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Mental Health (Josh) > T3 - Maternal Physiologic Changes (Josh) > Flashcards

T3 - Maternal Physiologic Changes (Josh) Flashcards

1
Q

— is return of uterus to non-pregnant state after birth .

— is failure of uterus to return to normal size and condition

A

Involution

Subinvolution

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2
Q

What is the first process to take place when the placenta is expelled from the uterus?

A

Uterine Involution

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3
Q

What is Autolysis?

A

tissue regeneration w/out leaving a fibrous scar at site of implantation

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4
Q

What is the second process of involution?

A

Autolysis

***makes implantation of future pregnancies possible

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5
Q

Where is the Fundus immediately after birth?

A

1-2 cm below the umbilicus

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6
Q

What happens to the Fundus within 12 hrs post-birth?

A

rises to umbilicus (or slightly above) then descends 1-2 cm (fingerbreath) every 24 hours

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7
Q

When would we expect the fundus to be nonpalpable?

A

by 2 wks

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8
Q

When the fundus starts descending, what is the rate of descent/

A

1-2 cm (fingerbreaths) q 24 hrs

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9
Q

By the — postpartum day, the fundus is back into the pelvic cavity and non-palpable.

A

9th or 10th

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10
Q

By 24 hours, the uterus is the size it was at — gestation.

A

20 wks

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11
Q

Where is oxytocin secreted?

A

Posterior Pituitary

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12
Q

— initiates and maintains uterine contractions.

A

Oxytocin

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13
Q

What do contractions do post-birth?

A

control bleeding at placental site by compression of blood vessels

reduce size of uterus

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14
Q

What should fundus assessment be post-delivery?

A

midline

firm

appropriate location for time past delivery

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15
Q

Where would the fundus be on PP day 3, 10 and 6 wks?

A

PP day 3: 2-3 fingerbreaths below umbilicus, firm, midline

PP day 10: non palpable

PP 6 wks: back to non-pregnant location

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16
Q

Who are afterpains (associated w/ contractions) more severe with?

A

multigravidas

breast feeding clients

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17
Q

What interventions for afterpains?

A

offer pain meds or NSAIDs (ibuprofen) BEFORE breast feeding

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18
Q

What causes afterpains?

A

cramping from oxytocin release after birth

***intensifies w/ breastfeeding

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19
Q

— is responsible for milk production.

— is responsible for milk letdown.

A

Prolactin

Oxytocin

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20
Q

What enhances milk let down?

A

comfort and relaxation

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21
Q

When would afterpains resolve?

A

3-7 days

***assure client that afterpains are helping uterus return to prepregnant size and shape

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22
Q

Interventions to enhance contracted state of uterus?

A

Empty bladder q 2hr

Manual massage or relaxed uterine muscle

Pitocin or Methergine

Breast feeding

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23
Q

When would Methergine be contraindicated?

A

BP 140/90

***causes increased BP

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24
Q

When is Lochia Serosa?

A

days 4-9

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25
Q

When is Lochia Alba?

A

days 10-14

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26
Q

When is Lochia Rubra?

A

days 1-3

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27
Q

Normal Lochia Rubra:

A

Bright red

SMALL clots

Blood, decidual & trophoblastic debris

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28
Q

Normal Lochia Serosa:

A

Pink/Brownish

Decreases over time

Serum, leukocytes, tissue debris & old blood

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29
Q

Normal Lochia Alba:

A

Creamy

Disappears over time

Leukocytes, epithelial cells, mucous, serum & bacteria

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30
Q

Signs of Uterine Infection

A

Lochia has an offensive odor

Lochia reverts to an earlier stage of color/amount

Lochia persists beyond normal time

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31
Q

Documenting bleeding amount:

A

Scant =

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32
Q

What is classified as hemorrhage post-partum?

A

blood loss of 500 mL or greater

***can be early or late

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33
Q

What is the critical time for an early hemorrhage?

A

1 hr post delivery

  • may be related to lacerations
34
Q

What would an early hemorrhage look like?

A

continuous trickle of blood in spite of contracted uterus

35
Q

When would a late hemorrhage happen?

A

24 hrs or more post delivery

36
Q

What causes a late hemorrhage?

A

retained fragments of placenta in uterus

***associated w/ infections

37
Q

How should the cervix look after birth?

A

Soft immediately

Bruised w/ many small lacerations (watch for infections)

2-3 cm open for several days (1 fingertip after 1 wk)

38
Q

When does the cervial Os return to prepregnant round state?

A

never

it changes from round to lateral, slit-like shape

39
Q

What is the shape of the Os for multiparas?

Nuliparas?

A

lateral, slit-like shape

round

40
Q

What happens to the Vagina post-delivery?

A

Mucosa thin and without rugae

Prepregnancy size by 6-10 wks

41
Q

What causes the thinning of the mocosa in vagina post-delivery?

