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normal postpartum Flashcards

(48 cards)

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1
Q

how often should the uterus be assessed postpartum

A
  • 1hr: q15mins
  • 2 hrs: q30 mins
  • next 22hrs: q4hrs
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2
Q

what should be done before assessing the fundus

A

instruct the pt to void first

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3
Q

how should the lower uterine segment be supported during fundal assessment

A

place one hand just above the pubic symphysis to prevent uterine inversion

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4
Q

what is uterine involution

A

return of the uterus to its nonpregnant state after birth

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5
Q

how long does uterine involution take

A

around 6-8 wks

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6
Q

what are afterpains, and who experiences it more

A
  • mod to severe cramps caused by UCs
  • more common in multiparous women
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7
Q

why do afterpains occur

A

uterus contracts to remain firm and prevent hemorrhage

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8
Q

what interventions help relieve afterpains

A
  • encourage frequent voiding
  • warm compress
  • ibuprofen/acetaminophen
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9
Q

where is the uterien fundus immediately after birth

A

midway between the umbilicus and pubic symphysis

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10
Q

where should the fundus be within 12 hrs postpartum

A

level of umbilicus or 1cm above

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11
Q

how much does the uterus descend each day postpartum

A

~ 1cm each day

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12
Q

when is the uterus no longer palpable

A

by day 14, as it descends into the pelvis

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13
Q

when does the cervix regain its prepregnancy form

A

after 2-3 days, but doesn’t return to its original shape, appears like a jagged slit “fish mouth”

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14
Q

how does lactation affect the cervix

A

hormonal changes leads to thinner vaginal mucosa and reduces lubrication

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15
Q

what is the purpose of lochia

A
  • expel remaining tissue, bacteria
  • shedding prevents scarring
  • indicates stage of healing
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16
Q

what are the 3 types of lochia and their timeframes

A
  • lochia rubra (1-3D): red, small clots
  • lochia serosa (4-10D): pink/brown, serosanguineous
  • lochia alba (11-21D): creamy yellow
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17
Q

what are abnormal findings with lochia

A
  • foul odor
  • heavy bleeding
  • large clots
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18
Q

what does REEDA stand for in perineal assessment

A

R: redness
E: edema
E: ecchymosis
D: discharge
A: approximation of edges

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19
Q

how long do perineal lacerations/episiotomies take to heal

A

~ 6 wks

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20
Q

interventions for perineal pain & healing

Study These Flashcards
A
  • first 2 days: ice packs, cold sitz baths
  • after 1st day: warm sitz baths
  • lie on side to reduce pressure
  • wear peripads snugly to prevent rubbing
  • topical anesthetics
21
Q

how can postpartum mothers prevent perineal infections

Study These Flashcards
A
  • use peri-bottle with warm water after elimination
  • change peripads frequently
  • wash hands when doing pericare
22
Q

when do vaginal folds (rugae) begin to reappear postpartum

Study These Flashcards
A

~ 3 wks but are less prominent

23
Q

how does estrogen deprivation effect the vagina postpartum

Study These Flashcards
A
  • thinner vaginal mucosa
  • temporary loss of rugae
    leading to vaginal dryness and discomfort (dysparenunia)
24
Q

when does vaginal lubrication improve postpartum

Study These Flashcards
A

once ovarian function returns (menstruation), the vaginal mucosa will thicken

25
what hormonal changes occur leading to milk production postpartum
- decreased estrogen & progesterone - increased prolactin
26
what hormone is responsible for the milk ejection reflex
oxytocin (posterior pituitary gland) in response to infant suckling
27
what is colostrum
yellowish fluid that precedes milk production, high in protein and low in carbs, filled with immune stuff
28
what is primary breast engorgement
temporary swelling, tightness, and discomfort d/t increased vascular and lymphatic flow
29
what is crucial to assess postpartum when listening to breath sounds
pulmonary edema
30
what happens to stroke volume and CO postpartum
- increases in the first 24-48hrs as blood returns from the uteroplacental unit - returns to prepregnancy levels within 10 days
31
why does the risk for orthostatic hypotension increase postpartum
deceased vascular resistance in the pelvis during the first week, resulting in less blood return to the heart
32
why might WBCs be elevated postpartum
can rise to 30,000 (normal is 4.5-11) d/t stress and labor and will return to normal within a week
33
what are the s/s of postpartum cystitis
- increased urinary frequency & urgency - dysuria: pain or burning - suprapubic tenderness - hematuria - malaise
34
why does postpartum diaphoresis occur
d/t decreased estrogen, help the body to excrete excess fluid retained during pregnancy | mostly at night
35
what are Rubin's 3 stages of maternal behavior
1. taking in (24-48hrs) 2. taking hold (wks) 3. letting go (long-term)
36
what is the focus of the mother during Rubin's taking in stage
- focus on own comfort and physical recovery - relives and talks about birth exp - depends on others - decreased ability to make decisions
37
how does the mother's behavior change in Rubin's taking hold stage
- focus starts to shift to infant - interested in infant cues and needs - start to leg go of pregnancy role - more independent
38
what emotional struggles may occur during Rubin's taking hold stage
- feelings of inadequacy/overwhelmed - baby blues: mood swings, sadness, crying, fatigue
39
when should a mother seek help for postpartum depression
if symptoms of baby blues lasts 4+ wks and interfere with daily function
40
what happens during Rubin's letting go stage
- accepts the baby as an individual - returns to work - reconnect with partner - may feel guilt, anxiety, grief about leaving the baby
41
HR > 100bpm after first 24-48 hours can indicate what
- postpartum hemorrhage - infection - dehydration
42
what are some feeding cues that indicate the baby is hungry
- licking, smacking of lips - extend tongue - putting hand in mouth, sucking on fingers - turning head to mother's voice
43
what are the LATCH score categories
L: latch A: audible swallowing T: type of nipple C: comfort of nipple H: hold/positioning
44
what does the LATCH score tell you
score of < 2 indicates areas for support
45
newborns typically feed on one breast for how long
10-15 mins
46
how often should a newborn feed
feed q1-3 hrs 8 to 12 feeds/day
47
nurse teaching for latching
bring newborn close to breast with chin touching the lower half of the breast, then bring the newborn up and over the nipple
48
nurse teaching for removing a newborn from nipple
gently slide a clean finger into the corner of the mouth to break suction

Maternity & OB (7 decks)

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