus to rise?

We want the body to clamp down on itself to stop bleeding

And if our bladder is full, the uterus is competing for space and won’t properly clamps down

So it can cause post partum hemorrhage

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After 24 hours PP( post partum ) the uterus shrinks to a size of what?

20 weeks gestation

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After 24hours and goes to about the size of 20th week gestation, the uterus rapidly decrease at what cm
And until what day halfway U and pubis?

1-2cm
6th day

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At what weeks or days should post partum, should you no longer be able to palpate the uterus?

2 weeks (14 days )

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What is subinvoluion?

Uterus failed to contract down, get down and shrink

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What is the number 1 cause of postpartum hemorrhage is?

Uterine atony

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If mom uterus is not getting firm and hard as a rock, what will happen?

It will cause her to bleed
Which prompts us to check it out

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What are 3 things we should look out for during subinvolutiom?

Retained part
( piece of placenta is still left )

Vaginal/cervical lacteration
( tearing )

Full bladder
( no space to clamp down )

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In the recovery period you are massaging mom uterus every ___mins in order to make sure it’s firm

15mins

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How will we chart this measuring or feeling of the uterus after 15mins? (3)

Boggy
Firm
Firm with massage

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What are the 3 lochias after delivery ?

Lochia rubra
Lochira serosa
Lochia alba

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How long is lochia rubra?
How should it smell like?
What color is it?
Flows like what?

Birth 3-4 days PP
Fleshy menstrual period
Dark red blood
Heavy menstrual period

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How long is lochia serosa?
How is the flow?
What color is this?

4-12 days
Moderate to small
Pinkish brownish discharge

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How long is lochia alba?
What is the flow?
What color is this?

12-3 weeks
Gradually disappearing
Scant creamy whitish discharge
( yellowish white discharge )

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It’s important to tell mom that if she noticed a change in discharge
So let’s say she was at serosa and slowly moving over to alba
But then all of a sudden it goes back to rubra
What do we usually tell her why this is the case?

She’s been moving too much
On her feet too much!

Lay down & feet up

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During vaginal bleeding right after birth
What are we as nurses going to do and tell our patient? (3)

Massage the uterus
Encourage to empty bladder
Encourage breastfeeding

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Why do we encourage Breastfeeding to mom if she is bleeding?

Because the body will release oxytocin And that signals the uterus to contract and clamp down, so no more bleeding

If the uterus is firm what do we suspect may be the cause of why mom is still bleeding ? (2)

Vaginal lacteration Hematoma

Remember how the video It talked about how much blood mom should be losing A saturated pad, meaning the entire pad is covered in heavy amounts of blood within ____mins pooling!! Means what?

15mins Emergency ( always ask mom to lift up )

Cardiovascular changes Mother Nature has a way of protecting us by inducing a lot of fluids to help us deliver, What is this called and how much percentage?

Pregnancy induced hypervolemia (40-50%)

Why do we have pregnancy induced hypervolemia?

Because when we give birth we are gonna lose a lot of fluids and blood

Vaginal birth How much percentage and ml wise do we lose in fluid and blood?

10% 300-500ml

Cesarean birth How much do we lose in percentage and ml wise we lose in blood and fluids?

15-30% 500-1000ml

Cardiac output will be increased during what? (3)

Pregnancy Labor 2 weeks after labor

When should cardiac output return back to normal?

6-8weeks pp

6-8weeks PP our cardiac output should have decreased by how much?

30%

Once we give birth to the placenta and baby, our body will have a drastic decrease in what two hormones?

Estrogen and progesterone

The decrease in estrogen and vascular pressure causes what?

Diuresis

Since we lose two of the highest hormones during pregnancy, what do you think dirueis is going to do to mom? And when do you think it starts ?

Excessive sweating especially at night? Usually day2-3

Why is mom still at risk for preeclampsia even after 6 weeks of delivery?

Because mom is hypercoagulable She’s trying to loose all that fluid but you know she can’t do it in a single day

Rememeber preeclampsia, is not normal A headache can be common But if it doesn’t go away with? Then it’s a sign to check in

Normal medications

Since mom is hypercoagulable even after birth What do we tell her to look out for?

DVT ( one leg swollen, hot, red than the other )

If mom has increased WBC, what does that mean?

It’s normal!! She doesn’t have an infection, it’s a normal response to be being pregnant

If mom has elevated temperature 12 hours post baby is it normal?

