Chapter 20 Flashcards
What does postpartum mean?
Is the period interval between birth and return of the reproductive organs to their non pregnant state
Post partum is also referred to what other two terms?
Puerperium
Fourth trimester of pregnancy
What does involution mean?
The return of uterus to non pregnant state
Right after delivery ( baby and placenta ) the fundus is palpated at what?
Uterus -2
How do measure this?
Starting from the umbilicus
Two fingers below
( where you’d feel the uterus right after delivery )
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
What are some common deviations of uterus measurement right after delivery that can alter the results?
A full bladder
Why do we encourage emptying of the bladder in order to properly measure?
Because bladder will cause distention and misplace the proper uterus height
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
After 24 hours PP( post partum ) the uterus shrinks to a size of what?
20 weeks gestation
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
At what weeks or days should post partum, should you no longer be able to palpate the uterus?
2 weeks (14 days )
What is subinvoluion?
Uterus failed to contract down, get down and shrink
What is the number 1 cause of postpartum hemorrhage is?
Uterine atony
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
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 )
In the recovery period you are massaging mom uterus every ___mins in order to make sure it’s firm
15mins
How will we chart this measuring or feeling of the uterus after 15mins? (3)
Boggy
Firm
Firm with massage
What are the 3 lochias after delivery ?
Lochia rubra
Lochira serosa
Lochia alba
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
How long is lochia serosa?
How is the flow?
What color is this?
4-12 days
Moderate to small
Pinkish brownish discharge
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 )
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
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
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!
