post partum

Question 1

changes in the uterus

Answer 1

-returns to size of pre-pregnant state
-by 12hrs it is at the umbilicus
-descends at one finger-breadth/day
-no longer palpable by approx. 10-12 days after birth

Question 2

changes in lochia

Answer 2

-days 1-3, rubra
-days 4-10, serosa (pink & brown)
-day 11 to 4-8 weeks, alba (white, yellow, creamy)

Question 3

excessive lochia

Answer 3

-saturating pad in 15min or less
-pooling of blood under buttocks

Question 4

cervix changes

Answer 4

-2 weeks, firm to soft
-6weeks, new appearance, returns to normal

Question 5

vagina changes

Answer 5

-edematous
-few rugae
- at 3 weeks closer to normal stage
- at 6 weeks normal

Question 6

perineum changes

Answer 6

-edematous, bruised
-4 to 6 weeks till normal tone

Question 7

cardiovascular changes

Answer 7

-blood volume drops rapidly
-CO increased intrapartum then decreases in a few days
-bp remains the same
-bradycardia (40-80)
-coagulation factors are elevated for 2-3 weeks
-diuresis 2-3 days after birth
-hct and hgb decrease slightly but rises over the next 2-3 weeks
-wbc increased

Question 8

respiratory changes

Answer 8

-diaphragm return to normal position
-changes in rib cage and thoracic cavity resolve
-SOB and rib aches relieved
-resp. rate normal
-lung functions normalize by 1-3 weeks

Question 9

postpartum pt risks

Answer 9

-risk for falls
-DVTs

Question 10

urinary system changes

Answer 10

-diuresis, up to 3000mL/day, up to 12 hours after birth
-impaired urge to urinate, risk for retention, due to anesthesia, prolonged use of oxytocin, and physical injury

Question 11

Assessment of urinary system

Answer 11

-bladder distention
-voiding schedule (encourage voiding when feeding)
-s/s of infection
-document I&O
-impaired urge to void, decreased sensation
-monitor first few urinations after birth
-risk for UTI

Question 12

endocrine changes

Answer 12

-estrogen and progesterone decrease abruptly, breast engorgement and diuresis
-prolactin is produced in breastfeeding women, help with milk production

Question 13

sexual health changes

Answer 13

-problems r/t drive, arousal, orgasmic d/o, and dyspareunia
-normal for up to 6 weeks

Question 14

ovulation and menses changes

Answer 14

-ovulation occurs within a month, even without the presence of menses
-meses occurs 4-6 weeks, or 8 weeks in a non breast feeding women
-breast feeding can take 8 weeks-6 months or more

Question 15

phases of maternal role attainment

Answer 15

-dependent (taking in phase): 24-48hrs, reliant on nurse and support people, help mother reflect on birth and accept baby is here
-dependent-independent (taking hold): needs education, encouragement, and reassurance
-interdependent: adapt to mother and wife phase, building relationship back with ohter

Question 16

paternal adaptaion

Answer 16

engrossment: increased preoccupation and interest in baby

Question 17

sibling adaptation

Answer 17

-children may regress
-involve them in care of baby

Question 18

breast changes

Answer 18

-colostrum immediate, milk forms day 3-5
-monitor breasts for breaks, red areas- indications that baby is latching wrong

Question 19

breastfeeding

Answer 19

-at least 8-12 feedings/24 hrs
-frequency depends on baby
-lactch

Question 20

latch scoring

Answer 20

-L:Latch
-A:audible swallowing
-T: type of nipple
-C:Comfort (breast/nipple)
-H:hold

Question 21

musculoskeletal system changes

Answer 21

-returns to pre-pregnant state by 6-8 weeks after birth
-diastis recti fixed with exercises
-educate on pp strengthening exercises- kegel and pelvic tilt

Question 22

immune system status

Answer 22

-+ Hep B mother, infant needs HBIG or HBV within 12 hrs
-rh- mother with rh+ baby needs rhogam within 72 hrs
-if not immune to varicella, given pp and 2 dose in 4-8 weeks
-tdap given in third trimester to prevent pertusiss in infant
-rubella titer <1:8, MMR needed