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NURS 4500: Midterm Material > Class 4: Body Systems Changes Throughout Perinatal Period > Flashcards

Class 4: Body Systems Changes Throughout Perinatal Period Flashcards

1
Q

describe vital signs throughout pregnancy (BP, HR, T, RR)

A
  • normal BP in pregnancy = <140/90
  • increased HR (15-20 bpm)
  • temp should remain in N range
  • no change or slight increase in RR
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2
Q

describe VS intrapartum (BP, HR, RR, T)

A
  • both SBP and DBP can increase during contractions and return to baseline between
  • r/o supine hypotension
  • HR may increase in 1st and 2nd stage
  • increased RR (d/t increase in physical exertion during labor & increased O2 consumption)
  • temp may be slightly elevated
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3
Q

describe VS during postpartum (HR, BP, RR, T)

A
  • HR and BP return to prepregnant lvls within few days
  • BP could stay elevated longer w HTN
  • return to prepregnancy RR
  • temp may increase to 38* within first 24 hrs due to dehydrating effects of labour –> should be afebrile after 24 hrs
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4
Q

describe changes to cervix during pregnancy (3)

A
  • hypertrophy
  • hyperplasia
  • increased vascularity
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5
Q

describe changes to uterus during pregnancy (5)

A
  • increase in size
  • decidua increases
  • increased vascularity
  • uterus elongates
  • uterus rises out of pelvis into abdomen
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6
Q

describe the position of uterus during the first 12 weeks of pregnancy

A
  • within pelvis
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7
Q

describe the position of uterus at 20 weeks of pregnancy

A
  • uterine fundus around the umbilicus
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8
Q

describe the position of uterus from 36-40 weeks of pregnancy

A
  • fundus at xiphoid process
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9
Q

describe changes in contractility during pregnancy

A
  • 16+ weeks Braxton hicks contractions may be felt (painless, irregular, stop w walking or exercise)
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10
Q

describe changes to uteroplacental blood flow during pregnancy

A
  • increases dramatically
  • blood flow thru uteroplacental vascular system at 40 weeks is 450-650 mL/min
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11
Q

describe changes to uterine contractions during intrapartum period

A
  • normally intensify and increase in freq throughout labor process
  • strong, regular process
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12
Q

what contributes to the start of labor contractions (5)

A

increased:
- estrogen
- oxytocin
- prostaglandins
- decreased progesterone
- progressive uterine distension and pressure = increase irritability of muscle layer of the uterus

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13
Q

what changes to the cervix occur during the intrapartum period

A
  • effaces (up to 100%) & dilates (from closed to 10cm, aka fully dilated) throughout the first stage of labour
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14
Q

describe changes to the cervix during the post-partum period (4)

A
  • cervix is 2-3cm within 2-3 days postpartum
  • by 1 week, 1cm
  • bruising & small lacerations at the outer part of the cervix that opens into the vagina
  • external os of the cervix never returns to its pre-pregnancy appearance, appear as jagged line/slit instead of circular
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15
Q

describe how ovarian function of lactating vs nonlactating varies during the postpartum period

A
  • lactating and nonlactating persons differ in timing of first ovulation and menstruation d/t elevated prolactin lvls in lactating persons suppress ovulation
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16
Q

describe changes to ovarian function postpartum in nonlactating person (3)

A
  • ovulation can occur as early as 27 days after birth
  • mean time = 7-9 weeks postpartum
  • 70% of non-lactating birthers menstruation within first 12 week after birth
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17
Q

describe changes to ovarian function postpartum in lactating person

A
  • return of ovulation depends on breast/chest/pumping patterms
  • mean time = 6 months after birth
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18
Q

define: lochia

A
  • the name for the uterine discharhe that passes vaginally following birth
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19
Q

what 3 types of lochia occur postpartum

A
  • lochia rubra
  • lochia serosa
  • lochia alba
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20
Q

describe the appearance of lochia rubra, what does it include (3)?

