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Maternal Newborn: Giving Birth/Intrapartum Complications > Postpartum: Sherpath > Flashcards

Postpartum: Sherpath Flashcards

Postpartum

1
Q

Descent of the Uterine Fundus: Three processes

A

Contraction of the muscle fibers
Catabolic processes
Regeneration of uterine epithelium

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2
Q

Subinvolution

A

is a slower than expected return of the uterus to its non-pregnant size and consistency

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3
Q

What may delay the uterus from returning to it pre-pregnancy state?

A

Retention of placental fragments
Pelvic infection
May not be evident until well after discharge

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4
Q

Involution can be evaluated by measuring the descent of the fundus.

A

About 1 cm per day
14 days after childbirth, the fundus should no longer be palpable.
“After pains” or intermittent uterine contractions, cause discomfort for many women (multiparas, breastfeeding)

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5
Q

Bubble Assessment: B (Breast)

A

Colostrum excretion
Assist mom with putting baby to nipple within first hour of birth
Assist with breastfeeding positions, techniques

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6
Q

Bubble Assessment: U (Uterus)

A 
Location of fundus above baseline level
Fundus displaced from midline
Excessive lochia
Bladder discomfort
Bulge of bladder above symphysis
Frequent voidings of less than 150 mL of urine, which may indicate urinary retention with overflow
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7
Q

Bubble Assessment: B (Bowel)

A

Push fluids
Assist to toilet
May need stool aids

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8
Q

Bubble Assessment: B (Bladder)

A

Monitor for distention
Assess for retention
Displaced fundus

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9
Q

Bubble Assessment: L (Lochia)

A 
Lochia rubra
Lochia serosa
Lochia alba
Color
Amount, type, and odor
Foul odor suggests endometrial infection
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10
Q

Bubble Assessment: E (Episiotomy)

A

Pericare

Infection prevention

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11
Q

Focused Assessment: Perineum

A

First-degree: Involves the superficial vaginal mucosa or perineal skin.
Second-degree: Involves the vaginal mucosa, perineal skin, and deeper tissues, which may include fascia and muscles of the perineum.
Third-degree: Same as second-degree lacerations but involves the anal sphincter.
Fourth-degree: Extends through the anal sphincter into the rectal mucosa.
Perineum: After childbirth may be edematous and bruised
Episiotomy or trauma
Healing takes up to 4–6 months

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12
Q

Focused Assessment: Vagina

A

It takes 6–10 weeks for the vagina to regain its non-pregnant size and contour

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13
Q

Focused Assessment: Fundus and Lochia

A 
Lower extremities
Homan’s sign, +/-
Edema and deep tendon reflexes
Vital signs
Blood pressure
Orthostatic hypotension
Pulse
Respirations
Temperature
Pain
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14
Q

Focused Assessment: Periurethral Area

A

A laceration in the area of the urethra may cause women difficulty urinating after birth. An indwelling catheter may be necessary for a day or two.

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15
Q

Focused Assessment: Vaginal Wall

A

A laceration involving the mucosa of the vaginal wall.

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16
Q

Focused Assessment: Cervix

A

Tears in the cervix may be a source of significant bleeding after birth.

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17
Q

Provide Comfort Measures

A 
Ice packs
Sitz baths
Perineal care
Topical medications
Positioning
Analgesics 
Rest
18
Q

Normal Lochia Rubra(1-3 days)

A

Bloody; small clots; fleshy, earthy odor, red or red/brown

19
Q

Normal Lochia Serosa (4-10 days)

A

Decreased amount; serosanguineous; pink or brown-tinged

20
Q

Normal Lochia Alba (11-21 days)

A

Further decreased amounts; white, cream, or light yellow

21
Q

Abnormal Lochia Rubra

A

Large clots; saturated perineal pads; foul odor

22
Q

Abnormal Lochia Serosa

A

Excessive amount; foul smell; continued or recurrent reddish color

23
Q

Abnormal Lochia Alba

A

Persistent lochia serosa; return to lochia rubra, foul odor; discharge continuing

24
Q

Postpartum changes by system: Neurological

A

Bilateral and frontal headache common due to changes in fluid and electrolyte balance
Spinal headaches due to spinal anesthesia
Blurred vision, photophobia, and abdominal pain may indicate preeclampsia

