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OB211_01_Unit II > Postpartum Physiologic Adaptations > Flashcards

Postpartum Physiologic Adaptations Flashcards

1
Q

What is the physiological goal of the “4th trimester”/postpartum period?

A

Maternal return to homeostasis and prevention of postpartum hemorrhage

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2
Q

When does the “4th trimester begin”?

A

As soon as the baby is born

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3
Q

What are the reproductive components we are assessing during this period?

A
  • Uterus
  • Afterpains
  • Lochia
  • Cervix
  • Vagina
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4
Q

What are the two main things we are assessing the uterus for?

A
  1. Involution
  2. Descent
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5
Q

What is the main goal of uterine involution and descent?

A

For the uterus to return to pre-pregnancy size and position

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6
Q

What are the 3 aspects involved in involution of the uterus?

A
  • Contraction of muscle fibers around blood vessels
  • Catabolism
  • Regeneration of the uterine endometrium
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7
Q

Why is contraction important to involution?

A
  • Contractions immediately after delivery prevent hemorrhage
  • It is the contractions that pulls the fibers closer together and cause the uterus to shrink
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8
Q

What is the catabolism in relation to involution?

A
  • Breaking down of excess tissue
  • Shedding the endometrium
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9
Q

What is the progression of fundal height from delivery?

A
  • 1cm above umbilicus on day of delivery
  • 1cm below umbilicus 24hrs later (Day 1)
  • 1cm reduction from umbilicus every day thereafter
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10
Q

How is involution fundal height assessed?

A
  • One hand is placed at the symphasis pubis, to maintain uterine position
  • The other hand pushes downward to assess height
  • Lower hand is to prevent the uterus from inverting as pressure is placed upon the top of it
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11
Q

As involution occurs, what do we pay attention to regarding the decent of the uterine fundus?

A
  • Uterus shrinks and decends back into the pelvic cavity
  • It takes about 6-8wks for the uterus to get back to pre-pregnancy normality
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12
Q

When doing a postpartum fundal assessment, what 3 things are we assessing?

A
  1. How firm
  2. Fundal height; How many cm below umbilicus
  3. Is it midline?
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13
Q

When doing a postpartum fundal assessment, should the pt have a full or empty bladder and why?

A
  • It should be empty
  • A full bladder can cause the uterus to shift to the right off the midline
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14
Q

Outside the three assessment items, what else are we paying attention to during and following the postpartum fundal height assessment?

A
  • We are keeping an eye on the lochia flow for increase/passage of clots
  • This would also be documented
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15
Q

What are “afterpains”?

A
  • Uterine muscles have been stretched and are contracting back, which cana be a painful process
  • This can be more pronounced for multiparas
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16
Q

What is the role of oxytocin/pitocin in involution?

A

It causes the uterine contractions involved in involution

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17
Q

What is Lochia?

A

the vaginal discharge after giving birth, containing blood, mucus, and uterine tissue

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18
Q

How many types of Lochia are there and what are there names?

A
  • Three
  • Names
    • Rubra
    • Serosa
    • Alba
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19
Q

Explain Lochia Rubra

A
  • PP Day 1-3
  • Composed of deep red blood, shreds of membranes w/ some mucus
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20
Q

Explain Lochia Serosa

A
  • PP Day 4-10
  • Pinkish/brownish - serosanguinous
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21
Q

Explain Lochia Alba

A
  • Day 11 and on
  • Yellow to green to whitish to clear progressively
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22
Q

How long does lochia clearance take?

A

4-6 weeks

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23
Q

What does malodorous lochia indicate?

A

infection

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24
Q

What is the concern regarding excessive discharge of bright red blood from the vagina?

A

It is an indication of cervical/vaginal laceration or hemorrhage.

