postpartum Flashcards
postpartum - exact number of weeks
6 weeks following the birth and the return of the reproductive organs to their normal, non-pregnant state
high in iron
beans, lentils, tofu, baked potato, cashew, leavy greens, spinach, fortified ceral, whole grain bread. Eat a variety of meat alternatives along with vitamin C–rich foods. Vit C, vitamin A, meat, fish and poultry during your meals
decreases iron
phytates (cereals and grains), calcium (milk and dairy) and polyphenols (tea and coffee)
intra-uterine device Mirena and Paragard (Mirena is a delayed T-string)
a T-shaped device inserted into the uterus that releases copper, progesterone, or levonorgestrel. Failure rate - .2%. can be used during action. insertion requires professional. may cause menstrual irregularities, prolonged amenorrhea, can be expelled, may increase risk of pelvic infection. user must check string regularly for placement. no protection against STDs. delay of fertility after discontinuation up to 6 - 12 months. may cause cramps, bleeding, PID, infertility, perforation of uterus. Instruct woman to locate string and check placement monthly.
depo-provera (injectable progestins) (depo is 12 and 12)
injectable progestin that inhibits ovulation. failure rate - 6%. may cause menstrual irregularities, return visit needed every 12 weeks. may cause weight gain, headaches, depression, and return to fertility delayed up to 12 months. no protection against STDs. Inform woman of delayed fertility.
vaginal contraceptive ring (the ring 1 and 2)
vaginal ring about 2 inches that is inserted into vagina, then releases estrogen and progestin. may cause vaginal discharge. can be expelled without notice. no protection against STDs. instruct woman to use backup if ring is expelled and remains out for more than 3 hours
transdermal contraceptive system - wear how long?
patch that releases estrogen and progestin. failure rate - 9%. may cause skin irritation, may fall off and not be noticed. no protection against STDs. less effective in women over 200 lb. instruct woman to apply patch every week for 3 weeks and not to wear one during week 4.
oral contraceptives
a pill that suppresses ovulation by combined action of estrogen and progesterone. failure rate 8%. must take pill every day. some side effects. no protection against STDs. Side effects - dizziness, nausea, mood changes, high BP, blood clots, heart attacks, stroke. Can not use with smokers or a history of thromboembolic disease
contraceptive sponge - can cause what? and how long to leave in? (the sponge is only good for 24 hours)
disk-shaped polyurethane device containing spermicide that is activated when wet. failure rate - 25%. can fall out during voiding. no protection against STDs. can cause irritation, allergic reaction, toxic shock. caution women not to leave in longer than 24 hours
cervical caps - (Tu’s cap)
soft cup shaped latex fits over base of cervix. failure rate 24%. No protection against STDs. Odor may occur if left too long. May cause irritation or allergic reaction. Abnormal PAP test, risk of toxic shock. Patient must be instructed on removal and insertion. leave in at last 6 hrs, but not longer than 24.
diaphragm (w/ spermicide) - made of what?
shallow latex cup with spring in rim to hold in vagina. failure rate 16%. does not use hormones. considered medically safe. may protect against cervical cancer. No protection against STDs. side effects - allergy to latex, rubber, or spermicide. may cause toxic shock, may become dislodged. woman just be taught to insert and remove correctly.
condoms and spermicides
failure rate - 15%, side effect - decreased sensation, interferes with spontaneity, breakage risk, couples must be instructed on proper placement. protects against STDs
Contraceptive methods can be divided into four types (BB, I’m HP)
behavioral methods, barrier methods, hormonal methods, and permanent methods
Fertility awareness(FAM)
methods are based on identifying fertile days in a woman’s cycle and avoiding sexual intercourse during that time.Collectively, the potentially fertile days up to and including the day of ovulation are called the “fertile window.women need to have regular menstrual cycles for it to be effective.
behavioral -
abstinence, FAM (25% failure rate), withdrawal (coitus interruptus), factional amenorrhea method (LAM)
barrier
condom, diaphragm, cervical cap, sponge
hormonal contraception
OC, injectable contraceptive, transdermal patch, vaginal ring, implantable contraceptive, intrauterine contraceptive, emergency contraceptive.
permanent
tubal ligation or Ensure for women, vasectomy (men)
Discuss postpartum teaching regarding postpartum sexual activity and factors that would affect comfort in the postpartum women - how many weeks and what type of contraceptives?
Typically, sexual intercourse can be resumed once bright red bleeding has stopped and the perineum is healed from an episiotomy or lacerations. This is usually by the third to the sixth week postpartum. However, there is no set, prescribed time at which to resume sexual intercourse after childbirth. There is no scientific basis for the traditional recommendation to delay sexual activity until the 6-week postpartum checkup. Coital discomfort and localized dryness usually plague most postpartum women until menstruation returns. Water-soluble lubricants can reduce discomfort during intercourse.The nurse should inform the client that intercourse can be resumed if bright red bleeding stops. Use of water-based gel lubricants can be helpful and should not be avoided. Pelvic floor exercises may enhance sensation and should not be avoided. Barrier methods such as a condom with spermicidal gel or foam should be used instead of oral contraceptives. Reassure the breast-feeding mother that she may notice a let-down reflex during orgasm and find her breasts are sensitive when touched by her partner
Postpartum blues - when do they appear?
occurs in the first week after birth(peak on postpartum days 4 and 5) till approximately 10 days. typically do not affect the mother’s ability to function and care for her child ▪ Postpartum blues is a phase of emotional lability characterized by crying episodes, irritability, anxiety, confusion, and sleep disorders. Symptoms usually arise within the first few days after childbirth, reaching a peak at 3 to 5 days and spontaneously disappearing within 10 days. Although postpartum blues is usually benign and self-limited, these mood changes can be frightening to the woman. Women should also be counseled to seek further evaluation if these moods do not resolve within 2 weeks as postpartum depression may be developing.
The taking-hold phase (taking hold of my concerns)
occurs when the client begins to assume control over her bodily functions (usually lasts several weeks after the birth, characterized by both dependent and independent behavior, with increasing autonomy)). She is also showing strong interest in caring for the infant by herself. she will be particularly concerned about her health, the infant’s condition, and her ability to care for herself or himself. She still requires assurance that she is doing well as a mother
maternal adjustment - how long? (adjust quickly)
the time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process. During the first 24 to 48 hours after giving birth, mothers often assume a passive role in meeting their own basic needs for food, fluids, and rest, allowing the nurse to make decisions for them concerning activities and care. They spend time recounting their labor experience to others. When interacting with the newborn, new mothers spend time claiming the newborn and touching them, commonly identifying specific features in the newborn, such as “he has my nose” or “his fingers are long like his father’s”
Synchrony
Synchrony is an essential component of the interaction between a mother and her infant and is characterized by adaptive and reciprocal behaviors that promote a mutually rewarding interaction. (reacting together)
Reciprocity
the process by which the infant’s abilities and behaviors elicit/excite a parental response. (like response back to someone) Reciprocity is described by two dimensions: complementary behavior and sensitivity. Complementary behavior involves taking turns and stopping when the other is not interested or becomes tired. Parents who are sensitive and responsive to their infant’s cues will promote their development and growth
- Biorhythm
the scientific basis for interventions (such as cycled lighting, feeding schedule, and caregiving pattern) aimed at improving the fit between infant and the environment? Infant development includes maturation of biorhythms. Two basic changes in biorhythm include establishment of circadian rhythm and day-night pattern
Entrainment -
Entrainment - the act of adopting a common rhythm by both the mother and infant?
