T3 -Maternal Physiological Changes (Josh) Flashcards Preview

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Flashcards in T3 -Maternal Physiological Changes (Josh) Deck (80):
1

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

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

Involution

Subinvolution

2

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

Uterine Involution

3

What is Autolysis?

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

4

What is the second process of involution?

Autolysis

***makes implantation of future pregnancies possible

5

Where is the Fundus immediately after birth?

1-2 cm below the umbilicus

6

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

7

When would we expect the fundus to be nonpalpable?

by 2 wks

8

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

1-2 cm (fingerbreaths) q 24 hrs

9

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

9th or 10th

10

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

20 wks

11

Where is oxytocin secreted?

Posterior Pituitary

12

--- initiates and maintains uterine contractions.

Oxytocin

13

What do contractions do post-birth?

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

14

What should fundus assessment be post-delivery?

midline

firm

appropriate location for time past delivery

15

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

16

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

multigravidas

breast feeding clients

17

What interventions for afterpains?

offer pain meds or NSAIDs (ibuprofen) BEFORE breast feeding

18

What causes afterpains?

cramping from oxytocin release after birth

***intensifies w/ breastfeeding

19

--- is responsible for milk production.

--- is responsible for milk letdown.

Prolactin

Oxytocin

20

What enhances milk let down?

comfort and relaxation

21

When would afterpains resolve?

3-7 days

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

22

Interventions to enhance contracted state of uterus?

Empty bladder q 2hr

Manual massage or relaxed uterine muscle

Pitocin or Methergine

Breast feeding

23

When would Methergine be contraindicated?

BP 140/90

***causes increased BP

24

When is Lochia Serosa?

days 4-9

25

When is Lochia Alba?

days 10-14

26

When is Lochia Rubra?

days 1-3

27

Normal Lochia Rubra:

Bright red

SMALL clots

Blood, decidual & trophoblastic debris

28

Normal Lochia Serosa:

Pink/Brownish

Decreases over time

Serum, leukocytes, tissue debris & old blood

29

Normal Lochia Alba:

Creamy

Disappears over time

Leukocytes, epithelial cells, mucous, serum & bacteria

30

Signs of Uterine Infection

Lochia has an offensive odor

Lochia reverts to an earlier stage of color/amount

Lochia persists beyond normal time

31

What is classified as hemorrhage post-partum?

blood loss of 500 mL or greater

***can be early or late

32

What is the critical time for an early hemorrhage?

1 hr post delivery

- may be related to lacerations

33

What would an early hemorrhage look like?

continuous trickle of blood in spite of contracted uterus

34

When would a late hemorrhage happen?

24 hrs or more post delivery

35

What causes a late hemorrhage?

retained fragments of placenta in uterus

***associated w/ infections

36

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)

37

When does the cervial Os return to prepregnant round state?

never

it changes from round to lateral, slit-like shape

38

What is the shape of the Os for multiparas?

Nuliparas?

lateral, slit-like shape

round

39

What happens to the Vagina post-delivery?

Mucosa thin and without rugae

Prepregnancy size by 6-10 wks

40

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

post-partum estrogen deprivation

41

What happens to the Perineum post-partum?

Edema and Erythematous

42

How long does it take episiotomy to heal?

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

43

What does REEDA stand for?

Redness

Edema

Ecchymosis

Discharge (of EPISIOTOMY, not lochia)

Approximation of episiotomy

44

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

lay on side and lift butt cheeks

***need a penlight

45

1st degree laceration

superficial vaginal mucosa or skin of perineum

46

2nd degree laceration

deeper tissues including muscles of perineum

47

3rd degree laceration

same as 2nd but extends to include ANAL SPHINCTER

48

4th degree laceration

extends through anal sphincter into the RECTAL MUCOSA

49

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

Periurethral

50

No suppositories with which type of lacerations?

3rd and 4th degree

51

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

up to 6 mths

***Kegel exercises promote tone

52

What happens to Progesterone and Estrogen postpartum?

decrease rapidly and at lowest levels within 1 wk

53

Nursing actions w Type 1 DM moms?

may require much less insulin for several days after birth

54

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

drop

***diabetogenic effects of pregnancy are reversed

55

Which hormones have an inverse relationship during postpartum stage?

Estrogen (decreases)

Prolactin (increases)

***suppresses ovulatoinq

56

When menstruation returns, what will it look like?

1st cycle will be very heavy

return to normal after 3-5 cycles

57

What influences the duration of Anovulation?

Frequency of breastfeeding

Duration of breastfeeds

58

Assessment of Lactating Breasts:

Soft (Ear) - 1st or 2nd day

Filling (Nose) - 3rd or 4th day

Engorged

59

What is engorged breast?

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

60

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

protein and immunologic factors

fats and carbs

61

When is Colostrum secreted?

When is True Milk secreted?

first 2-3 days

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

62

Milk increases in direct proportion to ---

sucking of infant

63

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

64

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

7-9 wks

***6 mths for lactating

65

-- and -- are influenced by breast feeding.

Ovulation

Menstrual cycle

***BF is NOT an effective form of BC

66

--- blood loss from vaginal birth

--- blood loss from C-section.

500 mL

1000 mL

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

67

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

fluid shifts as uteroplacental circulation is eliminated and circulating vol increases

68

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

return to intravascular spaces

69

How is all the extra fluid volume eliminated postpartum?

diuresis and diaphoresis

***output may > 3000 mL/day

70

Why are postpartum moms predisposed to blood clots?

activation of blood-clotting factors and immobility

71

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

72

When do vital signs return to normal postpartum?

few days

73

What are we concerned about w/ increased leukocytosis postpartum?

elevated WBCs may obscure an infection

***monitor other signs including Temp

74

Why is peristalsis slowed postpartum?

progesterone

decreased muscle tone

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

75

Encourage --- postpartum.

voiding

- client may have decreased sensitivity to fluid pressure

76

Client education r/t potential UTI

empty bladder q2h at minimum

77

What is urinary frequency w/ overflow?

urge to pee frequently but don't empty bladder

78

Integumentary System changes postpartum:

Chloasma disappears

Areolae and Linea Nigra may NOT disappear totally

Striae Gravidarum will fade but NOT GO AWAY

79

If a high fundus, what should we first suspect?

full bladder

*** can also cause excessive bleeding

80

Why get them moving ASAP postpartum?

prevent blood clots due to activation of clotting factors