Maternal Newborn Chapter 22 Sg

Front 1

what is involution?

Back 1

the return of the uterus to a nonpregnant state after birth

Front 2

Involution begins when?

Back 2

immediately after expulsion of the placenta with contraction of the uterine smooth muscle.

Front 3

What is subinvolution?

The most common causes of subinvolution are (2)

Back 3

(the failure of the uterus to return to a nonpregnant state)

retained placental fragments and infection

Front 4

3. T/F -A scar is left behind on the endometrium prohibiting the placenta in future pregnancies to attach in the same place. Explain

Back 4

False. upward growth of the endometrium causes sloughing of necrotic tissues and prevents the scar formation that is characteristic of normal wound healing. this unique healing process enables the endometrium to resume its usual cycle of changes and to permit implantation and placentation in future pregnancies.

(no scar tissues = growth and blood)

Front 5

what is Lochia –

for the 1st two hours after birth the amount of discharge should be

Back 5

postchildbirth uterine discharge

-that of a heavy menstrual period and then should steadily decrease

Front 6

Lochia rubra
-what does it consist of?
-what is the color of the flow?

Back 6

consists mainly of blood and decidual and trophoblastic debri

-bright red and contains clots and then the flow pales, becoming pink and brown after 3-4 days. (serosa)

Front 7

Lochia serosa
-what does it consist of?
-the median duration of discharge is?
-what color is it?
-about 10 days after childbirth, the drainage becomes what color?

Back 7

conists of old blood, serum, leukocytes, and tissue debris.

the median duration of discharge is 22-27 days. in most women

-pink and brown

about 10 days after childbirth, the drainage becomes yellow to white (lochia alba)

Front 8

Lochia alba-
-what does it consists of?
-how long does it continue for?
-what color is it?

Back 8

leukocytes, deciduas, epithelial cells, mucous, serum, and bacteria.

-lochia alba usually continues for 10-14 days but may last longer and still be normal.
-yellow to white

Front 9

____ exercises, which help to strengthen perineal muscles and encourage healing, are recommended after childbirth.

Back 9

kegal

Front 10

what kind of women differ considerably in the time when the first ovulation occurs and when menstruation resumes.

Back 10

lacting vs nonlactating

lacting mean length of time for ovulation is 6 months

nonlacting women can ovulate as early as 27 days and they menstrate 3 months after birth

Front 11

Postpartal dieresis, caused by what 3 things, aids the body in ridding itself of excess fluid.

Back 11

decreased estrogen levels,

removal of increased venous pressue in the lower extremities

loss of the remaining pregnancy induced increase in blood volume_

Front 12

8. The breasts gradually become fuller and heavier as the colostrum transitions to milk by about ___ to ___ hours after birth; this is often referred to as the “milk coming in”.

Back 12

72 to 96 hours

Front 13

List 5 suggestions you can offer to help relieve the discomfort of engorgement.

Back 13

a breast binder or well-fitted, supportive bra, ice packs, fresh cabbage leaves and or mild analgesic may be used to relieve discomfort.

Front 14

Pregnancy-induced hypervolemia allows most women to tolerate considerable blood loss during childbirth.
-what is pregnancy induced hypovolemia?

Back 14

an increase in blood volume of at least 35% more than pregnancy values near term

Front 15

Is there is an increased or decreased risk of thromboembolism in the immediate puerperium. Why?

Back 15

increased. clotting factors and fibronogen are normally increased during pregnancy and remain elevated for a short time after birth.

Front 16

List adaptations of the mother’s musculoskeletal system that are reversed after the birth and one that is not reversed.

Back 16

reversed- relaxation and subsequent hypermobility of the joints and the change in the mother’s center of gravity in response to the enlarging uterus.

not reversed- show size gets larger

Front 17

gravida


gravidity

Back 17

gravida:a women who is pregnant
gravidity:pregnancy

Front 18

multigravida:

Back 18

a women who has had two or more pregnancies

Front 19

multipara:

Back 19

a women who ahs completed two or more pregnancies to 20 or more weeks gestation

Front 20

nulligravida:

Back 20

a woman who has never been pregnant

Front 21

nullipara:

Back 21

a woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks of gestation

Front 22

parity

Back 22

the # of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation when they are born, not the number of fetuses (ex: twins) born. Whether the fetus is born alive or is stillborn (fetus who shows no signs of life at birth) does not affect parity

Front 23

postdate/postterm:

Back 23

a pregnancy that goes beyond 42 weeks of gestation

Front 24

preterm:

Back 24

a pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks of gestation

Front 25

primigravida:

Back 25

a woman who is pregnant for the first time

Front 26

primipara:

Back 26

a woman who has completed 1 pregnancy with a fetus of fetuses who have reached 20 weeks of gestation

Front 27

term:

Back 27

a pregnancy from the beginning of week 38 of gestation to the end of week 42 of gestation

Front 28

viability:

Back 28

capacity to live outside the uterus; about 22 to 25 weeks of gestation

Front 29

Understand the relationship between hCG levels and pregnancy tests. (Not specific tests) What are high and low levels indicative of?

Back 29

chorionic gonadotropin (hCG) is the earliest biochemical marker for pregnancy and preganancy tests are based on the recognition of hCG or beta subunit of hCG.
-Higher than normal levels of hCG may indicate abnormal gestation (Fetus with down syndrome) or multiple gestations
-An abnormally slow increase or decrease in hCH levels may indicate ectopic pregnancy or impending miscarriage

Front 30

During pregnancy the pH of the vagina is more acidic. What does that result in?