Voice
Voice - speaking in soft, high-pitched tones
Eye Contact
Eye Contact - positive bonding
Touch
Touch is a basic instinctual interaction between a parent and his or her infant and has a vital role in the infant’s early development.
early contact (with the trunk)
early period of acquaintance, mothers touch their infants in a characteristic manner. Mothers visually and physically “explore” their infants, initially using their fingertips on the infant’s face and extremities and progressing to massaging and stroking the infant with their fingers. This is followed by palm contact on the trunk. Eventually, mothers draw their infant toward them and hold the infant
skin-to-skin
Skin-to-skin contact during the first hour following birth is the gold standard to initiate breast-feeding. physiologic (thermoregulation, cardiorespiratory stability), and behavioral (sleep, breast-feeding duration, and degree of exclusivity) domains as an effective therapy to relieve procedural pain and improve neurodevelopment. In addition, kangaroo care provides the newborn with optimal physiologic stability, warmth, and opportunities for the first feed
Describe the necessary postpartum nursing assessments that must occur to a patient that has received morphine via the epidural route - how often to check on pt? (morphine is 12 and 12)
Morphine can cause respiratory depression. Patients with morphine epidurals have frequent respiratory rate checks, q 30-60 minutes for 12 hours and 1-2 hours for an additional 12 hours.
morphine - who can order it?
The Morphine epidural is considered active for 24 hours following injection. If the patient needs additional pain medications, the orders must come from the anesthesiologist, not obstetrician
morphine - how is unlike IV?
Other common side effects of morphine epidurals are pruritus, urinary retention and N/V . Unlike systemic morphine (IV, IM, SQ, PO), altered level of consciousness or decreased peristalsis are not considered expected side effects of morphine epidurals
perineal lacerations - how often to assess? (lacerate every 8 hours)
perineal lacerations - Assess the episiotomy and any lacerations at least every 8 hours to detect hematomas or signs of infection.
Lacerations are classified based on their severity and tissue involvement: 1st, 2nd and 3rd degree (skin, muscle, anal)
▪ First-degree laceration involves only skin and superficial structures above muscle;
▪ second-degree laceration extends through perineal muscles ;
▪ Third-degree laceration extends through the anal sphincter muscle but not through the anterior rectal wall
episiotomies - how long to heal? (pissed for 2 weeks, actually, months)
episiotomies - majority of healing takes place within the first 2 weeks, but it may take 4 to 6 months for the episiotomy to heal completely
episiotomies - how often to assess? (pissed for 4 hours)
Inspect the episiotomy for irritation, ecchymosis, tenderness, or hematomas. Assess for hemorrhoids and their condition.
o Monitor episiotomy site for redness, edema, warmth or discharge to identify infection.
o Assess vital signs at least every 4 hours to identify changes suggesting infection.
o Apply ice pack to episiotomy site to reduce swelling.
episiotomies - nursing instruction
Instruct client on use of sitz bath to promote healing, hygiene, and comfort.
o Encourage frequent perineal care and peripad changes to prevent infection.
o Recommend ambulation to improve circulation and promote healing.
o Instruct client on positioning to relieve pressure on perineal area.
o Demonstrate use of anesthetic sprays to numb perineal area.
ice - when to start using? (Ice in the 4th semester)
Ice is the first measure after vaginal birth - pain from edema, an episiotomy or laceration. apply during the fourth stage of labor and for the first 24hr to reduce perineal edema and to prevent hematoma formation—thus reduce pain and promote healing. Use ice = ice pack wrapped in a disposable covering or clean washcloth Intermittently for 20 min, removed for 10 mins
heat
peribottle: filled w/ warm water and sprayed over the perineal area after each voiding and before applying new perineal pad. can be used either for vaginal birth ( VB )or c section (CS )women.
after the first 24hr for pain
after the first 24hr, sitz bath w/ room temperature water is substituted for the ice pack. used to reduce local swelling and promote comfort for episiotomy (surgical cut), perineal trauma or inflamed hemorrhoids. cold to room temperature— enhances vascular circulation and healing. Before using a sitz bath, the woman should cleanse the perineum with a peribottle or take a shower using mild soap.
sitz bath - how often
advise patient to use site bath several times a day.
vaginal birth - topical
topicaltreatment is a local anesthetic spray such as benzocaine topical and can be used for pain.
vaginal birth - Pharmacologic method for hemorrhoid pain
Pharmacologic methods used to reduce hemorrhoid pain include local anesthetics (dibucaine) or steroids (hydrocortisone acetate)
nipple pain
nipple pain - treatments include beeswax, glycerin-based products, petrolatum, lanolin, and hydrogel products. Also applying expressed breast milk to nipples and allowing it to drymay help
pain - analgesics
Analgesics such as acetaminophen and oral nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen or naproxen are prescribed to relieve mild postpartum discomfort. For moderate to severe pain, a narcotic analgesic such as codeine or oxycodone in conjunction with aspirin or acetaminophen may be prescribed
vaginal birth - discomfort - bladder
bladder distention, incomplete emptying, and inability to void are common and cause pain. Full bladder may lead to hemorrhoids. Encourage patient to void often
afterbirth pains
secretion of oxytocin stimulates uterine contraction and causes the woman to experience pain
Why are postpartum women at risk for coagulation problems - and how long do they last?
plasma levels rise. coagulation factors increased during pregnancy and remain elevated for 2 to 3 weeks postpartum o Smoking, obesity, immobility, and postpartum factors such as infection, bleeding, and emergency surgery (including emergency cesarean section) also increase the risk of coagulation disorders.
feeding cues - 1 - 5
1 - alert or fussy prior to care. Rooting and hands to mouth. good tone.
2 - alert once handled. some rooting or taking pacifier. adequate tone.
3 - brief alert w/ care. no hunger cues (crying, rooting, suckling). adequate tone.
4 - sleeping throughout care. no hunger cues. no change in tone.
