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NUR 102 OB Assessment #1 > Postpartum Adaptations > Flashcards

Postpartum Adaptations Flashcards

1
Q

Postpartum Period - the first 6 weeks after birth

Retrogressive changes (back to normal) & progressive changes (e.g. initiation of lactation)

A
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2
Q

___ refers to the changes the reproductive organs undergo after childbirth to return to their nonpregnant size & condition

This begins immediately following the delivery of the placenta

A

Involution

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3
Q

Uterine involution entails 3 processes:

  1. Contraction of the ___
  2. Catabolism
  3. Regeneration of the ___
A

muscle fibers

uterine epithelium

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4
Q

Contraction of the muscle fibers

Immediate contraction

Uterus contracts down & returns to normal shape & size

Can take up to 6 weeks to heal

A

Catabolism

Breakdown of cells into similar compounds

Products absorbed by bloodstream that get excreted by urine as nitrogenous waste

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5
Q

Regeneration of the uterine epithelium

  • Outer portion of epithelial lining gets expelled w/placenta
  • In about 2-3 days the remaining decidua (the endometrial present during pregnancy) separates into 2 layers

> ___ layer that gets expelled into lochia (vaginal discharge)

> second layer as source for new endometrium

  • 2-3 weeks after birth except for area of placenta (can take up to 6 weeks to heal)
A

superficial

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6
Q

How big is the placenta-sized wound in your uterus after giving birth?

A

About the diameter of an average-sized dinner plate; 8.5 inches

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7
Q

Descent of the Uterine Fundus

  • Measured in relation to the umbilicus
  • Descends by 1 centimeter, or 1 “fingerbreadth” per day
  • Is documented in relation to the umbilicus (e.g. U-1, at U, U+2)
  • If the process of involution does not occur properly, ___ occurs & can cause postpartum hemorrhage

> The uterus goes higher; a major cause is a full bladder

> Important to monitor location & contractility of the uterine fundus

A

subinvolution

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8
Q

“Afterpains”

Multiparous women

Multifetal/gestational pregancies

Polyhydramnios

Larger children

A
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9
Q

Lochia (vaginal discharge)

___ - red/reddish brown; mostly blood w/small particles of decidua & mucous; 3 days

___ - white/cream/light yellow; leukocytes, decidual cells, epithelial cells, fat, cervical mucous, & bacteria; 11th day to 3rd week, could last to 6th week

___ - pink/brown tinged; serous exudate, erythrocytes, leukocytes, & cervical mucous; days 4-11

A

Rubra

Alba

Serosa

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10
Q

Amount

Scant: less than a 2.5cm (1 inch) stain on a perineal pad

Light: 2.5-10cm (1-4 inch) stain

Moderate: 10-15cm (4-6 inch) stain

Heavy: saturated perineal pad

Excessive: saturated perineal pad in 15 minutes

A
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11
Q

Cervical Changes

Heals rapidly (by end of 1st week)

Internal OS closes, external OS (seen on speculum exam) remains permanently changed

Oval = nulliparous; Slit-like = multiparous

Cervix will have some slight dilation to it afterwards

A
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12
Q

Vagina

* Edematous

* Multiple small lacerations may be present

* Rugae are initially absent, return by 3-4 weeks postpartum

* Complete involution takes 6-10 weeks

* Vaginal mucosa is ___

* Lactation suppresses ovarian function & that will affect estrogen production

> Breastfeeders = dyspareunia

A

atrophic

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13
Q

Perineum

* Edematous

* May be ___

* Episiotomy/laceration

* Hemorrhoids

* Nursing care is focused on relief of discomforts

> ___ for healing; ___ for pain

> Topical anesthetics & prescribed analgesics

A

ecchymotic (bruising)

warmth; ice

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14
Q

Episiotomies

  1. Midline episiotomy
  2. Medio-lateral episiotomy

Right or left more common

A
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15
Q

Perineal Lacerations

1st / 2nd / 3rd / 4th º

> 2nd º most common w/perineal muscles torn

Perineal lacerations & vaginal/cervical lacerations

A
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16
Q

Cardiovascular System - Cardiac Output

* Transient increase immediately following childbirth

* Returns to pre-labor values within 1 hour after delivery

* Returns to pre-pregnancy levels by 6-12 weeks after birth

Plasma Volume

* Body rids itself of the excess plasma volume via diuresis & diaphoresis; decline in aldosterone

A

Blood Values

* Marked leukocytosis as high as 30,000 during labor & immediate postpartum period; >6 days - normal

* Hgb & hct are difficult to interpret due to remobilization of excess body fluid

Coagulation

* 4-6 weeks for hemostasis

* Elevations in clotting factors continue for several days or longer following delivery, increasing risk for thromboembolism formation

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17
Q

Gastrointestinal System

* Anticipate client needs: fluids & foods soon after childbirth

___ is common in the postpartum period

* Bowel tone & intestinal motility remain sluggish for several days

* Abdominal musculature is relaxed

* Decreased food & fluid during labor may lead to small, hard stools

* Perineal lacerations, episiotomies, & rectal hemorrhoids can add discomfort

A

Constipation

* Often prescribed stool softeners & laxatives postpartum to prevent and/or treat constipation

