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Maternal Child Nursing (Exam 1) > Exam 1 (Maternal Physiologic Changes) > Flashcards

Exam 1 (Maternal Physiologic Changes) Flashcards

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1
Q

Postpartum Period

A

Time between birth and return of reproductive organs to normal non-pregnant state.

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2
Q

Uterine Involution?

A

The return of uterus to nonpregnant state.

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3
Q

When does uterine involution begin?

A

Begins imediately after the placenta is delivered.
By 24 hrs uterus is same size as 20 wks gestation.
Fundus descends 1-2 cm q 24 hrs.

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4
Q

How is uterine involution accomplished?

A

Accomplished through uterine smooth muscle contraction.

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5
Q

When does uterus return to true pelvis?

A

by 2wks

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6
Q

What is Subinvolution?

A

is the failure of the uterus to return to normal nonpregnant state.

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7
Q

What usually causes subinvolution?

A

Normally caused by retained placental fragments & infection.

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8
Q

Afterbirth Pains?

A

are uterine contractions that compress intrauterine blood vessels to decrease bleeding.

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9
Q

What stimulates afterbirth pains?

A

These are stimulated the by presence of oxytocin released from the pituitary gland.

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10
Q

What stimulates oxytocin?

A

Breastfeeding stimulates oxytocin release to promote contractions - may increase mother’s pain significantly.

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11
Q

When is afterbirth pain more severe?

A
  • Worse in 2nd, 3rd, 4th, & subsequent pregnancies b/c muscle tone is increased in 1st pregnancy.
  • Most noticeable in pregnancies where uterus is greatly distended (polyhdramnois, twins).
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12
Q

Which pt would you expect to have the worst afterbirth pains?

A

Twin pregnancy

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13
Q

Placenta site?

A

Vascular constriction & thrombosis cause the placental site to hemostasis.

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14
Q

Placental site regeneration occurs in?

A

6 wks postpardum

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15
Q

What is Lochia?

A

Postbirth uterine discharge

  • Initially bright red
  • Becomes pink or reddish brown
  • May contain small clots of blood
  • May continue x 6 wks
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16
Q

Lochia rubra?

A

Bright red

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17
Q

Lochia serosa?

A

Brown or pink

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18
Q

Lochia alba?

A

White or yellow

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19
Q

What increases lochia?

A

Increases with ambulation & breastfeeding initially then slows when uterus clamps down from oxytocin release.

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20
Q

When does lochia accumulate?

A

Lochia pools in vagina when in lying position & rapidly gushes when woman stands.

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21
Q

Is the Lochia amount more or less after cesarean?

A

Amount is usually less after cesarean.

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22
Q

What may cause lochia serosa?

A

Continued lochia serosa at 3-4 wks postpartum may be due to endometritis, especially if accompanied by fever, pain, or abdominal tenderness.

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23
Q

A client gushes blood after delivery. Which time frame would be of concern?

A

When lying quietly in the bed.

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24
Q

When does the vaginal wall return to pre-pregnacny size?

A

6-10wks

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25
Q

What happens to the Rugae?

A

can be permanently flattened.

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26
Q

What happens to the mucosa?

A

Atrophic with little or no lubrication in lactating women until menstruation begins.
Causes dyspareunia & can be alleviated w/ a water soluble lubricant.

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27
Q

When should Episiotomy & vaginal lacerations be healed by?

A

2-3wks

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28
Q

Hemorrhoids should be reduced in..

A

6wks

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29
Q

Pelvic relaxation?

A

lengthening & weakening of fascial supports of pelvic structures.
May occur in any woman but is direct result of childbirth.

30
Q

How do you prevent pelvic relaxation?

A

Kegel exercise!

31
Q

What do placental hormones do?

A

Placenta and placental hormones cause an elevation of blood sugar; delivery of placenta & decline in placental hormones - lower blood sugar levels.

32
Q

What intervention will a nurse need to implement if patient is type 1 DM?

A

Insulin will likely have to be reduced (if patient is taking).

33
Q

What happens to Estrogen & progesterone after the delivery of the placenta?

A

markedly decline after placenta delivery.

34
Q

What does the decrease of estrogen do to the body?

