POSTPARTAL CARE (PUERPERIUM) Flashcards by Thea Jamali

It is the six week period after
delivery of the baby.

Puerperium

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What happens in puerperium?

Retrogressive
-involution of the uterusand vagina

Progressive
- production of milk for lactation
- restoration of the normal menstrual cycle
- beginning of a parenting role.

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the return of reproductive organs to their pre pregnant state.

Involution

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How will you know that Uterine involution is happening?

Through Analysis of lab data.
-evaluating uterine size and consistency and amount of lochia flow

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When does a woman’s psychological
adjustment begins?

woman’s psychological adjustment begins

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The patient’s lochial flow is no more than one saturated perineal pad that is?

50 ml every 3hours

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What do do you call it when it is during which the old way is gone but the new way is not yet
comfortable

Neutral zone

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An act of ending old ways

Letting go

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new ideas and concepts are put into action

New Beginning

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The postpartum period is a time of transition during which the couple gives up concepts such as?

“childless” or “parents of one”

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This phase is largely a time of reflection.

Taking In phase

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What is the timeframe of taking in phase?

1-3 days, largely PASSIVE

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What phase would you realize when She prefers having a nurse attend to her needs and make decisions for her rather
than do these things herself.

Taking in Phase

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It is in this phase where Woman usually wants to talk about her
pregnancy

Taking in

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In this phase she begins to have strong interest

Taking Hold Phase

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Begins to initiate action. Make her own decisions. she begins to take a stronger interest
in her infant and begins maternal role behaviors.

Taking hold phase

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This phase is where she redefines her role, gives up fantasized image and her old role.

Letting go phase

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What is a sign that the woman is beginning effective interaction.

Looking directly at her newborn’s face, with direct eye contact (en face position)

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Many fathers can be observed staring at a newborn for long intervals in this same way, what do you call it?

Engrossment

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The more time a woman has to spend with her baby, the sooner she can become better acquainted with her child, feel more confident in her ability to care for her

True

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This occurs when the infant remains in the woman’s room and the mother and child are together 23 out of 24 hours a
day.

Rooming- in

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MATERNAL CONCERNS AND FEELINGS IN
THE POSTPARTAL PERIOD

• Breast Soreness
• Regaining their fatigue
• Regulating the demands of housework
• Their partner
• Children
• Coping with emotional tension and sibling jealousy
• Fatigue

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This phenomenon may be caused by hormonal changes, particularly the decrease in estrogen and progesterone that occurred with delivery of the placenta

Postpartal Blues

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An overwhelming feeling of sadness that cannot
be accounted for this is evidenced by:

➢ Tearfulness
➢ Feeling of inadequacy
➢ Mood liability
➢ Anorexia
➢ Sleep disturbance
➢ Irritability

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include those related specifically to the reproductive system as well as other systemic changes

Physiologic Changes

the denuded surface of the uterus until involution is complete, causes what?

Hemorrhage

How much does the uterus weigh?

1kg

After one week the uterus will weigh how much?

500g

At the 6th week it will weigh about?

50g

When does uterine contraction begin?

Placental delivery

contraction of the uterus after birth causes intermittent cramping termed as?

After pains

strong uterine contractions felt more particularly by multi- paras, those who delivered large babies or twins, and those who breastfeed

Afterbirth pains

These are Uterine discharges consisting of blood, deciduas, WBC, Mucus and some bacteria

Lochia

first 3 days postpartum, red, and moderate in amount, consists mostly of blood, fragments and devcivuda

Rubra

As the amount of blood involved in the cast-off tissue decreases (about the fourth day) and leukocytes begin to invade the area, as they do with any healing surface, the flow becomes pink or brownish

Serosa

On about the 10th day, the amount of the flow decreases and becomes colorless or white with streaks of brownish mucus

Lochia Alba

After birth, the cervix is

soft and malleable

Because of the great amount of pressure experienced during birth, the perineum is

edematous and tender immediately after birth.

Labia majora and minora typically remain what?

atrophic and softened after birth

Labia majora and minora typically remain what?

atrophic and softened after birth

GOOD METHOD TO CHECK POSTPARTUM CHANGES

BUBBLERS B – Breast U – Uterus B – Bladder B – Bowel L – Lochia E – Episiotomy R – Emotional Response S – Homan’s Sign

is the main estrogen secreted by the placenta during pregnancy

Estriol

Follicle-stimulating hormone (FSH) remains low for about how long?

12 days

By week 1, what hormones are all at prepregnancy levels

progestin, estrogen, and estradiol

During pregnancy, as much as how many of excess fluid accumulates in the body?

2,000 to 3,000 ml

What begin almost immediately after birth to rid the body of this fluid?

Diuresis and Diaphoresis

hydronephrosis or increased size of ureters that occurred during pregnancy remains present for about

4 weeks after birth

Some postpartum mothers may have difficulty voiding because of

decreased abdominal pressure or trauma to muscle of the bladder

Voiding maybe initiated by?