A
  • bright red or dark bleeding
  • includes blood and decidual/trophoblastic debris
  • can include small clots
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21
Q

describe the onset, heaviness and duration of lochia rubra

A
  • amount of a heavy menstrual period in first 2 hrs after birth
  • may soak a pad every 2-3 hrs
  • lasts 3-4 days
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22
Q

describe the appearance of lochia serosa, what does it include (4)?

A
  • brownish or pinkish color
  • includes old blood, serum, leukocytes, and debris
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23
Q

describe the heaviness and duration of lochia serosa

A
  • flow = mild to moderate
  • days 4-10 (can be longer, lasting up to 27 days, majority day 10)
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24
Q

describe the appearance of lochia alba, what does it include (6)?

A
  • white in color
  • includes leukocytes, decidua, epithelial cells, mucus, serum, and bacteria
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25
Q

describe the heaviness and duration of lochia alba

A
  • light flow or spotting
  • from day 10 up to 4-8 weeks post partum
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26
Q

describe uterine placement during the postpartum period

A
  • should be midline on the abdomen
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27
Q

deflection of the uterus can indicate??

A
  • a distended bladder
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28
Q

describe the size and consistency of the uterus during the postpartum period

A
  • initially, uterus should feel about size of grapefruit, round
  • fundus should feel firm
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29
Q

what does a soft/boggy postpartum indicate?

A
  • uterine atony
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30
Q

what is uterine atony

A
  • the most common cause of excessive bleeding in the postpartum period as it means the intra-myometrial blood vessels are not being adequately compressed by the uterine muscle contractions
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31
Q

what is subinvolution? what is this often related to?

A
  • the failure of the uterus to return to the non pregnant state
  • often related to retained placental fragments or infection
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32
Q

expulsion of the placenta leads to? specifically which ones? what happens specifically in non-lactating birthers?

A
  • decreased placental-produced hormones
  • estrogen and progesterone lvls drop markedly
  • in non-lactating birthers, estrogen lvls begin to increase 2 weeks after birth
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33
Q

describe endomatreial regeneration postpartum

A
  • completed by postpartum day 16, except at the placental site where it is completed at 6 weeks
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34
Q

describe changes to the vagina, vulva, and perineum during pregnancy (5)

A
  • Chadwick sign
  • leukorrhea
  • increased thickness of mucosa
  • increased vascularity and sensitivity
  • relaxation of CT
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35
Q

describe changes the vagina, vulva, and perineum during the intrapartum period (2)

A
  • stretching of the vagina and vaginal introitus occurs during birth
  • perineal lacerations may occur during birth or epsiotomy may be performed
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36
Q

if forceps are used for birth, what can occur on the pelvic floor?

A
  • hematomas
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37
Q

describe changes to the vagina during the postpartum period (7)

A
  • thin and smooth immediately after birth
  • rugae restored in 3rd week postpartum
  • gradually decreases in size and regains tone, but may never return to pre-pregnancy state
  • dryness (d/t increased estrogen) and coital discomfort may persist until return of ovarian function
  • thin vaginal mucosa (d/t estrogen deprivation)
  • then thickening of vaginal mucosa with return of ovarian function
  • mucosa may remain atrophic in lactating person, at least until menses return
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38
Q

describe changes to the perineum during the postpartum period (2)

A
  • episiotomies/laceration repairs –> site initially erythematous and edematous
  • hemorrhoids (anal varicosites) can occur and decreased within 6 weeks of birth (should be soft and pink)
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39
Q

how are perineal lacerations classified?

