Postpartum Mod 1 Concepts

Question 1

Onset of postpartum depression and signs/symptoms?

Answer 1

Onset: within first year after birth of baby

Signs and symptoms:

Persistent tiredness, overwhelmed, anxious, feelings of hopelessness, lack of interest in life events, poor libido, poor hygiene, no desire or unable to care for infant, and suicidal thoughts

Question 2

Interventions for postpartum depression

Answer 2

Talk about depression

explain what is likely to contribute to the depression

encourage mother to express feelings

Suggest getting help with infant and housework for overwhelming feelings

Provide phone numbers for medical/psych resources.

Question 3

Signs of postpartum infections include

Answer 3

Fever/chills
Pain or redness of wound
Tachycardia
Purulent wound drainage
Foul smelling lochia
Elevated WBC
Uterine subinvolution
Frequency and urgency of urination
Localized redness, warmth, or tenderness in the breast tissue

Question 4

Postpartum blues/baby blues refers to temporary, self limiting period of weapiness.

Treatment for this type of sadness includes:

Answer 4

No medication or formal treatment is required

Question 5

The uterus returns to its normal size through a gradual process of_______?

Answer 5

Involution

**happens in three retrogressive processes: ***
-contraction of muscle fibers
-Catabolism, which strengths enlarged myometrial cells
-Regeneration of uterine epithelium, by shedding of lochial discharge

Question 6

If a patient is not breast-feeding, how long after birth should menstruation resume?

Answer 6

Within several weeks.

Ovulation may return at any time, so breast-feeding is not considered a safe contraceptive.

Question 7

The (puerperium period/4th trimester) is how many weeks after birth of baby??

Answer 7

Six weeks: time when woman’s body begins to return to pre-pregnant state 

Question 8

The uterus weighs approximately 1000 g after birth, by approximately 1 WEEK, the uterus shrinks by 50% and weighs about 500 g.

During the first 12 hours postpartum where should fundal height be located ?

Answer 8

At the umbilicus.

Question 9

Over the first few days of birth, the uterus typically descends from the level of the umbilicus at rate of how many fingerbreadths or centimeters per day?

Answer 9

1 cm or fingerbreadth.

By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis .

Question 10

Subinvolution results from what causes?

Answer 10

Infection

Prolonged labor and difficult birth

Incomplete expulsion of amniotic membranes and placenta

Over distention of uterine muscles (multiple pregnancies or large fetus)

Question 11

A full bladder may displace the uterus from the midline, what nursing intervention would you apply to this situation?

Answer 11

Help the patient to the bathroom to void urine, recheck uterus to see if it’s midline, massage the fundus if boggy

Question 12

The process of involution and restoration of endometrium is reflected in the characteristics of lochia.

What is lochia and how long does it typically occur after birth?

Answer 12

vaginal discharge that occurs for 4-8 weeks after birth.

Question 13

Lochia changes in color throughout the weeks after birth.

What are the three stages and expected colors of discharge?

Answer 13

1) Lochia rubra: deep red mixture of mucus, tissue debris, and blood. 3-4 days

2) Lochia serosa: pinkish brown contains leukocytes, tissue, RBC, and serous fluid. 3-10 days

3) Lochia alba: creamy white/light brown consist of leukocytes, tissue, and fluid. 10-14 days 😅may last for 3-6 weeks😅

Question 14

Lochia at any stage may have fleshy odor, but an offensive odor usually indicates what?

Answer 14

Infection, such as endometriosis

Question 15

“Afterpains” are a part of involution process, uterine contractions.

All women experience these pains, but some women experience them more acutely. WHY?

Answer 15

Multiparous (multiple pregnancies) and breast-feeding women.

Repeated stretching from multiple pregnancies and stimulation during breast-feeding releases oxytocin causing worsening of afterpain.

👍🏻 Afterpains respond well to oral analgesics 👍🏻

Question 16

The cervix typically returns to pre-pregnant state by week six of postpartum.

What is the difference of a cervix before pregnancy and after?

Answer 16

The internal cervical OS returns to normal by two weeks.

External OS widens and never appears the same after childbirth.
instead of circle, looks like a slit

Question 17

The perineum stretches during childbirth, and vast majority sustain some degree of perineal trauma.

Perineum is edematous for one or two days after birth.

If birth involved an episiotomy or laceration, complete healing may take how long ?

Answer 17

4 to 6 months in absence of complications at site.

Nursing interventions for episiotomy include:
🔥Ice packs, pouring warm water over area via Peribottle, witch hazel pads, anesthetic sprays, and sitz bath🔥

Question 18

The cardiovascular system undergoes dramatic changes after birth.