* First stool occurs within 2-3 days postpartum, w/normal bowel patterns resuming 8-14 days postpartum

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18
Q

Urinary System

* Edema can be present from birth trauma

* Women are still @ risk of urinary retention & bladder distension, increasing the risk of UTI & inc postpartum bleeding

* Stress incontinence may begin during pregnancy or during the postpartum period

> Encourage Kegel exercises

* Ureters & kidneys complete involution 2-8 weeks after delivery

A

Musculoskeletal System: Muscles and Joints

* Muscle fatigue (in neck, shoulders, arms)

* Headaches

* Pelvis begins to return to pre-pregnancy position

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19
Q

Musculoskeletal System: Abdominal Wall

* Muscle tone is diminished during pregnancy

* Diastasis recti may occur

> Minimal to severe

A

Integumentary System

* Receding pigmentation

* Resolution of melasma & linea nigra

* Striae gravidarum fade to silver

* Postpartum hair loss (due to hormone changes; 4-20 weeks > delivery)

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20
Q

Neurological System

* Temporary changes from anesthesia (lack of feeling in legs or dizziness)

* Bilateral & frontal headaches (due to fluid & electrolyte imbalances)

> Be wary for a spinal headache or signs of preeclampsia

A
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21
Q

Endocrine System

  • Rapid decline in estrogen, progesterone, & human placental lactogen
  • ___ is able to fully activate w/the decrease of estrogen & progesterone, stimulating milk production

> 2-3 days > childbirth

  • In non-breastfeeding mothers, ___ returns to nonpregnant levels
  • ___ is secreted & stimulates “letdown”
A

Prolactin

prolactin

oxytocin

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22
Q

Ovulation & Menstruation

* Ovulation may occur before the 1st postpartum menses

* Education regarding contraception is important

* Return of menses

> Non-nursing mothers: 6-9 weeks after childbirth

> Nursing mothers: as early as 2 months or as late as 18 months

A
23
Q

Postpartum Weight Loss

Approximately 5.5kg is lost during childbirth

An additional 4kg is lost over the following 2 weeks, & another 2.5kg is lost by 6 months

Many women do not lose all of their pre-pregnancy weight, and retain 1kg w/each pregnancy

Diets are not recommended for lactating mothers as they need an additional ___ calories per day for infant nutrition

A

500

24
Q

Postpartum Vaccination

* RhO(D) Immune Globulin

> Give within 72 hours > childbirth

> RhoGAM

> Given to prevent the development of maternal antibodies that will affect subsequent pregnancies

> Scenario where mother is Rh (-) & baby is Rh (+)

A

* Rubella vaccine (MMR)

> Live vaccine; wait 28 days to get pregnant

* Pertussis vaccine (Tdap)

* Flu vaccine

> Thimerosol-free

> NOT nasal route (is live); 9/30-5/1 flu season range

* COVID vaccine (in postpartum)

25
Q

Focused Assessments - During the Recovery Period

* 1st 2 hours after delivery of the placenta

Initial assessment of the woman following childbirth includes:

  • Vital signs / skin color / location & firmness of fundus
  • Amount & color of lochia / perineum / presence, degree, location of pain
  • IV infusions / urinary output / status of abdominal incision (if present d/t cesarean delivery)
  • Level of feeling & ability to move s/p anesthesia (e.g. moving legs; strength level)
A

Focused Assessments - Following a Vaginal Birth

Vital signs / fundus / lochia / perineum / bladder elimination / breasts / lower extremities

26
Q

Lochia

  • Lessened but shouldn’t be absent (could be a clot that is masking a postpartum hemorrhage)

Perineum - “REEDA”

Redness / Edema / Ecchymosis / Discharge / Approximation (i.e. laceration, healing or suture for episiotomy)

A

Bladder elimination

  • S/S of urinary retention

Breasts

  • Engorgement regardless of breastfeeding status
  • Nipple characteristics
27
Q

Vital signs

  • Obtain weight for quantitative blood loss
  • Hypovolemia - dehydration
  • Orthostatic hypotension
  • 140/90 BP: preeclampsia; can happen up to 2 weeks later
  • Lower pulse after placenta delivery
  • Tachycardia to rule out hemorrhage & infection
  • Temperature up to 100.4° common post delivery (>100.4° or persists more than 24 hours = seek out provider)
A

Lower extremities

  • Look for S/S of thrombophlebitis
  • Weakened or absent peripheral pulses
  • Signs of thromboembolism development
  • Check DTR’s (hyperactive can indicate preeclampsia)
28
Q

Focused Assessments - Following a Cesarean Birth

  • In addition to the usual postpartum assessment, also must assess as postoperative patient!

Pain Relief

  • Patient may be on PCA or receive opioid rx into the epidural space, providing 18-24 hours of comfort [at risk up to 24 hours]
  • Assess respiratory status frequently, including respiratory rate & oxygen saturation
A

Gastrointestinal

  • Assess for S/S of a paralytic ileus (abdomen distension, absent bowel sounds, inability to pass gas or stool)
  • Assess dressing/incision
29
Q

Assessing the Uterine Fundus

  • Feel firm, soft?
  • Support the lower uterine segment so we prevent inversion of the uterus

> Inversion - uterus kind of prolapses through into vagina but is inverted

A
30
Q

?