5 - significant HR, RR, O2 or work of breathing outside baseline.
football hold (quarterback)
In the football hold , the mother holds the infant’s back and shoulders in her palm and tucks the infant under her arm. Remind the mother to keep the infant’s ear, shoulder, and hip in a straight line. The mother supports the breast with her hand and brings it to the infant’s lips to latch on. She continues to support the breast until the infant begins to nurse. This position allows the mother to see the infant’s mouth as she guides her infant to the nipple. This is a good choice for mothers who have had a cesarean birth because it avoids pressure on the incision.
cradling position
The cradling position is the one most commonly used . The mother holds the baby in the crook of her arm, with the infant facing the mother. The mother supports the breast with her opposite hand.
across the lap position
across-the-lap position , the mother places a pillow across her lap, with the infant facing the mother. The mother supports the infant’s back and shoulders with her palm and supports her breast from underneath. After the infant is in position, the infant is pulled forward to latch on.
side-lying position
the mother lies on her side with a pillow supporting her back and another pillow supporting the newborn in the front. To start, the mother props herself up on an elbow and supports the newborn with that arm, while holding her breast with the opposite hand. Once nursing is started, the mother lies down in a comfortable position
facilitating latch (latch onto VC)
To promote latching-on, instruct the mother to make a C or a V shape with her fingers. In the C hold , the mother places her thumb well above the areola and the other four fingers below the areola and under the breast. In the V hold , the mother places her index finger above the areola and her other three fingers below the areola and under the breast. Either method can be used as long as the mother’s hand is well away from the nipple so the infant can latch on
milk ejection reflex (Oxy let down)
milk ejection reflex - Oxytocin also acts on the breast by eliciting/exciting the milk let-down reflex during breast-feeding.
feeding frequency and duration -
feeding frequency and duration - The nurse should suggest the client feed the baby every two or three hours to help her reduce and prevent further engorgement.
breast support
breast support - The nurse should suggest the client wear a well-fitting bra to provide support and help alleviate breast discomfort for non-breastfeeding pt. Application of cold compresses to the breasts is suggested to reduce engorgement for non-breastfeeding clients.
maternal nutrition and milk production - how much protein, etc?
To meet the needs for milk production, the woman should eat an additional 500 calories per day, 20 grams of protein per day, 400 mg of calcium per day, and 2 to 3 quarts of fluid per day
breast engorgement - pain management for breast-feeding and non breast-feeding? (feeding gets warm)
The nurse should suggest the client feed the baby every two or three hours to help her reduce and prevent further engorgement in breastfeeding clients. o Application of warm compresses and expressing milk frequently are suggested to alleviate breast engorgement in breastfeeding client. Application of cold compresses to the breasts is suggested to reduce engorgement for non-breastfeeding clients
mastitisis inflammation of the lactiferous (milk-producing) glands of the breast.
Treatment of mastitis focuses on two areas : emptying the breasts and controlling the infection. Frequent breast emptying helps both infectious and noninfectious mastitis. Frequent nursing is advised.
breast care and care for sore nipples
breast care and care for sore nipples - Hydrogel dressings are used prophylactically in treating nipple pain. The nurse can suggest drying the nipples following feedings if the client experiences nipple pain
plugged milk ducts
plugged milk ducts - The mother should continue to nurse during engorgement to avoid a plugged milk duct, which could lead to mastitis.
breastfeeding as contraception - (how old must the infant be?)
breastfeeding and contraception - Ovulation may occur before menstruation. Therefore, breast-feeding is not a totally reliable method of contraception unless the mother exclusively breast-feeds, has had no menstrual period since giving birth, and whose infant is younger than 6 months old
oxytocin (how long does it work?) (oxy for 20 min is a letdown)
acts so that milk can be ejected from the alveoli to the nipple. Therefore, sucking by the newborn will release milk. A decrease in the quality of stimulation causes a decrease in prolactin surges and thus a decrease in milk production. Prolactin levels increase in response to nipple stimulation during feedings. Prolactin and oxytocin result in milk production if stimulated by sucking (Blackburn, 2018) (Fig. 15.3). If the stimulus (sucking) is not present, as with a woman who is not breast-feeding, breast engorgement and milk production will subside within days postpartum.Oxytocin stimulates the uterus to contract during the breast-feeding session and for as long as 20 minutes after each feeding. Oxytocin also acts on the breast by eliciting the milk let-down reflex during breast-feeding. sucking by the newborn will release milk
Prolactin - when does it start working? (prolactin is lactin)
Prolactin from the anterior pituitary gland, secreted in increasing levels throughout pregnancy, triggers the synthesis and secretion of milk after the woman gives birth. During pregnancy, prolactin, estrogen, and progesterone cause synthesis and secretion ofcolostrum, which contains protein and carbohydrate but no milk fat. It is only after birth takes place, when the high levels of estrogen and progesterone are abruptly withdrawn, thatprolactin is able to stimulate the glandular cells to secrete milk instead of colostrum. This takes place within 4 to 5 days after giving birth.
advantages of breast feeding - maternal (and the big one)
Can facilitate postpartum weight loss by burning extra calories
Stimulates uterine contractions to control bleeding
Lowers risk for ovarian and endometrial cancers
Facilitates bonding with newborn infant
Lowers risk of type 2 diabetes
Breast milk is free unlike formula
Reduces risk of postpartum depression
Promotes uterine involution as a result of release of oxytocin
Lowers the risk of breast cancer and osteoporosis
Affords some protection against conception, although it is not a reliable contraceptive method
advantages of breastfeeding - neonatal (and allergies?)
Stimulates growth of positive bacteria in digestive tract
Reduces incidence of stomach upset, diarrhea, and colic
Begins the immunization process at birth by providing passive immunity
Promotes optimal mother–infant bonding
Reduces risk of newborn constipation
Promotes greater developmental gains in preterm infants
Provides easily tolerated and digestible formula that is sterile, at proper temperature, and readily available with no artificial colorings, flavorings, or preservatives
Is less likely to result in overfeeding, leading to obesity
Promotes better tooth and jaw development as a result of sucking hard
Provides protection against food allergies
Lowers health care costs due to fewer illnesses
Is associated with avoidance of type 1 diabetes and heart disease
postpartum infection - causes
Prolonged (>18 to 24 hours) premature rupture of membranes (removes the barrier of amniotic fluid so bacteria can ascend)
Cesarean birth (allows bacterial entry due to break in protective skin barrier)
Urinary catheterization (could allow entry of bacteria into bladder due to break in aseptic technique)
Regional anesthesia that decreases perception of need to void (causes urinary stasis and increases risk of urinary tract infection)
postpartum infection - causes
Staff attending to woman are ill (promotes droplet infection from personnel)
Compromised health status, such as anemia, obesity, smoking, drug abuse (reduces the body’s immune system and decreases ability to fight infection)
Preexisting colonization of lower genital tract with bacterial vaginosis,Chlamydia trachomatis,group B streptococci,S. aureus, andE. coli(allows microbes to ascend)
Retained placental fragments (provides medium for bacterial growth)
Manual removal of a retained placenta (causes trauma to the lining of the uterus and thus opens up sites for bacterial invasion)
postpartum infection - causes
Insertion of fetal scalp electrode or intrauterine pressure catheters for internal fetal monitoring during labor (provides entry into uterine cavity)
Instrument-assisted childbirth, such as forceps or vacuum extraction (increases risk of trauma to genital tract, which provides bacteria access to grow)
Trauma to the genital tract, such as episiotomy or lacerations (provides a portal of entry for bacteria)
Prolonged labor with frequent vaginal examinations to check progress (allows time for bacteria to multiply and increases potential exposure to microorganisms or trauma)
Poor nutritional status (reduces body’s ability to repair tissue)
Gestational diabetes (decreases body’s healing ability and provides higher glucose levels on skin and in urine, which encourages bacterial growth)
Break in aseptic technique during surgery or birthing process (allows entry of bacteria)
Misoprostil - don’t give how
Misoprostil - stimulates uterine contraction to reduce bleeding. never give undiluted as bolus injection IV.
