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132 Cards in this Set
- Front
- Back
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T/F - the uterus is a muscular organ
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T
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What is the job of the uterus until birth?
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houses and nourishes the fetus
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What is the job of the uterus during labor?
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contracts rhythmically to expel the fetus
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What three divisions make up the uterus?
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1-corpus
2-isthmus 3-cervix |
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Where is the fundus located?
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at the top of the uterus
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Name the three parts of the cervix
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1-internal os
2-cervical canal 3-external os |
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How long does the postpartum period last?
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6 weeks or 42 days
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Define puerperium
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return of reproductive organs to their non-pregnant state; can last up to 6 weeks (or 42 days)
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Do organs ever return to their pre-pregnant state?
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no
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Explain retrogressive r/t puerperium
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stuff that returns to non-pregnant state
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Explain progressive r/t puerperium state
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stuff that changes in order to accommodate
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Reproductive organs that change during postpartum
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uterus, cervix, vagina, perineum, breasts, endocrine
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Non-reproductive organs that change during postpartum
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abdomen, urinary, GI, musculoskeletal, integumentary, vascular
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What event sends a signal to the brain that a woman is no longer pregnant?
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placental expulsion
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Pregnancy is a vaso-dilated/constricted state. Why?
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vasodilated; to provide nourishment to the fetus
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Define uterine involution
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the rapid return of the uterus to its non-pregnant state
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When does uterine involution occur?
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immediately pp
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What endogenous hormone is responsible for uterine contraction?
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oxytocin
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What exogenous hormones i responsible for uterine contraction?
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pitosin
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What 2 things occur as a result of smooth muscle contractions in the uterus pp?
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1-thrombi in uterine wall
2-reduce size of uterus |
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What is the importance of administering pitosin pp and why is it considered "the gold standard?"
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to decrease the risk of pp hemorrhaging
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By what day should the fundus no longer be palpable
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10 days pp
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By what point is the uterus back to its non-preganant state?
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6 weeks pp
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Describe the fundal height immediately after birth
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it overcorrects; halfway between pubis symphasis (pubic bone) and umbilicus (belly button)
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Describe the fundal height 12hrs after birth
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rises to "one finger breath" above the umbillicus
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Describe the fundal height at 24hrs after birth
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at umbilicus or 1 finger breath below umbilicus
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If a baby is delivered at 6:50pm, describe the fundal height at:
a) 10pm b) 6:50am c) 6:50pm |
a-halfway btw pubis & umbilicus
b-1 fb above umbilicus c-at umbilicus or 1 fb below |
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As a general rule of thumb explain how much the fundal height should decrease per day
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~1 fb/day
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Under normal circumstances, how many days do we expect to measure fundal height?
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9 days
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What is potentially the most dangerous time for a woman after birth? Why?
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one hour after birth; if the uterus does not contract enough postpartum hemorrhage results
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What is the #1 cause of maternal death?
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postpartum hemorrhage
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What term describes a uterus that hasn't contracted postpartum?
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atony
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Define subinvolution
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failure or delay of the uterus to return to the non-pregnant state
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What are two potential causes of subinvolution?
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1-retained placental fragment
2-infection |
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What are after pains
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uterine contractions in the pp period
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After pains tend to be stronger for primiparas/multiparas? Why?
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multiparas; uterus is more stretched out from multiple births so the contractions to reduce its size are stronger
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What causes the presence of lochia pp?
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sloughing of uterine wall; it hasn't shed for 9mos!
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When does the body start producing progesterone again pp?
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until first ovulation
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By what time is the endometrium regenerated pp?
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within 6wks after delivery
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Name the 3 color descriptions of lochia and the time frames we would expect to see each one
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1-lochia rubra, 1-3 days pp
2-lochia serosa, 3-10 days pp 3-lochia alba, 10days-6wks pp |
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Describe the color of lochia rubra and what contents it may have
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red blood, with small particles of residual debris and mucous from placenta site
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Describe the color of lochia serosa and what contents it may have
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amount of blood decreases, leukocytes start to invade the area which signals healing; the color is a pinkish/brown
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Describe the color oh lochia alba and what contents it may have
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pale in color; contains cells, serum, leukocytes, and bacteria
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If color of lochia gets darker from one pp day to the next, what should you tell the pt?
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REST!!!
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There is more bleeding in a natural/c-section birth?
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c-section
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Describe the amount of blood seen with scant, light, moderate, and heavy when recording lochia
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scant < 2.5cm (1in)
light = 2.5cm-10cm (1-4in) moderate = 10-15cm (4-6in) heavy = saturated w/in 1hr |
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Upon assessment you notice that the pt's pad is saturated; what two interventions should be performed?
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1-ask when it was changed
2-massage to help contract fundus and clot off the bleeding |
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When do pregnancy hormones decrease?
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as soon as the placenta is no longer present
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What hormones decrease with placental expulsion?
