Maternity 5-1 Flashcards
Postpartum - how many weeks?
the period between the birth of the newborn and the return of the
reproductive organs to their normal non- pregnant state. Usually complete by 6-8 weeks post-birth
Involution
Return of the uterus to
a non-pregnant state after birth.a non-pregnant state after birth.
Begins with the expulsion of the
placenta and contraction of the
smooth muscle.
Subinvolution
failure of the
uterus to return to nonpregnantuterus to return to nonpregnant
Uterine Assessment:
Consistency,
location relative to umbilicus,
midline/right/left
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postpartum VS - how often?
Head-to-toe assessment: Q shift and PRN
VS & OB assessment (includes pain!) up to 2 hours PP:
q 15 x 1 hour
q 30 x 1 hour
VS & OB assessment: twice shift/1st 24 hours, once shift/> 24 hours PP
Additional post c/s assessments PRN
PROCESS OF INVOLUTION (contract the hemo cat)
Contraction of uterine muscle fibers
Hemostasis is achieved primarily by compression of the intra-myometrial blood vessels as the uterine contracts
Catabolism: shrinking of enlarged myometrial cells
After lochia sheds, uterine lining regenerates
Fundus not palpable by 10 days post birth
FACTORS PROMOTING INVOLUTION
Oxytocin (Pitocin)
Breastfeeding
Urine output
Fundal Massage
Ambulation
bladder too full
uterus will go to right
Lochia Rubra (red for 3 days)
~2-3 days
* Blood, decidual
tissue/debris, mucus
* Color: bright red
Lochia Serosa - what days? (seriously pink and brown)
~3-10 days
* Blood, serum, leukocytes
and tissue debris
* Color: pinkish brown
Lochia Assessment- how many pad changes a day?
- Amount: Initially, expect 6-8 pad changes per day
- Odor
- Clots
Lochia - scant (scantly one, do the conversion)
Lochia Assessment
* Scant < 2.5cm (1 inch)
Vagina and Perineum
Bruising and edema of the perineum
* Lacerations/Episiotomy
* Hemorrhoids
Hemorrhoids
- Symptoms: Itching, Discomfort Bright
Red Bleeding - Interventions: Stool softeners, witch
hazel pads (Tucks), topical ointment,
increased fiber in diet
Nursing Care: Perineal Trauma
Ice packs: 1st 24 hours
* Peri-bottle with every voiding
* Sitz Bath (after 24 hours)
* Pain Control
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Urinary Tract: Postpartum Changes - what about gfr?
Urinary Tract: Postpartum Changes
* Decreased GFR & Renal plasma flow
* Tone/size of structures returns to pre-
pregnancy state (6-8 weeks)
maximum time to allow a pt to go without peeing?
6 hours
Nursing Care:
Urinary Tract
Postpartum - how often to void?
Assist patient to void following delivery
* Assess for fundal displacement
* Encourage to void q2 hours
* Pain relief & Edema/trauma: ice, analgesia, sitz bath,
topical spray
* Difficulty voiding:
* Decreased sensation of full bladder
* Pain
* Edema/trauma
* Peppermint essential oil in toilet water
* Document urine output per provider order
* Bladder scanner/straight cath PRN
GI Tract - constipation for how long?
Bowel tone will improve as
progesterone levels decline.
Delayed spontaneous bowel
movement, up to 5 days PP.
Labor/birth effects: pre-labor diarrhea,
lack of food, dehydration, anticipatory
pain due to lacerations/tissue trauma
C/S: Intra-op narcotics, disruption of
intestines during surgery, delayed
ambulation, NPO
GI Changes/Nutrition - how many extra calories if breastfeeding?
Breast-feeding vs. bottle-
feeding
* If breast-feeding:
* Encourage prenatal
vitamins
* Increase calories if breast-
feeding (450-500 kcal)
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Nursing Care: GI Changes
Encourage hydration and ambulation
* Diet high in fiber
* Stool softeners/laxatives/anti-gas meds PRN
* Encourage normal food intake
* Adhere to ATC non-narcotic pain regimen post C/S
* Comfort measures
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Nursing Care: GI
Changes/Nutrition - foods high in what?
Iron PRN
* Foods high in iron
* Iron supplement/infusion
* Education: constipating
effect of p.o. iron
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Cardiovascular System: Postpartum
Changes - cardiac output
Heart: returns to pre-pregnant position
* Cardiac output: gradually declines/3 months, HR
slows/increased stroke volume
Cardiovascular System: Postpartum
Changes - when does coagulation return to normal? (coag is the number of the beast)
Increased coagulability of pregnancy: Returns to pre-pregnancy state
by 6 weeks
Respiratory System:
Postpartum Changes - RRs?
RR: 16-24
Diaphragm returns to normal
position
SOB relief
Integumentary System:
Postpartum Changes - when does hair loss occur?
Pregnancy pigmentation fades: melasma, linea nigra, nipples
* Hair loss: more hairs in resting phase pre-birth, most hair loss by 3
months PP w/ dec in estrogen
* Striae gravidarum: stretch marks start to fade
linea nigra - fade or not?
usually fades
integumentary
Pregnancy pigmentation fades: melasma, linea nigra, nipples
* Striae gravidarum: stretch marks start to fade
endocrine
Delivery of placenta: rapid clearance of placental hormones
Endocrine System - when does menses return for breastfeeding and non-breastfeeding?