Prostaglandin/Hemabate
Prostaglandin/Hemabate - stimulates uterine contractions to treat postpartum hemorrhage due to uterine atony when not controlled by other methods. assess vitals.
Methylergonovine/Methergine -
Methylergonovine/Methergine - stimulates uterus to prevent and treat postpartum hemorrhage due to atony or sub involution.
Oxytocin/Pitocinoxytocin : first line therapy
▪ secretion of oxytocin stimulates uterine contraction and causes the woman to experience after pains
▪ Oxytocin stimulates the uterus to contract during the breast-feeding session and for as long as 20 minutes after each feeding.
▪ Oxytocin also acts on the breast by eliciting the milk let-down reflex during breast-feeding.
▪ Stimulates the uterus to contract/to contract the uterus to control bleeding from the placental site, 20–40 units in a liter IV or 10 units IM
Risk factors for hemorrhage:
Precipitous labor (less than 3 hours)
o Uterine atony
o Placenta previa or abruptio placenta
o Labor induction or augmentation
o Operative procedures (vacuum extraction, forceps, cesarean birth) o Retained placental fragments
o Prolonged third stage of labor (more than 30 minutes)
o Multiparity, more than three births closely spaced
o Uterine over distention (large infant, twins, hydramnios)
o Nursing intervention : suggest pt to void, immediate fundal massage, intravenous fluid resuscitation, and administration of uterotonic medications.
after birth - uterus - how long before it’s back to a normal size?
returns to its normal size through a gradual process, involution, involving retrogressive changes that return to its nonpregnant size & condition. This process is facilitated by uterine contractions that help compress blood vessels & expel excess uterine contents. Initially, the uterus is located near the umbilicus & gradually descends into the pelvic cavity over the next few weeks. By the end of the postpartum period (around 6 wks), the uterus typically regains its non-pregnant size.
3 retrogressive processe (retro contracts for cats in our generation)
Contraction: muscle fibers to reduce those previously stretched during pregnancy
Catabolism: shrinks enlarged individual myometrial cells
Regeneration: uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off & shed during lochial discharge.
Subinvolution
delayed/absent involution d/t retained placental fragments/infection
Responsive to early diagnosis & treatment
Factors that facilitate uterine involution
Complete expulsive of amniotic membranes & placenta @birth
Complication-free labor & birth process
Breast-feeding
Early ambulation
Factors that inhibit involution
Prolonged labor & difficult birth
Incomplete expulsion of amniotic membranes & placenta
Uterine infection
Overdistention of uterine muscles:
Multiple gestation
Hydramnios
Large singleton fetus
Full bladder: displaces the uterus & interferes w/contractions
Anesthesia: relaxes uterine muscles
Close childbirth spacing: frequent & repeated distention decreases tone & causes muscular relaxation
Contractions/Afterpains - which women have the worst afterpains? (just 2)
aka involutional contractions, are intermittent contractions of the uterus that help to reduce uterine size and control bleeding.
More acute in multiparous & breast-feeding women secondary to repeated stretching of the uterine muscles from multiple pregnancies/stimulation during breast-feeding w/oxytocin released from the pituitary gland.
Danger sign - afterpains
Afterpains are usually stronger during breast-feeding b/c oxytocin released by the sucking reflex strengthens the contractions. Mild analgesics reduce this discomfort.
Lochia - how long does it last? (locked for 4-8 weeks)
vaginal discharge that occurs after birth & continues for approximately 4-8 wks.
Results from involution, during which the superficial layer of the decidua basalis becomes necrotic & is sloughed off.
After childbirth: lochia is bright red & consists of (Lock the fiber and decide on R and WBCs)
Blood
Fibrinous products
Decidual cells
Red & WBCs.
Lochia from the uterus is (pH)
alkaline, but becomes acidic as it passes through vagina.
Patterns of lochia flow vary in
amount & duration among women & pregnancies. Each day, the amount of bleeding should be less & the color lighter. The color changes result from the changing composition of the tissue that is sloughed & expelled during the endometrial restoration process
lochia rubra - how long? (Rubra 3)
initial discharge, usually bright, deep-red mixture of mucus, uterine tissue, & blood that occurs for the 1st 3-4 days postpartum. As uterine bleeding subsides, it becomes paler & more serous.
Lochia serosa - how long? (seriously pink and brown) (3,4; 4,10; 10, 14)
2nd stage. Lighter pinkish brown & is expelled 4-10 days postpartum. Lochia serosa primarily contains leukocytes, dicidual tissue, RBCs, & serous fluid.
Lochia alba - when does it start, and how long does it last? (Rubra is my lucky number)
Final. Dischage is creamy white/yellow to light brown & consists of leukocytes, decidual tissue & reduced fluid content. Occurs from days 10-14 but can last 3-6 wks postpartum in some women & still be considered endometritis.
Danger sign:
Reappearance of bright-red blood after lochia rubra has stopped. Reevaluation by a health care provider is essential if this occurs.
Cervix
gradually undergoes a process called involution, extending into the vagina & remains partly dilated, bruised, & edematous.
cervix - Returns to its prepregnant state by when (but not totally normal) (cervix on 66 too)
wk 6 of the postpartum period & gradually closes, but never regains its prepregnant appearance.
cervix - appearance after birth
Shapeless, edematous & is easily distensible for several days.
Perineum - and how long do bruising and swelling last? (not as long as you think)
often edematous & bruised for the 1st day/2 after birth
perineum - If the birth involved an episiotomy/laceration, how long to heal? (peri is long)
If the birth involved an episiotomy/laceration, complete healing may take as long as 4-6mos in the absence of complications at the site, such as hematoma/infection.
perineum muscle tone - does it return to normal?
may/may not return to normal, depending on the extent of injury to muscle, nerve, & connecting tissues.
Danger sign: Failure to maintain & restore perineal muscular tone can lead to
urinary incontinence later in life for many women.
Resumption of ovulation: - just varies
return to ovulation and menstrual cycles varies among women. Exclusive breastfeeding can delay ovulation due to the suppression of gonadotropin secretion. However, it’s not a reliable method of contraception.
resumption of ovulation - Estrogen (ester hides for a week)
drops profoundly & reach their lowest level a week into postpartum
resumption of ovulation - progesterone (progeria stops lacation)
Progesterone (gets uterus ready to accept egg): quiets the uterus to prevent a preterm birth during pregnancy & its increasing levels during pregnancy prevent lactation from starting before birth takes place.
Progesterone - levels after birth? (Progeria more shy than ester)
Decrease dramatically after birth & are undetectable 72 hrs after birth.
