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Flashcards in 1229 Exam 4 Postpartum Deck (68)
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1

postpartum

(puerperium) begins after the delivery of the placenta and ends when the body returns to the prepregnant state. (aprox. 6 weeks)

2

physiological maternal changes during postpartum:

uterine involution
lochia flow
cervical involution
decrease in vaginal distention
changes in ovarian function and menstration
breast changes
urinary tract changes
GI tract changes
cardiovascular changes

3

Physical Risk during the postpartum period:

hemorrhage
shock
infection
constipation
fatigue
UTI
Thrombophlebitis

4

Hormone released from the pituitary gland, coordinates and strengthens uterine contractions

Oxytocin

5

A firm and contracted uterus prevents what?

bleeding and hemorrhage

6

afterpains

uncomfortable uterine pains during postpartum

7

Decreased estrogen is associated with:

breast engorgement
diaphoresis
diuresis
diminished vaginal lubrication

8

focused physical assessment:

breast
uterus (fundal height, uterine placement and consistency)
bowel and GI function
bladder function
lochia (color, odor, consistency, and amount)
episiotomy (edema, ecchymosis, approximation)
vitals and pain
teaching needs

9

fudus immediately after delivery

firm, midline with the umbilicus, and approximately at the level of the umbilicus

10

fudus 12 hours postpartum

1 cm above umbilicus midline and firm

11

fundus every 24 hours postpartum

should descend approx. 1 to 2 cm (finger breaths)

12

fundus by day six

should be half way between the symphysis pubis and he umbilicus

13

fundus by day ten

should lie within the true pelvis and should not be palpable.

14

uterine involution

uterus returns to its prepregnant state. (aprox 1000g to 60g)

15

locating the fundus

1. explain procedure to pt.
2. wears gloves
3. cup non dominant hand just about the symphysis pubis to support the lower segment of the uterus
4. with dominant hand, palpate the pt's abdoomen to locate.
(usually start a few inches above umbilicus)
*document fundal height, location, and uterine consistency

16

Lochia stages

lochia ruba, lochia serosa, lochia alba

17

bright red color, bloody consistency, fleshy odor, may contain small clots, transient flow increases during breastfeeding and upon rising last 1 to 3 days after deliver

lochia ruba

18

pinkish brown color and serosanguineous consistency. last from approximately day 4 -10 after delivery.

lochia serosa

19

yellowish, white creamy color, fleshy odor. lasts from approximately day 11 up to and beyond 6 weeks postpartum.

lochia alba

20

< 2.5 cm of blood

scant

21

< 10 cm of blood

light

22

> 10 cm of blood

moderate

23

one pad saturated within 2 hours

heavy

24

one pad saturated in fifteen mins or less/ pooling of blood under buttocks

excessive blood loss

25

excessive spurting of bright red blood from the vagina

possibly indicating a cervical or vaginal tear

26

numerous large clots and excessive blood loss

hemorrhage

27

fould odor

infection

28

persistent lochia ruba in the early postpartum period beyond day three:

retained placental fragments

29

continued flow of lochia serosa or alba beyond the normal length of time (esp. if it is accompanied by a fever, pain, or abdominal tenderness)

endometritis

30

Nursing interventions for perineal tenderness, laceration, and episotomy:

promote measures for the client to help to soften her stools
educate the client about proper cleansing to prevent infection
promote comfort measures