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Maternal Newborn-MJ > T3-Maternal Physiologic Changes > Flashcards

T3-Maternal Physiologic Changes Flashcards

1
Q

Return of uterus to non-pregnant state after birth

A

Involution

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2
Q

Failure of uterus to return to normal size and condition

A

Subinvolution

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3
Q

Tissue regeneration w/o leaving a fibrous scar at site of implantation

A

Autolysis

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4
Q

What is the first process of involution?

A

When placenta is expelled from the uterus

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5
Q

What is the second process of involution?

A

Autolysis

*makes future pregnancies possible

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6
Q

The fundus is ____ the umbilicus immediately after giving birth

A

1-2 cm below umbilicus

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7
Q

Within 12 hours after giving birth, the fundus rises to _______ then it descends _____ every 24 hours

A

Within 12 hours after giving birth the fundus rises to UMBILICUS or SLIGHTLY ABOVE then descends 1-2 cm (FB) every 24 hours

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8
Q

When is the fundus non palpable?

A

By 2 weeks

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9
Q

Where is the fundus at the 9th or 10th day postpartum?

A

Back into pelvic cavity and non palpable

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10
Q

By _____ the uterus is the size it was at 20 weeks

A

24 hours

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11
Q

Where is oxytocin secreted from?

A

Posterior pituitary

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12
Q

What initiates and maintains UC?

A

Oxytocin

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13
Q

Contractions control bleeding at the placental site by _____

A

Compression of blood vessels

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14
Q

What causes the reduction in the size of uterus?

A

Contractions

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15
Q

How do we document a normal fundus?

A
  • Midline, firm, and at appropriate location for time past delivery
  • Document the firmness and position of fundus in relation to umbilicus and abdominal line

Ex: Uterus firm, midline, 2FB below umbilicus

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16
Q

Cramping from oxytocin release after birth (pain r/t UC)

A

Afterpains

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17
Q

T/F: Afterpains decrease when first breastfeeding

A

FALSE—afterpains INTENSIFY when first breastfeeding

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18
Q

Who is afterpains more sever in: multigravidas, primagravidas, breastfeeding clients? (SATA)

A

Multigravidas and breast feeding clients have more severe afterpains

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19
Q

When do afterpains usually resolve?

A

3-7 days

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20
Q

What are afterpains doing?

A

Getting the uterus back to prepregnant shape and size

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21
Q

What is the intervention for afterpains associated with UC?

A

Offer pain meds or non steroid anti-inflammatory med BEFORE breast feeding (ibuprofen)

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22
Q

What are some interventions to enhance contracted state of uterus?

A
  • Empty bladder q2h
  • Manual massage of relaxed uterine muscle
  • Administer pitocin or methergine PRN
  • Breastfeed because it releases oxytocin
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23
Q

How is methergine usually administered: IV or IM?

A

IM

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24
Q

Does methergine cause decrease or increase in BP?

A

INCREASE

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25
Q

If the BP is ____ we DO NOT give methergine

A

Greater than 140/90

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26
Q

What lochia do we see 1-3 days post birth?

A

Rubra

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27
Q

What lochia do we see 4-9 days post birth?

A

Serosa

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28
Q

What lochia do we do see 10-14 days post birth?

A

Alba

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29
Q

What lochia is this: pink/brownish

A

Serosa

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30
Q

What lochia is this:

Bright red; may have small clots

A

Rubra

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31
Q

What lochia is this:

Creamy color

A

Alba

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32
Q

What lochia contains blood, decimal and trophoblastic debris?

A

Rubra

*If it is large clots, increased bleeding, or foul odor this is ABNORMAL

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33
Q

What lochia consists of serum, leukocytes, tissue debris, and old blood?

A

Serosa

*If it is excessive bleeding; continues to be bright red at 4-9 days, or has odor this is ABNORMAL

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34
Q

What lochia consists of leukocytes, epithelial cells, mucous, serum, and bacteria?

A

Alba

*If it is persistent or returns to an earlier stage at the 10-14 day period or has odor then this is ABNORMAL

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35
Q

What are signs of uterine infection?