Ovulation may occur before first period.
* Menses: May return at 6-8 weeks if not breastfeeding exclusively or
exclusively
* Breast-feeding: dependent upon frequency of breast-feeding,
average 6 months
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endocrine
Delivery of placenta: rapid clearance of
placental hormones
* Adrenal release: patient may experience
shaking in 1st 30 min PP
* Decrease in estrogen: diuresis, remain low if
breastfeeding
* HCG, HPL, progesterone all drop
* Prolactin: inc w/ breastfeeding, released by
anterior pituitary
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Postpartum Pain Management:
Sources of Pain
Remember: Assess, Intervene PRN, Re-assess, Document!
* Uterine cramping
* Afterpais
* Stronger w/ multiparity, full bladder, breastfeeding
* Oral analgesia, heat therapy, frequent voiding
* Perineal/labial/rectal
* Oral analgesia, care of lacerations/hemorrhoids
* Breasts:
Nipple tenderness
Assess positioning
Teach nipple care
Engorgement
Encourage frequent breastfeeding
Cold packs
NSAIDS
Supportive bra
Cold Cabbage leaves
Areola softening
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Sources of Pain - Post C-Section pain
Assist w/ mobility PRN
* Promote early ambulation
* Promote return of GI function
* Ensure pain controlled: the more mobile the patient, the less
likely pain is to be severe
* Assess incision for infection
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Postpartum Pain Management:
Analgesia
Oral Analgesia: Acetaminophen, Ibuprofen, Oxycodone
* IV, non-narcotic: Acetaminophen, ketoralac
* NSAIDs (ibuprofen/ketorolac)
* Inhibit prostaglandin
* Decrease inflammatory responses
* Effective in peripheral tissues
* Epidural/Spinal: Duramorph
* PCA: dilaudid, morphine
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Lactation: Breast Changes - what stimulates breast tissue?
Prenatally: Mammary
glands develop/proliferate
* Estrogen stimulates dev’t
of breast tissue
Lactation:
Hormones - Prolactin -what do high levels do?
High levels suppress
FSH/ovulation
Inc days 4-5 PP w/ drop of
estrogen/progesterone
Increase in response to nipple
stimulation
Maternal Contraindications to
Breastfeeding
Chemotherapy or radioactive isotopes
* “illicit” drugs
* Active TB
* HIV positive (in the U.S.)
* Certain Rx drugs
* Resources: Lactmed, Hale’s guide
uterine weight
Uterus weighs 2.2 lb (1,000 g) at time of FT birth, 2 oz at 6 wk PP
lochia light - (lights out at 10)
- Light < 10 cm (4 inches)
lochia moderate - (moderate comes after lights out)
- Moderate > 10cm
lochia heavy - pad in how many hours?
- Heavy = one saturate pad within 2 hours
decreased estrogen - mucosa?
thin mucosa, absence of rugae, dryness (3-4 weeks)
urinary - diuresis due to…(what hormones?)
- Increased output: diuresis due to decreased oxytocin/decreased blood volume/decreased aldosterone (12 hours
PP-1 week) - Risk for urinary retention: swelling,
anesthesia, decreased urge to void, pain - Risk of infection: d/c foley ASAP
what drugs help involution? (hmm, helps involution?)
Hemabate, Misoprostol, Methergine
BP - when does it return to normal? (it’s all within the postpartum timeframe)
- BP: decrease/1st 2 days PP, inc to normal by 6 weeks PP
blood volume - when does it return to normal? (jessica’s blood is 26)
- Blood volume: drops rapidly PP/returns to pre-pregnant
state 2-6 weeks
plasma - how does it decrease?
- Plasma volume: decrease through diuresis/increase H &H
when do wbc return to normal? (think, WBC can’t stay high too long)
- WBCs: rise intrapartum, return to normal at 4-6 days PP
clotting factors - how long do they stay elevated? (clots until age 23)
- Clotting factors remain elevated 2-3 weeks PP
- Monitor for DVT/thromboembolism
hemaglobin and hematocrit? when is the dip?
- H & H: initial dip (1st 24 hours), then rise
when does tidal volume return to normal? (tidal 13)
Tidal volume/functional residual
capacity: pre-pregnant state by 1-
3 weeks PP
diaphoresis - when does it occur? (sweat at first)
- Diaphoresis: mechanism to rid body of excess fluid in first week PP
endocrine - adrenal release when? (think of pt)
- Adrenal release: patient may experience shaking in 1st 30 min PP
Decrease in estrogen - what happens? (estrogen dies)
- Decrease in estrogen: diuresis, remain low if breastfeeding
- HCG, HPL, progesterone drop or increase?
- HCG (Human chorionic gonadotropin), HPL (Human placental lactogen (HPL), progesterone all drop
prolactin - increase or decrease?
- Prolactin: inc w/ breastfeeding, released by anterior pituitary
postpartum breasts - when do they become fuller?
- PostpartumBreasts gradually become fuller and heavier 72-96 hours
PP - Transition from colostrum only to full breast milk