A
  • based on the tissue/structures involved
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40
Q

what is a 1st degree perineal laceration

A
  • involves skin and structures superficial to the muscles
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41
Q

what is a 2nd degree perineal laceration

A
  • extends thru the muscle
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42
Q

what is a 3rd degree perineal laceration

A
  • extends thru the anal sphincter
43
Q

what is a 4th degree perineal laceration

A
  • involves the anterior rectal wall
44
Q

describe the healing process of perineal lacerations

A
  • intiial healing occurs within 2-3 weeks to the point that the perineum is barely distinguishable from that of a nulliparous person
  • complete healing can take up to 6 months
45
Q

describe changes to the breasts during pregnancy (8)

A
  • heightened sensitivity from tingling to sharp pain
  • areolae become more pigmented
  • dilation of blood vessels in breasts visible
  • colstrum may be present and potentially expressed @ 16 weeks or later
  • lactations does not occur until after birth (d/t drop in estrogen)
  • growth and development of mammary glands completed by mid pregnancy
  • fullness, heaviness
  • breasts more coarse/lobular w development of lacteriferous ducts
46
Q

describe changes to the breast during the intrapartum period (6)

A
  • no milk present
  • colostrum usually present at birth (or prior)
  • oxytocin stimulates the milk-ejection reflex –> stimulates milk letdown
  • milk-ejection reflex can occur during labour = letdown of colostrum
  • hormones decrease rapidly w birth = stim of prolactin production
  • placing infant skin to skin stimulate feeding cues in infant
47
Q

the 1st feeding (colostrum) should ideally occur how long after birth?

A
  • in the first hour
48
Q

what stimulates release of prolactin in the post-partum period (3)

A
  • fall of progesterone after birth
  • in response to infant feeding and emptying chest/breasts
  • stimulates milk production and secretion
49
Q

what stimulates the release of oxytocin during the postpartum period? what does oxytocin stimulate?

A
  • infant sucking at nipple
  • oxytocin stimulates the milk-ejection reflex (may feel tingling sensation as milk ejection occurs)
50
Q

what is the nipple erection reflex

A
  • when infant cries or sucks at chest/breast, helps to move milk thru the ducts to nipple pores
51
Q

describe changes to breast during postpartum period

A
  • for 1st 24 hrs after birth, breast tissue has no appreciable changes
  • days 1-2 after birth breasts are soft
  • nipple should have skin intact, no sores, no pain
52
Q

what is an imp consideration for indivi w flat or inverted nipple?

A
  • birther may need additional support to latch infant
53
Q

describe milk production post-partum

A
  • 72-96 hrs after birth, milk production begins
  • milk production should stop approx 1 week after birth if no chest/breast feeding/pumping occurs
54
Q

describe changes to the breast after milk production (6)

A

breasts become:
- tender
- full
- warm
- may feel lumps as milk ducts fill
- painfully full breasts may occur (engorgement)
- should soften w feedings

55
Q

whats imp to note w breast milk?

A
  • most substances ingested by the birther will pass to the infant thru breast/chest milk
56
Q

describe changes to the CVS during pregnancy (7)

A
  • increased CO (~1500mL or 40-50%)
  • decreased PVR = decreased venous return
  • varicose veins
  • lower leg/feet edema (dependent edema)
  • heart sounds change (systolic murmur, split S1/S2, audible S3)
  • heart position moves up, rotated forward, and left
  • increased clotting times
57
Q

describe the impact of decreased PVR on BP

A
  • decreased BP (DBP>SBP) in 1st and 2nd trimester
  • by 3rd trimester usually increases by still within normal ranger
58
Q

describe changes to the CVS during the intrapartum period (2)

A
  • process of labour increases CO
  • supine hypotension when ascending vena cava and descending aorta are compressed
59
Q

describe changes to CVS during the postpartum period (3)

A
  • blood volume returns to non-pregnancy lvls within a few days of birth d/t diruesis process
  • CO returns to non-pregnancy lvls after 48 hrs
  • diaphragm descends = normal cardiac axis restored, point of maximal impulse normalized
60
Q

what is the average blood loss for a vaginal birth? c-section?

