Postpartum Flashcards
When does the maternal recovery stage start? How long does it last?
Starts with the delivery of the placenta and lasts from 1-4 hr
Main goal during immediate postpartum period
Prevent postpartum hemorrhage
When should parent-newborn binding begin to occur?
During fourth stage of labor
When does postpartum period begin? When does it end? How long dies it last?
Begins after the delivery of the placenta and ends when the body returns to the prepregnant state. This process takes approximately 6 weeks.
Greatest risk during postpartum period
Hemorrhage, shock, infection
What coordinates and strengthens uterine contractions?
Oxytocin
What does breast feeding do to oxytocin?
Stimulates the release of endogenous oxytocin from pituitary gland
Uncomfortable uterine cramping is referred to as….
Afterpains
What does a firm and contracted uterus prevent?
Excessive bleeding and hemorrhage
After delivery of placenta what do hormones do?
Estrogen, progesterone, and placental enzyme insulinase decrease resulting in a decreased blood glucose, estrogen, and progesterone levels
What is decreased estrogen associated with
Breast engorgement, diaphoresis, and diuresis of excess extra cellular fluid accumulated during pregnancy
What does decreased estrogen diminish
Vaginal lubrication. Local dryness and intercourse discomfort may persist until ovarian function returns and mensturation resumes
What does a decreased progesterone result in?
Increase in muscle tone throughout the body
What does decreased placental enzyme insulinase result in?
Reversal of diabetogenic effects of pregnancy, which lowers blood glucose levels immediately in the puerperium
Nursing goals for the postpartum women
Prevent infections, hemorrhage and engorgement
Comfort and rest
Safety in care for infant
Provide knowledge about self care and infant care
Where is fundus 6-12 hours after delivery
Midline, at umbilicus (or just above)
Should go down 1fb per day postpartum
If uterus is displaced and deviated after birth what should your first nursing action be
Ask her to void
What should temp be after 1st 24 hours
Back to normal
Can raise to 100 degrees and it be normal up until 24 hrs postpartum
What happens to estrogen and progesterone after delivery of placenta
Decreases
How does infant sucking help with milk production
Provides stimulus for hormone release
What are the three different stages of lochia and when will you see these
Rubra- 3-4 days after birth
Serosa- 3-10 days after birth
Alba- 10-14 (could be longer)
What could it mean if a postpartum woman is having heavy amounts of bright red bleeding
Too much activity
When does the postpartum period begin
After birth of the placenta
What does lochia typically begin as
Rubra
Does cardiac output quickly return to non pregnant values after birth
No, due to the increasing amount of venous return there is an increase in stroke volume
Does the postpartum woman commonly experience tachycardia or bradycardia
Bradycardia
Why is bradycardia normal in the postpartum woman
There is an increase in fluid and with each pump of the heart it is pushing out a lot more blood so it does not have to pump as much
Pulse will be lower
Is profuse diaphoresis (sweating) common or uncommon in early postpartum
Common
The uterus returns to its normal size through a process called
Involution
After pain refers to
The uterine contractions that occur after birth
What is engorgement
Swelling of the breast tissue that occurs 2-4 days after birth
What are the three phases fathers go through
Expectations, reality, and mastery
What is a normal pulse for the postpartum mother
40-60
Anything higher is considered tachycardia
What could tachycardia indicate
Hemorrhage
What should postpartum blood pressure be
That of a normal adult
What if blood pressure is too high?
Too low?
Too high- preeclampsia
Too low- hemorrhage (fluid loss)
Where is the fundus at directly after delivery
Midway between symphysis pubis and umbilicus
Why is the fundus higher 6-12 hours after delivery thaN it is directly after delivery?
Right after delivery there is so much oxytocin that it drastically contracts uterus and 6-12 hours later there is not that much oxytocin so it doesn’t contract it as much
What are the three things you want a postpartum woman to be aware of with her lochia
If it has an odor= infection
Check amount and color
What causes after pains
Release of oxytocin
What happens with after pains the more deliveries you have
They get worse with each child
What can stretching of the uterus due to after pains
Make them worse
Why is a women hungry after delivery
It takes as many calories to labor as it does to run a marathon
What are the things a postpartum women can and cannot eat
No restrictions. Can eat whatever she wants
When will a women be VERY thirsty
After delivery and when she is breast feeding
What contributes to a postpartum women’s constipation
She is in pain and does not want to push to have a bowel movement
What can you do to help with her constipation
Give her stool softener, ice pack for the pain, fluids, and a litacam spray to numb the area
How much blood is normally lost during a vaginal birth?
C-section?
