module 10 Flashcards
Postpartum fungus positioning tone hemostasis
midline and at umbilicus (directly postpartum) firm
involution
the movement of the uterus back to the pre pregnancy position occurs at a rate of 1 cm per day. contractions allow for this to happen
subinvolution
when the uterus does not recede back to its pre pregnancy position
could be the result of the bladder not being emptied
what causes the uterus to deviate up and to the right
a full bladder. this can even cause the uterus to be boggy
what is the role of oxytocin postpartum?
oxytocin helps with hemostasis. it allows for the vessels that were once attached to the placenta to clamp off. oxytocin is released from the pituitary gland
what is the sequence of lochia
lochia rubra from day 0 to day 3 lochia serosa from day 4- day 10 lochia alba from day 11-day 14 the lochia should move in a very specific sequence and should not move backward pads should be changed every 2-3 hours
postpartum vagina and perineum
- the vaginal rugae or folds in the vagina will be different. they allow for stretching during labor
- the introitus is the opening to the body at the vagina. it may be red and swollen. there may be lacerations or an episiotomy(standard practice is moving away from this and it is typically only used with a vacuum or forceps) there can also be a hematoma
- there may be painful sex
- and overall dryness
pelvic muscular support
supportive tissues of the pelvic floor torn or stretched during childbirth
may require 6 months to regain tone
kegel exercises encourage healing
postpartum endocrine system
- pituitary hormones play a role in ovarian function
- the timing of ovulation is influenced by lactation patterns
- throughout pregnancy, the placenta is the major producer of hormones however after the placenta is delivered, it takes 2 weeks for placental hormones to drop and for the pituitary to take over.
the urinary system postpartum
- glomerular filtration rate and renal flow increase for diuresis. within 12 hours diuresis begins increasing urine output. diaphoresis often occurs at night for the first 2-3 days postpartum
- the risk of infection of UTI if catheterization was necessary. voiding sensations will be affected and the first void should be within the first 6 hours after birth
postpartum diuresis
- large amounts of intravenous fluids given during labor
- decreasing antidiuretic effect of oxytocin as its level declines
- buildup and retention of extra fluids during pregnancy
- decreasing production of aldosterone-the hormone that decreases sodium retention and increases urine production
Gastrointestinal system postpartum
- relief from the pregnant uterus
- sluggish bowels related to hormonal changes
- constipation is no longer due to pregnancy but due to fears of pushing. a colace and reassurance are important.
- hemorrhoids are varicosities that are due to straining
- avoid suppositories with rectal sutures from lacerations
musculoskeletal changes postpartum
binder can be used for support
integumentary system adaptation
- pigmentation fades
- stretch marks fade to silvery lines and to lighter brown in women of color
- temporary hair loss
- vascular abnormalities, spider angiomas, palmar erythema, and epulis regress with rapid decline in estrogens
- spider nevi persist indefinitely for some
respiratory system
tidal volume, minute volume, vital capacity, and functional residual capacity, return to prepregnant values within 1 to 3 weeks of birth
immune system
- the immune system is mildly suppressed during pregnancy, but it returns to a prepregnant state
- rebound of the immune system can cause flare-ups of some autoimmune diseases such as lupus erythematosus and multiple sclerosis
thermoregulation postpartum
- uncontrollable shaking chill immediately following birth. this is physiologic: there is a large cascade occurring in the body
- could possibly be due to nervous system response, vasomotor changes, shift in fluids, and or work of labor
- normal unless accompanied by elevated temperature
- nursing intervention: reassurance is key: this is a normal response to birth can also give a warm blanket
Breasts: human lactation
- secretion of milk by breasts
- the result of the interaction of progesterone, estrogen, prolactin (milk production), and oxytocin(milk let down)
- milk supply is dependent on the release of prolactin (the anterior pituitary) and oxytocin (posterior pituitary)
- begins after the delivery of the placenta because of a decrease in progesterone and estrogen and an increase in prolactin
- stimulation and release of milk are necessary for the continued release of prolactin. “supply and demand”
colostrum
is high in fats and calories. it enhances bowel emptying of infants. it is sufficient until breast milk comes in
ovulation and return of menstruation
- the interplay of hormones such as estrogen, progesterone, prolactin, and oxytocin
- nonlactating women see a return of menstruation 7-9 weeks after birth
- lactating women: return of ovulation and menses dependent on breastfeeding frequency and duration; anywhere from 2 -18 months. should not rely on breast feeding for birth control
taking in phase
first 24 to 36 hours
focus is on self: rely on other to meet their needs
very dependent- may need to be reminded to eat, shower, sleep
there is a desire to review the birth experience
taking hold phase
starts 2 days postpartum and lasts approx 10 days
alternates between the need for extensive nurturing and a desire to take charge
responds enthusiastically to opportunities to learn and practice baby care
emotional change: possible experiences with the blues
letting go phase of rubins phases
focus on the forward movement of the family as a unit with interacting members
reassertion of relationship with partner
resolution of individual roles
engrossment: partner psychological adapttation
perception of newborn as perfect
strong attraction to the newborn
awareness of distinct features of the newborn
extreme elation by father
three stages of role development: expectations, reality, transition to mastery