Cardiac output remains high for first few days of postpartum, and then gradually declines within how many months after birth ?

Answer 18

Approximately 3 months.

Blood volume increases substantially during during pregnancy, drops rapidly after birth, and returns to normal within four weeks postpartum.

Question 19

Despite the decrease in blood volume after birth the hematocrit levels remain relatively stable (may even increase)

An acute DECREASE in hematocrit is not an expected finding and may indicate what condition ?

Answer 19

May indicate hemorrhage, reflecting a predominant loss of plasma.

Question 20

Is a lower pulse rate of 60 - 80 bpm in the first few weeks of postpartum normal or abnormal?

Answer 20

Normal. Slowing of the heart is related to increased blood flow back to the heart after woman is no longer profusing the placenta.

Question 21

Giving birth simulates the hypercoagulability state these coagulation factors remain elevated for 2 to 3 weeks postpartum.

What is this put the postpartum woman at risk for?

Answer 21

Vessel damage and immobility puts them at risk for thromboembolism (blood clots) in the lower extremities and lungs.

Question 22

Urinary retention is a major cause of uterine atony, which allows excessive bleeding.

Why does urinary retention/ bladder distention increase the risk of postpartum hemorrhage?

Answer 22

Urinary retention displaces the uterus from the midline to right and can inhibit the uterus from contracting properly.

Question 23

Postpartum diuresis occurs as a result of several mechanisms:

large amounts of IV fluids, decreasing antidiuretic effect of oxytocin as it declines, retention of extra fluids during pregnancy.

Diuresis begins within how many hours after childbirth and returns to normal function within how long??

Answer 23

Diuresis begins within 12 hours after childbirth and continues 1 week postpartum.

Normal function returns within a month after birth

Question 24

Musculoskeletal system changes associated with pregnancy include:

Answer 24

-Increased ligament laxity
-Weight gain (center of gravity)
-Carpal tunnel syndrome
These change back after pregnancy ^^

One joint that does not return to pre-pregnant state is feet with a permanent increase in shoe size.

Question 25

What is separation of the rectus abdominis muscles called?

Answer 25

Diastasis recti.

More common in women with poor abdominal muscle tone before pregnancy

Question 26

Breast milk typically appears within _______days

Answer 26

4-5 days after child birth.

AAP recommends exclusively breastfeeding for first 6 months of life

Question 27

What is considered the “gold standard” to initiate breastfeeding in moms who chose to do so?

Answer 27

Skin to skin contact for the 1st HOUR after birth on stomach

Instinct occurs when newborn is left undisturbed on stomach to move up to chest to attempt latching/feeding

Question 28

2 days after birth breasts are soft and nontender. Women may report TINGLING sensation, this is termed what?

Answer 28

Let down reflex

Occurs immediately before or during breastfeeding

Question 29

Engorged breasts occur due to?

Answer 29

Infrequent feeding or ineffective emptying

Signs and symptoms:
-hard and tender to touch

Question 30

Nursing interventions for breast engorgement?

Answer 30

Frequent emptying of the breasts helps minimize discomfort and resolve in engorgement.

-OTC anti inflammatory
- standing in warm shower or applying warm compress before feedings
- breast massage or expression
- cabbage leaf compresses

Question 31

If a woman desires NOT to breastfeed, how can she suppress lactation?

Answer 31

Wear a tight supportive bra 24 hours daily

Apply ice to her breast for 15 to 20 minutes every hour

Avoid sexual and non sexual stimulation

engorgement typically subsides in 2 to 3 days with these application measures

Question 32

What four major hormones are influential during the postpartum period?

Answer 32

Estrogen: drops profoundly at birth and reaches lowest level one week postpartum

Progesterone: quiets the uterus to prevent a preterm birth during pregnancy, DROPS To completely undetectable after 72 hours after birth.

Oxytocin: stimulates the uterus to contract and illicit the milk letdown reflex during breastfeeding

Prolactin: associated with breast-feeding process by stimulating milk production. Levels remain elevated into the six week after birth for breast-feeding women.

Question 33

The formation of a relationship between a parent and a newborn through a process of physical and emotional interactions:

Answer 33

Attachment

Question 34

Skin to skin contact _____________, By placing the infant onto the bear chest of mothers and fathers to enhance parent newborn attachment.

Answer 34

Kangaroo care

Question 35

Up to 85% of new moms suffer from baby blues.

What are the signs and symptoms and how long does this last?

Answer 35

Signs and symptoms:
-mild depressive symptoms, anxiety, irritability, mood, swings, loss of appetite, insomnia, tearfulness, and fatigue

Symptoms usually peak 4 to 5 days, postpartum and usually resolved by day 10.

* should not affect the mothers ability to function or care for her child**