Transistions: normal postpartum Flashcards
(36 cards)
when does postpartum start ?
24-48 hrs after birth
72 hrs after C-sec
how many stages of labor?
4
what does the 1st stage involve?
- latent phase: when contractions become regular and painful and cervical effacement and dilation commence to 3 cm
> dont want to give anything for pain, could make contractions stop - active phase: labor is well established when contractions becoming more painful, frequent and longer
> 4-8cm - transition phase: contractions take on more expulsive nature, bearing down feeling, mood swings
> 8-10 cm
second stage
commences with full dilation of cervix and ends with delivery of baby
> during: fetal head descends under the pubic arch and gradually thins and stretches the vaginal opening
> contractions occur q 2-3 min?
for primips (nullip)- can last up to 3 hrs - usually push for 60 min
for multip- can be less than 20 min
third stage
birth of baby until the placenta and membranes are delivered
> the separation of placenta facilitated by uterine contractions
> once the baby born, the uterus contracts and retracts which causes the placenta to pull away from the wall of the uterus
> usually occurs within 20-30 min. if longer than 30 min, might start to get worried about hemorrage
fourth stage
one to 4 hrs after birth, although 2 hrs is most common
> time for psychological adjustment and stabilization for the mother… also includes the baby adjustment to extrauterine life
characteristics of postpartum
how long does it last?
> up to 6 weeks after birth
> physical and psychological adjustments to a preperg state
> considered to be retrogressive (getting back to prepreg state) and progressive (C-sec scar/episiotomy)
Physiological changes of the uterus
immediately postpartum
> uterus is size of grapefruit, 5 cm below umbilicus and above pubic symph
> the walls clamp and the vessels compress
> 6-12 hrs postpartum—> the uterus is at the umbilicus
> usual descent is 1cm/day. at 10 days, it should be back down
what if the uterus is boggy and high?
> causes increase bleeding and clot formation
> uterus is being lazy and can cause increased bleeding
what if the uterus is firm and deviated to the side?
> may be a full bladder
> get PT to void IF she is not hemorrhaging
what about size/weigh of uterus?
myometrium?
> decrease in weight from 1000 gm to 50gm
reverse hypertrophy. same amount to cells. just shrink
> myo- lining of uterus. takes about 3 weeks to heal and the placenta site takes about 6-7 weeks to heal
how do you check the fundus?
one hand at pubis and other at top of fundus.
use only one hand if she had a C-sec
what factors affect involution
(causing no contraction…)
- prolonged labor
- GA
- excessive analgesia
- difficult birth
- grand multip- 5 or more. poor uterus muscles
- overdistension of the uterus- too much amniotic fluid (polyhydramnious), big baby, twins
- full bladder
- retention of products of conception
- infection
When mom gets up out of bed she feels blood gush and run down her leg. What do you do?
> ease mom back to bed and assess how much blood loss, clotting, pad? is it coming from a tear?
assess fundus
do VS
do more frequent assessments
massage the uterus
have her empty bladder q2h. she would lose sensation after birth and so getting her to pee would start to dierese her
get her brest feeding. hormones are released from feeding which will help contraction of the uterus
changes to the Cervix, vagina and perimeum
cx and vag-
>bruised and poss lacerations
> decreased vag tone
> dysparunia (painful intercourse) - teach the use of water sol gel
perineum-
> intact? tear or episiotomy?
> assess for REEDA ( redness, edema, ecchymosis, discharge and approximation), pain
> also assess for hamorrhage
Nursing interventions for perineum
> assess for pain q shift or more
assess knowledge- how to care for site
Teach:
> application of ice pack or tea bag pads (titanic acid draws out the swelling, inflam, bacteria
> Peri bottle usage- little soap and water. use after voiding
> inspect and wipe clean to dirty
> kegals
> sitz bath- for up to 20min a few times per day
reproductive health
return to mensuration varies
non-breast feeding = 7-12 weeks
breast feeding can be as early as 12 weeks and as delayed as 3
return of ovulation
non-breast feeding 70-75 days
breast feeding 6 months
teaching sexual activities
> after lochia serosa
when there is decreased pain
alternative positions
use of lubricant
> talk about contraception
Changes in the GI system
Delay in BM
> there is decreased eating during labor
> often BM in L and D d/t pushing
> fear of BM d/t pain from episiotomy
Nursing:
> give stool softeners
> diet high in roughage and + fluids (for BM and breast feeding)
> hemorrhoid care
change in urinary system
caused by: > increased capacity > swelling > bruising and pain > decreased sensation
Nursing:
> assess amount, frequency and characteristics
Teach:
> need to empty q2h
> S and S of bladder infection
changes in VS
always go back to see what her normal was.
Temp:
> 1st 24 hrs can be up to 38.0 C d/t over exertion and dehydration
> if elevated temp after 24 hrs, infection? premature rupture of membranes?
> if elevated temp 3-4 days, could be d/t lactogensis (milk coming in). only seen if the mom had a C-sec
BP:
> transient increase to normal within a few days
> exceptions. PIH (preg inducted HTN) and PPH (post-part hemorrhage
Pulse:
> bradycardia for 6-10 days = Normal
> tachycardia associated with blood loss, infection, fear and pain
blood changes
Leukocytosis - esp in long labors
> increased defense against infection, increased healing process
> 25,000 - 30,000 (usual 4,500 - 11,000)
> will return tp normal by the end of the first week
Hgb and Hct
> assess after day 2, normal or better in 2-6 weeks
> Hgb below 120 = anemic
> best indicator to assess Hgb is after she has diuresed
> best assessed after day 2 - due to hemodilution
other blood changes
Platelets:
> fall due to placenta separation
> increased by the 3-4 day
Fibrinolytic levels:
> normal for first few hrs but are at risk for thromboembolism in first 6 weeks d/t increase diameter of veins.
> talk to mom about exercising
> rub the legs all the way down to feel for any painful and hot spots
> also assess CWMS
