Unit 14 Flashcards
What are physiologic changes of the uterus?
Involution (return of the uterus to a nonpregnant state) - 1-2 cm decrease every 24 hrs
Contractions - oxytocin helps contraction, afterpains 3-7 days, more noticeable in multiple gestation
Endometrial regeneration begins within 3 days after birth and is completed by 3rd week
What are lochia physiologic changes?
Uterine discharge
Rubra: bright red, 1-3 days
Serosa: 4-10 days, pinkish-brown; old blood
Alba: whitish-yellow, 2-6 weeks
What are cervix physiologic changes?
Soft immediately after birth
12-18 hours to shorten, become firm, regain pre-pregnant form
What are vagina and perineum physiologic changes?
Thinness of vaginal mucosa, absence of rugae - reappear in 3 weeks
Dryness, absence of mucosa, and coital discomfort may occur until ovarian function returns
Episiotomies health within 2-3 weeks
Hemorrhoids decrease within 6 weeks
What are pelvic physiologic changes?
Supportive tissues of pelvic floor are torn or stretched, requires 6 months to regain tone
Kegel exercises encourage healing
What are ovary physiologic changes?
Menstruation starts:
–> 27 days if not lactating
–> up to 6 months if lactating
What physiologic changes happens with breastfeeding?
Colostrum = “liquid gold”, yellow color, more concentrated through milk, happens before lactation
Milk comes in 72-96 hours.
Breastmilk will adjust to baby’s needs
What are physiological changes that happen with nonbreasting?
Engorgement resolves spontaneously
Discomfort decreases within 24-36 hours
Ice packs are encouraged
What are cardiovascular physiological changes?
BP increases
Temperature increases
Hematocrit and hemoglobin drops 3-4 days
WBC elevate
Coagulation increased
Blood volume changes depend on factors (blood loss, extravascular water mobilized and excreted, hypervolemia)
What is the acronym for postpartum assessment?
BUBBLEE
breast - educate about engorgement
uterus - firm and midline
bowel - passing gas in a couple days, stool softeners encouraged
bladder - empty it, full bladder increases bleeding
lochia, laceration - no large clots, weight pads, check fundus
edema
emotional status
What are postpartum cares?
Prevent excessive bleeding
Prevent infection
Promote comfort
Promoting nutrition - 1800-2200 cal/day; lactating women need 450-500 cal more/day and encourage omega-3 DHA increase
Promote normal bowel and bladder patterns
Promote rest, ambulation, exercise
Promote breastfeeding
Education and resources
What are postpartum discharge instructions?
Self-care
Education about signs of complications (fever, increase of pain, excessive bleeding, reopening or infection, and preeclampsia s/s)
Sexual activity & contraception
Medications (vitamins, pain, stool softeners)
What are causes of postpartum hemorrhage?
laceration, placental separation, manipulation of the fundus, traction on the umbilical cord, uterine atony, prolapse of the uterus, subinvolution, infection, retained placental fragments, coagulopathy
What are the diagnosis of hemorrhage?
1000 mL + cumulative blood loss
Bleeding with hypovolemia within 24 hrs of birth
What are medications for hemorrhage?
oxytocin
Misoprostol (PO or rectally)
Carboprost (fever and diarrhea are common s/s; asthma is contraindicated)
Methylergonovine (contraindicated with HTN)
