PostComplicationsAdap Flashcards
How long does it the uterus and vagina to return to pre-pregnant size? How much does the uterus decease in size a day? When is the fungus no longer palpable?
Pre-pregnant size takes up to 6 weeks.
Decreases in size 1cm (1 finger breadth) a day
Fundus not palpable about 10 days after delivery
When the uterus contracts after devilry. Often in response to breastfeeding.
Afterpains.
Complications in labor, delivery, or in the postpartum period can delay involution.
Different stages of lochia?
Scant: less than 2 inches stain Light: less than 4 Moderate: less than 6 Large: larger than 6 Tain and saturated in 2 hours Excessive: saturated within 1 hour
Blood volume and cardiac output decreases postpartum are related to what? How long does it take to return to normal? What remains that increases the risks for DVTs and PE?
Related to blood loss at delivery. Takes about 6-8 weeks to return to normal.
Hypercoagulable state remains for 2-3 weeks.
Blood plasma is further reduced due to diuresis. Explain hematocrit? Pulse?
Hematocrit stays stable or increases due to plasma reduction. Acute decrease in hematocrit is unexpected.
Pulse decrease is normal for a postpartum woman: 40-60 bpm.
Why might postpartum women have difficulty voiding?
Anesthetic block inhibits neural functioning of the bladder. Oxytocin has an antidiuretic effect. Lacerations or swelling of the perineum. Hematomas.
What can inhibit contractions of the uterus postpartum?
Displacement of the uterus with a full bladder.
Diuresis of a postpartum woman within 12 hours?
Up to 3,000mL a day.
<150mL per void may indicate retention.
No void in 4-6 hours post delivery may require catheterization.
There is no longer pressure on the abdominal organs after delivery, but explain constipation, appetite, and thirst?
Constipation can be caused by decreased peristalsis which causes decreased bowel tone. Fear of pain with bowel movement.
Hungry and thirsty because of energy expenditure and NPO status during labor.
How does one assist a postpartum woman with elimination?
Privacy, get up as soon as possible. Pain management. Increasing fluids. Stool softener or laxatives, dietary changes.
For difficulty voiding use warm water on the perineum or hearing running tap water.
Why are hip and joint pain increased? What happens to abdominal muscles?
Decreased progesterone and relaxin. Fatigue and exercise intolerance.
Joints eventually return to pre-pregnant state but there’s a permanent increase in shoe size.
The abdominal wall stretches which means loss of muscle tone requiring specific exercises.
Explain the changes in the integumentary postpartum
Darkened pigment in the skin fades with decreased estrogen and progesterone. Temporary hair loss can occur within 3 months of delivery due to decreased estrogen. Diaphoresis can be profuse in early postpartum period as increased body fluids of pregnancy return to normal.
RR postpartum? Diaphragm?q
16-24 bpm. Diaphragm returns to normal position. Pregnancy experienced SOB and rib pain resolve. Lung function changes of pregnancy return to normal quickly.
Estrogen and progesterone levels drop quickly after delivery of the placenta. Breastfeeding?
Decreased estrogen causes breast engorgement. Breastfeeding keeps estrogen levels low. It’s dependent on the frequency of breast-feeding.
Progesterone and prolactin after postpartum?
Progesterone levels begin to increase again with menstrual cycle. Prolactin remains elevated in women who are breastfeeding.
Suckling on the breast stimulates hormone release. First secretions?
Prolactin stimulates milk production. Oxytocin causes the let down release of milk.
Colostrum, high in protein and carbs but not milk fat. Breast milk comes in at 4-5 days.
When does the postpartum assessment happen? What’s involved?
Begins within an hour of delivery. Frequent vitals and fundal checks per protocol. Patient history, pregnancy, labor, delivery events, interventions.
Vitals for a postpartum woman?
Temp as high as 100.4 normal for first 24hrs. Bradycardia can be normal for the first week. BP can vary with position but should stay similar to labor.
What should be looked for with persistent perineal pain?
Hematoma. Pre-medicate postpartum women for pain
BUBBLE EEP
Breasts and nipples Uterus Bladder Bowels Lochia Episiotomy Extremities (lower) Emotions (bonding) Pain
Explain what three things cause a predisposition to DVT postpartum?
Stasis of blood: compression of large veins by gravid slows blood flow back to the heart.
Altered coagulation due to pregnant state.
Localized vascular damage in any vessel, not just the legs during the birthing process.
What are some subtle signs of DVT?
Lower extremity tightness or aching relieved by rest, feels like compression possibly. Edema in the affected leg, usually the left. Warmth, tenderness, redness in the affected calf. Low-grade fever.
This lasts from immediately after birth until about 24-48 hours.
Taking-in. Mother depends on others to help meet her needs and relives the birth process.
This begins 3 days post partum and lasts for several weeks.
Taking-hold. Mother is more self-sufficient but still needs reassurance. Preoccupied with the present.
Explain letting-go?
Reestablishes relationships with others. Adapts to parenthood. More confident in ability to care for the newborn.
The emotional attraction in the first 30-60 minutes to a few hours after birth.
The strong affection between the infant and mother or significant other.
Bonding. Continuation of the relationship that began during pregnancy. During this time, the infant is quiet, alert, and looks at the mother.
Attachment
Monitor the mother’s interest in the newborn. Further emotions/bonding monitoring?
Is she feeding and caring for it? Is she interested or disinterested? Does she want the baby in the nursery all the time?
Use a standard postpartum screening tool on all post natal women. PPD is the most common complication of pregnancy
