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NRSG 206: OB > [Exam 2] Chapter 15 – Postpartum Adaptations > Flashcards

[Exam 2] Chapter 15 – Postpartum Adaptations Flashcards

1
Q

When does the puerperium period begin?

A

After the delivery of the placenta and lasts 6 weeks.

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2
Q

Reproductive System Adaptations: What events occur after birth?

A

Shedding of the placenta and subsequent uterine involution involving tissue destruction and repair/remodeling

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3
Q

Reproductive System Adaptations - Uterine Involution: The return to its normal size involves what three processes?

A

Contraction of muscle fibers to reduce those previously stretched

Catabolism, which shrinks enlarged myometrial cells

Regeneration of uterine epithelium from lower layer of the decidua.

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4
Q

Reproductive System Adaptations - Uterine Involution: Size of uterus after 1 week and at end of 6 weeks?

A

Weights 1000 g before birth

500 g after 1 week

50 g at end of 6 weeks

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5
Q

Reproductive System Adaptations - Uterine Involution: How quickly does the uterus descent?

A

At a rate of 1 cm per day.

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6
Q

Reproductive System Adaptations - Uterine Involution: Subinvolution may occur if it does not return to its normal place. What is this?

A

Delayed or absent involution

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7
Q

Reproductive System Adaptations - Uterine Involution: What helps promote uterine involution?

A

Complete expulsion of amniotic membranes and placenta at birth, complication-free labor and birth process, breast-feeding- and early ambulation

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8
Q

Reproductive System Adaptations - Uterine Involution: What may inhibit involution

A

Prolonged labor and difficult birth, incomplete expulsion of amniotic membranes/placenta, uterine infection, and over-distention of uterine muscles.

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9
Q

Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia?

A

Discharge that occurs after birth and continues for 4-8 weeks.

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10
Q

Reproductive System Adaptations - Uterine Involution and Lochia: Why does this occur?

A

From involution. When superfiical layer of decidua basalis becomes necrotic and sloughs off

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11
Q

Reproductive System Adaptations - Uterine Involution and Lochia: How does this appear immediately after birth?

A

Bright red and contains mainly blood, decidual cells, and RBC and WBCs.

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12
Q

Reproductive System Adaptations - Uterine Involution and Lochia: Lochia passes through what three stages?

A

Lochia Rubra

Lochia Serosa

Lochia Alba

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13
Q

Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia Rubra?

A

Deep-red mixture of mucus, tissue debris, and blood that occurs for first 3-4 days after birth. As bleeding subsides, becomes paler

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14
Q

Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia Serosa?

A

2nd stage. Pinkish brown and is expelled 3-10 days postpartum.

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15
Q

Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia Alba?

A

Final Stage. Discharge is creamy white or light brown . Occurs 10-14 days but can last 3-6 weeks postpartum

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16
Q

Reproductive System Adaptations - Uterine Involution and Lochia: How should this smell?

A

Fleshy Smell. offensive odor indicates an infection

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17
Q

Reproductive System Adaptations - Uterine Involution and Afterpain: When is this most common?

A

In acute multiparous and breast-feeding woman. Due to stimulation during-breast-feeding with oxytocin released

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18
Q

Reproductive System Adaptations - Uterine Involution and Afterpain: Primiparous woman exerpience mild afterpains why?

A

Because their uterus is able to maintain an contracted state

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19
Q

Reproductive System Adaptations - Uterine Involution and Cervix: When changes occur here?

A

Internal cervical os returns to normal but external cervical os is no longer shaped like a circle, but looks like a fish mouth

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20
Q

Reproductive System Adaptations - Uterine Involution and Vagina: What happens as estrogen production resums?

A

Mucosa thickens and rugae return.

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21
Q

Reproductive System Adaptations - Uterine Involution and Vagina: How long for the vaginal epithelium to be restored?

A

By 6-8 weeks.

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22
Q

Reproductive System Adaptations - Uterine Involution and Perineum: How long for healing if laceration occured?

A

May take 4-6 months in absence of complications at site.

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23
Q

Reproductive System Adaptations - Uterine Involution and Perineum: What comfort measures can be given for perineal lacerations?

