exam 2 postpartum changes Flashcards
What is the postpartum period?
The period of time between birth and the return of the reproductive organs back to their non-pregnant state.
–> 6 weeks
What do you need to know about the Reproductive System and Associated Structures (uterus)?
Uterus:
Uterine involution is the return of the uterus to a non-pregnant state.
The process starts after the delivery of placenta and then contraction of smooth muscle of the uterus occurs.
At the end of the third state of labor, the uterus is located at the midline and 2 cm below the umbilicus
Within the 1st 12 hours, the fundus can rise 1 cm above the umbilicus
Fundus will continue to descend 1 to 2 cm every 24 hours
Should not be able to palpate the fundus after 2 weeks
Return to non-pregnant location by 6 weeks
What do you need to know about the Reproductive System and Associated Structures (other)?
Cervix – gradually closes
Vagina & Perineum
Pelvic Muscular Support
where is the fundus located?
at the top of the uterus
what is the Day 1-3 Lochia?
lochia rubra
normal: bloody small clots fleshy earthy odor, red or red brown
abnormal: large clots saturated peri pads and foul odor
what is day 4-10 lochia?
lochia serosa
normal: decreased abnormal serosanguineous and pink or brown tinted
abnormal: excessive amount foul smell continued or recurrent reddish color
what is day 11-21 lochia?
lochia alba (may last until 6 wks in some)
normal: white cream or light yellow color decreasing amounts
abnormal: persistent lochia serosa return to lochia rubra, foul odor, discharge continuing
What happens to the placental hormone of the endocrine system during postpartum?
decrease Estrogen
decrease Progesterone
decrease HCG
autolysis
what are the metabolic changes of the endocrine system during postpartum?
decrease HCS
decreased estrogen
decreased cortisol
decreased insulinase
decreased T3 and T4
what are the pituitary hormones and ovarian function changes of the endocrine system during postpartum?
decreased or increased prolactin
what are the postpartum urinary system changes?
Glycosuria disappears
↑ BUN
↓ excess fluid in the tissues
May have ↓ urge to void
what are the postpartum GI system changes?
Appetite
Bowel movements
want them to have this for 3 days important because it’s considered “liquid gold” has antibodies to help the baby build their immune system
colostrum
comes in on the 3-4th day
mature milk
the breast have completely filled but it’s difficult to produce milk, the milk builds up in breast.
engorgment
infection; cracking of nipples, need to get milk out and get antibiotics. Related to the invasion of bacteria, microorganisms, etc.
mastotitis
what do you need to know about non-breastfeeding?
more stimulation the more milk, so no NIPPLE STIMULATION! Tight fitting bra, no water, no touching breast or playing with breast. Uterus will take longer to go down. Mom decides on if they want to breast or bottle feed, let the patient make their educated decision after they have been educated by the nurse. Make sure they know the right info. Powder formula and how to use it.
how can thrush in the newborns mouth occur?
candidiasis due to the mom’s breast or bottles are NOT clean. Make sure breastfeeding moms know to wash off their nipples after
what are the postpartum CV changes?
Blood Volume
- plasma volume decreases during the first few days
- plasma volume is replenished by 3rd pp day
Cardiac Output
- ↑ initially
- back to pre-labor value within 1 hr.
- ↓ decreases gradually to pre-pregnancy level
Vital Signs
- possible ↑ temp for during 1st 24 hr.
- pulse ↑ x1 hr., then ↓ over the next 24 hr.
- WNL
- transient increase in BP
Blood Components
- Hgb & Hct ↓ for 3-4 days, then back to pre-pregnant by 8 weeks
- ↑ WBC
Coagulation factors
- ↑ clotting factors & fibrinogen
Varicosities
- Varices empty rapidly, with complete or near complete emptying during the postpartum period. Back of her legs, front of legs, labia, etc. due to pushing.
what are the postpartum respiratory changes?
- intra-abdominal pressure ↓
- chest wall compliance ↑
what are the postpartum neuro changes?
- neurological discomforts of pregnancy go away
- headaches are common, but warrant careful assessment
What are the postpartum MS system changes?
Abdominal wall back to pre-pregnancy state
Time for muscle tone return varies
Diastasis recti abdominis
Back pain resolves
what are the postpartum integumentary system changes?
- melasma (chloasma): dark pigmentation on the face will go away.
- hyperpigmentation of areolae (if not breastfeeding, will take longer to go away)
- linea nigra (will go away)
- striae gravidarum: will not go away, but will fade
- spider nevi: in their legs, will not go away
what are the postpartum immune system changes?
- immune system return to its pre-pregnancy state
What does BUBBLE HE stand for and what occurs in each postpartum assessment phase?
B=breast
U=uterus
B=bowel (hemorrhoids, etc.)
B=bladder (rule: 30mL/Hr minimal)
L=lochia (No odor = good, distinct odor, bad odor = infection)
E=episiotomy/Laceration (L, R, or midline episiotomy) (3rd, 2nd, 1st, or 4th degree) Skid marks = abrasions on the inside and can’t be sewn up.
H=Heaviness & Hemorrhoids (constant trickle of bright red blood = something is bleeding, and we NEED TO KNOW WHAT IT IS!
E=emotions
