exam 2 postpartum changes

Question 1

What is the postpartum period?

Answer 1

The period of time between birth and the return of the reproductive organs back to their non-pregnant state.
–> 6 weeks

Question 2

What do you need to know about the Reproductive System and Associated Structures (uterus)?

Answer 2

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

Question 3

What do you need to know about the Reproductive System and Associated Structures (other)?

Answer 3

Cervix – gradually closes
Vagina & Perineum

Pelvic Muscular Support

Question 4

where is the fundus located?

Answer 4

at the top of the uterus

Question 5

what is the Day 1-3 Lochia?

Answer 5

lochia rubra
normal: bloody small clots fleshy earthy odor, red or red brown
abnormal: large clots saturated peri pads and foul odor

Question 6

what is day 4-10 lochia?

Answer 6

lochia serosa
normal: decreased abnormal serosanguineous and pink or brown tinted
abnormal: excessive amount foul smell continued or recurrent reddish color

Question 7

what is day 11-21 lochia?

Answer 7

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

Question 8

What happens to the placental hormone of the endocrine system during postpartum?

Answer 8

decrease Estrogen
decrease Progesterone
decrease HCG
autolysis

Question 9

what are the metabolic changes of the endocrine system during postpartum?

Answer 9

decrease HCS
decreased estrogen
decreased cortisol
decreased insulinase
decreased T3 and T4

Question 10

what are the pituitary hormones and ovarian function changes of the endocrine system during postpartum?

Answer 10

decreased or increased prolactin

Question 11

what are the postpartum urinary system changes?

Answer 11

Glycosuria disappears
↑ BUN
↓ excess fluid in the tissues
May have ↓ urge to void

Question 12

what are the postpartum GI system changes?

Answer 12

Appetite
Bowel movements

Question 13

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

Answer 13

colostrum

Question 14

comes in on the 3-4th day

Answer 14

mature milk

Question 15

the breast have completely filled but it’s difficult to produce milk, the milk builds up in breast.

Answer 15

engorgment

Question 16

infection; cracking of nipples, need to get milk out and get antibiotics. Related to the invasion of bacteria, microorganisms, etc.

Answer 16

mastotitis

Question 17

what do you need to know about non-breastfeeding?

Answer 17

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.

Question 18

how can thrush in the newborns mouth occur?

Answer 18

candidiasis due to the mom’s breast or bottles are NOT clean. Make sure breastfeeding moms know to wash off their nipples after

Question 19

what are the postpartum CV changes?

Answer 19

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.

Question 20

what are the postpartum respiratory changes?

Answer 20

• intra-abdominal pressure ↓
• chest wall compliance ↑

Question 21

what are the postpartum neuro changes?

Answer 21

• neurological discomforts of pregnancy go away
• headaches are common, but warrant careful assessment

Question 22

What are the postpartum MS system changes?

Answer 22

Abdominal wall back to pre-pregnancy state
Time for muscle tone return varies
Diastasis recti abdominis
Back pain resolves

Question 23

what are the postpartum integumentary system changes?

Answer 23

• 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

Question 24

what are the postpartum immune system changes?

Answer 24

• immune system return to its pre-pregnancy state

Question 25

What does BUBBLE HE stand for and what occurs in each postpartum assessment phase?

Answer 25

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