Module 9 Unit A study guide Flashcards
What causes afterbirth pain
Relaxing and re-contracting of the uterus
Which client is most likely to experience strong afterbirth pains
Clients whose uterus was greatly distended
Polyhydramnios
Large infant
Multiple babies
Breastfeeding
Afterbirth pains are
more noticeable in births where the uterus was overdistended
Lochia rubra
consists of:
blood
decidual
trophoblastic debris
glow generally lasts 3-4 days and pales, becoming pink or brown
Lochia serosa
Consists of:
Blood
serum
leukocytes
tissue debris
generally occurs around day 3 or 4 after childbirth
Lochia Alba
Occurs in most women after day 10
can continue up to 6 weeks after childbirth
what should Lochia smell like
Should smell like a normal menstrual cycle unless an infection is present
what is the mechanism that causes diaphoresis and diuresis in the early postpartum period?
Loss of increased blood volume associated with pregnancy
what occurs in the urinary system postpartum
fluid loss through perspiration and increased urinary output accounts for weight loss post partum
When does kidney function returns to normal postpartum
1 month
When is bladder tone restored postpartum
5-7 days after childbirth
How will menstrual cycle be after childbirth
first menstrual cycle to be heavier than normal
and the volume of subsequent cycles will return to prepregnant levels within 3-4 cycls
Describe ovarian function postpartum
The first flow is heavier, with within 3 - 4 cycles returns to normal
When does ovulation occurs postpartum
within the first month for 70% nonlactating women, it returns within 12 weeks after birth.
Breastfeeding women take longer to resume ovulation
At 4 days PP where should you feel the uterine fundus
4 fingerbreath below umbilicus
Healing at the placental site takes about
6 weeks
swelling and increased vascularity of the vagina will be decreased by
3-4 weeks
Right after birth the maternal cardiovascular system instability is due to what factors
blood loss
autotransfusion of fluid from losing placenta
extracellular fluid
During the first postpartum week, women lose approximately how many pounds of water weight
5
When will the placental totally regenerate
6 weeks
Swelling and increased vascularity of the vagina normally decrease by how many weeks postpartum
3-4 weeks
Where is the uterine fundus normally located 4 days post-delivery
two fingerbreadths below the umbilicus
What is taking hold
strives for independence and autonomy in hr new role
When does stabilization of Hgb and Hct typically occurs
24-48 hours after birth
How long will it take for hemoglobin and hematocrit to reach prepregnant level
4-6 weeks
what happens to stroke volume and cardiac output in the FIRST HOUR
increase by almost 80%
How long does it take for maternal blood volume to return to pre pregnant levels
2 weeks
How long does the hypercoagulable state of pregnancy continue
first few weeks
Mechanism of fibrinolysis
Decreased during pregnancy and in the first few weeks postpartum which puts our clients at risk for thromboembolism
When does fibrinolysis begin to normalize
24-48 hours
when does full normalization of coagulation factors occur
4-6 weeks
When does platelets normalize
12 weeks
Note regarding cardiovascular system
Physically, with the removal of the gravid uterus the inferior vena cava no longer has to share a space with the gravid uterus and coupled with the return of the extracellular fluid to the maternal circulation, there is
- Increase in stroke volume and cardiac output by almost 80% in the first 1 hour
- Causing a simultaneous decrease in maternal heart rate (rationale: each pump of the heart is now more effective and sends more oxygenated blood to the body so the heart rate can slow down without losing oxygenation to the body.
Clinical takeaway regarding cardiovascular system postpartum
There is an increased risk for cardiovascular adverse events in the postpartum period. If the client has risk factors such as preexisting cardiac disease, hypertension or preeclampsia, the dramatic fluid shifts may lead to complications , like pulmonary edema, cardiac failure and death.
How long does it takes for the maternal blood volume to return to pre-pregnant levels
2 weeks
Note regarding respiratory system
The respiratory system quickly return to a nonpregnant respiratory function following the birth of the baby and placenta
The reduction of intra-abdominal pressure allows for normal diaphragm excursion and a rapid return of normal residual air volume
The loss of placenta progesterone leads to the immediate return of many normal nonpregnant respiratory parameters. These changes lead to the rapid resolution of pregnancy dyspnea and shortness of breath
Respiratory clinical pearls
Post partum client reports of shortness of breath and/or chest pain should be taken very seriously with prompt evaluation considering the increased risk of cardiovascular thromboembolic events in the postpartum period.
when does diuresis starts PP
within 12 hours
How long does profuse diaphoresis occurs
especially at night, in the first 2-3 days after birth
Which narcotic is not recommended in breastfeeding clients
Codeine
Why is Vitamin K given to new born babies
helps the newborn’s clot appropriately
Some factors to help reduce the risk of SIDS
Pacifier use….can help decrease SIDS
Keep the room at least 5 degree warmer then the rest of house (overheating can increase SIDS
Avoid any exposure to secondhand smoke (Secondhand smoke is an important SIDS risk factor
When does Physiologic jaundice peaks
about 3-7 days after birth
How common is jaundice in term infants
50-60%
How common is jaundice in preterm infants
80%
What are some red flags that could signal that jaundiced appearing baby is not normal
Jaundice appears 24-48 hours after birth
Jaundice that is worsening extending to the lower half of body (the lower on the baby’s body the jaundice is the higher the serum level generally is
Fetus behavioral changes
Can the uterus be palpable at 2 weeks PP
No….it is a pelvic organ at 2 weeks.
when does vaginal swelling and vascularity decrease
3-4 weeks
when does vaginal rugae reappears
3-4 weeks
how longs does carefully repaired lacerations or episiotomies usually heal
within 2-3 weeks, but could take longer depending on the extent of the repair
when does bowel movement return PP
3 days PP
when does the fundus begins to descent into the pelvic pp
after 24 hours
what are normal WBC value during the first 10 - 12 days PP
20,000-25,000
when does respirations return to normal PP
6-8 weeks
when does hemorrhoids decrease in size
6 weeks
How long does it takes for the uterus to return to original size
full 6 weeks
what is involution
end of the puerperium
what is the puerperium
interval between birth of the newborn and the return of the reproductive organs to their normal nonpregnant state
how long does puerperium last
3-6 weeks