A

Ice packs, pouring warm water of area with peribottle. witch hzel pads, and sitz baths

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24
Q

Reproductive System Adaptations - Uterine Involution and Perineum: How long to restore muscle tone and why must this be done?

A

May take 6 months. Failure to restore this may lead to urinary incontinence later in life

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25
Q

Cardio System Adaptation: How long for CO and blood volume to return to normal?

A

Within 4 weeks.

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26
Q

Cardio System Adaptation - Pulse and BP: Decrease in CO is reflected how?

A

In bradycaria (40-60 bpm) for first 2 weeks

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27
Q

Cardio System Adaptation - Pulse and BP: What would it mean if woman had tachycardia after birth?

A

May indicate hypovolemia, dehydration, or hemorrhage.

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28
Q

Cardio System Adaptation - Pulse and BP: Should these decrease in postpartum period?

A

No.. CO and BP should not decrease

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29
Q

Cardio System Adaptation - Pulse and BP: Trend of BP after birth?

A

Falls in first 2 days, adn then increases 3-7 days after childbirth, adn returns to normal by 6 weeks

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30
Q

Cardio System Adaptation - coagulation: What changes here during pregnancy affect woman?

A

Coagulation, reduced fibrinolysis, and pooling adn stasis of blood in lower limb puts them at higher risk for blood clots.

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31
Q

Cardio System Adaptation - coagulation: When does this return to normal??

A

3 Weeks. Smoking, obesity, or immobility increase risk for this

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32
Q

Cardio System Adaptation - coagulation: Why is this elevated after birth?

A

Because it was stimulated at birth. Remains elevated for 2-3 weeks. This along with vessel damage during birht places woman at risk for thromboembolism

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33
Q

Cardio System Adaptation - Blood Cellular Components: What happens to Hgb and Hct?

A

Decrease slightly in first 24 hurs. During next 2 weeks, rise slowly.

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34
Q

Cardio System Adaptation - Blood Cellular Components: What happens to WBC?

A

Increases in labor and remains elevated for 4-6 days after birth, then falls to 6,000 - 10,000

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35
Q

Urinary System Adaptations: How do women do here after receiving anesthetic block or oxytocin?

A

Anesthetic inhibits neural functioning of bladder

Oxytocin has ADH effect.

At risk for incomplete emptying, bladder distention, and difficulty voiding

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36
Q

Urinary System Adaptations: Urination may be impeded by what?

A

Perineal laceration

Generalized swelling and bruising of perineum

Hematomas

Decreased bladder tone

Diminished sensation of bladder pressure

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37
Q

Urinary System Adaptations: Difficulty voiding can lead to what?

A

Urinary retention, bladder distention, and UTI infection

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38
Q

Urinary System Adaptations: Urinary retention can cause displacement of uterus from midline to where?

A

To the right and can inhibit the uterus from contracting properly

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39
Q

Urinary System Adaptations: Retention major cause of uterine atony, which is what?

A

Allows excessive bleeding.

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40
Q

Urinary System Adaptations: Why does postpartum diuresis occur?

A

As a result of large amount of IV fluid given, decreased ADH effect of oxytocin, and buildup/retention of extra fluids during pregnancy

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41
Q

GI System Adaptations: Why does this return to normal quickly?

A

Because gravid uterus no longer fills the abdominal cacity and causes pressure on abdominal organs

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42
Q

GI System Adaptations: Progesterone decliens, which usually cuases what?

A

Caused relaxation of smooth muscle during pregnancy and diminished bowel tone

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43
Q

GI System Adaptations: Decreased peristalsis occurs why?

A

Analgesics, surgery, diminished intra-abdominal pressure, and low-fiber diet, and insufficient fludi intake

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44
Q

Musculoskeletal System Adaptations: What changes occur during pregnancy?

A

Increased ligament laxity, weight gain, change in center of gracity, and carpal tunnel syndrome.

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45
Q

Musculoskeletal System Adaptations: What hormones decline after pregnancy which caused the joints to relax?

A

Relaxin, Estrogen, and Progesterone. Causes joints to return to prepregnant state

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46
Q

Musculoskeletal System Adaptations: What does a decline in relaxin and progesterone cause in women?