A
  • Lochia has offensive odor
  • Lochia reverts to an earlier stage of color or amount
  • Lochia persists beyond normal time
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36
Q

Documentation of bleeding: How much is scant?

A

Less than 2.5 cm

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37
Q

Documentation of bleeding: How much is small/light

A

Less than 10 cm

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38
Q

Documentation of bleeding: how much is large/heavy?

A

Saturated within 2 hours

39
Q

How should we measure amount of bleeding–what is the better way: cm or weight?

A

Weight

*1gm=1mL

40
Q

Hemorrhage in postpartum is defined as blood loss of _____ or greater

A

500mL

41
Q

What is the critical time of early hemorrhage?

A

1 hour past delivery

42
Q

How often do we assess for hemorrhage after birth?

A

q15 min X 4 times then q30 min for 2 times, then qhours for 4 times, then q8hours

43
Q

T/F: Early hemorrhage may be r/t lacerations

A

True

44
Q

What is early hemorrhage indicated by?

A

Continuous trickle of blood in spite of contracted uterus

45
Q

When is late postpartum hemorrhage?

A

24 hours or more after delivery

46
Q

What is late PPH caused by?

A

Retained fragments of placenta in uterus

*this is why we inspect placenta after it is expelled!!

47
Q

The cervix is soft ______

A

Immediately after birth

48
Q

T/F: The cervix may be bruised and have small lacerations

A

True

49
Q

The cervix is ____ open for several days. After 1 week it is the _____ size

A

2-3 cm open for several days; size of fingertip after 1 week

50
Q

External cervical os changes from round to slit-like os of multiparous women. T/F: It returns to prepregnant round state after delivery of baby.

A

FALSE-it will never return to the prepregnant round state

51
Q

The vagina mucus is thin and without rugae. Why?

A

Caused by postpartum estrogen deprivation

52
Q

When does the vagina get to pre pregnancy size?

A

6-10 weeks after delivery

53
Q

The perineum may have edema and erythematous. How do we check for episiotomy and lacerations and the healing of them?

A

REEDA

  • Have them lay on side
  • Spread butt cheeks apart
  • Use a light and check REEDA
54
Q

What heals better: episiotomy or laceration?

A

Episiotomy; this has a better approximation of the cut

55
Q

What does REEDA stand for?

A
  • Redness
  • Edema
  • Ecchymoses
  • Discharge (from suture line; not lochia)
  • Approximation of episiotomy
56
Q

How are lacerations measured?

A

1st-4th degree

57
Q

What is a first degree laceration?

A

Superficial vaginal mucuosa or skin of perineum

58
Q

What is a second degree laceration?

A

Deeper tissues including muscles of perineum

59
Q

What is a third degree laceration?

A

Same as 2nd but extends to include anal sphincter

60
Q

What is a 4th degree laceration?

A

Extends through anal sphincter into rectal mucosa

61
Q

What is a periurethral laceration?

A

A laceration in the area of the urinary urethra

*Hurts a lot due to urine being acidic and an open cut

62
Q

What degree lacerations cannot get a suppository?

A

3rd and 4th degree lacerations

63
Q

Supportive tissues of pelvic floor are torn or stretched during childbirth. It takes up to ___ to remain tone. Do ____ to promote tone.

A

6 months; kegel exercises

64
Q

Placental hormones decrease rapidly. Estrogen and progesterone levels at lowest within ___.

A

1 week

65
Q

Prolactin is up and estrogen is down. What does this mean?

A

Milk is in but menstrual periods may be delayed

66
Q

Type I DM mothers may require less or more insulin for several days after birth?

A

LESS

67
Q

Prolactin level is ____ than estrogen

A

Higher

68
Q

The inverse relationship between estrogen and prolactin appears to _____

A

Suppress ovulation

*when the cycle comes back the first one will be very heavy but should return to normal after 3-4 cycles

69
Q

Duration of involution is influenced by ____ and ____

A

Breastfeeding and strength of sucking stimulus

70
Q

Prolactin from _____ is responsible for ____

A

Anterior pituitary is responsible for milk production

71
Q

Oxytocin from _____ is responsible for ______

A

Posterior pituitary is responsible for milk ejection or let-down reflex

72
Q

Nipple stimulation does what?

