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43 Cards in this Set

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PostPartum

AKA

Time
AKA puerperium

4th trimester of pregnancy

6 weeks following childbirth
Changes in MOM
hormones....
uterus........
Placental hormones decline  body return to the pre pregnant state

Involution process begins following delivery
Involution......

caused by...........
Involution is a reduction in uterine size after delivery to the pre-pregnant state

caused by uterine contractions that constrict & occlude underlying bld vessels at the placental site;
What happens with the Uterus?
Uterus.......
time.............
Rapid reduction in size and weight after birth

within 5-6 weeks after delivery
Uterine Lining:
called when not preg.......
called when preg..............
placental site is fully healed within ......................
endometrium when not preg

dicidua during pregnancy

6-7 weeks
Involution occurs......
locaton........

Within 12 hours...........
At end of 3rd stage of labor

uterus is midline & 2cm below umbilicus

12hrs.-fundus rises to level of umbilicus
Fundus descends ____________every 24 hours
1-2 cm
1 week fundus.................
is halfway b/t umbilicus & symphysis pubis
_________________ is given immediately after expulsion of placenta
Pitocin
Subinvolution is...........

whats the most common cause....................
Failure of the uterus to return to a non-pregnant state

retained placental fragments & infection
A soft or _______ uterus should be ...............
boggy

massaged until firm to prevent hemorrhage
Medications may be administered to stimulate uterine contractions and prevent excessive bleeding
Oxytocin (Pitocin): routinely given following delivery
Methergine: given IM or PO to decrease bleeding
Hemabate: given IM to decrease bleeding
Assure the uterus remains firm to ........................
decrease hemorrhage
A full bladder ..........

increasing the risk ...............
displaces the uterus

increasing the risk of uterine atony and postpartum hemorrhage
To assess uterine bladder..............
lay mother down with head flat for the most accurate findings
non-pharmacologic way to prevent excessive blood loss
Mom may be encouraged to breastfeed immediately following delivery
Afterpains are................

what are they simlar to.....
Intermittent uterine contractions cause “afterpain” similar to menstrual cramps
drug of choice for after pains...
Motrin
After pain worsen with...........
Worsens with multiparous & breastfeeding moms
Mechansm of after pans............(how t works)
Breastfeeding or Nipple stimulation à leads to release of endogenous oxytocin from the posterior pituitary à causing the uterus to contract à cramping
What is lochia?

composed of.....
Vaginal discharge after delivery
Composed of endometrial tissue, blood, and lymph
Classifying Lochia
Color
Quantity
Odor
Lochia odor..............
Should be fleshy or menstrual odor
Lochia Rubra

composed of......

time......
composed mostly of blood
lasts approximately 3 days following delivery
Lochia Serosa:

composed of......

time.....
composed of blood and mucus

lasts 4-10 day
Lochia alba:

composed of......

time.......
composed of mostly mucus
may be yellow to white
lasts 11-21 day
Lochia Quantity
Scant: less than 2 inch stain Light: less than 4 inch stain Moderate: less than 6 inch Large or Heavy:larger than 6 in stain/1 saturated pad in 2 hrs
Excessive: saturation of pad within 15 minutes
If lochia is excessive…
Check and apply new pad every 15 minutes
Count and weigh each pad
Note: 1 gram = 1 mL of blood
The cervix regains muscle tone, but
never closes as tight as it was before pregnancy
A constant trickle of bright red blood may indicate .........
a cervical laceration especially if the fundus remains firm
Within 6 weeks the vagina has
regained most of its form, but never returns fully to the size it was prior to pregnancy
The Perineum is often..........
Often edematous, tender, and bruised
Epsiotomy:
incisional site to enlarge the vaginal opening during delivery
Laceration:
tearing of the perineum during birth
Nursing post partum Assessment............
VLF
Monitor Vital Signs
Observe Lochia character, color, amount, odor, and presence of clots
Evaluate firmness, height, and location of fundus
Document: Fundus firm, midline, located 1 FB below the umbilicus
REEDA
Observe perineum for hematoma, edema, and episiotomy using REEDA acronym
Redness
Edema
Ecchymosis
Discharge
Approximation
Episiotomy Care
Wash hands prior to cleansing or changing pads
Wash perineum with mild soap & warm water once daily
Clean & apply pad from front to back
Change pad ea void/ defecation
Ice pack first 24 hours
Squeeze bottle & blot dry after voiding
Sitz bath 2X qd for 20 minutes
Anesthetic cream or spray
Witch hazel pads
Postpartum Assessment.....
BBP
Observe bladder for fullness, pain, or inability to void
Observe breast for engorgement, nipple tenderness, and breastfeeding
Pain: determine location, character, and severity
What About DAD!
evaluate....
observe......
Evaluate family interaction, family support, and signs of postpartum depression
Observe for interest in the newborn

Do they make eye contact with the newborn, do they touch and console the baby
The production of ______and ______ stop once the placenta delivers
estrogen and progesterone
FSH rises causing the return of ovulation and menstruation between ___________ weeks
6-8 weeks
Breastfeeding moms may not ovulate, but
breastfeeding is not considered a reliable method of birth control
Ovulation can occur without .....
Menstruation