Yes But afterwards it concerning

She forgot to mention when talking about the lochia, if mom is moving too much we know she may have increase bleeding so we tell mom to relax But what is the biggest sign of infection or something wrong when regarding this healing stage of bleeding?

There shouldn’t be a foul odor to it!!

In the video it mentions endocrine changes It’s important to note that we are going to have placental hormonal changes So that means what 4 things decreases?

Estrogen Progesterone HCG HPL

However the anterior pituitary contuines to secrete ?

Prolactin secretions

What does prolactin do to the body? (2)

Helps mom produce milk Preventions of ovulation

Prolacatin helps mom produce more milk and precents ovulation However this can cause what?

Lactational amenorrhea ( no period cause of the fact we are breastfeeding )

Lactaional anenorrhea How long does it last for breast mom? How long for non breast mom?

10weeks-6 months 6-10weekz

How a huge nursing consideration to note about this is that Even tho prolactin helps stop ovulation It’s super important to educate both breast feeding moms and non breast feedings mom on the ? And why?

Usage of contraceptive methods Prevent closely spaced pregnancies

So we know decrease in estrogen causes the body to?

Dirusis

What does the decrease in progesterone do?

Triggers the increase of prolactin in the pituitary gland

How does breastfeeding usually start? Then goes into What? At what time ^

Colostrum Lactogenesis II ( milk coming out ) 27-96hours

What is the most alert time for a baby?

30mins of life

Why do we encourage mom to immediately start breast feeding her baby, especially in those 30mins?

To encourage clamping and body to feed baby

The breast milk has all the nutrients a baby needs for the first what?

6 months of life!

What are the benefits of breast milk for the baby?(6)

Lower rates of - allergies - ear/lung infections - obesity - sudden infant death Healthier weight gain Better long term outcomes

What are the benefits of breastinf for the mom? (7)

Reduces urterine bleeding Burn calories Reduces risk of - breast/ovarian/uterine cancer - osteoporosis - arthritis - type 2 diabetes - heart disease

Plus breast milk is free !! And it’s encouraged to immediately start this, during?

Skin to skin contact right after birth

After birth Initially breast make what? What is it?

Colostrum - high in immune cells & antibodies - low in fat - laxatives effect Help first stools

Can mom feel her milk come in? And how?

Enlarged and heavy it will feel like And yes

Will a no breast feeding mom still produce colostrum?

Yes

When does engorgement occur for non breast mom? And does it resolve on it own? How can we help?

3-4th day PP yes Ice pack Don’t stimulate it

Urinary system Renal function - reneal glycosuria disappears by 1 weeks postpartum Fluid loss - post partial diuresis of ECF urthrea and bladder - immediately after birth, excessive bleeding can occur if bladder becomes distended - stress incontienced

Gastrointestinal system Mom is most likely to experience what? And why?

Constipation Because of that progesterone

Why do we encourage mom to increase fluid? Or what?

To help aid her constipation Stool softener

Integumentary system Stays or disappears? Name what it is too! After birth What is melsama ? What is hyperpigmentation ? Where ^(2) Straie gravidarum Angiomatas Notes : Hair loss usually is reported after 3 months PP

Mask of pregnancy - goes away Darken of areole and linea nigra Doesn’t go away Stretch marks Turns white so kinds stays Vascular spiders Usually goes away

Musculoskeletal system Adaptions of system are reversed The return of muscle tone depends on previous tone, proper exercise, and among if adipose tissue present What is diastasis recti abdominus?

The abdominal wall muscles seperate

Joints are stabilized at what weeks after birth?

6-8weeks

Neurological system is the same thing but coming back Headaches are common but what!!

If it’s too bad or can’t be treated with medications Risk of preclampsia

Notes The rebound of the immune system can trigger flare ups of autoimmune conditions

What are 2 signs of progression of uterine involution?

Fundal heights and lochia

What is normally the time body is back to normal?

6 weeks

The uterus involutes rapidly and returns to true pelvis by ?

2 weeks after birth

The return of ovulation and menses is determined in part by whether or not the woman is?

Lactating ( breastfeeding )

Rapid or increasing heart rate and low or decreasing blood pressure can indicate what?

Hypovolemia secondary to hemorrhage

Hypercoagulablity predisposes women to?

DVT!