Class 4: Body Systems Changes Throughout Perinatal Period Flashcards
(103 cards)
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
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
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
4
Q
describe changes to cervix during pregnancy (3)
A
- hypertrophy
- hyperplasia
- increased vascularity
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
6
Q
describe the position of uterus during the first 12 weeks of pregnancy
A
- within pelvis
7
Q
describe the position of uterus at 20 weeks of pregnancy
A
- uterine fundus around the umbilicus
8
Q
describe the position of uterus from 36-40 weeks of pregnancy
A
- fundus at xiphoid process
9
Q
describe changes in contractility during pregnancy
A
- 16+ weeks Braxton hicks contractions may be felt (painless, irregular, stop w walking or exercise)
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
11
Q
describe changes to uterine contractions during intrapartum period
A
- normally intensify and increase in freq throughout labor process
- strong, regular process
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
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
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
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
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
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
18
Q
define: lochia
A
- the name for the uterine discharhe that passes vaginally following birth
19
Q
what 3 types of lochia occur postpartum
A
- lochia rubra
- lochia serosa
- lochia alba
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
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
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
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)
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
25
describe the heaviness and duration of lochia alba
- light flow or spotting
- from day 10 up to 4-8 weeks post partum
26
describe uterine placement during the postpartum period
- should be midline on the abdomen
27
deflection of the uterus can indicate??
- a distended bladder
28
describe the size and consistency of the uterus during the postpartum period
- initially, uterus should feel about size of grapefruit, round
- fundus should feel firm
29
what does a soft/boggy postpartum indicate?
- uterine atony
30
what is uterine atony
- 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
31
what is subinvolution? what is this often related to?
- the failure of the uterus to return to the non pregnant state
- often related to retained placental fragments or infection
32
expulsion of the placenta leads to? specifically which ones? what happens specifically in non-lactating birthers?
- decreased placental-produced hormones
- estrogen and progesterone lvls drop markedly
- in non-lactating birthers, estrogen lvls begin to increase 2 weeks after birth
33
describe endomatreial regeneration postpartum
- completed by postpartum day 16, except at the placental site where it is completed at 6 weeks
34
describe changes to the vagina, vulva, and perineum during pregnancy (5)
- Chadwick sign
- leukorrhea
- increased thickness of mucosa
- increased vascularity and sensitivity
- relaxation of CT
35
describe changes the vagina, vulva, and perineum during the intrapartum period (2)
- stretching of the vagina and vaginal introitus occurs during birth
- perineal lacerations may occur during birth or epsiotomy may be performed
36
if forceps are used for birth, what can occur on the pelvic floor?
- hematomas
37
describe changes to the vagina during the postpartum period (7)
- 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
38
describe changes to the perineum during the postpartum period (2)
- 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)
39
how are perineal lacerations classified?
- based on the tissue/structures involved
40
what is a 1st degree perineal laceration
- involves skin and structures superficial to the muscles
41
what is a 2nd degree perineal laceration
- extends thru the muscle
42
what is a 3rd degree perineal laceration
- extends thru the anal sphincter
43
what is a 4th degree perineal laceration
- involves the anterior rectal wall
44
describe the healing process of perineal lacerations
- 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
describe changes to the breasts during pregnancy (8)
- 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
describe changes to the breast during the intrapartum period (6)
- 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
the 1st feeding (colostrum) should ideally occur how long after birth?
- in the first hour
48
what stimulates release of prolactin in the post-partum period (3)
- fall of progesterone after birth
- in response to infant feeding and emptying chest/breasts
- stimulates milk production and secretion
49
what stimulates the release of oxytocin during the postpartum period? what does oxytocin stimulate?
- infant sucking at nipple
- oxytocin stimulates the milk-ejection reflex (may feel tingling sensation as milk ejection occurs)
50
what is the nipple erection reflex
- when infant cries or sucks at chest/breast, helps to move milk thru the ducts to nipple pores
51
describe changes to breast during postpartum period
- 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
what is an imp consideration for indivi w flat or inverted nipple?
- birther may need additional support to latch infant
53
describe milk production post-partum
- 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
describe changes to the breast after milk production (6)
breasts become:
- tender
- full
- warm
- may feel lumps as milk ducts fill
- painfully full breasts may occur (engorgement)
- should soften w feedings
55
whats imp to note w breast milk?
- most substances ingested by the birther will pass to the infant thru breast/chest milk
56
describe changes to the CVS during pregnancy (7)
- 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
describe the impact of decreased PVR on BP
- decreased BP (DBP>SBP) in 1st and 2nd trimester
- by 3rd trimester usually increases by still within normal ranger
58
describe changes to the CVS during the intrapartum period (2)
- process of labour increases CO
- supine hypotension when ascending vena cava and descending aorta are compressed
59
describe changes to CVS during the postpartum period (3)
- 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
what is the average blood loss for a vaginal birth? c-section?
