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

Exam 1 (Maternal Physiologic Changes) Flashcards

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
What happens to the Rugae?
can be permanently flattened.
26
What happens to the mucosa?
Atrophic with little or no lubrication in lactating women until menstruation begins. Causes dyspareunia & can be alleviated w/ a water soluble lubricant.
27
When should Episiotomy & vaginal lacerations be healed by?
2-3wks
28
Hemorrhoids should be reduced in..
6wks
29
Pelvic relaxation?
lengthening & weakening of fascial supports of pelvic structures. May occur in any woman but is direct result of childbirth.
30
How do you prevent pelvic relaxation?
Kegel exercise!
31
What do placental hormones do?
Placenta and placental hormones cause an elevation of blood sugar; delivery of placenta & decline in placental hormones - lower blood sugar levels.
32
What intervention will a nurse need to implement if patient is type 1 DM?
Insulin will likely have to be reduced (if patient is taking).
33
What happens to Estrogen & progesterone after the delivery of the placenta?
markedly decline after placenta delivery.
34
What does the decrease of estrogen do to the body?
Breast engorgement & diuresis.
35
Prolactin levels elevated until 12 wks PP if?
Breastfeeding
36
Prolatin levels are influenced by?
Influenced by frequency & duration of breastfeeding, # of supplemental feedings.
37
Elevated Prolactin during breastfeeding suppresses..
Ovulation
38
Infant sucking reflex?
variation in prolactin levels.
39
Is breastfeeding a reliable form of birth control?
No
40
Prolactin levels decline rapidly in the non lactating woman Ovulation could occur in...
Ovulation as early as 27 days after birth in nonlactating women. Remember 3 months!
41
Mean time to ovulation if lactating is
6 months
42
How long before abdominal muscle return to pre-pregnant state?
6wks
43
Diastasis recti abdominis?
Abdominal wall muscles separate due to a large baby or over distended uterus.
44
Which hormone suppress ovulation in the postpartum woman?
Prolactin
45
When does diuresis occur?
Within 12 hrs begin to diurese.
46
Renal function (# of voids) decreases to normal levels within..
1 month PP
47
What can cause bladder extension?
Bladder distention may occur postpartally secondary to pelvic soreness, vaginal lacerations, or episiotomy.
48
What does bladder extension cause?
Excessive bleeding can occur if bladder distended d/t inability of uterus to clamp down.
49
The primary danger of a distended postpartum bladder is..
Excessive uterine bleeding.
50
When do normal Bowel habits return?
2-3 days. | Kegel Exercises!
51
Colostrum
present in the breast & yellow before lactation begins. Rich in antibodies.
52
What teaching should you implement on breastfeeding women?
Lumps are not uncommon & mother should be reassured.
53
What is the description of true milk?
True milk marks beginning of lactation with bluish-white appearance.
54
Non-breastfeeding women should not...
express milk!
55
When does engorgement and discomfort resolve for non-breastfeeding women?
24-36hrs
56
What can help comfort non-breastfeeding women?
Breast binder, tight bras, ice packs, cabbage leaves, & mild analgesics for discomfort. Avoid nipple stimulation.
57
On way to alleviate engorgement pain in the breastfeeding woman is..
Breastfeed often!
58
How much blood volume is lost during vaginal birth?
500mL
59
How much blood volume is lost during cesarean?
1000mL
60
Blood volume significants?
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
Cardiac output is
Elevated up to 24wks PP
62
What portion of the blood has the greatest loss?
Plasma
63
What is significant about WBC count?
WBC increase to 20,000-25,000 during the first 10-12 postpartum days. Infections difficult to detect at this time.
64
What is significant about coagulation factors?
Risk of thromboembolism increased d/t increased clotting factors & fibrinogen levels in immediate PP period. Worse after cesarean birth.
65
Why is it important to assess a headache after delivery?
Postpartum onset preeclampsia, stress, or leakage of CSF after spinal or epidural anesthesia.
66
Joints return to normal in..
6-8wks
67
What body part does not return to normal size after delivery?
Feet. This is due to Relaxin.
68
Cholasma?
(mask of pregnancy) disappears at end of pregnancy.
69
Hyperpigmentation?
Of areola & linea nigra may not regress completely after childbirth. May be permanent in some women.
70
Stretch marks (striae gravidarium)
fade but do not disappear.
71
Spider angiomas (telangiectasia)
usually regress.
72
What is the most noteable change in PP women's integumentary?
Profuse diaphoresis

Maternal Child Nursing (Exam 1) (11 decks)

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