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1-Human placental lactogen (hPL)
2-Human chorionic gonadotropin (hCG) 3-estrogen 4-progesterone 5-cortisol |
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What term describes the sort of changes seen with hormones that decrease after placental expulsion
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retrogressive
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What term describes the sort of changes seen with hormones that increase after placental expulsion
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progressive
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What hormone is the basis of pregnancy tests
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hCG; human chorionic gonadotropin
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What 2 hormones are responsible for maintaining pregnancy
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1-estrogen
2-progesterone |
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What 2 hormones increase after placental expulsion
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1-oxytocin
2-prolactin |
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What hormone is responsible for milk let-down?
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oxytocin
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What hormone is responsible for uterine contractions
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oxytocin
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What hormone is responsible for milk production
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prolactin
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What hormone (1) promotes normal nutrition and growth of fetus and (2) promotes maternal breast development for lactation
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hPL; human placental lactogen
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What hormone (1) helps maintain the corpus luteum to persist for the first 6-8 weeks of pregnancy and (2) helps to secrete progesterone and estrogen
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hCG; human chorionic gonadotropin
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What responsibilities does estrogen have r/t pregnancy?
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1-maintains pregnancy until development of placenta
2-causes breast enlargement 3-growth of ductal system of the breasts 4-enlargement of external genitalia |
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What responsibilities does progesterone have r/t pregnancy?
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promotes normal continuation of pregnancy
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What responsibilities does cortisol have r/t pregnancy?
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1-helps with metanolism of glucose, protein and fats
2-anti-inflammatory effect that is thought to help prevent rejection of fetus |
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Why do breasts enlarge during/after pregnancy?
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1-estrogen
2-larger glands 3-fluid accumulation |
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What 2 hormones cause continued production and release of breast milk as a result of suckling?
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1-oxytocin
2-prolactin |
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Is there a big/little difference in a woman's breast immediately after birth?
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little
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When do we expect to see colostrum pp?
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2-3 days
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When do the breasts become full pp?
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3-5 days
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How many days does it take for the external os opening to narrow down to the size of a pencil?
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by the 7th day
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What 2 changes might we see in the perineum pp?
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1-hemmorhoids r/t bearing down 2-edema/bruising from the birthing process
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Describe a nulliparous cervix and a parous cervix r/t the external os
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1-round os
2-slit os |
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What is a good way to describe how to perform kegal exercises to a pt?
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stop mid-urination, then continue
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How much hct and hgb is lost with 250ml of blood loss
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hct = 4pt
hgb = 1g |
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Why would a woman's appetite increase pp?
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1-labor is work
2-generally, NPO |
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Why is bowel evacuation delayed pp?
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presence of fetus decreases peristalsis in small intestine; increased fluid absorption which can result in constipation
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At what point in time do we administer a straight catheter pp?
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if the woman has not urinated w/in 48hrs after labor
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Explain what is meant by hemoconcentration, pp?
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decreased blood volume appears concentrated in comparison to previous hemodilution during pregnancy
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Explain the increased WBC count pp
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1-dehydration
2-trauma so migration of WBCs *this is normal, check temp for infection |
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What is linea negra
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hyperpigmentation on the abdomen seen during pregnancy r/t hormone secretion
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Explain why hair loss is considered "perceived hair loss," pp
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hair growth decreases pp, so although the hair is being lost at its typical turnover rate, it appears as though it is greater because hair is not growing in as fast
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Components of PP Nursing Assessment
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VS, Breasts&nipples, Abdomen, Uterus&fundus, Bladder, Perineum, Lochia, LE's
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What sort of temp might you find when performing a pp assessment?
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elevated w/in first 24hrs is normal
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What is one reason it is especially important to assist a pp woman out of bed?
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blood loss
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Upon palpation, you notice that the fundus is deviated, what does this finding suggest?
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the bladder is full and the pt needs to urinate
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What are you checking for in the LE's with a pp pt?
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1-swelling
2-cap refill 3-pedal pulses 4-holman's sign |
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What does Holman's sign assess?
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DVT
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Explain the procedure when assessing Holman's sign
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1-ask pt before if she is having any pain in leg
2-extend and lift leg, supporting the calf 3-DF the foot, and feel the calf 4-ask the pt if there is pain in the calf |
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When assessing the fundus what position should the woman be in
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lying flat
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What are abnormal findings of the fundus?
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1-fundal height greater than expected
2-fundus is not firm (boggy) |
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If the height of the fundus is greater than expected, what might this imply?
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subinvolution
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Components to look for with a cesarean incision
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1-approximation of edges
2-errythema 3-inflammation 4-swelling 5-drainage 6-staples 7-clean 8-dry 9-intact 10-dressing, open to air |
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Degree of perineal tears is in close relation to what? The better this is, the less likely a woman is to tear.
