Exam 1 Flashcards
Puerperium
“Postpartum Period” - 6 weeks following childbirth. AKA: 4th trimester of pregnancy
Postpartum
There is a fall in the blood levels of placental hormones
Uterine Changes Postpartum
The uterus should return to its normal size 5-6 weeks after delivery. The placental site is fully healed in 6-7 weeks.
Placement of Fundus after delivery
Immediately after placenta is expelled, midline or at/below level of umbilicus. After 24 hours will descend 1cm a day. By 10 days pp should no longer be palpable
Afterpains
Decrease rapidly within 48 hours, more often in multiparas, breastfeeding mothers. No ASA should be used pp because of interference with blood clotting
Lochia
Composed of endometrial tissue, blood and lymph.
Involution
The changes that the reproductive organs, particularly the uterus, undergo after birth to return them to their prepregnancy size.
Subinvolution
Failure of the uterus to return to the prepregnant state after 6 weeks
Lochia Rubra
Red because it is composed mostly of blood; lasts for about 3 days after birth
Lochia Serosa
Pinkish because of its blood and mucus content. Lasts from 3rd through 10th day after birth
Lochia Alba
Mostly mucus and is clear and colorless or white. Lasts from 10th through 21st day after birth
Lochia Weight Conversion
1g of weight = 1mL volume of blood
Absence of Lochia
Not normal and may be associated with blood clots retained within the uterus or with infection
Abnormal Characteristics needing Reported
Foul smelling lochia, Lochia rubra beyond 3rd day, lochia that returns to bright red after is progressed to serosa or alba.
Medications to stimulate uterine contraction
Oxytocin (IV) and Methergine (IM or orally)
Cervix PP
Regains its muscle tone but never closes as tightly as during the prepregnant state
Vagina PP
Rugae disappear and then reappear 3 weeks pp, within 6 weeks it regains most of its prepregancy form but never returns to the size it was before
REEDA
Five signs to assess the perineum pp or cesarean incision. Redness, Edema, Ecchymosis, Discharge, Approximation.
Perineal Care
Ice for 12-24 hours removing when ice melts and waiting 10 mins to reapply. After 24 hours heat with chemical warmpack, sitz bath, or bidet
Medications for perineal pain
Hydrocortisone and pramoxine (Epifoam), benzocaine, and witch hazel pads
Phase 1 on Rubin’s Psychological Changes of the Puerperium
“Taking In” - Mother is passive and willing to let others do for her. Conversation centers on her birth experience. Mother has great interest in infant and little in learning. Primary focus is on recovery from birth, her need for food, fluid and deep sleep.
Phase 2 on Rubin’s Psychological Changes of the Puerperium
“Taking Hold” - Mother begins to initiate action, becomes critical of her performance, increased concern about her body’s functions. This phase is IDEAL for teaching.
Phase 3 on Rubin’s Psychological Changes of the Puerperium
“Letting Go” - Give up previous lifestyle, give up their ideal of their birth experience, give up the fantasy child to accept the real child.
Phase 1 of Newborn Transition to Extrauterine Life
0-30 mins; (Period of reactivity); tachycardia gradually lowering to normal rate, irregular respirations, rales present on auscultation, infant is alert, frequent Moro reflex, tremors, crying, increased motor activity
Phase 2 of Newborn Transition to Extrauterine Life
30min - 2 hrs; (decreased responsiveness); decreased motor activity, rapid respirations (up to 60/min), normal HR, audible bowel sounds
Phase 3 of Newborn Transition to Extrauterine Life
2-8 hrs; (second period of reactivity); abrupt brief changes in color and muscle tone, presence of oral mucus, responsiveness to external stimuli, infant stabilizes, begins suck-swallow coordination and is ready for regular feedings
Temp of Newborn
97.7-98.6 axillary; remains in radiant warmer until temp stabilized and first bath delayed until temp is normal, should be recorded 30 mins after bath and 1hr after transfer to open crib.
HR of Newborn
110-160 bpm
BP of Newborn
65/30 - 95/60, taken in all 4 extremities or 1 leg and 1 arm
Preterm Skin
thin and somewhat transparent, vernix covering most of the skin surface, heavily covered with lanugo
Postterm Skin
peeling, vernix absent
Prolactin
From the anterior pituitary gland and causes milk production
Oxytocin
from the posterior pituitary gland causes milk letdown
Foremilk
the first milk the infant obtains, it is more watery and quenches the infants thirst
Hindmilk
The later milk that has a higher fat content
Colostrum
Late in pregnancy and for the first few days after birth, yellowish, rich in antibodies. Provides protein, vit A and E, essential minerals. Lower in calories. Has a laxative effect, which aids in eliminating meconium
Transitional Milk
7-10 days after birth, Has fewer immunoglobulins and proteins, has increased lactose, fat, and calorie content
Mature Milk
by 14 days after birth, bluish color, 20kcal/oz and all the nutrients the infant needs
Moro Reflex
If jared, infant draws up legs and arms fan out then come toward midline in an embrace position (3-6 months)
Tonic Neck Reflex
If you turn the infants head to one side, the arm and leg on that side will extend while the opposite side flexes (5-7 months)
Normal Head Circumference
12.5-14.1 in / 32-36cm
Anterior Fontanel
Diamond shape, at junction of parietal and frontal bones, closes at 12-18 months
Functional Heart Murmur
The result of blood passing through NORMAL valves
Organic Heart Murmur
Caused by blood passing through ABNORMAL openings
Normal Newborn Temp
97.8-98.9 (report anything over 99.8 or below 97.1)
Normal Newborn Pulse
110-160
Normal Newborn RR
30-60 (report any nasal flaring, noisy respirations, or chest retraction)
Average Newborn Length
46-56cm/19-21.5 in
BUBBLE Assessment
B (breasts) U (uterus) B (bowel) B (bladder) L (lochia) E (episiotomy)