A

Fatigue and activity intolerence and also distorted body image. This causes hip and joint pain that interferes with ambulation

47
Q

Musculoskeletal System Adaptations: What is diastasis recti?

A

Separation of the rectus abdominis muscles, caused by women who have poor abdominal muscle tone before pregnancy

48
Q

Integumentary System Adaptations: What happens as estrogen and progesterone decreases here?

A

Darkened pigmentation on abdomen (linea nigra) face, (Melasma) and nipples gradually fades

49
Q

Integumentary System Adaptations: Most common time for hair loss?

A

Within 3 months after births, with estrogen returning and more hair falling out.

50
Q

Integumentary System Adaptations: What does striae gravidarum (stretch marks) evantually turn into?

A

Fade into silvery lines.

51
Q

Integumentary System Adaptations: Why do women wake up drechened in sweat? (Diaphoresis)

A

This is to reduce amount of fluids retained during pregnancy and restore prepregnant body fluid levels

52
Q

Respiratory System Adaptations: What changes occur here?

A

Diaphragm returns to usual position. Returns to normal within 1-3 weeks

53
Q

Endocrine System Adaptations: Decreased estrogen levels here associated with?

A

Breast engorgement and with the diuresis of ecess ECF. Lowest 1 week after birth

54
Q

Endocrine System Adaptations: When does Estrogen increase?

A

Once breast-feeding frequency decreases

55
Q

Endocrine System Adaptations: What happens to hCG and hPPL?

A

Declien quickly after birth. Undetectable after one week

56
Q

Endocrine System Adaptations: What happens to Progesterone levels?

A

Gone by 3 days. REestablished with return of first menses.

57
Q

Endocrine System Adaptations: When does Prolactin decline?

A

Within 2 weeks for non-breast feeding woman

58
Q

Weight Loss After Childbirth - Lactation: What hormones cause this?

A

Progesterone, Estrogen, Prolactin, and Oxytocin

59
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: Breast-feeding recommended for how long?

A

For the first six months.

60
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What does Estrogen stimulate here?

A

Growth of the milk collection (ductal) system

61
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What does Progesterone stimulate here?

A

Growth of the milk production sste

62
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What does Prolactin trigger?

A

Synthesis and secretion of milk after woman gives birth.

63
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: When does the cchange from colostrum to milk occur?

A

When 4-5 days, after estrogen and progesterone are abruptly withdrawn

64
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What does Oxytocin do?

A

Acts to milk can be ejected frm the alveoli to niple.

65
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: Prolactin levels increase when?

A

In response to nipple stimulation during feeing

66
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What is the gold standard to initiate breast-feeding?

A

Skin-to-skin contact during first hour.

67
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What is the breast crawl?

A

Newborn instinct to crawl up mother abdomen to her breast.

68
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: Breast milk production can be summarized as?

A

Prolactin levels increase with decrease in estrogen and progesterone

Prolactin initiates milk prod.

Oxytocin reelased to promote milk let-down

Infant sucking at each feeding provides continuous stimulus for prolactin

69
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: what is the let-down reflex?

A

A tinglign sensation in both breasts, which occurs before or during breast-feeding.

70
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What is Engorgement?

A

Postnatal physiologic painful condition in whcih distention and swelling of breast tissue occur as a result of increase in blood dand lymph supply. Peaks in 3-5 days.

71
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: What can engorgement result from?

A

Infrequent feedings or ineffective emptying of breasts.

72
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: How can you minimize discomfort seen with engorgement?

A

Frequent emptying of breasts. Also standing inw arm shower and applying warm compress helps.

73
Q

Weight Loss After Childbirth - Lactation and Breast-Feeding: Treatment to reduce pain of breast engorgement includes

A

heat or cold applicatiions, breast massage, milk expression, ultrasound, and breast pumping

74
Q

Weight Loss After Childbirth - Lactation and Suppressing Lactation: What can be done if a women does not desire to breast-feed?

A

Wear tight, supporitive bra 24 hours daily, apply ice to breasts for 20 mins every other hour, avoid sex stimulation and do not manually express milking from nipples

75
Q

Weight Loss After Childbirth - Ovulation and Return of Menstruation: What four major hormones are influenctial in postpartum period?

