Nclex Ch 24: The Postpartum Period And Associated Complications

Front 1

Postpartum

Back 1

-Reproductive tract return to the normal non pregnant state
-Usually completed by 6 weeks after delivery

Front 2

Involution

Back 2

-Rapid decrease in size of uterus
-Breastfeeding clients may experience more rapid return of uterus
-Weight of uterus decreases from 2lbs to 2oz
-Fundus steadily defends into the pelvis and fundal height decreases about 1 finger (1cm) breadth a day
-10 days postpartum uterus cannot be palpated abdominally
-A flaccid fondus indicates uterine atony and should be massaged until firm
-Tender fondus indicates infection

Front 3

Lochia

Back 3

-Rubra:bright red to day 3
-Serosa: brownish pink day 4-10
-Alba: white discharge day 10-14
-Should smell like normal menstral flow
-Decreases daily
-Increases with ambulation
-Weight pad before and after and time between pads

Front 4

Cervix
Vagina

Back 4

-Cervical involution occurs; after 1 week the muscle begins to regenerate
-Vaginal distension decreases, although muscle tone never restored completely

Front 5

Ovarian Function

Back 5

-Ovarian function depends of the how fast the pituitary function is restored
-Menstrual flow resumes within 8 weeks among non breast feeding women and 3-4 months for breastfeeding women
-May experience amenorrhea during entire period of lactation
-Breastfeeding should not be used as a form of birth control

Front 6

Breasts

Back 6

-Decrease of estrogen and progesterone levels after delivery stimulates increased prolactin levels which promote breast milk production
-Breast become distended with milk on the third day
-Engorgement occurs with 48-72 hours
-Nonbreastfeeding mother should avoid nipple stimulation, apply breast binder, tight fitting bra, apply ice packs, take a mild analgesic to relieve discomfort of engorgement

Front 7

Urinary Tract

Back 7

-Diuresis usually begs within the first 24 hours after delivery

Front 8

GI

Back 8

-Women are usually very hungry after delivery
-Constipation can occur
-Hemorrhoids are common

Front 9

Vital Signs

Back 9

-Bradycardia is common during the first week with a range of 50-70 beats per minutes; if >100 may indicate excessive blood loss or infection
-BP remains unchanged; suspect hypovolemia if it decreases
-Temp may rise to 100.4 as a result of dehydrating effects of labor; any higher may be from infection and should be reported

Front 10

Breast Feeding

Back 10

-L: latch achieved by infant
-A: audible swallowing
-T: type of nipple
-C: comfort of mother
-H: help given
-Uterine cramping may occur during the first day while mother is nursing when oxytocin stimulation cause uterus to contract
-Wash breasts once daily; if engorgement occurs have mother breastfeed frequently and apply warm packs before feeding a ice after, and massage the breasts
-Do not use soap on the breasts
-If cracked nipples develop, expose nipples to air for 10-20 minutes after feeding and rotate baby for each feeding
-Babys stools will be light yellow, seedy, watery and frequent
-Avoid gas producing food and caffeine
-Hormonal contraceptives may cause a decrease in the milk supply and should avoid for first 6 weeks
-Estrogen containing contraceptives that contain estrogen are not recommended for breastfeeding mothers; rather progestin only are less likely to interfere with milk supply

Front 11

Cystitis

Back 11

-Infection of the bladder

Front 12

Hematoma

Back 12

-Localized collection of blood into the tissue of the reproductive sac after delivery; predisposing conditions: delivery with forceps, injury to blood vessels; can be life threatening
-Abnormal severe pain; pressure in the perineal area; sensitive, bulging mass in perineal area with discolored skin; inability to void; decreased hemoglobin and hematocrit; s/sx shock (pallor, tachycardia, hypotension)
-Place ice on hematoma site, encourage fluids, prep for urinary cath, prep for incision and evacuation of the hematoma if necessary

Front 13

Hemorrhage

Back 13

-Bleeding of 500mL or more after delivery
-Early (during first 24 hrs): caused by uterine atony (loss of tone), lacerations, or inversion
-Late (after 24 hrs): caused by retained placental fragments
-Interventions: massage the fudus, monitor vitals and funds every 5-15 min, monitor and estimate blood loss, monitor LOC, oxytocin may be administered, blood infusions may be administered, monitor hemoglobin and hematocrit

Front 14

Mastitis

Back 14

-Inflamation of the breasts as a result of infection; primarily seen breastfeeding mothers 2-3 weeks out
-Localized heat and swelling; pain; temp; flu-like symptoms
-Instruct in good hand washing and breast hygiene; apply heat or cold as prescribed, maintain lactation, encourage the manual expression of milk or breast pump every 4hrs

Front 15

Subinvolution

Back 15

-Incomplete involution or the failure of the uterus to return to its normal size and condition
-Data: Uterine pain on palpation, uterus is larger than expected, more vaginal bleeding than normal
-Monitor hemoglobin and hematocrit; elevate legs to promote venous return; encourage frequent voiding; Methyergine may be prescribed