Post Partum Flashcards
Psychological Changes
Phases:
Taking-in: Proud of the labor and delivery and pregnancy (talks about it a lot), Needs the nurse to focus on her, Very dependent on baby care, Hungry, Cold
Taking-hold: Initiates baby care, Getting up and ready for the day, More independent
If young or first child: may question ability
Letting-go: Will be sending patient home by this time, If poor and can’t afford baby bed, take a drawer, empty it out and put the baby with some padding inside, Reorganizing thoughts and family
Promotion of Bonding: Bonding happens just might take longer for some than others, Cultural differences in bonding play a role,
Development of parental love (include dad) and positive family relationships:
Rooming-in- baby in the same room as the mother
Complete- 24/7
Partial- Nursery at night
Sibling visitation
Exception: The flu
Enface: face to face with the baby
Maternal concerns and feelings
Abandonment: during pregnancy, the focus is on her, now it’s on the baby.
Disappointment: During pregnancy think you have the Gerber baby inside and then they come out and it’s not true. Doesn’t live up to your fantasy baby.
Postpartum blues: Sets in about day 2 or 3. Occurs in 80% of all women. Due to hormone switch from a lot (placenta output), to much less. Just sad/crying without a reason. Lasts about 2 weeks.
Postpartum Depression: Anything more than 2 weeks. Can last up to a year. Need meds, therapy. Can go into postpartum psychosis (911).
Respiratory Changes
Hormonal changes relieve stuffiness
Relief from dyspnea due to the birth the lungs can expand easier and the diaphragm is more useable
Nasal stuffiness is relieved within 24 hours
C-section: turn, cough, deep breathe
Sensitivity to odors has gone away if it hasn’t already
Hormonal Changes
With delivery of placenta, drastic reduction in hormones
- In 24 hours – no hCG/hPL
- Estrol decreasing during 2nd week
- **Due to decrease in Placental lactogen,
insulin need goes down (makes more resistant to insulin)
Increase in Prolactin- helps manufacture milk
- In 7 days -progestin, estrone, estradiol up to pre-pregnancy levels
- By 12 days FSH starting to rise in order to start a new menstrual cycle
Urinary Changes
Diuresis 1st 2 days postpartum: May detect leg edema 1st day, Rapid filling of the bladder, Will be putting out more urine because you have so much extra blood in your system. Will go away within 24-48 hours.
May have difficulty voiding: Due to swelling, Epidural residual- might not feel like you need to go, Increased bladder size- baby stretches the bladder so less muscle tone, ***Can’t go longer than 6 hours after delivery without voiding
Urine more nitrogenous: Due to breakdown of uterine muscle tissue
Ureters decrease in size to normal (takes a while)
***Measure the first couple of voids: If putting out small amounts at a time: could be retention with overflow, Might need to Catheter
Bladder should return to normal within 6 weeks
Circulatory Changes
Diuresis & blood loss decrease the extra volume needed in pregnancy
Diuresis also concentrates the H&H slowly to pre-pregnany levels, Will be dilute because of the extra fluid. Will concentrate after a few days, Take H&H ***2nd day, keep an eye on it
If anemic prenatally will be more so post partum.
Will retain the high levels of fibrinogen during 1st pp weeks
Elevated WBCs x 5-6 days
Anytime you are under stress, you will have an elevation of WBC
She is also healing, which raises the WBC count
Watch for post partum infections but it’s normal to have elevated WBCs
Varicosities/hemorrhoids recede
At delivery, will have much more fluid than needed.
First time you listen, might hear a murmur. Chart this!!
High coagulation: more at risk for a DVT
Heart will return to normal position in the body. (moves up in pregnancy)
Gastrointestinal Changes
Digestion and absorption active
Bowel sound active
Stool passage may be delayed due to effect of relaxin from the placenta in the system
Mom usually has a BM by the 2nd day
Evacuation may be difficult due to perineal discomfort
May be afraid it will hurt.
Poop happens behind the perineal area
Encourage them to go so that they don’t absorb more water and get an obstruction
Decreased abdominal muscle tone
Intrgumentary/MS Changes
Skin:
Stretch marks still red, will start to change to silvery (cauc) , darker (Blacks) at 3-6 months
Chloasma/linea nigra will disappear by 6 wks
For most
Excessive oil production resolves
Hair may start to fall out
Diaphoresis (sweating)
MS
Laxity of joints/ligaments
Fall risk
Muscular fatigue/soreness
Diastasis recti ( guts and stuff come out in between “6-pack”) will indent at first & may appear bluish Modified sit-ups will help
Abdominal wall and supporting ligaments will return to prestretched condition
Waddle goes away
PUPPs (skin)
Pruritic Uticarial Papules & Plaques of pregnancy
Takes a couple of months to go away. Can happen during pregnancy or post-partum
Neuro Changes
Altered Sleep Patterns
Listening for the baby
Numbness in legs, dizziness
Safety when getting up
From epidural
***Headaches Need to be evaluated Could have PIH Spots before their eyes Headache Jerky BP Seizure
Emotions
Wide range: from laughing to crying in no time at all
Baby blues
Gaining attention span
Slow progression but will come back
Immune System
- **If Rh neg, needs RhoGam within 72 hours
- **Check before she goes home that she had this!
Rubella (measles) vaccination Nonimmune status If nonimmune, need vaccine ***Signed consent Avoid pregnancy for 1 month If she gets pregnant with the active virus, could cause a lot of problems for the abby Flu-like SS may occur
Reproductive changes
Breasts Bigger - Milk produced at 3-4 days - Transient engorgement Colostrum - High protein - Antibodies
Uterus
Will go down 2 finger space per day
Lochia
Red and thick at first
Ruba Contains uterus lining
Serum (pink/brown) along with the red
10 days: becomes white (Alba): Will continue for 3 weeks. Some say as soon as this comes, it’s okay to have intercourse.
No intercourse while bleeding
We typically say 6 weeks for intercourse
Cervix
Will remain edemetis for 3-4 months
Vagina
Stretched out, wrinkles are ironed out. Will take a few weeks for them to come back
6 to 10 weeks before normal estrogen lubrication
Decreases sexual response
Perineum Depends on what kind of delivery Sore Ovaries - 10-12 weeks for nonlactation - 12-36 for lactating
Placental site healed within 6 weeks
Multiple pregnancies and larger babies will have more afterbirth pains
Effects of retrogressive changes
Exhaustion
Weight loss 5 lbs of fluid Birth: 12 lbs Lochea- 2-3 pounds at 6 weeks Weight at 6 weeks becomes your new baseline
Progressive changes
Progressive changes
Lactation
Return of menstrual flow
Usually 6-10 weeks even if they are nursing
Vital signs
Temperature Can become dehydrated during labor which raises temp Not abnormal for a high temp Needs fluids Will probably be elevated for 24 hours ***100.4 is international fever Engorgement can also raise temp
Pulse
Go back down to your usual pulse rate
If rapid: look under the covers for blood
Turn her to her side to see blood
Respirations: no notes?
Blood pressure Depends on medications Can be elevate ***Anything over 140/90, physician must be notified Orthostatic hypotension