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nutrition
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What are the benefits of peri-bottle use?
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1-urge to urinate
2-cleans the area 3-barrier for incision from acidic urine |
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Define Episiotomy
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surgical incision of the perineum to prevent tearing and to help to release pressure on the fetal head at birth
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Define Laceration
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a jagged cut or tear that may involve only the skin layer of may penetrate deep subcutaneous tissues or tendons
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1st degree laceration/ episiotomy
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involves superficial vaginal mucosa or perineal skin
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2nd degree laceration/ episiotomy
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involves the vaginal mucosa, perineal skin, and deeper tissues, which may include mm of the perineum
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3rd degree laceration/ episiotomy
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same as 2nd degree + anal sphincter involvement; to the edge, not through
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4th degree laceration/ episiotomy
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extends THROUGH the anal sphincter into the rectal mucosa
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What is one complication found with 4th degree lacerations/ episiotomies?
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infection; stool spillage
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Name some areas where a woman might suffer from lacerations, excluding the perineum
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1-periurethral area
2-vaginal wall 3-cervix |
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If the uterus is contracting appropriately but the woman is still bleeding heavily, what might you investigate?
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additional lacerations
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Describe cervical tears
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1-typically found at 10 and 2
2-contracted fundus 3-spurting blood 4-source of significant bleeding |
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What are some additional items used to help soothe hemorrhoids and tears/ episiotomies?
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1-peri bottle
2-witch hazel pads, chilled 3-sitz bath |
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How much Pitosin is administered pp?
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20 units (in LR 1000cc) x 2 = 40
Rate = 100-125cc/hr |
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When is baby's FU? Mommy's FU?
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baby = 3-5 days
mommy = 6-8wks |
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How long is mommy ordered NPV (nothing per vagina)?
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not until fu w/ doctor, which is usually 6-8wks pp
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If mommy is taking pain meds what is something we need to warn her about?
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don't hold baby somewhere you might fall asleep, like in a chair
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Why is RHOGAM administered pp?
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If mommy is Rh- and baby is Rh+ it is important that RHOGAM is administered during the pp period so that mommy doesn't develop AB's to the Rh+ blood she may have be exposed to during placental expulsion; important for future pregnancies
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Important macronutrient mom needs pp
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protein
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Important nursing interventions pp
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1-prevent infection
2-prevent excess bleeding 3-comfort, rest, ambulation, exercise 4-nutrition 5-bowel and bladder function 6-breast feeding, lactation suppression 7-health promotion, protection of future pregnancies |
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HIV risk from mommy to baby
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< 2%
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Phases of Maternal PP adjustment
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1-Dependent
2-Dependent-Independent 3-Independent |
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Phases of "paternal" adjustment
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1-expectations
2-reality 3-transition to mastery |
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Is there a timeline for the phases of maternal/paternal adjustment? What needs to be achieved?
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no; advancement needs to be made
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Prevalence of Postpartum Blues
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50-80% of ALL women = benign
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Duration of Postpartum Blues (peaks, resolves)
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peaks within first week; resolves by second week
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Describe postpartum blues
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1-usually unrelated to events
2-comes and goes 3-ablility to care for baby 4-normal |
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Prevalence of Postpartum Depression
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15-20% of PP women
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Duration of Postpartum Depression
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3-12wks, can last up to a year
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What is the #1 sign of postpartum depression
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w/d and social isolation
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S&S's of postpartum depression
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1-worsening of sleep disturbances (none/always)
2-appetite change (never/always) 3-worsening depression and irritability ("snaps") 4-w/d & social isolation 5-lacks compensatory measures 6-interaction w/ baby is burdensome & demanding |
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PP Discharge teaching
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1-self care
2-signs of complications 3-sexual activity 4-contraception 5-prescribed meds 6-fu's and routine check ups 7-support groups 8-social interaction 9-s&s's of ppb & ppd |
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Expected blood loss during a vaginal birth that is still considered normal
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up to 500cc
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Expected blood loss during a c/s birth that is still considered normal
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up to 1,000cc
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What volume of blood loss during a vaginal birth is termed as postpartum hemorrhage
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800cc
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Mom's CO PP is increased/decreased initially?
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increased
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3 reasons maternal CO increases PP
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1-blood from uteroplacental unit now returns to maternal central
2-pressure on the blood vessels from gravid uterus is now gone 3-mobilization of excess fluid finds its way into vasculature |
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What (2) ways does the body rid itself of excess plasma volume during the pp period?
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1-diuresis
2-diaohoresis |
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How much diuresis is expected to see during the pp period
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~3,000cc/day
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What tiem of day should a new mom expect to experience increased diaphoresis
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at night
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Time course of PP changes in CO? (initially, for how long, when does it recover)
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1-initially elevated
2-elevated for 48hrs 3-returns to pre-pregnancy levels within 2 weeks pp |
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Define diuresis
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urine production
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