Reestablished w/1st menstrual cycle
Oxytocin: during postpartum period - how long does it work? (Oxy works for about 20 min)
uterus stimulated by oxytocin to contract during the breast-feeding session & for as long as 20 mins after each feeding. Acts on the breast by eliciting the milk let-down reflex during breast-feeding.
prolactin - how long is it elevated? (lactatin on route 66)
associated w/breast-feeding process by stimulating milk production, remain elevated into the 6th wk after birth
prolactin - when does it decrease - in nonlactating women? (not a pro at 3 weeks)
Fluctuate in proportion to nipple stimulation.
Levels decrease in nonlactating women, reaching prepregnant levels by the 3rd postpartum wk
Abdomen
Abdomen: stretched during pregnancy, gradually regain tone. They might also appear loose due to the stretching, & this may take time to return to its previous state
Urinary postpartum diuresis
Urinary postpartum diuresis: increased urinary output due to the elimination of excess fluids that accumulated during pregnancy. This diuresis helps to reduce edema and maintain fluid balance
Bladder distension - you just can’t feel it
due to decreased bladder sensation and the pressure exerted by the uterus during pregnancy. Adequate emptying is important to prevent urinary retention and potential complications
Intestinal motility & resumption of regular bowel habits
slows down during pregnancy, and it takes some time postpartum for normal bowel habits to resume. Encouraging hydration, fiber intake, and early ambulation can help prevent constipation
Breastfeeding mothers & colostrum - rich in what? (not the anti you think)
Colostrum, rich in antibodies & nutrients by providing essential nutrition to the newborn & promoting immunity, is the initial milk produced by the breast during the 1st few days postpartum.
Blood volume changes
Blood volume changes: increases during pregnancy, gradually decreases after childbirth, leading to a mild physiological anemia postpartum
Vital signs
Vital signs: BP, pulse, & RR may show some variability during the postpartum period. It’s important to monitor these vital signs to detect any abnormal changes
CBC values - Hgb & Hct (opposite of what you’re thinking)
CBC values: Hgb & Hct levels may be lower d/t the decrease in blood volume. Close monitoring is essential to detect any significant changes that might require intervention
Coagulation factors & varicosities - when do they return to normal? (just after the birth)
Coagulation factors & varicosities: Coagulation factors return to pre-pregnancy levels postpartum. Varicose veins, which can develop/worsen during pregnancy d/t increased pressure on blood vessels, may gradually improve after childbirth
Skin/integumentary
Skin/integumentary (especially striae/stretch marks): Striae gravidarum (stretch marks) are a common occurrence d/t the stretching of the skin during pregnancy. While they may not completely disappear, they often fade in color & become less noticeable over time
vaginal delivery - changes - CV - immediately after delivery
Immediate: after delivery, there is a decrease in blood volume, cardiac output, & peripheral resistance
vaginal birth - reproductive changes - immediate (just the uterus)
Immediate: Uterus undergoes involution, decreasing in size
vaginal birth - GI changes - what happens on day 1 and 2, and what to assess for?
Immediate: Decreased gastric motility
Days 1 – 2: Hunger & thirst motility
Assessment: Assess bowel sounds, abd distention, & passage of flatus
Offer clear fluids & gradually progress to a regular diet
vaginal birth - integumentary
Immediate: Stretch marks may fade
Assessment: Inspect perineum, incision sites, & breasts for any signs of infection/complications
vaginal birth - muscleskeletal (just joints)
Immediate: Joints revert to pre-pregnancy state
Assessment: Observe gait & assess for any musculoskeletal discomfort
Postpartum RN Assessment/Exam for Vaginal Delivery: - VS - how often to assess?
Freq: q 4-8 hrs during the 1st 24 hrs, then q 8 hrs
Assess: HR, BP, RR, & temp
Postpartum RN Assessment/Exam for Vaginal Delivery - uterine - how often? (uterus in 1534)
Freq: q 15 mins for 1st hr q 30 mins for next 2 hrs q 4hrs
Assess: Fundus for firmness, position, & involution progress
Postpartum RN Assessment/Exam for Vaginal Delivery - lochia - how often?
Freq: @ each assessment related to uterine assessment
Assess: Color, amount, & odor
Postpartum RN Assessment/Exam for Vaginal Delivery - perineal - how often? (peri and lochie are friends)
Freq: @ each assessment
Assess: Lacerations, edema, & hematoma
Postpartum RN Assessment/Exam for Vaginal Delivery - breast
Assess: Fullness, nipple integrity, & signs of engorgement/infection
Postpartum RN Assessment/Exam for Vaginal Delivery - pain - how often? (pain, too)
Freq: Regularly
Assess: Pain level, location, & type; provide pain relief measures
Postpartum RN Assessment/Exam for Vaginal Delivery - bowel and bladder - how often? (bladder, too)
Freq: Regularly, esp. after delivery
Assess: Bowel sounds, abd distention, & urine output;
Encourage voiding & monitor for urinary retention/constipation
Postpartum RN Assessment/Exam for Vaginal Delivery - emotional - how often?
Freq: Regularly, during each interaction
Assess: Well-being, bonding w/baby, & signs of postpartum depression/anxiety
Rubella vaccine
Rubella vaccine: (the German measles vaccine) is administered to prevent rubella infection during pregnancy. Rubella is particularly concerning during pregnancy as it can lead to serious complications for the developing fetus.
physio changes - rubella vaccine
Immune response: The body’s immune system responds by producing specific antibodies against the rubella virus.
Antibody transfer: The antibodies produced because of the rubella vaccine can pass through the placenta & provide protection to the newborn against rubella infection during the early stages of life.
Breast milk - rubella
Breast milk antibodies: Rubella antibodies produced in response to the vaccine may also be present in breast milk, providing passive immunity to the infant through breastfeeding.
Maternal & infant protection: Postpartum, if the mother has been adequately vaccinated, she is less likely to contract rubella, reducing the risk of transmission to her infant
RhoGAM (moms are negative)
RhoGAM: given to Rh-negative pregnant women to prevent Rh isoimmunization. Rh isoimmunization can occur when an Rh-negative mother is exposed to Rh-positive blood, typically during childbirth. Without intervention, this can lead to hemolytic disease of the newborn in subsequent pregnancies.
physio changes - Rh Factor Sensitization (just antibodies)
Rh Factor Sensitization: If an Rh-negative mother is exposed to Rh-positive blood (e.g., during childbirth), she may develop antibodies against the Rh factor, which can affect future pregnancies
RH - when to give? (rush at 28 weeks)
Administration: given to Rh-negative pregnant women around the 28th week of pregnancy & within 72 hours of any event that could lead to Rh-positive fetal-maternal blood mixing (e.g., childbirth, miscarriage, ectopic pregnancy, amniocentesis)
RH - Prevention of Antibody Formation
Prevention of Antibody Formation: RhoGAM contains Rh antibodies that prevent the mother from forming her own antibodies against Rh-positive blood. This helps prevent sensitization and subsequent complications in future pregnancies
RH - Long-term Implication
Long-term Implications: RhoGAM administration during the postpartum period helps protect the mother from developing Rh antibodies. This is especially important if she plans to have more pregnancies with Rh-positive fetuses.
get from chart - CV
Physio Changes: Blood volume decreases, cardiac output gradually returns to normal, & BP stabilizes
get from chart - RN care
BP trends & stability
Monitoring for signs of thrombosis: swelling, redness, pain in legs. Hgb & Hct levels to assess for anemia
get from chart - GI
Physio Changes: GI motility returns to normal; appetite increases & constipation may occur.