Vaginal- 500cc
C-section- 1000cc
What can estrogen do to the blood
Increase clotting
Important to ambulate postpartum to decrease chances of blood clots
What can you do to help a women who does not want to breast feed
Tell her to stop stimulating nipple, use ice packs, wear a tight fitting bra
What happens to estrogen and progesterone after delivery of placenta
Decrease
What hormone triggers milk production
Prolactin
Where is prolactin released from
Anterior pituitary
What hormone triggers let down
Oxytocin
Where is oxytocin made
Posterior pituitary
What is the first fluid available to the newborn
Colostrum
When is breast milk usually produced
In 3 days of delivery
What does colostrum help with
EVERYTHING!
Helps with breaking up the Meconium in the baby so it can pass
Can a women with inverted nipples breast feed
Yes
What can you do to help a women get her nipples to turn the right way out
Place baby on nipple; the sucking could pull it out
Breast pump will usually do the same
What can you suggest for a breast feeding mom that wants to continue to breast feed but says that her nipples are so cracked it is painful
Nipple shields
What will you see with engorged breast?
Taut, shiny, tender, warm
What could happen if you don’t do anything to engorged breast?
Mastitis
Where is a good place to release some of engorgement of breast?
Standing in warm shower and massage breast to let some of engorgement out
What happens to linea negra?
Fades but never goes away
What are some postpartal abdominal wall changes?
Always some separation of rectus abdominus but it is the degree to which it happens which we are concerned about
What is weight loss from
Lose fluids, baby, placenta
When a mom who had a C/S is breast feeding what is something that might be helpful?
Pillow between baby and incision when breast feeding
Do you bleed or ovulate first?
Ovulate, so you can become pregnant again so you must be careful
Uncomfortable uterine pains that occur intermittently during first two or three days postpartum
Afterpains
Who are after pains more common in
Multiparous woman
Uterus that is not well contracted and feels soft when palpated
Boggy uterus
A process by which parents form an emotional relationship with their infant over time
Bonding
Fluid in breast during pregnancy and into early postpartal period; rich in antibodies, high in protein, and acts as laxative for new born
Colostrum
Separation of two rectus muscles along median line of abdominal wall
Diastasis recti
Face-to-face position in which parents and infants face are approximately 20 centimeters apart and on the same plane
En face
Swelling of breast tissue
Engorgement
How long does primary engorgement usually last? When does it reach a peak?
Primary engorgement usually lasts 48 hours and reaches a peak between 3rd and 5th days postpartum
A fathers absorption, preoccupation, and interest in his infant
Engrossment
Dome-shaped upper portion of uterus between points of insertion of Fallopian tubes
Fundus
Client compliant of sharp calf pain when leg is extended and client moves foot in a direction of dorsiflexion, such as walking or stretching legs
Homan’s sign
What is Homan’s sign a early sign of
Thrombophlebitis
Reduction in size of the uterus after delivery to its pre-pregnant state
Involution
Release of breast milk caused by contraction of milk glands in response to natural release of oxytocin
Let-down reflex
Thin, clear, yellow to white vaginal discharge that follows Lochia serosa, from approx 11 days to 3-6 weeks postpartum
Lochia alba
Red, menstrual-like vaginal discharge, from birth to three days postpartum
Lochia Rubra
Serous, pinkish-brown vaginal discharge that follows Lochia Rubra until approx 10 days postpartum
Lochia serosa
A maternal adjustment reaction accompanied by irritability, anxiety, a mild let-down feeling usually occurring between 2nd and 3rd postpartum day through 1st to 2nd week postpartum
Postpartum blues
Period starting after third stage of labor and ending with a return of uterus to pre-pregnant state at six weeks postpartum
Puerperium
If breast feeding exclusively menstruation delayed until when?
At least 3 months
What seems to suppress ovulation
Prolactin
If not breast feeding, menstruation _______
6-10 weeks
Is breast feeding a reliable form of contraception?
Only for 3 months when exclusively breast feeding
Should you bring breast to baby or baby to breast?
Baby to breast!
Time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process
Taking-in phase
Second phase of maternal adaption characterized by dependent and independent maternal behavior
Taking-hold phase
The third stage of maternal adaption and is when the woman establishes relationships with other people
Letting-go phase
What are the three stages to the maternal psychological adaptation
- Taking-in phase
- Taking-hold phase
- Letting -go phase
What are the three stages of father or partner attachment
1 expectations
2 reality
3 mastery
Preconceptions of what home life may be like with newborn
Expectations
Happens when father realizes that their expectations in stage 1 are not realistic
Reality
The father makes a conscious decision to take control and be the center of his newborns life regardless of his preparedness
Mastery
What does external cervix look like after a pregnancy
Jagged slit-like opening, often described as a fish mouth
