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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
Q

What is the conern with a heavy flow of lochia with numerous large clots?

A

Indicates you may be on the way to hemorrhage

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26
Q

Why do is it important for the pt to count the number of days regarding lochia rubra/serosa?

A

Pt will need to be seen to be assessed for adverse conditions that are prolonging the stages

27
Q

Persistent lochia rubra beyond PP day 3 indicates…

A

retained placental fragments

28
Q

What is indicated by going backward in the lochia stages?

For example, from Lochia Serosa back to Rubra.

A

indicative of possible hemorrhage

29
Q

Tampons should not be used PP for how long?

A

6-8wks

30
Q

When we are assessing pads, what is the key thing to keep an eye out for and why?

A
  • At least one pad being saturated w/in 1hr
  • It is an indication of hemorrhage
31
Q

Why does the cervix cause a risk for infection after birth?

A
  • Immediately after delivery the cervix is still open
  • There are possible small lacerations
32
Q

What chage happens to the OS of the cervix after having a child?

A

Nullipara = circle shaped

Post childbirth = heals in a slit or slash

33
Q

What changes in the vagina are observed after childbirth?

A
  • Greatly stretched
  • Walls appear edmatous; will regain thickness/size
  • May have small lacerations
  • Few vaginal rugae are present
34
Q

How long does it take for vaginal rugae to return?

A

3-4wks

35
Q

How long does it take for the vaginal epithelium to be restored?

A

6-10wks

36
Q

What is dysparenuia?

A
  • 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
Q

What are the guidelines to resuming sexual activity after childbirth?

A

6wks post delivery and clearance from provider prior to resuming

38
Q

What is the general condition of the perineum after childbirth?

A
  • Pelvic floor muscles stretch, thin and weaken with childbirth
  • May be edematous and erythematous (red)
39
Q

What are four things we are checking when assessing the perineum?

A
  • Amount/type of lacerations
  • Episiotomy conditions
  • Hematomas
  • Hemorrhoids
40
Q

What are our two main nursing considerations when caring for the perineum?

A
  • Relief of discomfort
  • Teaching self-care measures for when they are discharged
41
Q

What are the normal findings regarding PP Temperature?

A
  • 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
Q

What are deviations from normal findings regarding PP temperature and probable causes?

A
  • 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
Q

What are the normal findings regarding PP Pulse?

A
  • 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
Q

What are deviations from normal findings regarding PP pulse?

A
  • A rapid pulse or one that is increasing can indicate hypovolemia as a result of hemorrhage
45
Q

What are the normal findings regarding PP Respirations?

A

Respiratory Rate should decrease to within prebrith range by 6-8wks after childbirth

46
Q

What are deviations from normal findings regarding PP Respirations?

A

Hypoventilation (respiratory depression) can occur after an unusually high spinal block or epidural narcotic after c/s.

47
Q

What are the normal findings regarding PP BP?

A
  • BP altered slightly, if at all
  • Orhtostatic hypotension can develop w/in first 48hrs due to postbirth fluid shifts
48
Q

What are deviations from normal findings regarding PP BP?

A
  • 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
Q

What CV System Changes are effected in the PP period?

A
  • Thermoregulation
  • Cardiac OP
  • Plasma Volume
  • Coagulation
  • Blood Values
50
Q

What are our concerns regarding PP thermoregulation?

A
  • Thermoregulation systems a little off due to recovering systems
  • PP chill common
    • Provide warm blanket/fluids
  • If fever, different, indicative of infection
51
Q

What are our concerns regarding PP cardiac output?

A
  • 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
Q

What are our concerns regarding PP plasma volume?

A
  • 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
Q

What are our concerns regarding PP coagulation?

A
  • At risk for thrombus formation
    • Decreased risk with early ambulation
  • Monitor high-risk clients (hx of dvt) carefully!
54
Q

What are our concerns regarding PP WBC values?

A
  • 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
Q

What are our concerns regarding PP CBC values?

A
  • Levels will be altered as the body adjusts
  • You will see shifts on all values
  • 4-8 wks to return to about normal
56
Q

What are our concerns regarding PP clotting factors?

A
  • Fibrinogen
    • Increased (increased risk of blood clot development)
57
Q

Orthostatic hypotension needs to be monitored for the first 48hrs.

How should this be addressed?

A
  • 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
Q

How is digestion affected in the PP period?

A
  • Active soon after childbirth
  • Should be hungry after all the exertion
  • Assess for appetite and bowel function
59
Q

What are the considerations regarding constipation during the PP period?

A
  • A common problem
  • Reduced bowel tone due restricted intake during L&D, pain meds
  • Perineal trauma may interfere with elimination
60
Q

What are some nursing interventions to address constipation?

A
  • Early ambulation
  • Stool softeners and laxatives
  • Perineal care to reduce discomfort
61
Q

What is proteinuria and what is it indicative of?

A
  • Increased levels of protein in the urine.
  • This condition can be a sign of kidney damage
62
Q

What are our concerns regarding the urinary system in the PP period?

A
  • 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
Q

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?

A
  • 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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