Module 7 (Exam 1) Flashcards
Puerperium
The period of time after completion of the third stage of labor until uterine involution is complete (usually six weeks)
Focus of the Puerperium
- Physical and psychological adjustment to the process of childbirth
- Attention to learning needs
Involution
Rapid reduction in uterine size following childbirth
What does the reproductive system do after placental delivery?
- Uterus contracts immediately after placental delivery
- Uterine arteries are compressed and bleeding is controlled
- The cervix closes rapidly
- The vagina and perineum are usually edematous, bruised
Fundus
Upper portionof the uterus, superior to the fallopian tubes
Boggy Uterus
Term used to discuss the uterine fundus when it is not firmly contracted
Uterine Atony
Relaxation of uterine muscle tone following childbirth
Engorgement
Physiologic swelling of the breast tissue resulting from increased blood and lymph supply during transition to mature breast milk
BUBBLE HE
Breasts
Uterus/Fundus
Bladder
Bowel
Lochia
Episiotomy/Peruneum
Homan’s sign
Emotional Stability
When does the endometrium regenerate?
2-3 weeks after birth
6 weeks at placenta site
BP PP Assessment
BP should be less than 140/90
- Preeclampsia may be happening if BP is over this
- BP should be consistent with baseline
Pulse Assessment PP
Pulse should be less than 90
- PP woman is mildly tachycardic r/t dehydration (loss of 500mL fluid vaginal birth and 1000mL(1L) C-section)
Cardiovascular System PP
- Rapidly returns to pre-pregnant state
- Diaphoretic
- Diuresis
Physiologic Anemia
- During pregnancy, plasma increased 50%
- RBC increases 1/3
- The difference between plasma increase and RBC is uneven; there is more plasma than there are RBCs
- RBC are diluted in the amount of plasma volume
- Decline in maternal Hgb and Hct results
- Hence, physiologic anemia
- Must be distinguished from true anemia
Temperature PP
Less than 38C
Temperature 38C or higher indicates infection
When is a mild elevation in temperature expected and why does it occur?
- Mild elevation (less than 38C) occurs during the initial 24 hours PP
- Primary reason is dehydration
- Secondary reason is exertion
- Physiolgic breast engorgement
Hct and Hgb PP
- Gradual Recovery
- Less than or equal to 30% Hct (during pregnancy)
- Hct is normal by days 3-5 PP *Normal is 35-50%*
- Hgb greater than or equal to 10.5 g/dL (during pregnancy) is normal until the end of puerperium (six weeks) *normal is 12-18*
- Hgb is low
WBC PP Assessment
25,000-30,000 (Normal is 5,000-9,000)
- Increased after delivery because the body is healing; it is a healing response. WBC rush to the scene
- WBC also increase due to pain and stress
- Returns to baseline within 1 week PP
- *Considered normal unless there are other signs of infection
Coagulation Factors
- Blood hypercoagulation occurs during pregnancy
- Clotting increases
- Increased ability to form clots
- Break down of clots decreases during pregnancy
- Offers protection from hemorrhage during child birth
- Increases the risk of thrombus formation
- Continues for 3-4 weeks
- Diameter of deep veins remains increased for up to 6 weeks
- Increases risk for thromboembolic disease (pulmonary embolus)
- Weight of uterus puts pressure on the vena cava and iliac veins and partially obstructs blood return from veins in the legs, causing venous distention
Breast Assessment
- Observe latch to breast
- Observe effective transfer of colostrum (swallowing)
- Assess skin integrity of nipples/areolae for brusing/excoriation
- Assess lactogenesis to lactation..look for filling and firming
Interventions for Nipple Tenderness
- Facilitate deep, effective latch to breast
- Protect nipple and promote milk transfer
- Let colostrum dry on nipples following BF
Interventions for Physiologic Engorgement
- Increase BF frequency to 1.5-3hours per infant cues
- Coolpacks following BF
How long does it take to establish supply of breast milk?
3-4 weeks
Volume is related to frequency of feedings
Nursing management to help mothers produce copious milk supply
- Encourage freqent breastfeeding per infant cues
- Avoid supplementation unless medically indicated
How many calories does the breastfeeding mother burn?
- Need additional 500calories/day to support full lactation
- 170 of those calories are drawn directly from fat stores
- 330 calories additional intake
- Teach mother to drink fluids as they become thisty
