objective 5 Flashcards
6 weeks following childbirth
often referred to as the 4th trimester of pregnancy
postpartum
what are the physiological changes of the breasts?
Full but soft for the first 2-4 days, then firm anf fuller as blood flow increases & milk production begins
Engorgement may occur; the breast is hard, erect & very uncomfortable
The non-nursing mothers breasts return to normal size in 1-2 weeks
what are the physiological changes of the uterus?
Return to prepregnancy size & wt. Uterus prepregnancy size by 5-6 weeks
what are the physiological changes of the uterine lining?
shed with placenta
when are after pains felt?
48 hrs PP
Vaginal discharge after delivery, composed of tissue, blood and lymph
lochia
red blood, last 3-4 days after birth
lochia rubra
pinkish or brown, starts about 4th day and lasts for 2-3 weeks after birth
lochia serosa
clear/colorless, white or yellow, can last up to 4-6weeks
lochia alba
what should women report in regards to lochia?
Foul-smelling lochia (with or without fever)
Lochia rubra lasting longer than the 4th day
Unusually heavy flow of lochia
Lochia that returns to a bright red color after it has progressed to serosa or alba
what are the physiological changes of the cervix?
Regains muscle tone but never closes as tightly as prepregnant state
what are the physiological changes of the vagina?
Within 6 weeks regains most of its form but not to pre-pregnancy size
what are physiological changes of the perineum?
Often edematous, tender, & bruised
Episiotomy or lacerations may have occurred
what is REEDA?
Redness: without pain (pain=infection)
Edema: slight
Ecchymosis: bruising, slight
Approximation: no separation of episiotomy
when does menstruation resume?
7-9 weeks if not BF
6-12 months if BF
when does ovulation resume?
Return of ovulation is delayed if BF; however, it can occur at any time after birth (pregnancy is possible). Discuss contraceptives
when is it safe to resume sexual activity?
Its safe to resume sexual intercourse when bleeding has stopped & the perineum has healed
The vagina doesnt lubricate as well in the first 6 weeks (longer if BF); so advise her to use a water soluble lubricant
Teach about kegel exercised to strengthen muscles involved in urination, bowel function, & vaginal sensations during intercourse
what are the cardiovascular system changes?
Cardiac output and blood volume
Orthostatic hypotension
Coagulation
Blood values
Low HCT, elevated WBC
Chills
Related to sudden release of pressure on the pelvic nerves and vasomotor response involving epinephrine during the birth process
what are the urinary system changes?
A full bladder can displace the uterus and lead to PP hemorrhage
Decrease in bladder tone and uterus along with IV fluids during L&D fills the bladder quickly, but often results in incomplete emptying pp
Urinary stasis also imposes risk for UTI
what are the GI system changes?
constipation
how do we alleviate constipation?
Increase fluid and fiber intake
Increase activity, such as walking
Stool softeners for C section moms
what are the integumentary system changes?
Hyperpigmentation of the skin fades as hormone levels decrease
Linea nigra disappears
Striae fade to sliver
what are the musculoskeletal system changes?
Diastasis recti
Hypermobility of the joints
separation of the abdominal muscles
diastasis recti
what are some PP exercises?
Abdominal muscle tightening
Head lift
Pelvic tilt
Kegel exercises
what are the immune system changes?
Prevent blood incompatibilities and infection
RhoGAM is admin if women is Rh negative and baby is Rh positive
Give mother immunization for rubella if she is not immune
what is BUBBLEE?
Breasts
Uterus
Bladder
Bowel
Lochia
Legs
Episiotomy/laceration
Emotions
what are the 3 phases of PP?
Phase 1: taking in
Phase 2: taking hold
Phase 3: letting go
Referred to as ‘baby blues’
Usually occur in the first 3-5 days and resolve by 2 weeks
Conflict between joy and emotional left down
Teaching- reassure mom it is normal and temporary
PP blues
Previously known as PP depression or PP mood disorders
PMD can be anxiety, depression or psychosis
perinatal mood disorder
Anxiety
Irrational fear, worry, tension, trembling, N&V, dizziness, dyspnea & insomnia
perinatal anxiety
Persistent mood of unhappiness, 2-4 wks after birth
Interferes with responding to infants’ cues and parent-infant bonding
perinatal depression
what are the S&S of perinatal depression?
Lack of enjoyment in life, disinterest, difficult concentrating and making decisions, sleep disturbances, exhaustion, generally feeling unwell, crying, difficulties with ADLs
what is the treatment of PD?
Psychotherapy
Antidepressants
Social support from partner, family, social networks
Peer support
Incorporating partner and family in care planning
Exercise, self-care, relaxation techniques, adequate sleep
48hrs-2wks
Impaired sense of reality
Rae but can be fatal condition
Rapid onset, begins as early as 48-72hrs-2wks PP
perinatal psychosis
what are the S&S of perinatal psychosis?
depressed or elated mood (fluctuates), delusions, hallucinations
what are the 4 phases of adjustment to fatherhood?
Having expectations and personal intentions
Confronting reality and overcoming frustrations
Creating ones own personal father role
Reaping rewards of fatherhood
how does it impact siblings?
Age-dependent on how older siblings will respond to new baby
Prep impt
how does it affect grandparents?
Involvement determined by distance from family
Differ in their expected roles
Roles also affected by culture
Little conflict when both parties agree on what roles should be