Pertinent Info for RN Care:
Bowel mvmts frequent & consistent
Adequate hydration & nutrition intake
Monitor for signs of hemorrhoids/constipation
get from chart - reproductive
Uterine size & position: fundal height & firmness
Lochia characteristics: color, amount, & odor (infection/hemorrhage)
get from chart - reproductive
Physio Changes: Uterus undergoes involution (shrinking to pre-pregnancy size), lochia (vaginal discharge) occurs, & cervical changes revert.
get from chart - integumentary
Physio Changes: Skin changes (stretch marks) start to fade, hair loss may occur, & diaphoresis (excessive sweating) is common
Pertinent Info for RN Care:
Skin integrity, esp if there were any incisions/perineal tears
Assessing for signs of infection/excessive sweating
get from chart - muscoskeletal
Physio Changes: Joints & ligaments return to pre-pregnancy state, abd muscles may be lax (loose), & posture changes
Pertinent Info for RN Care:
Assessing abd muscle tone
Monitoring for back pain/joint discomfort
Providing guidance on exercises to regain muscle tone
get from chart - endocrine
Physio Changes: Hormone levels start to return to baseline, breastfeeding stimulates oxytocin release
Pertinent Info for RN Care:
Monitoring hormonal changes that might affect mood: postpartum blues, depression
Supporting breastfeeding & monitoring lactation
get from chart - urinary
Physio Changes: Diuresis occurs as excess fluid is eliminated, bladder tone returns to normal
Pertinent Info for RN Care:
Monitoring urinary output & signs of urinary retention
Assessing for signs of UTIs
Providing guidance on pelvic floor exercises
get from chart - respiratory
Physio Changes: RR & lung function return to pre-pregnancy levels
Pertinent Info for RN Care:
Monitoring RR & lung sounds
Providing education on deep breathing exercises
pertinent info - RN report
Delivery details: Vaginal/C-Section
Any complications during pregnancy, labor, or delivery
Medications received during labor & postpartum
Blood type & Rh status
Relevant healthy history & allergies
Any surgical interventions/repairs
Current VS & phys assessment findings
Breastfeeding/formula feeding plans
Psych & emotional well-being
fundus - Immediately Postpartum Period (Within 1 hr) (below, above, below)
Immediately Postpartum Period (Within 1 hr):
Uterine fundus is usually located at/slightly below the level of the umbilicus (navel) immediately after birth.
Position referred to as “U/1” or “U1” (uterus at the umbilicus level).
Fundal tone is firm, and the uterus may be palpable just above the symphysis pubis due to contractions
fundus - Postpartum Day #1 (day 1 is a finger above)
Postpartum Day #1:
Uterine fundus usually remains firm & may be found approximately 1 cm (fingerbreadth) above the umbilicus.
Position documented as “U/1+” or “U1+” (uterus 1 cm above the umbilicus.
Fundal height should gradually decrease as the uterus involutes.
fundus - Postpartum Day #2: (day 2 is one to two)
Uterine fundus continues to involute and is typically found approximately 1 to 2 cm below the umbilicus.
Position is documented as “U/2” (uterus 1-2 cm below the umbilicus).
Fundal height and tone should continue to improve.
correct charting example (u first)
Immediate Postpartum: U/1 - Fundus firm and midline.
Postpartum Day #1: U/1+ - Fundus firm, 1 cm above umbilicus.
Postpartum Day #2: U/2 - Fundus firm, 2 cm below umbilicus. Lochia serosa noted.
Factors Predisposing to Subinvolution
Refers to failure of the uterus to return to its pre-pregnancy size & position within the expected timeframe.
Uterine infection
Retained placental fragments
Overdistended uterus: multiple gestations, large baby, polyhydramnios (too much amniotic fluid)
Uterine anomalies
Prolonged labor/traumatic birth
Maternal anemia
Placenta accrete/other placental anomalies
reproductive - Involution of uterus
Involution of uterus: uterus undergoes involution, which is the process of returning to its pre-pregnancy size & position, involving contractions of the uterine muscles & shedding of excess uterine tissue.
subinvolution - CV
Blood volume reduction: blood volume, which increased during pregnancy, gradually returns to normal levels, which is important to prevent excessive bleeding.
Cardiac output normalization: cardiac output, which increased during pregnancy, gradually returns to non-pregnant levels.
subinvolution - hormonal
Hormonal changes: estrogen, progesterone, & human placental lactogen decrease after childbirth, while prolactin increases to initiate lactation.
subinvolution - GI
GI motility: slows down initially due to hormonal changes, but it gradually returns to normal as the body adjusts.
subinvolution - muscoskeletal
Ligament & joint relaxation: relaxing hormone levels decrease, leading to a gradual return of ligaments & joints to their pre-pregnancy state.
subinvolution - RN actions - what meds to give?
Close Monitoring: assess size, position, & consistency of uterus regularly
VS: monitor temperature for signs of infection
Fundal massage: gently massage uterus to prevent clot formation & ensure proper involution.
Administer uterotonics: meds (oxytocin) stimulate uterine contractions & prevent subinvolution.
Infection prevention: ensure aseptic techniques during procedures to prevent infection.
Emotional support: address psych concerns r/t delay in recovery
Education: educate pt about signs of subinvolution & the importance of reporting them promptly.
lochia - rubra
Lochia Rubra: bright red, bloody discharge during the first 1-3 days postpartum
lochia amount
should decrease over time; initially, may be heavy, & gradually decrease
lochia odor
lochia should NOT have a foul odor; Foul-smelling discharge indicates infection
lochia consistency
lochia should become thinner & watery as time passes
Day #1: Lochia Rubra:
Color: bright red, like a heavy menstrual flow
Amount: heavy flow, like the 1st day of a period
Odor: mild, earthy smell
Clots: passage of small to moderate clots is normal
Consistency: thicker & bloodier compared to later days
Day #2: Lochia Rubra
Color: still bright red, but may start to darken slightly
Amount: decreases compared to the 1st day, but still heavier than subsequent days
Odor: mild, earthy smell
Clots: smaller clots than on the 1st day, or none
Consistency: thinning out gradually
Day #3: Lochia Serosa
Color: begins to change to a pinkish/brownish color
Amount: noticeably lighter than the previous 2 days
Odor: mild, earthy smell
Clots: clots are rare/minimal
Consistency: thinner & less viscous compared to previous days
normal pattern of resumption of menses in both the nursing and non-nursing mother. - Non-nursing mother: (you get 7-9 weeks)
menstruation may resume as early as 7 to 9 weeks after giving
birth, but the majority take up to 3 months, with the first cycle being an
ovulatory
return of menses (menstrual periods) generally follows a certain patter, but individual variations can occur
1st few wks: period of amenorrhea (absence of menstruation) d/t hormonal changes associated w/pregnancy & breastfeeding. (several wks – few mos)
3-6 mos: menstruation resumes around 3-6 mos postpartum.