• Pouring on warm and cold water alternately over the vulva • Encouraging the patient to go to the comfort room and let her listen to the sound of running water • If this fails, catheterization is done

Usual blood loss with a vaginal birth

300-500ml

Usual blood loss with a Cesarean birth

500-1000ml

Bowel sounds are active but passage of stool through the bowel may be slow because of the still-present effect of?

Relaxin

a hormone which softens and lengthens the cervix and pubic symphysis for preparation of the infant’s birth during pregnancy

Relaxin

a hormone which softens and lengthens the cervix and pubic symphysis for preparation of the infant’s birth during pregnancy

Relaxin

Delayed bowel evacuation postpartum may be due to :

→ Decreased muscle tone → Lack of food or enema during labor → Dehydration → Fear of pain from perineal tenderness due to episiorrhaphy, lacerations, or hemorrhoids.

excessive pigment on the face and neck.

Chloasma

Linea nigra - abdomen will become barely detectable by how long?

6 weeks

overstretching and separation of the abdominal musculature, the area will appear as a slightly indented bluish streak in the abdominal midline

Diastasis recti

overstretching and separation of the abdominal musculature, the area will appear as a slightly indented bluish streak in the abdominal midline

Diastasis recti

It is a postpartum exercise that strengthen abdominal muscles help to strengthen abdominal muscles and return abdominal support to its prepregnant level.

Modified sit ups

Kegel and abdominal breathing on postpartum day

This is done on the second day to tighten and firm up abdominal muscles.

Chin-to chest

This exercise can be done when perineum has healed

Knee-to-abdomen

Th'e rapid diuresis and diaphoresis during the second to fifth days after birth usually result in a weight loss of

5 lb (2 to 4 kg)

Weight loss from lochia?

2-3 lbs. (1 kg)

For a total weight loss of about

19lb

approximately how much weight is lost at birth

12 lb (5.8kg)

It Reflect the internal adjustments occurring as the woman’s body begins its return to its prepregnant state.

Vital signs changes

Temperature is always taken in what manner during the puerperium because of the danger of vaginal contamination and the discomfort involved in rectal intrusion.

orally or tympanically

oral temp. rises above (38 C), excluding the first 24 hour period is considered

febrile, postpartal infection should be suspected.

when a woman’s breasts fill with milk on the third or fourth postpartum day during lactogenesis II, her temperature will rise for a period of hours because of the increased vascular activity involved; this process is termed?

Engorgement

As diuresis diminishes, the blood volume and blood pressure fall; pulse rate?

Increases

Reading above 140 mmHg systolic or 90mmHg diastolic indicate

postpartal Hypertension

Oxytocics, drugs administered; consequently can do what to BP

Increase

dizziness that occurs on standing because of the lack of adequate blood volume to maintain nourishment of brain cells.

Orthostatic hypotension

Indicates growth of milk glands and in breast size.

Estrogen level

thin, watery, pre lactation secretion.

Colostrum

feeling of tension in your the breasts on the 3rd or 4th day pp.

Primary engorgement

ability of milk to come forward in the breasts.

A let down reflex

With the delivery of the placenta, what happens to the production of placental estrogen and iprogesterone

It ends

If not breastfeeding, return flow is expected with?

6-10 weeks after delivery

If breastfeeding, menstrual return is expected in

3-4 months - lactational amenorrhea

still a possibility for the first 2 or 3 days after birth, until the myometrial vessels have sclerosed.

Hemorrhage

This information also lays a foundation for teaching self-care and child care specific to the woman’s knowledge level and needs

Family profile

this information helps in planning necessary procedures.

Labor and birth history

this information helps in planning necessary procedures.

Labor and birth history

this information helps in planning necessary procedures.

Labor and birth history

a collection of blood in the subcutaneous space from bleeding from the episiotomy incision that can become so extensive it causes intense pain and disrupts the suture line

Hematoma

PROVIDE PAIN RELIEF FOR AFTERPAINS

• Ibuprofen (Motrin) NSAID • Acetaminophen Tylenol (analegic)

PROVIDE PAIN RELIEF FOR AFTERPAINS

• Ibuprofen (Motrin) NSAID • Acetaminophen Tylenol (analegic)

MEDS RELIEVE MUSCULAR ACHES

• Acetaminophen (Tylenol) • Backrub

Pain in perineal region maybe relieved by:

• Sim’s position • Perineal heat lamp or warm sitz bath twice a day • Application of topical analgesics or administration of mild oral analgesics as ordered.

• Contracting and relaxing the muscles of the perineum 5-10 times in succession, as trying to stop voiding • Improves circulation and helps decrease edema. • Help the woman regain her prepregnant muscle tone and form.

Kegel exercises

Applying an ice or cold pack to the perineum during the first 24 hours reduces

perineal edema and the possibility of hematoma formation and also reduces pain and promotes healing and comfort.

Sitz baths has Water that is maintained at?

38-41c

Sitz bath is used

3-4 times a day, 20 mins

helps to decrease inflammation and relieve tension in the area.

Cortisone-based cream or warm sitz bath

Enc. Her to drink at least

, three to four 8 oz glasses of fluid a day

occurs because of relaxation of the abdominal wall and the intestine, now that they are no longer compressed by the bulky uterus.

Constipation

Stool softener prescribed n 1 st day

docusate sodium