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NU314 OB > Postpartum Adaptations > Flashcards

Postpartum Adaptations Flashcards

1
Q

Postpartum Period

A

critical transition time for woman, newborn, and family physiologically and psychologically

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2
Q

Puerperium Period

A

begins after the delivery of the placenta and lasts approximately 6 weeks

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3
Q

How does the uterus return to its normal size?

A

Gradual process of involution which involves retrogressive changes

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4
Q

What are the 3 retrogressive processes of involution?

A
  • Contraction of the muscle fibers to reduce those previously stretched during pregnancy
  • Catabolism
  • Regeneration of uterine epithelium
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5
Q

What happens during catabolism?

A

Enlarged , individual myometrial cells shrink

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6
Q

Lochia

A

vaginal discharge that occurs after birth and continues for approximately 4-8 weeks

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7
Q

What are the 3 stages of Lochia

A

Lochia rubra
Lochia Serosa
Lochia Alba

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8
Q

Lochia Rubra

A

Deep-red mixture that occurs the first 3-4 days after birth

-Mucus, tissue debris, and blood

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9
Q

Lochia Serosa

A

Second stage: pinkish brown and is expelled 3-10 days postpartum
-Leukocytes, decidual tissue red blood cells, and serous fluid

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10
Q

Lochia Alba

A

Final stage: Creamy white or light brown occurring from days 10-14 but can last 3-6 weeks postpartum
-Leukocytes, decidual tissue, and reduced fluid content

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11
Q

What is given to reduce the effects of afterpains?

A

oral analgesics

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12
Q

Who typically experiences worse after pains?

A

Women who are breast feeding or still receiving exogenous oxytocin

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13
Q

When does the cervix typically return to its prepregnant state?

A

Week 6 of the postpartum period

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14
Q

What will the cervical os now look like after birth?

A

Jagged slit-like opening–“Fish mouth”

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15
Q

How long does is take for the vaginal mucosa to thicken and rugae to return?

A

3 weeks

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16
Q

When will the vagina return to its prepregnant size?

A

6-8 weeks postpartum

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17
Q

When does normal mucus production and thickening of the vaginal mucosa return?

A

With ovulation

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18
Q

What is a common problem for postpartum women until menstruation returns?

A

Vaginal dryness and coital discomfort (dyspareunia)

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19
Q

How long can complete healing of the perineum take after an episiotomy or lacerations?

A

4-6 months

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20
Q

What comfort measures can be implemented for the perineum?

A 
ice packs
pouring warm water over area via peribottle
witch hazel pads
anesthetic sprays 
sitz baths
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21
Q

Why should nurses encourage women to practice pelvic floor exercises?

A

Improve pelvic muscle tone
Strengthen perineal muscles
Promote healing

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22
Q

When does cardiac output return to normal after birth?

A

3 months

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23
Q

How long does it take blood volume to return to normal after pregnancy?

A

4 weeks

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24
Q

A decrease in hematocrit during the postpartum period may indicate what?

A

hemorrhage

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25
Q

Is bradycardia or tachycardia normal during postpartum?

A

bradycardia

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26
Q

What causes bradycardia postpartum?

A

Increased blood that flows back to the heart and central circulation after it is no longer perfusing the placenta

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27
Q

Why may tachycardia in postpartum women indicate further investigation?

A

May indicate hypovolemia, dehydration, or hemorrhage

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28
Q

What happens with BP postpartum?

A

falls first 2 days and then increases 3-7 days after birth and returns to prepregnancy after 6 weeks

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29
Q

What may an increase in BP accompanied by headaches indicate?

A

preeclampsia

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30
Q

What may decreased BP during postpartum indicate?

A

infection or uterine hemorrhage

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31
Q

What places women at an increased risk for thromboembolism postpartum?

A

hypercoagulable state, combined with vessel damage during birth, and immobility

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32
Q

Urination may be affected by?

A
  • Perineal lacerations
  • Generalized swelling and bruising of the perineum and tissues surrounding urinary meatus
  • Hematomas
  • Decreased bladder tone
  • Diminished sensation of bladder pressure
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33
Q

Difficulty voiding can lead to what?

A

urinary retention
bladder distention
UTI’s

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34
Q

Urinary retention and bladder distention can cause what?

A

Displacement of the uterus from the midline and can inhibit the uterus from contracting properly which increases risk of hemorrhage

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35
Q

Urinary retention is a major cause of what?

A

Uterine atony

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36
Q

What are some causes of Postpartum Diuresis?