Influenced by: mother’s hormonal balance, breastfeeding practices, & indivudal variations.
Describe the normal pattern of resumption of menses in both the nursing and non-nursing mother. - Breastfeeding influence: - which hormone influences it?
suppresses the resumption of menses d/t the hormone prolactin, which inhibits ovulation; however, as breastfeeding freq & duration decrease, & as solid foods are introduced to the baby, prolactin levels decrease, & ovulation may return.
Describe the normal pattern of resumption of menses in both the nursing and non-nursing mother. - regularity
common for menstrual cycles to be irregular for the 1st few mos after they return d/t the body’s adjustment to hormonal changes
Describe the normal pattern of resumption of menses in both the nursing and non-nursing mother. -nursing mother
Nursing mother: breastfeeding can have an impact on the resumption of menses d/t the hormone prolactin.
nursing mother - menses - Lactational Amenorrhea
Lactational Amenorrhea: exclusive breastfeeding, esp when done on demand (freq. feedings day & night) can lead to lactational amenorrhea, where menstruation is suppressed. Prolactin levels remain high, inhibiting ovulation.
nursing mother - Prolactin Levels
Prolactin Levels: influenced by breastfeeing freq & duration, the more frequently a mother breastfeeds, esp during night, the longer prolactin levels are likely to remain high.
nursing mother - 1st 6 mos
1st 6 mos: many nursing moms experience lactational amenorrhea for the 1st 6 mos postpartum, esp if they are exclusively breastfeeding.
nursing mother - Intro of Solid Foods
Intro of Solid Foods: as solids are introduced & breastfeeding freq decreases, prolactin levels start to decline, leading to the return of ovulation & the resumption of menstrual periods.
nursing mother - Variability - return of menses
Variability: some nursing mothers may experience longer delays in the return of menses, while others might have periods resume earlier.
Note: breastfeeding patterns, hormonal variations, & individual differences influence timing of menstruation’s return.
Where would you expect to find the uterus in a postpartum patient with a full bladder
: in a postpartum pt with a full bladder, expect the uterus to be displaced upwards & backwards. A full bladder pushes the uterus upwards, preventing it from contracting & causing it to be positioned higher in the abd.
● Risk Factors for Postpartum Hemorrhage - labor, uterine shape, and placenta
Precipitous labor (less than 3 hours)
o Uterine atony
o Placenta previa (placenta covers the uterus) or abruptio placenta (placenta seperates from wall of uterus)
methylerogonivine - how often to assess VS and what to assess?
(it treats bleeding after childbirth) assess baseline bleeding, uterine tone and vital signs every 15 min. offer explanation to family.
cervix - internal - how fast does it return to normal?
Internal cervical os: gradually closes & returns to normal by 2 wks
cervix - external (external fish)
External os: widens & never appear the same after childbirth; no longer shaped like a circle; instead as a jagged slit-like opening, “fish mouth.”
prolactin - what do high levels do? (not pro fish)
High levels found to delay ovulation by inhibiting ovarian response to follicle-stimulating hormone.
vaginal delivery - CV changes - day 1-2
Days 1 – 2: Blood volume gradually returns to normal
vaginal delivery - CV changes - day 3-5 (stroke on day 3)
Days 3 – 5: Cardiac output & stroke volume increase
vaginal delivery - CV assessment - how often? (do cardio at least 4-8 hours)
Assessment: Assess vital signs (HR & BP) at least q 4-8 hrs during the 1st 24 hrs & then at least q 8 hrs for signs of hemorrhage/clot formation
vaginal birth - changes - day 1-10 - how should the lochia change? (the normal progression)
Days 1 – 10: Lochia (postpartum discharge) changes from bright red serosa alba
lochia serosa - what days will it appear? (seriously 4-10)
pinkish-brown/serosanguineous discharge from around days 4-10
Lochia Alba - how long does it last? (Jessica at 26)
whitish/yellowish discharge that can last for 2-6 wks postpartum
risk factors for postpartum hemorrhage (induce the hemorrhage)
o Labor induction or augmentation
o Operative procedures (vacuum extraction, forceps, cesarean birth)
o Retained placental fragments
risk factors for postpartum hemorrhage (hemorraging at 3)
o Prolonged third stage of labor (more than 30 minutes)
o Multiparity, more than three births closely spaced
risk factors for postpartum hemorrhage - distention
o Uterine over distention (large infant, twins, hydramnios)
o Nursing intervention: suggest pt to void, immediate fundal massage, intravenous fluid
resuscitation, and administration of uterotonic medications.
methylerogonivine - side effects (CHP SN w/ meth)
monitor for side effects - hypertension, seizures, cramping, N/V, palpitations
fundus - how often to assess? (fun at 1534)
Monitor uterine fundus for firmness & position q 15mins for 1st hr; then q 30 mins for next 2 hrs; then q 4 hrs;
Assess lochia for color, amount, & odor during each assessment
does HR increase or decrease in the first 2 weeks after birth?
decrease, bradycardia 40-60 bmp (due to excess blood going back to the mother’s heart)
do RBCs increase or decrease in early pregnancy?
decrease
what does progesterone do to muscles?
causes them to relax (also instestines), so after birth, they are less relaxed.
relaxin, estrogene, and progesterone do what to joints?
relax them
when is estrogen at its lowest point?
a week after birth
when are progesterone levels back to normal?
with the first menses
BAM
Commitment, attachment to the unborn baby, and preparation for delivery and motherhood during pregnancy
Acquaintance/attachment to the infant, learning to care for the infant, and physical restoration during the first 2 to 6 weeks following birth
Moving toward a new normal
Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months). The mother feels self-confident and competent in her mothering and expresses love for and pleasure interacting with her infant (Mercer & Walker, 2006)
description of lochia (lochia skips 3)
Scant: a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss
Light or small: an approximately 4-inch stain or a 10- to 25-mL loss
Moderate: a 4- to 6-in stain with an estimated loss of 25 to 50 mL
Large or heavy: a pad is saturated within 1 hour after changing it
do what if pt has excessive bleeding?
massage fundus until it is firm
prostaglandin - side effects
fever, chills, headache, N/V, diarrhea, flushing, bronchiospasm.
anterior rectal wall
4th degree
heavy lochia
entire pad . scant 1-2, light - 4, moderate - 4-6
hemorrage!!!!
fundus
hemorrhage risk - when is it most? (hemorrhaging for a week)
first week
6-12 hours after birth, fundus is where?
at abilicus
aldosterone
decrease - the hormone that decreases sodium retention and increases urine production. As a result: increase Na retention and decrease urine production.
when does diuresis start?
Diuresis begins within 12 hours after childbirth and continues throughout the first week postpartum. Normal function returns within a month after birth
what pts have the worst afterbirth pains?