25
Q

Postpartum changes by system: Cardiovascular

A

Transient increase in maternal cardiac output after childbirth
Excess plasma volume is eliminated by diuresis and diaphoresis
Gradually cardiac output decreases and returns to normal in 6–12 weeks
increased clotting factors predispose the postpartum woman to clot formation

26
Q

Postpartum changes by system: GI

A

ecreased food and fluid intake during labor
Reduced muscle and bowel tone
Fear of pain during defecation
First stool 2–3 days post birth

27
Q

Postpartum changes by system: GU

A

Increased bladder capacity and decreased sense to fluid pressure may result in urinary retention.
Stasis of urine allows time for bacteria to grow and can lead to urinary tract infection.
The distended bladder displaces the uterus and can interfere with uterine contraction and cause excessive bleeding

28
Q

Postpartum changes by system: Musculoskeletal

A

First 1–2 days after childbirth, muscle fatigue and aches
Abdominal wall: Diastasis recti
Reduction in musculoskeletal discomfort: Exercises to strengthen the abdominal muscles
Good posture
Body mechanics

29
Q

Postpartum changes by system: Integumentary

A 
Skin gradually returns to non-pregnant state: Decrease in hormone levels
Stretch marks (striae gravidarum) fade: Do not disappear
Loss of hair: Normal response to hormone changes
Begins 4–20 weeks after delivery
Regrown in 6–15 months
30
Q

Postpartum changes by system: Endocrine

A

Hormones: Human chorionic gonadotropin is present for 3–4 weeks
Resumption of ovulation and menstruation: Breastfeeding may delay the return of ovulation and menses
Ovulation may occur before the first menses
Lactation: Prolactin initiates milk production within 2–3 days of the birth

31
Q

Postpartum Weight Changes

A

Approximately 5.5 kg (12 lbs) is lost during childbirth
Fetus, placenta, amniotic fluid
Another 4 kg (9 lbs) is lost over the next 2 weeks
Another 2.5 kg (5 lbs) is lost by 6 months post delivery
Adipose tissue is used for energy expenditure during labor and breastfeeding

32
Q

Postpartum Psychosocial Assessment

A

Mild depression: “baby blues”, lasts a few days to a couple of weeks PP
Affects 70–80% of new mothers
PP Depression begins generally in the first week postpartum and can last 6 months or longer, debilitating
Should not last longer than 2 weeks
Must be distinguished from postpartum depression or postpartum psychosis
Panic disorder
Tachycardia, shortness of breath
Fear of dying or “going crazy”
Postpartum obsessive-compulsive disorder
Consuming thoughts of harming the baby
Posttraumatic stress disorder
Women perceive childbirth as a traumatic event

33
Q

Postpartum Psychosocial Assessment: S/S

A 
Feelings of sadness, crying
Loss of pleasure in usual activities
Anxiety, agitation or irritability
Feelings of guilt
Fatigue, sleep disturbances
Difficulty concentrating or making decisions
Depression (may not be present at first)
Suicidal thoughts
34
Q

Early Post Partum Hemorrhage

A

First 24 hours

Cumulative blood loss of 1000 mL or greater

35
Q

Late Post Partum Hemorrhage

A

From 24 hour up to 6 weeks postpartum
Sub-involution of the uterus
Retained placental fragments

36
Q

S/S of Post Partum Hemorrhage

A

A uterus that does not contract or does not remain contracted
Large gush or slow, steady trickle, ooze, or dribble of blood from the vagina
Saturation of one peripad per 15 minutes
Severe, unrelieved perineal or rectal pain
Tachycardia

37
Q

Collaborating with the provider: PPH

A

Uterine massage
Check bladder for distention.
Laboratory studies
Administer fluids and medication.

38
Q

PREVENTION: PPH

A

Identify predisposing factors.

39
Q

Hypovolemic Shock

A

During and after birth, women can tolerate a blood loss approaching that of blood added during pregnancy
1500–2000 mL
Compensatory mechanisms maintain the blood pressure so that vital organs are perfused
Shock occurs with excessive blood loss

40
Q

Uterine Atony: Manifestations

A

Fundus is difficult to locate
“Boggy” or soft feel to the fundus
Becomes firm when massaged
Excessive lochia and clots

41
Q

Uterine Atony: Management

A

Measures to contract the uterus

Provide fluid replacement

Maternal Newborn: Giving Birth/Intrapartum Complications (11 decks)

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