A
  • large amounts of intravenous fluids given during labor
  • decreasing antidiuretic effect of oxytocin
  • buildup and retention of extra fluids during pregnancy
  • decreasing production of aldosterone
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37
Q

Aldosterone

A

hormone that decreases sodium retention and increases urine production

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38
Q

What causes decreased peristalsis to occur postpartum?

A 
Analgesics 
Surgery
Diminished intra-abdominal pressure
-Low-fiber diet
-Insufficient fluid intake
-Diminished muscle tone
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39
Q

Which moms would be extra fearful of a bowel movement after giving birth?

A

Women with an episiotomy, lacerations, or hemorrhoids

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40
Q

When does the women’s appetite return?

A

immediately after birth

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41
Q

What can be done to assist mom’s with their first bowel movement after birth?

A

Stool softeners

42
Q

All of moms joints will return to their prepregnant state except for where?

A

Her feet

43
Q

What will a decline in relaxin and progesterone levels cause?

A

Fatigue, activity intolerance, and distorted body image

-hip and joint pain that interferes w/ activity and exercise

44
Q

What leads to a loss in abdominal muscle tone and possibly separation from abdominal wall during pregnancy?

A

Stretching of the abdominal wall and muscles to accommodate the growing uterus

45
Q

What happens to the integumentary system postpartum?

A
  • pigmentation fades
  • stretch marks fade to silvery lines
  • Diaphoresis is common for about a week
  • hair loss is common first 3 months
46
Q

When will tidal volume, minute volume, vital capacity, and functional residual capacity return to prepregnant values?

A

within 1-3 weeks of birth

47
Q

What happens to the endocrine system postpartum?

A

Estrogen and progesterone levels drop quickly
Placental hormones decline rapidly
Prolactin levels decline w/in 2 weeks if NOT breastfeeding

48
Q

Lactation

A

secretion of milk by the breasts

49
Q

What is thought to bring on the process of lactation?

A

Interaction of progesterone, estrogen, prolactin, and oxytocin

50
Q

When does breast milk typically appear?

A

4-5 days after childbirth

51
Q

How long is exclusive breast feeding recommended?

A

6 months

52
Q

What is the gold-standard to initiate breast feeding?

A

Skin to skin contact during the first hour following birth

53
Q

Breast Crawl

A

baby moves on their mother’s abdomen up to her breast instinctively

54
Q

Engorgement

A

postnatal physiologic painful condition in which distention and swelling of the breast tissue occurs as a result of an increase in blood and lymph supply as a precursor to lactation

55
Q

When does breast engorgement peak

A

3-5 days postpartum

56
Q

What treatments can be used to reduce pain of engorgement?

A 
heat or cold applications 
cabbage leaf compress
breast massage and milk expression
ultrasound
breast pumping
anti-inflammatory agents
tight-supportive bra
avoid stimulation when not feeding
57
Q

What are the four main influential hormones during the postpartum period?

A

estrogen
progesterone
prolactin
oxytocin

58
Q

Estrogen

A

levels drop profoundly after birth and reach lowest level a week into postpartum period

59
Q

Progesterone

A

Quiets the uterus to prevent preterm birth during pregnancy and its increasing levels prevent lactation from starting before birth
-decrease dramatically after birth

60
Q

When are progesterone levels reestablished?

A

The first menstrual cycle

61
Q

Oxytocin

A
  • stimulates the uterus to contract during breastfeeding and for as long as 20 minutes after
  • elicits the milk let-down reflex during feeding
62
Q

Prolactin

A

stimulates milk production

63
Q

How long does prolactin remain elevated in women who breastfeed?

A

6 weeks after birth

64
Q

How long does prolactin take to reach prepregnant levels in women who do not breastfeed?

A

Third week postpartum

65
Q

How can prolactin delay ovulation during postpartum period?

A

By inhibiting ovarian response to FSH

66
Q

When may menstruation return for NON-lactating women?

A

7-9 weeks or up to 3 months after birth

67
Q

When may menstruation return for lactating women?

A

Depends on breast feeding frequency and duration; anywhere from 2-18 months

68
Q

When are afterpains usually stronger?

A

During breast feeding

69
Q

Why are afterpains typically stronger during breastfeeding?

A

Because oxytocin is released by the sucking reflex which strengthens the contractions

70
Q

What can be given to the mom to reduce discomfort of afterpains?

A

Mild analgesics

71
Q

What can lead to urinary incontinence later in life for many women?

A

Failure to maintain and restore perineal muscular tone

72
Q

If rectal tone is not regained through exercise it can be a problem for what?