Rx’s that serve as uterine relaxants

?

Given for management of preeclampsia; is a uterine relaxant

A

Tocolytics

magnesium sulfate

31
Q

?

Term that describes when the placenta detaches before it should; prior to delivery

A

abruptio placentae

32
Q

?

Term that describes when the placenta might have started to invade the uterine wall

A

placenta accreta

33
Q

?

Term that describes a placenta set low in the uterus

A

placenta previa

34
Q

Assessment of the Perineum

  • Turn patient on to the side & lift the buttocks; able to visualize the anus in this way too (i.e. check for hemorrhoids)
A
35
Q

Risk Factors for Postpartum Infection

* Operative procedures (cesarean birth, vacuum extraction, forceps)

* Multiple cervical exams

* Prolonged labor; prolonged rupture of membranes

* Manual extraction of placenta or retained fragments

> Provider manually puts whole hand into vagina into uterus to pull out placenta

A

* Diabetes

* Catheterization

* Bacterial colonization of the lower genital tract

36
Q

Nursing Care During the Immediate Postpartum Period

First 24 hours after delivery of placenta

* Providing comfort measures

  • Ice packs (create vasoconstriction; prevent edema of perineum & numb associated pain)
  • Sitz Baths (cool H2O in 1st 24 hours)
  • Perineal care
  • Topical medications
  • Sitting measures (squeeze buttocks as you sit)
  • Analgesics (NSAIDs, ibuprofen, acetaminophen)
A

* Promoting bladder elimination

* Providing fluids & food

> Encourage 2,500mL of fluids per day

* Preventing thrombophlebitis

37
Q

Maternal Role Adaptation

?

Begins in pregnancy & lasts for many months after birth

Reciprocal

A

Attachment

38
Q

?

Unilateral

Promoted during first 30-60 minutes after birth

A

Bonding

39
Q

Reciprocal Attachment Behaviors

* Make eye contact & engage in prolonged, intense mutual gazing

* Move their eyes in an attempt to “track” the parent’s face

* Grasps & holds the parent’s finger

* Moves synchronously in response to rhythms & patterns of the parent’s voice ( ? )

* Root, latch onto the breast, & suckle

* Be comforted by the parent’s voice or touch

A

entrainment

40
Q

Becoming Acquainted

Maternal Touch

* En face (eye contact made)

* Fingertipping

* Enfold (bringing in very close)

* Claiming/binding

A

Verbal Behaviors

* High-pitched voice

* Begins to identify baby by name

41
Q

Puerperal Phases

  1. Taking-In Phase
  2. Taking-Hold Phase
  3. Letting-Go Phase
A
42
Q

___ Phase

Time of relinquishment

A

Letting-Go

43
Q

___ Phase

Mother is focused on her own needs of fluid, food, & sleep

She details her labor to others as a way of realizing the pregnancy is over

Typically lasts for a day or less; may be prolonged in mothers who had cesarean deliveries

A

Taking-In

44
Q

___ Phase

Mother assumes responsibility for her own care

May have anxiety about caretaking abilities

Lasts several days

A

Taking-Hold

45
Q

Maternal Role Attainment

Anticipatory Stage

Formal Stage

Informal Stage

Personal Stage

A

“All Families Inherit Problems”

46
Q

? Stage

Mother accepts & feels comfortable w/the role of a parent

A

Personal

47
Q

? Stage

Begins at birth & lasts 4-6 weeks

Behavior is mainly guided by others (healthcare professionals, family, friends)

A

Formal

48
Q

? Stage

Begins during pregnancy

Seeks out role models to learn the role of a mother

A

Anticipatory

49
Q

? Stage

May overlap the formal stage - begins once mother identifies appropriate responses to infant cues

She is now following unique needs of the infant versus generalized directives

A

Informal

50
Q

Postpartum Blues

* Normal, is NOT depression

Mild, transient conditions (not lasting more than 2 weeks)

Affects 70-80% of new mothers

A

Characterized by:

Insomnia / irritability / fatigue / tearfulness / mood instability / anxiety

Contact healthcare provider if signs of depression become severe or last longer than two weeks

51
Q

?

Is a term used to describe displaying interest in the infant

A

engrossment

52
Q

Family Role Adaptations

Affects:

Fathers/partners

Siblings

Grandparents

A

Factors that affect:

Discomfort & fatigue

Knowledge of infant needs

Previous experience

Expectations about the newborn

Maternal age

Maternal temperament

Temperament of the infant

Availability of strong support systems

53
Q

Cultural Influences on Adaptation

Communication

* Numerous dialects & languages spoken

Dietary Practices

* Understanding the hot-cold theory of health & diet (cold being the postpartum period)

* Some cultures may not like hospital food - encourage them to bring meals from home

A

Health Benefits

* Another female member of the family is often involved in the care of the infant & the mother

* Variations in hygiene practices

NUR 102 OB Assessment #1 (11 decks)

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