A

Release of oxytocin

73
Q

Describe soft breasts and when do we see them?

A

1st or 2nd day PP; feels like ear

74
Q

Describe filling breasts and when do we see them?

A

3rd or 4th day; feels like nose

75
Q

Describe engorged breasts.

A

Breast distention r/t stasis of venous and lymphatic fluid; hard to touch and client complains of pain

76
Q

Colostrum is secreted first ____ post delivery. It is high in ___ & ____. It is low in ___ & ___.

A

Secreted first 2-3 days post delivery

High in: Protein and immunologic factors

Low in: Fats and carbs

77
Q

When is true milk secreted? When is it fully mature? How does it increase?

A

Secreted: 3-4th day

Fully mature: At about 2 weeks PP

It increases in direct proportion to nutritive infant sucking or pumping breasts

78
Q

If a woman is not wanting to breastfeed, what should we tell them about?

A
  • No hot showers directly on breasts (stimulates let down reflex)
  • Wear tight fitting bra
  • Use cabbage leaves
  • No nipple stimulation
  • Pain meds for engorgement
79
Q

When does menstrual cycle resume in non-lactating women? what about lactating?

A

Nonlactating: 7-9 weeks

Lactating: ~6 months

80
Q

____ and ____ are influenced by breast feeding

A

Ovulation and menstrual cycle

81
Q

Due to the increased BV during pregnancy, we can tolerate blood loss. How much blood loss in vaginal birth? c-section?

A

Vaginal birth: up to 500 mL

C-section: up to 1000 mL

82
Q

Response to blood loss: There is a fluid shift as uteroplacental circulation is eliminated resulting in _____ circulating volume. Fluid is eliminated by ____ & ____. Output may be ____.

A

Resulting in INCREASING circulating volume; fluid is eliminated by DIURESIS and DIAPHORESIS; output may be greater than 3000 mL/day

83
Q

Activation of blood clotting factors and immobility predispose to _____.

What are WBC values?

A

Predispose to thromboembolism

WBC values high–between 20-25 thousand
*WBC not always conclusive of infection first week

84
Q

Peristalsis is sluggish r/t progesterone effects as well as decreased muscle tone. What does this mean?

A

Constipation

85
Q

Loss of bladder muscle tone and increased capacity leads to ___ and ___ and ___

A

Retention and stasis of urine and UTI

*there is also decreased sensitivity to fluid pressure because the bladder tone is down/anesthesia effects (this can cause retention and stasis)

86
Q

What do we teach client to avoid potential UTI?

A
  • Empty bladder q2h AT LEAST

- Symptoms are dysuria and frequency with overflow (feel urge to urinate frequently but don’t empty the bladder)

87
Q
  1. Does chloasma disappear PP?
  2. Does hyper pigmentation of areolae and line nigra disappear PP?
  3. Does striae gravidarum go away PP?
A
  1. Chloasma: disappears
  2. Hyperpigmentation of areolae and linea nigra: May not regress totally but it DOES get lighter
  3. Stretch marks DO NOT go away (get lighter tho)
88
Q

Rh- mom and rh+ baby and no isoummunization occurs then RhoGAM is given within ____ of delivery

A

72 hours

89
Q

Immediately after birth, the uterine fundus is _____. After an initial rise, the fundus descends _____. Fundus should not be palpable after ____.

A

Below umbilicus; descends 1-2cm/24hr; not palpable after 9-10 days post birth

90
Q

The uterus must remain _____ to prevent excessive bleeding

A

Contracted

91
Q

Bleeding or fundus is high. What do we FIRST suspect?

A

Full bladder

92
Q

Activation of blood-clotting factors, immobility, and sepsis predispose to ______

A

Thromboembolism

93
Q

Marked diuresis, decreased bladder sensitivity, and over distention of bladder can lead to problems with urinary elimination especially ____

A

UTI

Maternal Newborn-MJ (29 decks)

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