A

Support may not be adequate during future pregnancies

73
Q

For Multicultural families nurses must be?

A

Open, respectful, and nonjudgmental

74
Q

How do Vietnamese women view the postpartum period?

A

A cold state and must protect themselves through warmth

75
Q

What would cultural practices include for Vietnamese women?

A
  • Warm water for hygiene and stimulation of lactation
  • Consuming warm foods
  • Stay indoors
76
Q

How is postpartum and childbirth viewed in China?

A

States which disturb the normal health balance between yin and yang

77
Q

How is balance reestablished between yin and yang for these women?

A

They engage in practices for a month related to the maternal role, physical activity, maintenance of body warmth, and certain food consumption

78
Q

Balance of Hot and Cold

A

Childbirth involves the loss of blood, which is considered hot, the postpartum period is considered cold, so the mother must balance that with the intake of hot foods

79
Q

Who is typically involved with hot-cold beliefs?

A

Latin American, African, and Asian people

80
Q

What may some women try to reduce infant/mom vulnerability and potential illness?

A

A month long confinement period after birth

81
Q

Confinement Period

A
  • Rest and recuperate
  • Avoid cold
  • Kept warm
  • Stay inside
  • Bathe infrequently
  • Avoid exercise
82
Q

What hormone plays an essential role in the chemistry aspect of bonding?

A

Oxytocin

83
Q

How can oxytocin be enhanced?

A 
Skin to skin
breastfeeding
eye contact
social vocalizations
maternal and milk odors
newborn massage
84
Q

Attachment

A

formation of a relationship between a parent and his or her newborn through a process of physical and emotional interactions

85
Q

What factors will influence attachment?

A

Environmental circumstances
Newborn health
Quality of nursing care

86
Q

What are the 3 phases of postpartum mood disorders?

A

Baby Blues
Postpartum Depression
Psychosis

87
Q

Baby Blues Characteristics

A 
Mild depressive symptoms
Anxiety 
Irritability 
Mood swings
Tearfulness 
Increased sensitivity 
Fatigue
88
Q

When will the Baby Blues peak and then typically resolve?

A

Peak at days 4 and 5

Resolve by day 10

89
Q

Postpartum depression and Psychosis

A
  • symptoms last longer, more severe, and will require treatment
  • lead to poor bonding, alienation, daily dysfunction, and violent thoughts/actions
90
Q

What are the 3 Stages for Partner Adaptation to Newborn?

A

Expectations
Reality
Transition to mastery

91
Q

Expectation Stage

A

Preconceptions about what home life will be like with newborn

92
Q

Reality Stage

A
  • Partners realize their expectations in stage 1 are not realistic
  • Feelings of being unprepared, stressed, irritable, frustrated, and possibly turned into depression
93
Q

Risk Factors for Postpartum Partner Depression

A
  • history of depression
  • financial problems
  • poor relationship w/ partner
  • unplanned pregnancy
94
Q

Transition to Mastery Stage

A

Partner makes conscious decision to take control and be at the center of newborns life regardless of preparedness

95
Q

Seven Behaviors of Engrossment

A
  • visual awareness of newborn
  • tactile awareness of newborn
  • perception of newborn as perfect
  • strong attraction to newborn
  • awareness of distinct features
  • extreme elation by father
  • increased sense of self-esteem
96
Q

Reva Rubin’s 3 Phases of Maternal Adjustment to Newborn

A

Taking-in Phase
Taking-hold Phase
Letting-go Phase

97
Q

Taking-In Phase

A

time immediately after birth when the client needs others to meet her needs and relives the birth process

98
Q

Taking-Hold Phase

A

Second Phase

  • dependent and independent maternal behavior
  • typically starts on day 2 or 3 postpartum
99
Q

Letting-Go Phase

A

Third Phase

  • women reestablish relationship with others
  • adapts to parenthood through her new role as a mother
100
Q

Maternal Variables affecting Maternal Role

A

Confidence, age, relationship w/ father, socioeconomic status, birth experience, stress, support system, personality, self-concept, health status, preparation, depression, anxiety, relationship w/ own mom

101
Q

Infant Variables affecting Maternal Role

A

Appearance, responsiveness, temperament, health status

102
Q

What are the 4 stages of becoming a mother?

A
  • Commitment, attachment to unborn baby, preparation for delivery
  • Acquaintance/attachment to infant, learning to care for baby
  • Moving toward new normal
  • Achievement of maternal identity

NU314 OB (21 decks)

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