mcn (!)

Question 1

period immediately after birth & extending for 6 - 8 wks after delivery
mother’s body returns to its pre-pregnant state

Answer 1

postpartum period | puerperium

Question 2

Nursing care should focus on

Answer 2

helping mother & her family adjust to changes
easing transition to the parenting role

Question 3

Phases of Puerperium

Answer 3

1 Taking in
2 Taking hold
3 Letting go

Question 4

Taking in phase

Answer 4

Dependent Phase
First 3 days post partum
Focus on self, not infant, on her own needs for sleep and rest
Passive, dependent and can’t make decisions
Need to discuss labor experiences
Sense of wonderment when looking at the neonate

Question 5

Taking hold phase

Answer 5

Dependent - Independent Phase
from 3rd to 10th day postpartum
focus on infant
active, independent and can make decisions
initiates self care activities, focus on bowels, bladder and breastfeeding
responds to instruction about infant care and self care
may express lack of confidence in caring for the neonate

Question 6

Letting go phase

Answer 6

Interdependent Phase
10 days to 6 weeks postpartum
readjustment
mother may feel deep loss over separation of baby from her body
wanting to feel safe and secure yet wanting to make decisions
finally redefines her new role
see self as separate from infant
gives up fantasized image of her child and accepts real one

Question 7

Postpartum Maternal concerns and feelings

Answer 7

Abandonment
Disappointment
Postpartal blues | Baby Blues
Postpartum depression

Question 8

mother may feel confused by a sensation very close to jealousy
shared responsibility for infant care can help alleviate these feelings

Answer 8

Abandonment

Question 9

Disappointment

Answer 9

difficult for mother to feel positive immediately about a child who does not meet their expectations

Question 10

Postpartal blues | Baby Blues

Answer 10

show up 3 to 4 days after birth and may last few weeks after delivery
50% of women experience some feelings of overwhelming sadness
mood swings, sudden crying episodes, irritability, anxiety, loneliness
feeling of happiness and love for newborn may be accompanied by feelings of helplessness, sadness and anxiety
Causes:
sudden and quick change in hormones
emotional and physical stress of giving birth

Question 11

moderate to severe depression in a woman after she has given birth
may occur soon after delivery or up to a year later
Causes:
caused by changes in hormone levels
Symptoms
Irritability
changes in appetite
feeling of worthlessness or guilt
feeling withdrawn or unconnected
lack of pleasure or interest in most or all activities

Answer 11

Postpartum depression

Question 12

rare compared to postpartum anxiety or depression
requires immediate attention, especially if with suicide thoughts or harms herself or baby
Symptoms
Hallucinations (hearing, sight, touch, etc)
Delusion (false, bizarre beliefs, which are not reality-based)
Drastic mood swings
Disorganization of speech (incoherence)
Disorganization of behavior (extremely inappropriate dress)
Extreme restlessness
Anger and agitation

Answer 12

Postpartum psychosis

Question 13

Uterine Involution

Answer 13

rapid decrease in uterine size as it returns to the nonpregnant state
weight decreases
fundic height decreases about 1cm per day
endometrium regenerates
by 10 days postpartum, uterus cannot be palpated abdominally
flaccid fundus indicates uterine atony and should be massaged until firm
tender fundus indicates infection

Question 14

uterine discharge consists of blood from placental site and debris from decidua
fleshy in odor, smells like normal menstruation
discharge decreases daily in amount but may increase with ambulation

Answer 14

Lochia

Question 15

complete cervical involution may take 3 – 4months
after 1 week the muscle begins to regenerate but is still about 1 cm dilated
permanent change cause by childbirth – the cervical os becomes slit-like or elongated

Answer 15

Cervix

Question 16

vaginal distention decreases
smooth and swollen
rugae reappear by 3 – 4 weeks
muscle tone is never restored to pregravid state

Answer 16

Vagina

Question 17

Postpartum Physiological Changes

Answer 17

Breast
Ovarian function and menstruation
Integumentary system
Gastrointestinal system
Urinary system
Musculoskeletal system

Question 18

Postpartum Complications

Answer 18

Postpartum Hemorrhage
Uterine atony
Subinvolution
Cystitis
Vulvar hematoma
Mastitis
Pulmonary embolism
Thrombophlebitis

Question 19

formation of a clot in vessel wall due to inflammation of vessel wall
partial obstruction of vessel can occur
increased blood-clotting factors
superficial, femoral, pelvic
elevate legs, never massage, monitor for signs of pulmonary embolism
warm packs, analgesics and heparin as prescribed

Answer 19

Thrombophlebitis

Question 20

passage of thrombus, often originating in one of the uterine or pelvic veins, into the lungs, where it disrupts circulation of blood
Dyspnea, tachypnea, tachycardia, cough, rales, hemoptysis, pleuritic chest pain, feeling of impending doom
Give O2, head levated, monitor VS, streptokinase and anticoagulants as prescribed

Answer 20

Pulmonary embolism

Question 21

inflammation of breast as a result of infection
seen in breastfeeding mothers 2-3 weeks after delivery but may occur anytime during lactation
localized heat and swelling, pain, elevated temperature, flu-like symptoms
advise good handwashing and breast hygiene techniques
warm or cold packs
encourage breastfeeding
use of support bra
analgesic and antibiotics as prescribed

Answer 21

Mastitis

Question 22

localized collection of blood into tissues of the reproductive sac after delivery
severe pain, pressure in perineal area with discolored skin
signs of shock (pallor, tachycardia, hypotension)
monitor VS, place ice at hematoma site, prepare for incision and evacuation of hematoma, ligation of bleeders
administer analgesics, antibiotics or blood products as required

Answer 22

Vulvar hematoma

Question 23

infection of the urinary bladder
burning pain on urination
lower abdominal pain
urinary frequency
fever
forced fluids up to 3L/day
institute measures to assist void, encourage frequent and complete emptying of the bladder
urinalysis
antibiotics as prescribed

Answer 23

Cystitis

Question 24

uterus remains large, and soft at 4 to 6 weeks postpartum
incomplete return of uterus to its prepregnant size and shape
Lochia is still present

Answer 24

Subinvolution

Question 25

inability of myometrium to contract and constrict blood vessels, resulting in open sinuses at site of placental separation
cause of 80 – 90% of early hemorrhage
may be slow & steady or sudden & massive
BP and PR may not change until it’s too late

Answer 25

Uterine atony

Question 26

bleeding 500 ml or more following delivery

Answer 26

Postpartum Hemorrhage