A
  • vaginal = 300-500 mLs
  • c-section = 500-1000 mLs
61
Q

describe changes to the resp system during pregnancy (9)

A
  • increased tidal function and minute ventilation
  • some dyspnea w normal SpO2
  • nasal congestion & nosebleeds
  • increased BMR
  • change in acid-base balance
  • elevated diaphragm
  • increased vascularity of mucus membranes
  • ligaments of chest relax
  • more O2 available to diffuse across placenta to fetus = allow for efficient exchange of CO2 from fetus to pregnant person
62
Q

what changes in acid-base balance occur during pregnancy (4)

A
  • decreased CO2
  • increased O2
  • decreased HCO3
  • slightly increased blood pH
63
Q

describe changes to the resp system during the intrapartum period

A
  • increased RR rate due to increase in physical exertion during labour = increased O2 consumption
64
Q

describe changes to resp system during the postpartum period

A
  • resp function returns rapidly to pre-pregnancy lvls
  • diaphragm descends
65
Q

describe changes to the renal system during pregnancy (4)

A
  • increased CO = increased renal flow to kidneys
  • ureters and renal pevlsi relax & dilate which causes flow of urine to slow, urine retention
  • increased UO & urinary freq
  • increased risk of UTIs and pyelonephritis
66
Q

how should a urine dip look during pregnancy (5)

A

should be clean with no:
- leukocytes
- glucose
- ketones
- blood
- protein

67
Q

what is the best position to promote optimal renal flow

A
  • side lying
68
Q

describe changes to the renal system during the intrapartum period (2)

A
  • trauma can occur to the urethra and bladder during birth process
  • spontaneous voiding can be difficult
69
Q

why might spontaneous voiding be difficult during the intrapartum period (4)

A
  • tissue edema from pressure of fetus’ presenting part
  • discomfort
  • analgesia
  • embarrassment (difficulty voiding of bedpan)
70
Q

describe urine dipstick during intrapartum period

A
  • proteinuria may occur due to increase in muscle activity (only time proteinuria may be considered normal)
71
Q

describe changes to the renal system during the postpartum period

A
  • diuresis occurs within 12 hrs to rid the body of excess fluid accumulated during pregnancy
  • may have trauma/bruising to the urinary meatus from birth
72
Q

what causes diruesis during postpartum period? (3)

A

due to decreased:
- estrogen
- removal of increased venous pressure in lower extremities
- loss of pregnancy induced increase in blood volume

73
Q

what can be a significant contributor to postpartum uterine bleeding and why?

A
  • a full/distended bladder
  • bc it displaces the uterus
74
Q

what is imp to note if client was catheterized during labour/birth

A
  • increased risk of UTI in the postpartum period
75
Q

describe pregnancy proteinuria and glycosuria during the postpartum period

A
  • resolves within 6 weeks after birth
76
Q

trauma to the bladder and urethra during birth and anesthesia (ie epidural) can affect what? what can this result in? what may be required due to this?

A
  • the voiding reflex
  • can result in urinary retention and bladder distension
  • may require urinary catheterization if bladder is full/distended and unable to void
77
Q

most birthers are able to void spontaneously how long after birth?

A
  • within 8 hrs after birth
78
Q

bladder tone is usually restored how long after birth?

A
  • within 1st week after birth with adequate emptying
79
Q

describe changes to the integ system during pregnancy (7)

A
  • increased pigmentation on skin by week 16
  • stretching of skin (striae gravidarum, palmar itching)
  • increased hypertrophy and vascularity
  • gums may bleed
  • hair and nail changes (vary by person)
  • increased perspiration
  • acne may worsen
80
Q

where is increased skin pigmentation seen in pregnant individuals (6)

A
  • nipples
  • erealoae
  • axillae
  • vulva
  • melasma
  • linea nigra
81
Q

describe integ changes during the intrapartum period

A
  • minute tears to the skin around the vaginal introitus can occur as a result of stretching during birth
82
Q

describe integ changes during the postpartum period (2)

A
  • striae, if present, fade from red to silver but are permanent
  • increased pigmentation of areolae and linea nigra may not regress completely
83
Q

describe changes to the hematologic system during pregnancy (5)

A
  • increased blood volume (~50%)
  • increased RBCs (~20-30%)
  • dilution of RBCs
  • increased clotting factors = increased risk fo DVTs or PEs
  • normal hgb >110
84
Q

describe changes to the immunologic system during pregnancy (5)

