objective 5 Flashcards by Kaitlyn Dominie

6 weeks following childbirth
often referred to as the 4th trimester of pregnancy

postpartum

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what are the physiological changes of the breasts?

Full but soft for the first 2-4 days, then firm anf fuller as blood flow increases & milk production begins
Engorgement may occur; the breast is hard, erect & very uncomfortable
The non-nursing mothers breasts return to normal size in 1-2 weeks

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what are the physiological changes of the uterus?

Return to prepregnancy size & wt. Uterus prepregnancy size by 5-6 weeks

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what are the physiological changes of the uterine lining?

shed with placenta

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when are after pains felt?

48 hrs PP

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Vaginal discharge after delivery, composed of tissue, blood and lymph

lochia

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red blood, last 3-4 days after birth

lochia rubra

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pinkish or brown, starts about 4th day and lasts for 2-3 weeks after birth

lochia serosa

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clear/colorless, white or yellow, can last up to 4-6weeks

lochia alba

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what should women report in regards to lochia?

Foul-smelling lochia (with or without fever)
Lochia rubra lasting longer than the 4th day
Unusually heavy flow of lochia
Lochia that returns to a bright red color after it has progressed to serosa or alba

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what are the physiological changes of the cervix?

Regains muscle tone but never closes as tightly as prepregnant state

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what are the physiological changes of the vagina?

Within 6 weeks regains most of its form but not to pre-pregnancy size

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what are physiological changes of the perineum?

Often edematous, tender, & bruised
Episiotomy or lacerations may have occurred

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what is REEDA?

Redness: without pain (pain=infection)
Edema: slight
Ecchymosis: bruising, slight
Approximation: no separation of episiotomy

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when does menstruation resume?

7-9 weeks if not BF
6-12 months if BF

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when does ovulation resume?

Return of ovulation is delayed if BF; however, it can occur at any time after birth (pregnancy is possible). Discuss contraceptives

when is it safe to resume sexual activity?

Its safe to resume sexual intercourse when bleeding has stopped & the perineum has healed
The vagina doesnt lubricate as well in the first 6 weeks (longer if BF); so advise her to use a water soluble lubricant
Teach about kegel exercised to strengthen muscles involved in urination, bowel function, & vaginal sensations during intercourse

what are the cardiovascular system changes?

Cardiac output and blood volume
Orthostatic hypotension
Coagulation
Blood values
Low HCT, elevated WBC
Chills
Related to sudden release of pressure on the pelvic nerves and vasomotor response involving epinephrine during the birth process

what are the urinary system changes?

A full bladder can displace the uterus and lead to PP hemorrhage
Decrease in bladder tone and uterus along with IV fluids during L&D fills the bladder quickly, but often results in incomplete emptying pp
Urinary stasis also imposes risk for UTI

what are the GI system changes?

constipation

how do we alleviate constipation?

Increase fluid and fiber intake
Increase activity, such as walking
Stool softeners for C section moms

what are the integumentary system changes?

Hyperpigmentation of the skin fades as hormone levels decrease
Linea nigra disappears
Striae fade to sliver

what are the musculoskeletal system changes?

Diastasis recti
Hypermobility of the joints

separation of the abdominal muscles

diastasis recti

what are some PP exercises?

Abdominal muscle tightening Head lift Pelvic tilt Kegel exercises

what are the immune system changes?

Prevent blood incompatibilities and infection RhoGAM is admin if women is Rh negative and baby is Rh positive Give mother immunization for rubella if she is not immune

what is BUBBLEE?

Breasts Uterus Bladder Bowel Lochia Legs Episiotomy/laceration Emotions

what are the 3 phases of PP?

Phase 1: taking in Phase 2: taking hold Phase 3: letting go

Referred to as ‘baby blues’ Usually occur in the first 3-5 days and resolve by 2 weeks Conflict between joy and emotional left down Teaching- reassure mom it is normal and temporary

PP blues

Previously known as PP depression or PP mood disorders PMD can be anxiety, depression or psychosis

perinatal mood disorder

Anxiety Irrational fear, worry, tension, trembling, N&V, dizziness, dyspnea & insomnia

perinatal anxiety

Persistent mood of unhappiness, 2-4 wks after birth Interferes with responding to infants’ cues and parent-infant bonding

perinatal depression

what are the S&S of perinatal depression?

Lack of enjoyment in life, disinterest, difficult concentrating and making decisions, sleep disturbances, exhaustion, generally feeling unwell, crying, difficulties with ADLs

what is the treatment of PD?

Psychotherapy Antidepressants Social support from partner, family, social networks Peer support Incorporating partner and family in care planning Exercise, self-care, relaxation techniques, adequate sleep

48hrs-2wks Impaired sense of reality Rae but can be fatal condition Rapid onset, begins as early as 48-72hrs-2wks PP

perinatal psychosis

what are the S&S of perinatal psychosis?

depressed or elated mood (fluctuates), delusions, hallucinations

what are the 4 phases of adjustment to fatherhood?

Having expectations and personal intentions Confronting reality and overcoming frustrations Creating ones own personal father role Reaping rewards of fatherhood

how does it impact siblings?

Age-dependent on how older siblings will respond to new baby Prep impt

how does it affect grandparents?

Involvement determined by distance from family Differ in their expected roles Roles also affected by culture Little conflict when both parties agree on what roles should be