A

post-partum estrogen deprivation

42
Q

What happens to the Perineum post-partum?

A

Edema and Erythematous

43
Q

How long does it take episiotomy to heal?

A

2-3 wks but can take as long as 4-6 wks

44
Q

What does REEDA stand for?

A 
Redness
Edema
Ecchymosis
Discharge (of EPISIOTOMY, not lochia)
Approximation of episiotomy
45
Q

What position should we put mom in to examine the episiotomy?

A

lay on side and lift butt cheeks

***need a penlight

46
Q

1st degree laceration

A

superficial vaginal mucosa or skin of perineum

47
Q

2nd degree laceration

A

deeper tissues including muscles of perineum

48
Q

3rd degree laceration

A

same as 2nd but extends to include ANAL SPHINCTER

49
Q

4th degree laceration

A

extends through anal sphincter into the RECTAL MUCOSA

50
Q

What type of laceration tears into the area of the urinary urethra?

A

Periurethral

51
Q

No suppositories with which type of lacerations?

A

3rd and 4th degree

52
Q

How long does it take pelvic muscles to regain tone postpartum?

A

up to 6 mths

***Kegel exercises promote tone

53
Q

What happens to Progesterone and Estrogen postpartum?

A

decrease rapidly and at lowest levels within 1 wk

54
Q

Nursing actions w Type 1 DM moms?

A

may require much less insulin for several days after birth

55
Q

Mothers who required lots of insulin during pregnancy may have a sudden — in insulin requirements.

A

drop

***diabetogenic effects of pregnancy are reversed

56
Q

Which hormones have an inverse relationship during postpartum stage?

A

Estrogen (decreases)

Prolactin (increases)

***suppresses ovulatoinq

57
Q

When menstruation returns, what will it look like?

A

1st cycle will be very heavy

return to normal after 3-5 cycles

58
Q

What influences the duration of Anovulation?

A

Frequency of breastfeeding

Duration of breastfeeds

59
Q

Assessment of Lactating Breasts:

A

Soft (Ear) - 1st or 2nd day

Filling (Nose) - 3rd or 4th day

Engorged

60
Q

What is engorged breast?

A

breast distention r/t stasis of venous and lymphatic fluid.

Hard to touch and client complains of pain

61
Q

Colostrum is high in – and – and low in – and –

A

protein and immunologic factors

fats and carbs

62
Q

When is Colostrum secreted?

When is True Milk secreted?

A

first 2-3 days

by days 3-4 (fully mature at 2 wks)

63
Q

Milk increases in direct proportion to —

A

sucking of infant

64
Q

If you don’t want to breast feed, what should you avoid?

A

hot showers b/c they stimulate milk let down

***don’t let dad play with them either

65
Q

In non-lactating women, when would menstrual cycle resume?

A

7-9 wks

***6 mths for lactating

66
Q

– and – are influenced by breast feeding.

A

Ovulation

Menstrual cycle

***BF is NOT an effective form of BC

67
Q

— blood loss from vaginal birth

— blood loss from C-section.

A

500 mL

1000 mL

***plasma levels decrease first few days due to diuresis

68
Q

What is the body’s response to blood loss during postpartum stage?

A

fluid shifts as uteroplacental circulation is eliminated and circulating vol increases

69
Q

By the 3rd PP day, what happens to extravascular fluid?

A

return to intravascular spaces

70
Q

How is all the extra fluid volume eliminated postpartum?

A

diuresis and diaphoresis

***output may > 3000 mL/day

71
Q

Why are postpartum moms predisposed to blood clots?

A

activation of blood-clotting factors and immobility

72
Q

What do WBCs look like postpartum?

A

remain elevated w/ values b/t 20,000 and 25,000 mm3

***WBC is not always a good indicator of infection postpartum b/c it remains elevated

73
Q

When do vital signs return to normal postpartum?

A

few days

74
Q

What are we concerned about w/ increased leukocytosis postpartum?

A

elevated WBCs may obscure an infection

***monitor other signs including Temp

75
Q

Why is peristalsis slowed postpartum?

A

progesterone

decreased muscle tone

***also scared to strain b/c of pain

76
Q

Encourage — postpartum.

A

voiding

  • client may have decreased sensitivity to fluid pressure
77
Q

Client education r/t potential UTI

A

empty bladder q2h at minimum

78
Q

What is urinary frequency w/ overflow?

A

urge to pee frequently but don’t empty bladder

79
Q

Integumentary System changes postpartum:

A

Chloasma disappears

Areolae and Linea Nigra may NOT disappear totally

Striae Gravidarum will fade but NOT GO AWAY

80
Q

If a high fundus, what should we first suspect?

A

full bladder

*** can also cause excessive bleeding

81
Q

Why get them moving ASAP postpartum?

A

prevent blood clots due to activation of clotting factors

Mental Health (Josh) (26 decks)

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