A

Estrogen, Progesterone, Prolactin, and Oxytocin

76
Q

Weight Loss After Childbirth - Ovulation and Return of Menstruation: Estrogen levels after birth?

A

Reach lowest level a week after pregnancy

77
Q

Weight Loss After Childbirth - Ovulation and Return of Menstruation: What does Progesterone do during pregnancy?

A

Quiets the uterus to prevent lactation from starting before birth . Reestablushed with first menstrual cycle

78
Q

Weight Loss After Childbirth - Ovulation and Return of Menstruation: How long for this to return?

A

Can return within 7-9 weeks if not feeding.

79
Q

Cultural Consideration for Postpartum Period: How do Vietnamese view this period?

A

As cold state and protect themselves through warm. Use warm water for everything.

80
Q

Psychological Adaptations - Parental Attachment Behaviors: Oxytocin plays a key role here how?

A

Effects enhanced by skin-to-skin contact, breast-feeding, eye contaact, social vocalizations, maternal and milk odors.

81
Q

Psychological Adaptations - Parental Attachment Behaviors: How can nurses promote kangaroo care?

A

By placing the infant onto the bare cheests of the mothers and fathers to enhance the parent-newborn attachment

82
Q

Maternal Psychological Adaptations - Mood Disorders: What mood changes may occur?

A

May include fatigue, irritable, or worried.

83
Q

Maternal Psychological Adaptations - Mood Disorders: Mood disorders can be divided into what three entities?

A

Maternal (Baby) Blues, Postpartum Depression, and Psychosis

84
Q

Maternal Psychological Adaptations - Mood Disorders: What are the signs seen with “baby blues” or maternal blues?

A

Mild depressive symtpoms, anxiety, irritability, mood swings, loss of apperite, trouble with sleeping, tearfulness.

85
Q

Maternal Psychological Adaptations - Mood Disorders: What does baby blues peak?

A

Postpartum day 4.

86
Q

Phases of Maternal Adaption to Parenthood and Talking-In Phase: Who created the maternal role framework??

A

Reva Rubin

87
Q

Phases of Maternal Adaption to Parenthood and Talking-In Phase: When does this occur?

A

Immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding birth

88
Q

Phases of Maternal Adaption to Parenthood and Talking-In Phase: What role do mothers assume 24-48 horus after birth?

A

Passive role in meeting their basic needs for food, fluids, and rest.

89
Q

Phases of Maternal Adaption to Parenthood and Talking-Hold Phase: What is htis?

A

Characterized by dependent and independent maternal behavior. Typically starts on the second to third day.

90
Q

Phases of Maternal Adaption to Parenthood and Talking-Hold Phase: How wil she act?

A

Will be taking hold and becoming preoccupied with present. Concerned about her health and infants health.

91
Q

Phases of Maternal Adaption to Parenthood and Letting-Go Phase: What happens here?

A

Woman reestablishes relationships wit other people. Assumes responsibility with more confidence now.

92
Q

Phases of Maternal Adaption to Parenthood and Letting-Go Phase: What are the four stages a women progresses through in establishing a maternal identity in becoming a mother?

A

Commitment, attachment to the unborn baby

Attachment to the infant, and learning to care for infant for 2-6 weeks

Moving toward new normal

Achievement of maternal identify through redefining self to incorporate motherhood.

93
Q

Partner Psychological Adaptations: Complexitis of the transitional process involved in forging a parenthood identity can be viewed at what three different levels?

A

Readjdustment ot a new self-image

Formation of a triadic family relationship

Adaptation to redefining themselves and their relationship with their partner

94
Q

Partner Psychological Adaptations: What is Engrossment?

A

The fathers or SO developing bond with the newborn, which is a time of intense absorption, preoccupation, and interest

95
Q

Partner Psychological Adaptations and Engrossment: What is the Visual Awareness of newborn?

A

Partner perceives newborn as attractive, pretty, or beautiful

96
Q

Partner Psychological Adaptations and Engrossment: What is the Tactile awareness of newborn?

