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Flashcards in OB Test 2:Postpartum Deck (27)
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0

What is the post-partum period?

From birth until the mother returns to normal

6 weeks (40 days)

1

Involution

Process of shrinking back to normal size

The increase in cell number is permanent but size will decrease

2

Involution: fundus level

After birth at 12 hours: below umbilicus
4weeks: level of umbilicus

3

Involution: subinvolution

Put pt at risk for hemorrhage from retained tissue or uterus infection

4

Involution: after pains

Pt perceive it as cramps. Increased in multigravida, breast feeding or if uterus is over distended

5

Involution: placental site

Heals by exfoliation, from bottom up, no scar

6

Lochia colors

Rubra: red clots, 1st couple days
Serosa: pink, serous discharge, upto 2-6 weeks
Alba: white, creamy, 1-2 weeks

7

Lochia odor

Non-foul
Earthy

8

Lochia amount

C-section: scant amount until Pitosin wears off
Coninuous bright red is abnormal
Could have uterus atony (not contracted) or laceration

9

Cervix conditions

- friable: easy to bleed
- may have small lacerations
- return to normal 1 week after birth
- cervix has no longer a circle but a sideways slip

10

Vagina conditions

- less rugae
- not producing mucous
- if breasted then ovulation is delayed

11

Perineum

REEDA (red, edema, ecumosis, drainage, approximation)
Episiotomy
Lacerations
Hematoma: may be pushed outside & shrink quickly
Hemorroids: bleeding under skin, painful, severe blood loss

12

Postpartum hormones

Placenta: decrease hCS (hPL)
Decrease estrogen
decrease progesterone
Pituitary: increase prolactin
Ovarian menstraul cycle: 10-12 weeks

13

Abdomen

Decrease muscle tone (2-3 months for tone back)
Diastasis recti abdominis

14

Renal system and fluid balance

Proteinuria
Diaphoresis and Diuresis
- characteristic
- void enormous amounts within 12 hours of delivery
- void upto 3,000cc per day
- elevated BUN
Bladder distention
Kidney function returns to normal after 1 month

15

Gastrointestinal changes

Appetite
First bowel movement takes awhile

16

Breasts

May be lumps (milk sacs) that move around
If mom don't stimulate breast
Day 1-2: colostrum
Day 2-3: filling
Day 3-4: engorgement, milk
Breast feeding
Non-nursing

17

Cardiovascular blood loss and protective mechanisms

Blood loss:
-vaginal: 500mL
-c-section: 700-1000mL
-1st PP: 500 mL
-6 weeks: 500 mL
Protective mechanisms
- placenta gone
- estrogen decrease (vasoconstriction)
- Diuresis (fluid moves from tissue to vascular space)

18

Postpartum vital signs

Take all vitals
T: upto 100.4 considered normal
Related to dehydration, delivery or epidural

19

Postpartum lab values

Hematocrit: decrease 3-4% = 1 gram
Hemoglobin: decrease 1 gram = 500 mL of blood loss
He modulation: loom anemic
Clotting factor: increase at delivery, not good infection indication

20

Neurological changes

Decrease edema
Headaches: associated with pre-eclampsia so take her BP

21

Skin and musculoskeletal changes

Pigmentation changes: stretch marks fade, darken areaola
Straiae gravidarum
Relaxed joints: feet may permanently grow

22

Postpartum nursing care and mothers concerns

Wellness orientated and family centered
- physical, psychological, education
Mothers concerns
- comfort
- contact with baby
- share her story
- learn, her desire to learn to care

23

Short stay maternity care

Newborns and mothers health protection act
- 2 days vaginal
- 4 days Caesarian
Anticipatory guidance
All PP care should include teaching

24

Dx: risk for deficient fluid volume

Assessment: BP, P, R, fundus, Lochia, perineum, bladder
Interventions:
- massage, empty bladder, oxytocin

25

Dx: risk for injury

Assessment: LOC, o2, legs, homans sign
Interventions:
- ID bands
- orient
- prevent falls, ambulate
- RhoGAM
- allergies
- call. Ell, low bed, side rails up
- slippers

26

Dx: risk for infection

Assessment: T, bladder, perineum, Lochia
Intervention
- 3 min scrub, hand washing
- gloves, bathing, infection control, rubella vaccine