Postpartum- EXAM 1 Flashcards
Puerperium
The postpartum period
Begins immediately after birth
Continuous for approximately 6 weeks
Fourth stage of labor
After birth is done; 3 stages done
Includes identifying and preventing hemorrhage
Evaluating pain
Observing bladder function, recover from anesthesia and providing initial care for the newborn
What do you look for when observing for hemorrhage
Vital signs, skin color, location and firmness of uterine fundus, lochia and pain
Care for the newborn phases and their time
Phase 1: from birth to 1 hour (usually in delivery room)
Phase 2: From 1-3 hours (usually in transition nursery or postpartum unit)
Phase 3: From 2-12 hours (usually in postpartum unit if rooming in with the mother)
Care for the newborn phase 1
From birth to 1 hour
Usually in delivery room
Care includes:
Maintaining thermoregulation, cardiorespiratory function
Observing for urination and passage of the meconium
Identifying mother, father and newborn
Performing brief assessment and encouraging bonding and breastfeeding
Apgar scoring includes:
Heart rate
Respiratory effort
Muscle tone
Reflex response
Skin color
What is involution
The rapid reduction in size as the uterus returns to non pregnant state
Bleeding is controlled by compression of muscle fibers
Top of the funds will descend into pelvis by 10th day
Uterus will approach prepregnant location by 5-6 weeks
When does the placental site heal
Over 6 weeks
What are afterpains
cramp like pains after birth caused by intermittent contraction of uterus after childbirth
Is more severe in multiparas
Lochia
discharge from the uterus of debris remaining after childbirth
Loch patterns vary
Has musty, stale odor, foul smell may mean infection and needs to be assessed
Total volume of 225 ml
Lochia rubra
First discharge
dark red, first few days and may contain small clots
Loch serosa
pinkish, days 3-10
Loch alba
creamy or yellowish, persists for 1-2 more weeks
Cervical changes after birth
Cervix is flabby and formless
Admits 2 fingertips for a few days after birth, the only 1 by end of first week
First childbearing permanently changes shape of external os
Vaginal changes
Appears edematous, bruised following birth
Size decreases, rug returns in 2-3 weeks
Appears normal by 6 weeks
Tone, contractility improves with perineal tightening exercises
Perineal changes
Soft tissue edemotaous bruised
Episiotomy or laceration should have initial healing within 2-3 weeks after birth
Complete healing may take up to 4-6 months
Ovulation and menstruation
Menstration returns 7-12 weeks after birth
As late as 3 years in 70% of breastfeeding mothers
All associated with the length of time the women breastfeeds
Abdomen after birth
Stretched abdominal wall, responds well to exercise within 2-3 months
May remain flabby
Diastasis recti abdomens may be present= separation of abdominal muscles
Stretch marks may be present
GI system
Bowels tend to be sluggish due to pregesterone and decreased abdominal muscle tone
Discomfortt from flatulence can be relieved from early ambition to use of antiflabulence meds, chamomile tea or peppermint tea
stool softeners may be helpful, especially if hemorrhage or laceracions
Urinary system
Increased bladder capacity
swelling and bruising of tissue around the urethra
Urinary output increases
Where is the fundus immediately after delivery
symphysis pubis and umbilicus
Vital signs after birth
Women should be febrile
Temp may increase and mother may shiver
Cardiac changes
Stabilizes and returns within 1 hour after birth
Diuresis in first 2-4 days helps decrease extracellular fluid, this results in weight loss
This is done to prevent pulmonary edema and cardiac problems
Neurological changes
Headaches are the most common symptom in postpartum, migraines may be persistent during and after pregnancy; especially if mother had sezuires
Psychological changes
Mother will experience various responses to now having a baby and may seem concerned about how to care for it
4 stages of maternal role attainment
Anticipatory, Formal, Informal and personal
Anticipatory stage
Occurs during pregnancy
Formal stage
Begins when the child is born
Informal stage
Begins when women starts making her own choices about being a mother
Personal stage
When women is comfortable with the idea of herself as a mother
Postpartum weight and nutrition
Initial weight loss of 10-12 lb, as a result of birth and expulsion of placenta and amniotic fluid
Within 6-8 weeks most women will return to post pregnancy weight
Postpartum nutritional staus
Constipation is common, encourage women to maintain high fluid intake and sources of fiber
Interventions to relieve perneal discomfort
Ice or gel packs to episiotomy
Sits bath or topical ointments or even witch hazel
What would you implement if a mother chooses not to breastfeed
Wear a supportive bra within 6 hours of birth to help suppress lactation
Apply ice packs under armpits for 20 min, 4 times a day
Avoid stimulation to breasts, can cause milk to come out