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25
What is the conern with a heavy flow of lochia with numerous large clots?
Indicates you may be on the way to hemorrhage
26
Why do is it important for the pt to count the number of days regarding lochia rubra/serosa?
Pt will need to be seen to be assessed for adverse conditions that are prolonging the stages
27
Persistent lochia rubra beyond PP day 3 indicates...
retained placental fragments
28
What is indicated by going backward in the lochia stages? For example, from Lochia Serosa back to Rubra.
indicative of possible hemorrhage
29
Tampons should not be used PP for how long?
6-8wks
30
When we are assessing pads, what is the key thing to keep an eye out for and why?
* At least one pad being saturated w/in 1hr * It is an indication of hemorrhage
31
Why does the cervix cause a risk for infection after birth?
* Immediately after delivery the cervix is still open * There are possible small lacerations
32
What chage happens to the OS of the cervix after having a child?
Nullipara = circle shaped Post childbirth = heals in a slit or slash
33
What changes in the vagina are observed after childbirth?
* Greatly stretched * Walls appear edmatous; will regain thickness/size * May have small lacerations * Few vaginal rugae are present
34
How long does it take for vaginal rugae to return?
3-4wks
35
How long does it take for the vaginal epithelium to be restored?
6-10wks
36
What is dysparenuia?
* Recurring pain in the genital area or within the pelvis during sexual intercourse. * The pain can be sharp or intense. * It can occur before, during, or after sexual intercourse.
37
What are the guidelines to resuming sexual activity after childbirth?
6wks post delivery and clearance from provider prior to resuming
38
What is the general condition of the perineum after childbirth?
* Pelvic floor muscles stretch, thin and weaken with childbirth * May be edematous and erythematous (red)
39
What are four things we are checking when assessing the perineum?
* Amount/type of lacerations * Episiotomy conditions * Hematomas * Hemorrhoids
40
What are our two main nursing considerations when caring for the perineum?
* Relief of discomfort * Teaching self-care measures for when they are discharged
41
What are the normal findings regarding PP Temperature?
* Elevation of temperature to 100.4°F resulting from dehydration after labor during the first 24hr can occur * Encourage hydration * Should return to normal after 24hr postpartum * If it does not, the patient must be assessed for postpartum infection * Temperature should be assessed q4 for the first 8hr after birth and then every 8hr
42
What are deviations from normal findings regarding PP *temperature* and probable causes?
* A diagnosis of puerperal sepsis is indicated if an increase of temp to ≥100.4 is noted after the first 24hrs or persists for 2 days. * Other posiblities are * mastitis * endometritis * UTI * other systemic infection
43
What are the normal findings regarding PP Pulse?
* First postpartum hour * Elevated pulse, stroke volume and cardiac output * Gradually decreases to a pre-pregnancy baseline by 8-10 weeks * Bradycardia is common during early postpartum period * BP and HR should be assessed at least q15mins for the first 2hr after birth and then q4-8hr as per facility policy
44
What are deviations from normal findings regarding PP pulse?
* A rapid pulse or one that is increasing can indicate hypovolemia as a result of hemorrhage
45
What are the normal findings regarding PP Respirations?
Respiratory Rate should decrease to within prebrith range by 6-8wks after childbirth
46
What are deviations from normal findings regarding PP Respirations?
Hypoventilation (respiratory depression) can occur after an unusually high spinal block or epidural narcotic after c/s.
47
What are the normal findings regarding PP BP?
* BP altered slightly, if at all * Orhtostatic hypotension can develop w/in first 48hrs due to postbirth fluid shifts
48
What are deviations from normal findings regarding PP BP?
* A low or decreaasing BP can indicate hypovolemia secondary to hemorrhage - *late sign* * Increased BP can result from excessive use of vasopressor or oxytocic medications * If headaches are present, HT must be ruled out as cause before analgesics are administered
49
What CV System Changes are effected in the PP period?
* Thermoregulation * Cardiac OP * Plasma Volume * Coagulation * Blood Values
50
What are our concerns regarding PP thermoregulation?
* Thermoregulation systems a little off due to recovering systems * PP chill common * Provide warm blanket/fluids * If fever, different, indicative of infection
51
What are our concerns regarding PP cardiac output?
* Increased blood flow of blood back to the heart * Increased by mobilization of excess extracellular fluid into vascular compartment * Bradycardia is common during the early postpartum period * Due to fluid shift, don’t assume its problematic
52
What are our concerns regarding PP plasma volume?
* Diuresis facilitated by declined in aldosterone production * Diuresis and diaphoresis rid the body of excess fluid * PP swelling is typically due to redistribution of fluid * Are ways the body gets rid of extra fluid * Diuresis - increase of urine voiding * Diaphoresis - sweating
53
What are our concerns regarding PP coagulation?
* At risk for thrombus formation * Decreased risk with early ambulation * Monitor high-risk clients (hx of dvt) carefully!
54
What are our concerns regarding PP WBC values?
* Values of 25-30Kmm3 (high) are common * White count may be elevated during delivery - normal, but watch closely for possible infection * Infection will have to be diagnosed by other s/s * Febrile, Malodorous fluids, etc * Monitor closely for infection!
55
What are our concerns regarding PP CBC values?
* Levels will be altered as the body adjusts * You will see shifts on all values * 4-8 wks to return to about normal
56
What are our concerns regarding PP clotting factors?
* Fibrinogen * Increased (increased risk of blood clot development)
57
Orthostatic hypotension needs to be monitored for the first 48hrs. How should this be addressed?
* First time will need to be monitored, maybe the first few * Before having them sit up, assess for sensitivity in feet/legs, have them push against your hands with your feet. If they can’t do that, they ain’t ready!
58
How is digestion affected in the PP period?
* Active soon after childbirth * Should be hungry after all the exertion * Assess for appetite and bowel function
59
What are the considerations regarding constipation during the PP period?
* A common problem * Reduced bowel tone due restricted intake during L&D, pain meds * Perineal trauma may interfere with elimination
60
What are some nursing interventions to address constipation?
* Early ambulation * Stool softeners and laxatives * Perineal care to reduce discomfort
61
What is proteinuria and what is it indicative of?
* Increased levels of protein in the urine. * This condition can be a sign of kidney damage
62
What are our concerns regarding the urinary system in the PP period?
* Reduced bladder tone * Due to progesterone relaxation of smooth muscle * Diminished sensitive to fluid pressure * Can lead to urinary retention * UTI risk * Diuresis * Traumatized urinary meatus
63
What is a way we can help a patient who may be having issues with the urge to void due to decreased sensitivity and reduced bladder tone?
* Schedule regular void times * Should be going at least every 2hrs with an amount \>150mL

OB211_01_Unit II (2 decks)

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