T3 -Maternal Physiological Changes (Josh) Flashcards by Josh Miller

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

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

Involution

Subinvolution

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

Uterine Involution

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What is Autolysis?

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

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What is the second process of involution?

Autolysis

***makes implantation of future pregnancies possible

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Where is the Fundus immediately after birth?

1-2 cm below the umbilicus

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

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

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When would we expect the fundus to be nonpalpable?

by 2 wks

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

1-2 cm (fingerbreaths) q 24 hrs

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

9th or 10th

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

20 wks

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Where is oxytocin secreted?

Posterior Pituitary

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— initiates and maintains uterine contractions.

Oxytocin

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What do contractions do post-birth?

control bleeding at placental site by compression of blood vesselsreduce size of uterus

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What should fundus assessment be post-delivery?

midline

firm

appropriate location for time past delivery

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

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

multigravidas

breast feeding clients

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What interventions for afterpains?

offer pain meds or NSAIDs (ibuprofen) BEFORE breast feeding

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What causes afterpains?

cramping from oxytocin release after birth

***intensifies w/ breastfeeding

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— is responsible for milk production.

— is responsible for milk letdown.

Prolactin

Oxytocin

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What enhances milk let down?

comfort and relaxation

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When would afterpains resolve?

3-7 days

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

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Interventions to enhance contracted state of uterus?

Empty bladder q 2hr

Manual massage or relaxed uterine muscle

Pitocin or Methergine

Breast feeding

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When would Methergine be contraindicated?

BP 140/90

***causes increased BP

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When is Lochia Serosa?

days 4-9

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When is Lochia Alba?

days 10-14

When is Lochia Rubra?

days 1-3

Normal Lochia Rubra:

Bright red SMALL clots Blood, decidual & trophoblastic debris

Normal Lochia Serosa:

Pink/Brownish Decreases over time Serum, leukocytes, tissue debris & old blood

Normal Lochia Alba:

Creamy Disappears over time Leukocytes, epithelial cells, mucous, serum & bacteria

Signs of Uterine Infection

Lochia has an offensive odor Lochia reverts to an earlier stage of color/amount Lochia persists beyond normal time

What is classified as hemorrhage post-partum?

blood loss of 500 mL or greater ***can be early or late

What is the critical time for an early hemorrhage?

1 hr post delivery - may be related to lacerations

What would an early hemorrhage look like?

continuous trickle of blood in spite of contracted uterus

When would a late hemorrhage happen?

24 hrs or more post delivery

What causes a late hemorrhage?

retained fragments of placenta in uterus ***associated w/ infections

How should the cervix look after birth?

Soft immediately Bruised w/ many small lacerations (watch for infections) 2-3 cm open for several days (1 fingertip after 1 wk)

When does the cervial Os return to prepregnant round state?

never it changes from round to lateral, slit-like shape

What is the shape of the Os for multiparas? Nuliparas?

lateral, slit-like shape round

What happens to the Vagina post-delivery?

Mucosa thin and without rugae Prepregnancy size by 6-10 wks

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

post-partum estrogen deprivation

What happens to the Perineum post-partum?

Edema and Erythematous

How long does it take episiotomy to heal?

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

What does REEDA stand for?

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

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

lay on side and lift butt cheeks ***need a penlight

1st degree laceration

superficial vaginal mucosa or skin of perineum

2nd degree laceration

deeper tissues including muscles of perineum

3rd degree laceration

same as 2nd but extends to include ANAL SPHINCTER

4th degree laceration

extends through anal sphincter into the RECTAL MUCOSA

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

Periurethral

No suppositories with which type of lacerations?

3rd and 4th degree

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

up to 6 mths ***Kegel exercises promote tone

What happens to Progesterone and Estrogen postpartum?

decrease rapidly and at lowest levels within 1 wk

Nursing actions w Type 1 DM moms?

may require much less insulin for several days after birth

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

drop ***diabetogenic effects of pregnancy are reversed

Which hormones have an inverse relationship during postpartum stage?

Estrogen (decreases) Prolactin (increases) ***suppresses ovulatoinq

When menstruation returns, what will it look like?

1st cycle will be very heavy return to normal after 3-5 cycles

What influences the duration of Anovulation?

Frequency of breastfeeding Duration of breastfeeds

Assessment of Lactating Breasts:

Soft (Ear) - 1st or 2nd day Filling (Nose) - 3rd or 4th day Engorged

What is engorged breast?

breast distention r/t stasis of venous and lymphatic fluid. Hard to touch and client complains of pain

Colostrum is high in -- and -- and low in -- and --

protein and immunologic factors fats and carbs

When is Colostrum secreted? When is True Milk secreted?

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

Milk increases in direct proportion to ---

sucking of infant

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

hot showers b/c they stimulate milk let down ***don't let dad play with them either

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

7-9 wks ***6 mths for lactating

-- and -- are influenced by breast feeding.

Ovulation Menstrual cycle ***BF is NOT an effective form of BC

--- blood loss from vaginal birth --- blood loss from C-section.

500 mL 1000 mL ***plasma levels decrease first few days due to diuresis

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

fluid shifts as uteroplacental circulation is eliminated and circulating vol increases

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

return to intravascular spaces

How is all the extra fluid volume eliminated postpartum?

diuresis and diaphoresis ***output may > 3000 mL/day

Why are postpartum moms predisposed to blood clots?

activation of blood-clotting factors and immobility

What do WBCs look like postpartum?

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

When do vital signs return to normal postpartum?

few days

What are we concerned about w/ increased leukocytosis postpartum?

elevated WBCs may obscure an infection ***monitor other signs including Temp

Why is peristalsis slowed postpartum?

progesterone decreased muscle tone ***also scared to strain b/c of pain

Encourage --- postpartum.

voiding - client may have decreased sensitivity to fluid pressure

Client education r/t potential UTI

empty bladder q2h at minimum

What is urinary frequency w/ overflow?

urge to pee frequently but don't empty bladder

Integumentary System changes postpartum:

Chloasma disappears Areolae and Linea Nigra may NOT disappear totally Striae Gravidarum will fade but NOT GO AWAY

If a high fundus, what should we first suspect?

full bladder *** can also cause excessive bleeding

Why get them moving ASAP postpartum?

prevent blood clots due to activation of clotting factors