Physiologic Changes and Physical Assessment

Question 1

decreased BP after delivery meanings (2)

Answer 1

-physiological adaption to decreased intrapelvic pressure
-also can indicate PPH

Question 2

othrostatic hypotension post delivery is….

Answer 2

common for the first few hours PP

Question 3

elevated BP post delivery….

Answer 3

may indicate preeclampsia

Question 4

a slow heart heart post delivery is called and caused by….

Answer 4

-puerperal bradycardia; 50-70BPM
-common for 6-10 days post delivery because of decreased strain on the heart, decreased blood volume, and increased stoke volume

Question 5

tachycardia post delivery….

Answer 5

result of PPH or prolonged labor

Question 6

how does the resp system adapt during pregnancy?

Answer 6

-increasing minute ventilation; primarily an increase in tidal volume with normal RR

Question 7

FRC and when does it return to normal post delivery

Answer 7

-functional residual capacity (refers to the amount of air the lungs can take)
-returns to normal within 1-2 weeks

Question 8

urinary changes PPH included (4) - and what does this put mothers are risk for (2)

Answer 8

-increased bladder capacity
-possible urinary retention due to edema of the tissues surrounding the urethra
-decreased sensitivity to bladder filling and fluid pressure
-increase urinary output for 12-24 hour

-excessive bladder distention/residual urine
-increased risk of UTI

Question 9

why are mothers at increased risk for constipation post delivery? (2)

Answer 9

-lack of muscle tone and slow motility from progesterone
-concerns for opening episiotomy

Question 10

common blood loss amount for vaginal delivery

Answer 10

200-500 ml

Question 11

common blood loss for c-section delivery

Answer 11

700-1000 ml

Question 12

hemoglobin to blood loss ratio

Answer 12

3 point drop for every 500ml of blood loss

Question 13

how long does it take for H&H to normal post delivery?

Answer 13

2-6 weeks

Question 14

WBCs post delivery…

Answer 14

elevate and may increase to 30,000 in the days after delivery without indication of infection but a WBC increase of 30% in 6 hours may indicate infection

Question 15

what is ursine involution?

Answer 15

the process of the uterus returning to pre pregnancy state

Question 16

how long does it take for the placenta site to heal in the uterus post delivery?

Answer 16

6-7 weeks

Question 17

non pregnant uterus weight/capacity

Answer 17

70-100g; capacity 5ml

Question 18

how many weeks does it take for the uterus to return to pre pregnancy weight?

Answer 18

3

Question 19

describe how uterine involution occurs (4 steps)

Answer 19

-estrogen and progesterone levels drop dramatically, causing cells of uterus to atrophy
-autolysis occurs, preteolytic enzymes (break down protein) are release and macrophages mirage to uterus
-spongy layer of decidua sloughs off as lochia
-basal layer of decidua separates into two layers, outer layer becomes necrotic and sloughs off and the in layer is the base for the endometrium

Question 20

lochia

Answer 20

tissue sloughed by the uterus

Question 21

rubra

Answer 21

reddish in color w clots in the first 1-3 days after birth

Question 22

serosa

Answer 22

after rubra, pink lochia for 3-10 days PP

Question 23

alba

Answer 23

after rubra and serosa, yellow whitish mucus lochia seen for 10-14 (or longer) PP

Question 24

cervix dilation PP

Answer 24

stays dilated for the first week when it should again be at 1cm

Question 25

vagina PP

Answer 25

may be bruised PP, by 3rd week rugae (folds) are seen again in the vaginal walls

Question 26

pelvic floor muscles PP

Answer 26

regain their tone 6 weeks PP, legal exercises help this process

Question 27

return to menses non breastfeeding mothers

Answer 27

7-9 weeks PP

Question 28

return of menses in breastfeeding mothers

Answer 28

2-18 months

Question 29

wound care for cesarean?

Answer 29

surgery-strips or staples and then covered with a sterile bandage; ice pack applied 15 mins at time to control pain and swelling in the 1st 24 hours; bandage is usually removed at 24 hours and wound is left open to air or covered with light sterile dressing; woman can usually shower at 24 hours; check site routinely

Question 30

wound care for episiotomy/lacerations

Answer 30

checked for signs of infections, hematoma or separation; ice pack is applied for 15 mins at a time in the 1st 24 hours for swelling and pain; after 24 hours sitz baths for 20 mins 2-4 times daily; caution woman to tighten buttocks when sitting to avoid stress on suture lines.