All women experience afterpains, but they are more acute in multiparous and breast-feeding women secondary to repeated stretching of the uterine muscles from multiple pregnancies or stimulation during breast-feeding with oxytocin released from the pituitary gland. Primiparous women typically experience mild afterpains because the uterus is able to maintain a contracted state.
lochia immediately PP
Immediately after childbirth, lochia is bright red and consists mainly of blood, fibrinous products, decidual cells, and red and white blood cells. The lochia from the uterus is alkaline but becomes acidic as it passes through the vagina.
cardiac output - decrease when?
The cardiac output deceases to prelabor values 24 to 72 hours postpartum
acute decrease in hematocrit - normal or not?
an acute decrease in hematocrit is not an expected finding and may indicate hemorrhage.
stroke volume and cardiac output
cardiac output and stroke volume during pregnancy begins to diminish after birth once the placenta has been delivered.
how quickly does coagulation return to normal? (3 coag)
within 3 weeks
hematocrit and hemoglobin levels
hemoglobin and hematocrit levels to decrease slightly in the first 24 hours.
uterine atony
weak or soft uterus. caused bleeding.
endocrine changes
Levels of circulating estrogen and progesterone drop quickly with delivery of the placenta
estrogen levels lowest - and when does it return to normal?
1 week after birth. return to normal within 2 weeks.
estrogen and progesterone - what do they do? (esther collects, progeria produces)
Estrogen stimulates growth of the milk collection (ductal) system, while progesterone stimulates growth of the milk production system.
prolactin after birth - increase or decrease?
increase (breastfeeding until 6 weeks later, non breastfeeding 3 weeks)
estrogen and progesterone - increase or decrease? and when are they undetectable? (ester only lasts 72 hours)
decrease. progesterone levels decrease dramatically after birth and are undetectable 72 hours after birth
when does breast engorgement occur? (engorge your fav number)
Breast engorgement usually peaks in 3 to 5 days postpartum and usually subsides within the following 24 to 36 hours
taking in phase (take in and relive)
immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process. This phase is characterized by dependent behavior. During the first 24 to 48 hours after giving birth, mothers often assume a passive role in meeting their own basic needs for food, fluids, and rest, allowing the nurse to make decisions for them concerning activities and care.
taking hold phase (take hold of my concerns)
She will be particularly concerned about her health, the infant’s condition, and her ability to care for them
temp after birth
within the normal range or a low-grade elevation. Some women experience a slight fever, up to 100.4°F (38°C), during the first 24 hours.
pulse after birth
Pulse rates of 60 to 80 beats per minute (bpm) at rest are normal during the first week after birth. higher than 100, investigate.
RR after birth
the same, 12-20.
BP after birth - highs and lows?
should not be higher than 140/90 mm Hg or lower than 85/60 mm
pain - what should the rating be?
keep between 0-2
how should the fundus feel after birth?
The fundus should be midline and should feel firm. A boggy or relaxed uterus is a sign of uterine atony (loss of muscle tone in the uterus).
fundus location after birth?
One to 2 hours after birth, the fundus is typically between the umbilicus and the symphysis pubis.
fundus after 14 days?
should be non-palpable
most common sign of PE?
chest pain of breathing problems
bonding occurs how quickly?
first 30-60 min
attachment
both parent and child, psychological. explore infant.
PP hemorrhage - definition
PPH is defined as a cumulative blood loss greater than 1,000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery
most common cause of PP hemorrhage
uterine atony
causes of late pp hemorrhage (the sub is late due to hemorrhaging)
obstetric lacerations, uterine inversion, subinvolution, and rupture are generally causes of late or delayed hemorrhage
5 Ts
Tone: uterine atony, distended bladder
Tissue: retained placenta and clots; uterine subinvolution
Trauma: lacerations, hematoma, inversion, rupture
Thrombin: coagulopathy (preexisting or acquired)
Traction: too much pulling on umbilical cord
how to massage fundus with pp hemorrhage
After explaining the procedure to the woman, place one gloved hand on the area above the symphysis pubis (this helps support the lower uterine segment).
Place the other gloved hand (usually the dominant hand) on the fundus.
With the hand on the fundus, gently massage the fundus in a circular manner. Be careful not to over-massage the fundus, which could lead to muscle fatigue and uterine relaxation.
Assess for uterine firmness (uterine tissue responds quickly to touch).
If firm, apply gentle yet firm pressure in a downward motion toward the vagina to express any clots that may have accumulated.
Do not attempt to express clots until the fundus is firm because the application of firm pressure on an uncontracted uterus could cause uterine inversion, leading to massive hemorrhage.
Assist the woman with perineal care and applying a new perineal pad.
Remove gloves and wash hands.
cytotec
Stimulates the uterus to contract/to reduce bleeding; a prostaglandin analog
800 mcg per rectum, one dose
cytotec - never give how?
bolus IV
cytotec contraindications (mis asthma)
allergy, active cardiovascular disease, pulmonary or hepatic disease; use with caution in women with asthma
methegrine (meth stimulates)
Stimulates the uterus to prevent and treat postpartum hemorrhage due to atony or subinvolution
0.2 mg IM injection
May be repeated in 5 minutes
Thereafter every 2–4 hours
methegrine - don’t use with what?
HTN
oxytocin
Stimulates the uterus to contract/to contract the uterus to control bleeding from the placental site
20–40 units in a liter IV
or
10 units IM
endometriosis - when does it develop? (wide range for infection)
uterine infection that typicmally develops within 2 to 4 days postpartum to as late as 6 weeks.
endometriosis - more common with what type of birth?
c-section. use antibiotics 1 hour before c-section.
Mastitis - when does it occur? (mattias is 2)
within the first 2 days to 2 weeks postpartum
Mastitis - most common bacteria?
staph aureus
redness - 1 point
< .25 cm
redness - 2 points
.5 cm
redness - 3 points
beyond .5 cm
edema - 1 point
< 1 cm from incision
edema - 2 points
1-2 cm from incision
edema - 3 points
> 2 cm from incision
ecchymosis - 1 point
1-2 cm from incision
ecchymosis - 2 points
> 1 cm bilaterally or 2 cm unilaterally
discharge - 1 point
serum present
discharge - 2 points (the sanguinous 2)
seroseanguineous present
discharge - 3 points (the bloody 3)
bloody, purulent discharge present
approximation - 1 point (how many cm)
skin separation less than 3 cm
approximation - 2 points (approximate body parts)
skin and sub q fat separated
approximation - 3 points (approximately 3 faces)
skin, sub q fat, and facial separation
cardiac output decrease - when does it return to nonpregnant levels?
rapidly falls over the next 2 weeks and usually returns to nonpregnant levels within 6 to 8 weeks postpartum.
BP after birth?
This decrease in cardiac output is reflected in bradycardia (40 to 60 bpm) for up to the first 2 weeks postpartum
when is the fundus at the umbilicus? (How many hours)
Approximately 6 to 12 hours after birth, the fundus is usually at the level of the umbilicus
endometriosis - what bacteria?
usually E. coli, Klebsiella pneumoniae, or G. vaginalis
