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44 Cards in this Set
- Front
- Back
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Postpartal period is when?
What is puerperium? |
-first 6 weeks after birth
-begins with delivery of placenta -ends when body systems return to prepregnant state Puerperium is 6 wks after birth |
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Involution
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-rapidly shrinking of the uterus after delivery.
-after delivery 2.4lbs size of grapefruit -1 wk 500 grams -6 wk 50 grams |
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What causes involution of the uterus?
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-contractions (oxytocin)
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What happens to the uterus during involution?
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-muscle fibers shorten
-walls of uterus thickens and gets smaller -fundus decreases at a predictable rate |
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What is the predictable rate of the fundus shrinking?
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-after birth-2cm below umbilicus
-by 12 hrs ~1cm above umbilicus -descends 1 cm per day until 9-10 days when you cannot palpate it anymore |
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Subinvolution
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-uterus does not return to nonpregnant state.
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Causes of subinvolution
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-retained placental fragments
-infections |
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What controls the contractions immediatley after placenta delivery?
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-oxytocin controled by the pituitary gland
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Exogenous oxytocin? what does it do?
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-Pitocin-IV or IM
-stimulates uterine smooth muscle contractions |
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"Afterpains" or contractions that occur PP occur for who and for how long
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-multigravida, twins, large body, cause of streatched uterus.
-lasts 2-3 days. |
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placental site
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-large open wound
-blood vessels pinched off; thrombi form; seal the site -eventually endometrail tissue forms over the raw area -no scar tissue formed |
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Lochia Rubra
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-1-3 days
-consists almost entirely of blood with small particles of decidua and mucus -small blood clots -for first 2 hours after birth, amount is similar to heavy menstrual flow -clots >2" are too big |
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Lochia serosa
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-4-10 days
-pink or reddish brown (old blood, leukocytes, tissue debris) -watery -no clots -no odor to earthy odor like meses -if happens longer than 10 days could indicate infection |
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Lochia Alba
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-at 10 days
-colorless to whilte or yellow -can last 2-6 weeks |
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Amount of lochia
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-increases with ambulation and breast feeding
-tends to pool when in bed -if on Pitocin, scant amounts |
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Bright red bleeding with firm uterus means what?
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laceration
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C-Section Lochia
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-lesser amount but still goes through 3 stages
-see later stage cause in hospital longer |
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Cervix immediately after delivery
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-soft, edematous; partly open, can admit two fingers
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Cervix within 24 hours
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-rapidly shortens, becomes firmer, thicker
-may look bruised with multiple small lacerations -by 7 days, external changes from round to a slit like opening; size of a pencil opening |
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Vagina PP
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-greatly streatched
-increased edema -small lacerations -very few rugae -estrogen with ovulation causes return to normal -BF moms, ovulation postponed; may experience vaginal dryness -takes 6 weeks to get back to prepregnant size |
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Perineum
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-muscles torn and stretched-swollen and reddened
-vulva is deep red, velvety appearance -lacerations, bruises around opeing -hemorrhoids-commonly seen. Usually decrease after childbirth |
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Episiotomy
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-surgical cut midline or mediolateral to increase vaginal outlet
-also to prevent laceration -prevents pressure on infants head -usually heals with little inflammatory reaction |
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Perineal laceration
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-occur when fetal head is being born
-classifications into 1, 2, 3, 4th degree |
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Hematoma
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-severe pain and rectal pressure
-can cause tissue necrosis -relief of perineal pain is nursing priority |
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Pelvic muscle support/healing
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-pelvic floor muscles may require 6 months to regain tone
-can lead to future problems -teach kegals |
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Endocrine system
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-human placental lactogen (hPL), estrogen, cortisol, and insulinase gone reverses diabetogenic effect
-decreased estrogen aids diuresis of fluids -decreased progesterone levels |
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Will a mom with type 1 diabetes require more or less insulin after delivery?
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-less insulin
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Pituitary hormone/ovarian function in a lactating woman?
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-levels remains increased
-suppresses ovulation-happens at about 6 months -may have menses even if not ovulating |
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Pituitary hormone/ovarian function in non-lactating women
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-prolactin levels decrease; reach prepregnant state in 3-4 weeks
-ovulation at 27 days to 10 weeks -70% resume menses by 12 weeks |
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Breasts/prolactin in non-lactating women
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-may secrete colostrum for 2-3 days
-engorgement of breast tissue occurs on 3rd day, lasts 24-36 hrs, usually resolves on own -should wear tight bra to compress milk ducts; cold applications to reduce swelling |
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Prolactin in the lactating women
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-high level of prolactin initiates milk production within 2-3 days
-continues to be produced by contact with nursing baby |
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Where is oxytocin produced and stored?
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-produced by hypothalamus
-stored in posterior pituitary |
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What does oxytocin do in the postpartum mom
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-increases tone and mobility of uterine muscle
-oxytocin stimulates release of milk into lactiferous ducts; increases flow, not volume; called let down reflex |
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Normal blood loss in delivery of single infant for vag and C/S
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-vag; 500ml
-C/S; 1000ml |
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What happens to the blood volume after baby is born
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-transient increase in blood volume
-causes increases BP and lowers P |
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Blood volume after delivery
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-decrease due to diuresis/uo = 3000ml in first few days
-can lose up to 5 lbs -diaphoresis |
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Blood clotting
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-during pregnancy increased fibrinogen
-remains elevated after baby is born -puts patient aat risk for DVT, PE's |
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Blood values
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-greater loss of plasma than blood cells; thus;
increased Hbg, increased Hct -WBC: during first 10-12 days 20,000-25,000 (5,000-10,000 normal) |
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Urinary system problems after delivery
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-urinary retention
-bladder distention |
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Urinary retention
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-much pressure on bladder and urethra (vag delivery)
-decreased bladder tone -edema of urethra -decreased sensation to void -if epidural or spinal feel no sensation until effects wear off |
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Bladder distention
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-due to postpartal diuresis within 12 hours
-should try to void within first 1-2 hours -bladder distention can lead to boggy fundus |
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Lactosuria
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-can be seen in nursing moms
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Proteinuria
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-can be seen a slight increase for 1-2 days
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Constipation
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-decreased muscle tone in intestines
-muscles used for defecation stretched -may be delayed until 2-3 days PP -fear of pain-episiotomy, hemorrhoids |