- vaginal = 300-500 mLs
- c-section = 500-1000 mLs
61
describe changes to the resp system during pregnancy (9)
- 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
what changes in acid-base balance occur during pregnancy (4)
- decreased CO2
- increased O2
- decreased HCO3
- slightly increased blood pH
63
describe changes to the resp system during the intrapartum period
- increased RR rate due to increase in physical exertion during labour = increased O2 consumption
64
describe changes to resp system during the postpartum period
- resp function returns rapidly to pre-pregnancy lvls
- diaphragm descends
65
describe changes to the renal system during pregnancy (4)
- 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
how should a urine dip look during pregnancy (5)
should be clean with no:
- leukocytes
- glucose
- ketones
- blood
- protein
67
what is the best position to promote optimal renal flow
- side lying
68
describe changes to the renal system during the intrapartum period (2)
- trauma can occur to the urethra and bladder during birth process
- spontaneous voiding can be difficult
69
why might spontaneous voiding be difficult during the intrapartum period (4)
- tissue edema from pressure of fetus' presenting part
- discomfort
- analgesia
- embarrassment (difficulty voiding of bedpan)
70
describe urine dipstick during intrapartum period
- proteinuria may occur due to increase in muscle activity (only time proteinuria may be considered normal)
71
describe changes to the renal system during the postpartum period
- 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
what causes diruesis during postpartum period? (3)
due to decreased:
- estrogen
- removal of increased venous pressure in lower extremities
- loss of pregnancy induced increase in blood volume
73
what can be a significant contributor to postpartum uterine bleeding and why?
- a full/distended bladder
- bc it displaces the uterus
74
what is imp to note if client was catheterized during labour/birth
- increased risk of UTI in the postpartum period
75
describe pregnancy proteinuria and glycosuria during the postpartum period
- resolves within 6 weeks after birth
76
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?
- 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
most birthers are able to void spontaneously how long after birth?
- within 8 hrs after birth
78
bladder tone is usually restored how long after birth?
- within 1st week after birth with adequate emptying
79
describe changes to the integ system during pregnancy (7)
- 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
where is increased skin pigmentation seen in pregnant individuals (6)
- nipples
- erealoae
- axillae
- vulva
- melasma
- linea nigra
81
describe integ changes during the intrapartum period
- minute tears to the skin around the vaginal introitus can occur as a result of stretching during birth
82
describe integ changes during the postpartum period (2)
- striae, if present, fade from red to silver but are permanent
- increased pigmentation of areolae and linea nigra may not regress completely
83
describe changes to the hematologic system during pregnancy (5)
- increased blood volume (~50%)
- increased RBCs (~20-30%)
- dilution of RBCs
- increased clotting factors = increased risk fo DVTs or PEs
- normal hgb >110
84
describe changes to the immunologic system during pregnancy (5)
- 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
describe changes to hematologic system during intrapartum period
- WBC count may increase
86
describe changes to hematologic system during postpartum period (3)
- hgb and hct lvls depend on blood loss
- increased risk of thromboembolism
- varicosities (legs, anus, vulva) generally regress entirely following birth
87
what contributes to the increased risk of thromboembolism postpartum (4)
- immobility
- potential vessel damage
- increase in clotting factors
- increase in fibrinogen
88
hgb and hct lvls usually return to non-pregnancy lvls by??
- 8 week postpartum
89
describe changes to GI system during pregnancy (8)
- 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
describe changes to GI system during intrapartum period (4)
- GI motility and absorption of solid food decreases
- stomach emptying time slows
- NV common
- stool present in rectum may empty during pushing phase
91
describe changes to GI system during postpartum period (2)
- quite hungry following initial recovery from birth, fatigue, and anesthesia
- spontaneous bowel evacuation may not occur for 2-3 days after birth
92
bowel function should return to normal how long postpartum?
- within 1 week postpartum
93
describe nursing care r/t GI system changes postpartum (3)
- encourage fluid and fibre intake
- stool softeners generally provided postpartum
- auscultate for BS
94
describe changes to the MSK during pregnancy (7)
- 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
describe changes to MSK during intrapartum period (4)
- 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
describe changes to MSK during postpartum period (4)
- 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
how long can it take for the supportive tissues of pelvic floor take to regain tone? what encourages healing?
- can take up to 6 months
- kegel exercises encourage healing
98
how long can it take for the abdominal wall to return to pre-pregnancy state
- up to 6 weeks
99
the time for the abdominal wall to return to pre-pregnancy state depends on?
- previous tone
- exercise
- exercise
- amount of adipose tissue
100
what may persist following birth r/t abdominal wall? what might it require?
- diastasis (separation) of the rectus abdominal muscle can persist
- may require surgery
101
what impact does estrogen have on the body system (3)
- increases vascularity
- increases tissue mass
- increases blood flow to areas
102
what impact does progesterone have on the body system? (2)
- stimulates growth of blood vessels
- causes smooth muscle relaxation
103
epidural insertion can potentially cause? what can this lead to?
- 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
