Postpartum Mod 1 Concepts Flashcards
Onset of postpartum depression and signs/symptoms?
Onset: within first year after birth of baby
Signs and symptoms:
Persistent tiredness, overwhelmed, anxious, feelings of hopelessness, lack of interest in life events, poor libido, poor hygiene, no desire or unable to care for infant, and suicidal thoughts
Interventions for postpartum depression
Talk about depression
explain what is likely to contribute to the depression
encourage mother to express feelings
Suggest getting help with infant and housework for overwhelming feelings
Provide phone numbers for medical/psych resources.
Signs of postpartum infections include
Fever/chills
Pain or redness of wound
Tachycardia
Purulent wound drainage
Foul smelling lochia
Elevated WBC
Uterine subinvolution
Frequency and urgency of urination
Localized redness, warmth, or tenderness in the breast tissue
Postpartum blues/baby blues refers to temporary, self limiting period of weapiness.
Treatment for this type of sadness includes:
No medication or formal treatment is required
The uterus returns to its normal size through a gradual process of_______?
Involution
**happens in three retrogressive processes: ***
-contraction of muscle fibers
-Catabolism, which strengths enlarged myometrial cells
-Regeneration of uterine epithelium, by shedding of lochial discharge
If a patient is not breast-feeding, how long after birth should menstruation resume?
Within several weeks.
Ovulation may return at any time, so breast-feeding is not considered a safe contraceptive.
The (puerperium period/4th trimester) is how many weeks after birth of baby??
Six weeks: time when woman’s body begins to return to pre-pregnant state 
The uterus weighs approximately 1000 g after birth, by approximately 1 WEEK, the uterus shrinks by 50% and weighs about 500 g.
During the first 12 hours postpartum where should fundal height be located ?
At the umbilicus.
Over the first few days of birth, the uterus typically descends from the level of the umbilicus at rate of how many fingerbreadths or centimeters per day?
1 cm or fingerbreadth.
By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis .
Subinvolution results from what causes?
Infection
Prolonged labor and difficult birth
Incomplete expulsion of amniotic membranes and placenta
Over distention of uterine muscles (multiple pregnancies or large fetus)
A full bladder may displace the uterus from the midline, what nursing intervention would you apply to this situation?
Help the patient to the bathroom to void urine, recheck uterus to see if it’s midline, massage the fundus if boggy
The process of involution and restoration of endometrium is reflected in the characteristics of lochia.
What is lochia and how long does it typically occur after birth?
vaginal discharge that occurs for 4-8 weeks after birth.
Lochia changes in color throughout the weeks after birth.
What are the three stages and expected colors of discharge?
1) Lochia rubra: deep red mixture of mucus, tissue debris, and blood. 3-4 days
2) Lochia serosa: pinkish brown contains leukocytes, tissue, RBC, and serous fluid. 3-10 days
3) Lochia alba: creamy white/light brown consist of leukocytes, tissue, and fluid. 10-14 days 😅may last for 3-6 weeks😅
Lochia at any stage may have fleshy odor, but an offensive odor usually indicates what?
Infection, such as endometriosis
“Afterpains” are a part of involution process, uterine contractions.
All women experience these pains, but some women experience them more acutely. WHY?
Multiparous (multiple pregnancies) and breast-feeding women.
Repeated stretching from multiple pregnancies and stimulation during breast-feeding releases oxytocin causing worsening of afterpain.
👍🏻 Afterpains respond well to oral analgesics 👍🏻
The cervix typically returns to pre-pregnant state by week six of postpartum.
What is the difference of a cervix before pregnancy and after?
The internal cervical OS returns to normal by two weeks.
External OS widens and never appears the same after childbirth.
instead of circle, looks like a slit
The perineum stretches during childbirth, and vast majority sustain some degree of perineal trauma.
Perineum is edematous for one or two days after birth.
If birth involved an episiotomy or laceration, complete healing may take how long ?
4 to 6 months in absence of complications at site.
Nursing interventions for episiotomy include:
🔥Ice packs, pouring warm water over area via Peribottle, witch hazel pads, anesthetic sprays, and sitz bath🔥
The cardiovascular system undergoes dramatic changes after birth.
Cardiac output remains high for first few days of postpartum, and then gradually declines within how many months after birth ?
Approximately 3 months.
Blood volume increases substantially during during pregnancy, drops rapidly after birth, and returns to normal within four weeks postpartum.
Despite the decrease in blood volume after birth the hematocrit levels remain relatively stable (may even increase)
An acute DECREASE in hematocrit is not an expected finding and may indicate what condition ?
May indicate hemorrhage, reflecting a predominant loss of plasma.
Is a lower pulse rate of 60 - 80 bpm in the first few weeks of postpartum normal or abnormal?
Normal. Slowing of the heart is related to increased blood flow back to the heart after woman is no longer profusing the placenta.
Giving birth simulates the hypercoagulability state these coagulation factors remain elevated for 2 to 3 weeks postpartum.
What is this put the postpartum woman at risk for?
Vessel damage and immobility puts them at risk for thromboembolism (blood clots) in the lower extremities and lungs.
Urinary retention is a major cause of uterine atony, which allows excessive bleeding.
Why does urinary retention/ bladder distention increase the risk of postpartum hemorrhage?
Urinary retention displaces the uterus from the midline to right and can inhibit the uterus from contracting properly.
Postpartum diuresis occurs as a result of several mechanisms:
large amounts of IV fluids, decreasing antidiuretic effect of oxytocin as it declines, retention of extra fluids during pregnancy.
Diuresis begins within how many hours after childbirth and returns to normal function within how long??
Diuresis begins within 12 hours after childbirth and continues 1 week postpartum.
Normal function returns within a month after birth
Musculoskeletal system changes associated with pregnancy include:
-Increased ligament laxity
-Weight gain (center of gravity)
-Carpal tunnel syndrome
These change back after pregnancy ^^
One joint that does not return to pre-pregnant state is feet with a permanent increase in shoe size.