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25 Cards in this Set

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Postpartum Period
A.K.A. Puerperium
A.K.A. The 4th Trimester of pregnancy

The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state.
Involution
The return of the uterus to a nonpregnant state after birth.
This process begins immediately after the expulsion of the placenta.
Within 12 hrs of delivery, the fundus may be approximately . . .
1 cm ABOVE the umbilicus
The fundus descends about...
1 to 2 cm every 24 hrs
Lochia
Postchildbirth uterine discharge.
Initially bright red, and may contain small clots.
Lochia Rubra
Consists mainly of blood and decidual and trophoblstic debris (bright red)
Lochia Serosa
Consists of old blood, serum, leukocytes and tissues debris
External Cervical Os
Never regains its prepregnancy appearance.
It is longer shaped like a circle but appears as a jagged slit.
Often described as a "fish mouth."
Postpardum Estrogen and Progesterone Levels
Decrease markedly after expulsion of the placenta.
Reach their lowest levels 1 week postpardum.
Human Chorionic Gonadotropin (hCG)
Disappears from maternal circulation in 14 days.
Prolactin Levels
Rise progressively throughout pregnancy.
Remain elevated into the 6th week after birth.
Influenced by the frequency of breast feeding, the duration of each feeding, and the degree that supplemental feedings are used.
Ovulation
Occurs as early as 27 days after birth in nonlactating women.
Mean time is 70 - 75 days.
Diastasis Recti Abdominis
The separation of abdominal wall muscles as a possible result of overdistention r/t a large fetus or multiple fetuses.
Physiological Adaptation
1. Uterus involution
2. Temperature (+100.4 F)
3. Leukocytosis - increased WBCs for couple days postp.
4. Chills/Shakes - warm blankt
5. Diaphoresis - night sweats
(blood supply increases by 30% - 50% and affects diaphoresis.)
6. After pains - take Ibuprophen on a SCHEDULE not PRN!
Warning signs of lack of attachment?
1. Unable to notice feeding cues.
2. Distance
3. Birth Defect
4. The baby is of a different gender than they were hoping for.
Postpartum Assessment
BUBBLE-HEC
Bladder, Uterus, Breast, Bowel, Lochia (healing = bright red), Episiotomy
Homan's sign (no longer using -DVT test), Emotional adjustment, Comfort
Levels of Tears
1. Primary - Vag. laceration
2. Secondary - Muscle
3. Tertiary - Muscle around
rectum
4. Tear all the way through rectal mucossa
Average amount of room for feeding of newborn?
5 - 7cc max
What factors would interfere with involution?
1.Uterus muscle (myometrium) is overstretched.
a. Large infant
b. Multiple gestation
2. Uterus tired
a. Prolonged labor with oxytocin
"Milk Coming In"
This is the process of the colostrum (a clear-yellow fluid) transitioning to milk to be expressed from the breast 72-96 hrs after birth
Breast Assessment/Care
Look For:
1. Intact Skin
2. Redness around the nipple
3. Fullness of breast
4. Hardened or reddened areas (be sure to show Dr.)
5. Engorgement d/t congestion
6. Apply ice for pain
7. Wear a cotton bra
8. Avoid breast stimulation if not breast feeding
Fundal Checks
1. Have mother empty bladder BEFORE you check fundus.
2. Two handed approach
a. One on top of the fundus
b. 2nd just above PUBIC bone supporting to prevent uterine prolapse
3. Check consistency
a. Firm, boggy
b. Fundus s/b firm like a GRAPEFRUIT
Respiratory Function
Returns to normal levels by
6 - 8 weeks after birth.
WBC Count
1. Normal leukocytosis of pregnancy = 12,000/mm3
2. During the 1st 10-12 days after childbirth, values between 20,000 and 25,000/mm3 are common
Lochia Levels
(how long do they last?)
1. RUBRA- usually no more
than 3 - 4 days.
2. SEROSA - by 3 - 4 days.
3. ALBA - after about 10 days

Bright red>Dark red>Pink>White>Clear
- Backwards movement (pink >red) means mother is doing to much!