A
  • spleen enlargment
  • increased # of leukocytes but decreased function
  • humoral immunity increases antibodies available to be transferred across placenta
  • pregnant person more susceptible to viruses and other pathogens
  • may have less symptoms from autoimmune disease
85
Q

describe changes to hematologic system during intrapartum period

A
  • WBC count may increase
86
Q

describe changes to hematologic system during postpartum period (3)

A
  • hgb and hct lvls depend on blood loss
  • increased risk of thromboembolism
  • varicosities (legs, anus, vulva) generally regress entirely following birth
87
Q

what contributes to the increased risk of thromboembolism postpartum (4)

A
  • immobility
  • potential vessel damage
  • increase in clotting factors
  • increase in fibrinogen
88
Q

hgb and hct lvls usually return to non-pregnancy lvls by??

A
  • 8 week postpartum
89
Q

describe changes to GI system during pregnancy (8)

A
  • increased intra-abdominal pressure
  • relaxed LES = reflux symptoms common
  • delayed gastric emptying
  • increased incidence of gallstones & cholecystitis
  • decreased GI motility = r/o constipation
  • increased incidence of gallbladder stasis
  • hemorrhoids common
  • NV in 1st trimester
90
Q

describe changes to GI system during intrapartum period (4)

A
  • GI motility and absorption of solid food decreases
  • stomach emptying time slows
  • NV common
  • stool present in rectum may empty during pushing phase
91
Q

describe changes to GI system during postpartum period (2)

A
  • quite hungry following initial recovery from birth, fatigue, and anesthesia
  • spontaneous bowel evacuation may not occur for 2-3 days after birth
92
Q

bowel function should return to normal how long postpartum?

A
  • within 1 week postpartum
93
Q

describe nursing care r/t GI system changes postpartum (3)

A
  • encourage fluid and fibre intake
  • stool softeners generally provided postpartum
  • auscultate for BS
94
Q

describe changes to the MSK during pregnancy (7)

A
  • increase weight
  • change in posture
  • pelvis tilts forward (shifts center of gravity)
  • ligament and joint laxity
  • ligaments and muscles of mid & low back strained
  • abdominal wall muscles stretch
  • feet may enlarge and/or become flatter
95
Q

describe changes to MSK during intrapartum period (4)

A
  • backache, joint ache related to fetal position
  • labour process can cause muscle cramping (separate from uterine contractions)
  • increased muscle activity during labor
  • fascial stretching and trauma during birth = pelvis muscle relaxation
96
Q

describe changes to MSK during postpartum period (4)

A
  • supportive tissues of pelvic floor torn or stretched during birth
  • abdominal wall is relaxed post-partum and regains muscular tone over several weeks
  • joints stabilized by 6-8 weeks following birth
  • may experience a permanent increase in shoe size
97
Q

how long can it take for the supportive tissues of pelvic floor take to regain tone? what encourages healing?

A
  • can take up to 6 months
  • kegel exercises encourage healing
98
Q

how long can it take for the abdominal wall to return to pre-pregnancy state

A
  • up to 6 weeks
99
Q

the time for the abdominal wall to return to pre-pregnancy state depends on?

A
  • previous tone
  • exercise
  • exercise
  • amount of adipose tissue
100
Q

what may persist following birth r/t abdominal wall? what might it require?

A
  • diastasis (separation) of the rectus abdominal muscle can persist
  • may require surgery
101
Q

what impact does estrogen have on the body system (3)

A
  • increases vascularity
  • increases tissue mass
  • increases blood flow to areas
102
Q

what impact does progesterone have on the body system? (2)

A
  • stimulates growth of blood vessels
  • causes smooth muscle relaxation
103
Q

epidural insertion can potentially cause? what can this lead to?

A
  • leakage of cerebrospinal fluid into the extradural space during placement of the needle
  • which can result in post-dural puncture headache in post-partum period

NURS 4500: Midterm Material (19 decks)

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