A

Partner has a desire to touch or hold the newborn and considers this activity to be pleasureable

97
Q

Partner Psychological Adaptations and Engrossment: What is perception of newborn as perfect?

A

Partner does not see any imperfectiosn

98
Q

Partner Psychological Adaptations and Engrossment: What is the strong attraction to the newborn?

A

Partner focuses all attention on newborn when they are in room

99
Q

Partner Psychological Adaptations and Engrossment: What is the awareness of distinct features of the newborn?

A

Partner can distinguish his/her newborn from others in nursery

100
Q

Partner Psychological Adaptations and Engrossment: What is extreme elation?

A

Partner feels a “high” after birth of their child

101
Q

Partner Psychological Adaptations and Engrossment: What is increased sense of self-esteem?

A

Partner feels proud, bigger, more mature and older after birth of their child

102
Q

Three Stage Role Developmental Process: What is Stage 1?

A

Expectations with preconceptions of what home life will be like. May be unaware of dramatic changes that can occur

103
Q

Three Stage Role Developmental Process: What is Stage 2?

A

Reality

Occurs when partners realize stage 1 is not realistic.

104
Q

Three Stage Role Developmental Process: Partners stress during stage 2 can turn into what?

A

DEpression. Can cause marital conflicts, reckless, or violent behaviors and to be withdrawn.

105
Q

Three Stage Role Developmental Process: RF for depression seen in stage 2?

A

Depression hx, financial problems, poor realtionships or unplanned pregnancy

106
Q

Three Stage Role Developmental Process: What is stage 3?

A

Transition to mastery. Makes unconscious decision to take control and be center of newborns life.

107
Q

Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement?

An increase in blood and lymph supply to the breasts
An increase in estrogen and progesterone levels
Colostrum production increases dramatically.
Fluid retention in the breasts due to the intravenous fluids given during labor
A

Increase in blood and lymph supply to the breasts

108
Q

In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman’s behavior to be characterized as which of the following?

Gaining self-confidence
Adjusting to her new relationships
Being passive and dependent
Resuming control over her life
A

Being passive and dependent

109
Q

The nurse is explaining to a postpartum woman 48 hours after her giving childbirth that the afterpains she is experiencing can be the result of which of the following?

Abdominal cramping is a sign of endometriosis.
A small infant weighing less than 8 pounds
Pregnancies that were too closely spaced
Contractions of the uterus after birth
A

Contractions of the uterus after birth

110
Q

The nurse would expect a postpartum woman to demonstrate lochia in which sequence?

Rubra, alba, serosa
Rubra, serosa, alba
Serosa, alba, rubra
Alba, rubra, serosa
A

Rubra, serosa, alba

111
Q

The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected?

Cream-colored lochia; uterus above the umbilicus
Bright-red lochia with clots; uterus 2 fingerbreadths below umbilicus
Light pink or brown lochia; uterus 4 to 5 fingerbreadths below umbilicus
Yellow, mucousy lochia; uterus at the level of the umbilicus
A

Light pink, or brown lochia. Uterus 4-5 fingerbreadths below umbilicus

112
Q

Prioritize the postpartum mother’s needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need.

\_\_\_\_\_\_\_\_\_ Learn how to hold and cuddle the infant.
\_\_\_\_\_\_\_\_\_Watch a baby bath demonstration given by the nurse.
\_\_\_\_\_\_\_\_\_ Sleep and rest without being disturbed for a few hours.
\_\_\_\_\_\_\_\_\_ Interaction time (first 30 minutes) with the infant to facilitate bonding
A

4, 3, 1, 2

113
Q

Immediately after childbirth in the recovery area, the nurse observes the mother’s partner’s fascination and interest in the new son. This behavior is often termed:

Attachment
Engrossment
Bonding
Temperamen
A

Engrossment

114
Q

After the nurse provides instructions to a postpartum woman about postpartum blues, which statement would indicate understanding of it? I will

“Need to take medication daily to treat the anxiety and sadness.”
“Call the OB support line only if I start to hear voices.”
“Contact my doctor if I become dizzy and fell nauseated.”
“Feel like laughing 1 minute and crying the next minute.”
A

Feel like laughing one minute, and crying the next minute

NRSG 206: OB (42 decks)

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