A

Breast engorgement & diuresis.

35
Q

Prolactin levels elevated until 12 wks PP if?

A

Breastfeeding

36
Q

Prolatin levels are influenced by?

A

Influenced by frequency & duration of breastfeeding, # of supplemental feedings.

37
Q

Elevated Prolactin during breastfeeding suppresses..

A

Ovulation

38
Q

Infant sucking reflex?

A

variation in prolactin levels.

39
Q

Is breastfeeding a reliable form of birth control?

A

No

40
Q

Prolactin levels decline rapidly in the non lactating woman Ovulation could occur in…

A

Ovulation as early as 27 days after birth in nonlactating women. Remember 3 months!

41
Q

Mean time to ovulation if lactating is

A

6 months

42
Q

How long before abdominal muscle return to pre-pregnant state?

A

6wks

43
Q

Diastasis recti abdominis?

A

Abdominal wall muscles separate due to a large baby or over distended uterus.

44
Q

Which hormone suppress ovulation in the postpartum woman?

A

Prolactin

45
Q

When does diuresis occur?

A

Within 12 hrs begin to diurese.

46
Q

Renal function (# of voids) decreases to normal levels within..

A

1 month PP

47
Q

What can cause bladder extension?

A

Bladder distention may occur postpartally secondary to pelvic soreness, vaginal lacerations, or episiotomy.

48
Q

What does bladder extension cause?

A

Excessive bleeding can occur if bladder distended d/t inability of uterus to clamp down.

49
Q

The primary danger of a distended postpartum bladder is..

A

Excessive uterine bleeding.

50
Q

When do normal Bowel habits return?

A

2-3 days.

Kegel Exercises!

51
Q

Colostrum

A

present in the breast & yellow before lactation begins. Rich in antibodies.

52
Q

What teaching should you implement on breastfeeding women?

A

Lumps are not uncommon & mother should be reassured.

53
Q

What is the description of true milk?

A

True milk marks beginning of lactation with bluish-white appearance.

54
Q

Non-breastfeeding women should not…

A

express milk!

55
Q

When does engorgement and discomfort resolve for non-breastfeeding women?

A

24-36hrs

56
Q

What can help comfort non-breastfeeding women?

A

Breast binder, tight bras, ice packs, cabbage leaves, & mild analgesics for discomfort.
Avoid nipple stimulation.

57
Q

On way to alleviate engorgement pain in the breastfeeding woman is..

A

Breastfeed often!

58
Q

How much blood volume is lost during vaginal birth?

A

500mL

59
Q

How much blood volume is lost during cesarean?

A

1000mL

60
Q

Blood volume significants?

A

Immediate blood loss at delivery that stabilizes by 2nd wk & normalizes completely by 6 months PP.
Extra blood volume in pregnancy (35%) allows greater blood loss at delivery.

61
Q

Cardiac output is

A

Elevated up to 24wks PP

62
Q

What portion of the blood has the greatest loss?

A

Plasma

63
Q

What is significant about WBC count?

A

WBC increase to 20,000-25,000 during the first 10-12 postpartum days.
Infections difficult to detect at this time.

64
Q

What is significant about coagulation factors?

A

Risk of thromboembolism increased d/t increased clotting factors & fibrinogen levels in immediate PP period.
Worse after cesarean birth.

65
Q

Why is it important to assess a headache after delivery?

A

Postpartum onset preeclampsia, stress, or leakage of CSF after spinal or epidural anesthesia.

66
Q

Joints return to normal in..

A

6-8wks

67
Q

What body part does not return to normal size after delivery?

A

Feet. This is due to Relaxin.

68
Q

Cholasma?

A

(mask of pregnancy) disappears at end of pregnancy.

69
Q

Hyperpigmentation?

A

Of areola & linea nigra may not regress completely after childbirth.
May be permanent in some women.

70
Q

Stretch marks (striae gravidarium)

A

fade but do not disappear.

71
Q

Spider angiomas (telangiectasia)

A

usually regress.

72
Q

What is the most noteable change in PP women’s integumentary?

A

Profuse diaphoresis

Maternal Child Nursing (Exam 1) (11 decks)

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