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31 Cards in this Set
- Front
- Back
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Fundus Position
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should be midway between umbilicus and symphysis pubis. About one hour later it rises to about the umbilicus. After the first day, should decrease by one fingerbreadth(think cm) per day
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Fundus consistency
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Should be firm.
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Rubra
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Dark red, contains epithelial cells, RBCs, WBCs, bacteria, deciduas, fetal debris, first 3-4 days
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Serosa
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pinkish to brown; contains serous exudae, deciduous, RBCs, WBCs, cervical mucus, microorganisms; Day 4-10
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Alba
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creamy or yellow; contains WBCs, deciduous cells, epithelial cells, mucus, bacteria; after day 10
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Cervix
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immediately after birth, it is spongy, flabby, and formless. Rapidly regains original form within a few hours. Changes from a dimple in appearance to lateral slit after birth.
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Vaginia
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Normal rugae are obliterated during birth. may become edematous and bruised. Changes in hormones means less lubrication. Muscle tone can be restored but not to the pre preg level
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Episiotomy
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a surgical incision either midline or medioloateral to enlarge the perineum for delivery
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Breast Changes
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Milk ducts and mammary glands enlarge. Colostrum: first product which may occur prior to delievery: yellow in color; has important antibodies to protect the newborn against infection. Breast milk usually comes in at 2-3 days postpartum
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Abdominal Wall
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muscles are streched and may appear loose and flabby (still look preg) Diastatis recti abdominis is the separation of the reuctus abdominis muscles. Muscle tone is restored with rest, good posture and exercise within 2-3 months.
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Cardiovascular
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estimated blood loss can be 200-500 mL. Postpartum women can tolerate blood loss well. increase in the volume of circulating blood by 10-15% which is protective against PP hemorrhage. Incr in WBCs, and blood clotting factors
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Urinary
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decr sensitivity to fluid pressure and decre sensation of bladder filling. at risk for distension, incomplete emptying, UTI,
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Diaphoresis
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Commonly seen, elimination of excess fluid and waste products via the skin. Diaphoretic episodes often occur at night. Caution the woman to protect from chilling. Remind women this is normal.
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Gastrointestinal Changes
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Hemorrhoids can become quite uncomfortable due to preg itself or from strenuous pushing. constipation can continue to be a problem due to the prolonged effects of progesterone from pregnancy.
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Endocrine Changes
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Estrogen/ Progesterone: dreast feeding slows the rapid decrease after delivery of placenta. non breast feeding hormone changes are more rapid.
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Vital Signs( Blood Pressure)
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BP should remain stable (compare to 1st trimester) Decreased BP may be related to postpartum hemorrhage. Increased BP may be related to pregnancy induced HTN.
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Vital Signs (temperature)
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may be up to 38 degrees C (100.4 F) first 24 hrs after birth. Infection must be considered w/ temp above 38C AFTER first 24 hrs.
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Breasts
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inspection of the nipples, everted, flat, inverted? Breast tissue soft, filling, firm? Temperature and color; Warm, pink, cool, red streak?
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Uterus
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Location (midline or deviated to R or L side) and tone: firm, firm w/ massage, boggy.
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Bladder:
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last time the pt empied her bladder(spontaneous or via a cath) palpable or nomn palpable? color, odor, amount of urine?
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Bowel
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date/time of last BM. Presence of flaus and hunger? (if colon was manipulated ausculate for bowel sounds) depending on age and c-section they may not have bowel sounds.
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Lochia
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color, amount, presence of clots, any free flow?
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Episiotomy/ Laceration
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type as well as other tissue trauma (lacerations, etc) asses using REEDA
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Homan's sign
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pain, varicosities, warmth, or discoloration of calves. Presence of pedal pulses, sensation and movement (after c/s, or anasthesia)
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Emotional Status
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affect, pt- family interaction, effects of exhaustion
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Bonding
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Interaction w/ infant--"taking in" phase--presence of finder tipping, gazing, enfolding, calling infant by name
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REEDA
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Redness, Edema, Ecchymosis(bruising), Discharge(not the lochia but from the wound itself), Approximation(can you see the lines)
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PPH- Early
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blood loss greater than 500 mL with in the first 24 hrs after delivery.
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PPH- Late
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Blood loss greater than 500 mL after the first 24 hrs but within the 6 week recovery period.
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Hematoma
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blood clot within the tissue; concealed blood loss
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PPH- Interventions
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try fundal massage first. Administration of oxytocics
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