Back 30

-this change is due to increased production of lactic acid caused by Lactobacillus acidophilus action on glycogen in the vaginal epithelium probably resulting from increased estrogen levels.
- The woman is at risk for an increased susceptibility of other infections like yeast infections because of the glycogen rich environment is more susceptible to Candida albicans

Front 31

How much does blood volume increase by?

Back 31

blood volume increases by 1500ml, or 40-45% above nonpregnant levels

Front 32

How much is the diaphragm displaced during pregnancy?

Back 32

4 cm

Front 33

during pregnancy, there is an increase in the amount of estrogen.. what does that cause?

Back 33

increased estrogen production causes decreased secretion of hydrochloric acid causing peptic ulcer formation or flare-up of existing peptic ulcers is uncommon during pregnancy

Front 34

during pregnancy, there is an increased amount of progesterone which causes

Back 34

decreased tone and motility of smooth muscles, resulting in esophageal regurgitation, slower emptying time of the stomach and reverse peristalsis.
-As a result the women may experience acid indigestion or heartburn (pyrosis) beginning as early as the 1st trimester and intensifying through the 3rd trimester

Front 35

Why are gallstones in pregnancy more common?

Back 35

-the gallbladder is quite often distended because of its decreased muscle tone during pregnancy.
-increased emptying time and thickening of bile caused by prolonged retention are typical changes
-these features, together with slight hypercholesterolemia from increased progesterone levels, may account for the development of gallstones during pregnancy

Front 36

What do progesterone and estrogen do in pregnancy?

-progesterone and estrogen cause fat to deposit in subQ tissues over the abdomen, back, and upper thighs and this fat serves as

Back 36

-the increased levels of progesterone and estrogen suppress secretion of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the anterior pituitary. (amenorrhea or slight painless spotting can occur)

an energy reserve for both pregnancy and lactation.

Front 37

-progesterone is essential for what?

Back 37

maintaining pregnancy by relaxing smooth muscles, resulting in decrease uterine contractility and prevention of miscarriages.

Front 38

estrogen promotes:

Back 38

the enlargement of the genitals, the uterus, and the breasts and increases vascularity, causing vasodilation. estrogen causes relaxation of pelvic ligaments and joints.

Front 39

how does estrogen alters the metabolism of nutrients?

Back 39

by interfering with folic acid metabolism, increasing the level of total body proteins and promoting retention of Na and water by the kidneys.

Front 40

-the fundus descends about 1-2 cm every

Back 40

24 hrs

descends = move down

Front 41

what is responsible for stimulating the massive growth of the uterus during pregnancy

Back 41

-increase estrogen and progesterone levels

Front 42

Involution Process

what is released from the pituitary gland?
why?

Back 42

-oxytocin released from the pituitary gland

-strength and coordinate uterine contractions

Front 43

Involution Process

-what is achieved by compression of intramyometrial blood vessels as the uterine muscle contracts

Back 43

postpartum hemostasis

Front 44

Afterpains

1st time mothers, uterine tone is ____ and the fundus generally remains:

Back 44

-in 1st time mothers, uterine tone is good and the fundus generally remains firm and the woman usually has mild uterine cramping

Front 45

what 2 things intensify uterine contractions and why?

Back 45

-breastfeeding and oxytocic medication intensify these afterpains because both stimulate uterine contractions

After birth, the oxytocin gives mom contractions which helps the uterus contract and the woman bleeds less. If the uterus does not crunch down or contract the woman will hemorrhage. Uterine atony (without tone) causes postpartum hemorrhage. Massaging helps the uterus to contract and bleed less.

Front 46

Lochia

-if a woman receives oxytocic medication, her flow is

Back 46

often scant until the medication wears off

Front 47

Lochia

-flow of lochia usually increases with

Back 47

ambulation and breastfeeding

Front 48

Lochia

-lochia tends to pool in the vagina when the woman is lying in bed, upon standing the woman may experience

Back 48

a gush of blood

Front 49

Lochia

-lochia should smell like

Back 49

normal menstrual flow

Front 50

Urinary System

what may be partly responsible for causing an increase in renal function

Back 50

-high steroid levels

Front 51

Urinary System

-kidney function returns to normal within

Back 51

a month after birth

Front 52

Postpartal Diuresis
-within ___hrs of birth women begin to lose the excess tissue fluid accumulated during pregnancy

-profuse diaphoresis occurs (esp at night) for the first ____days after childbirth


-increase or decrease, in urinary output

Back 52

12 hours

2-3 days


increase

Front 53

Urethra and Bladder

-birth induced trauma, increased bladder capacity following childbirth and the effects of conduction anesthesia combined to cause a (increase or decrease) urge to void

Back 53

decraese

Front 54

Urethra and Bladder

-decreased voiding combined with postpartal dieresis may result in

Back 54

bladder distension

Front 55

Urethra and Bladder

-immediately after birth, excessive bleeding can occur if the bladder becomes

Back 55

distended b/c it pushes the uterus up and to the side and prevents the uterus from contracting firmly

Front 56

Breasts
as the colostrum transitions to milk after birth
-how do the breasts feel:

Back 56

-the breasts may feel warm, firm, and somewhat tender


-bluish white milk with a skim milk appearance can be expressed from the nipples

Front 57

Breasts

-as milk glands and milk ducts fill with milk, breast tissue may feel somewhat

Back 57

nodular or lumpy (they shift) and typically only lasts 24-48 hrs