ch. 12 from notes

• 6 weeks after birth
• physical and psychological adjustments
• body returns to pre pregnant state

• -vital signs-sl. increase in temp., should be afebrile in 24 hrs.
• -slight bradycardia normal for 6-10 days
• -weight loss-immediate 10-12 lbs, prepregnant weight by 6-8 weeks
• -fundal check-location, position (R, L, midline), tone (should be firm not boggy)
• -postpartal chill-shaking is normal, give warm blanket

• -solid mass of tissue, grapefruit size for about 2 days, then decreases rapidly (involution)
• -fundus at midline just below umbilicus
• -measurement of fundus by fingerbreaths in relationship to umbilicus
• -firm or boggy
• -average blood loss-400-500 mls (delivery)
• -assess/massage

• under=u/2
• above=2/u

• -difficult, prolonged labor
• -anesthesia
• -grand multiparity
• -imcomplete expulsion of products of conception (pieces of placenta)
• -full bladder

• -uncomplicated labor and delivery
• -complete expulsion of products of conception
• -early ambulation
• -breast feeding (stimulates uterine contractions)

discharge of exfoliated tissue from healing placental site

• 1) rubra-dark red 1-3 days with clots
• 2) serosa- pinkish 4-10 days
• 3) alba- creamy yellow white discharge

4-6 weeks

• -colostrum
• -primary engorgement
• -subsequent engorgement (once milk comes in)
• -mastitis (inflammation and infection of breast through cracks in nipples
• -nipple irritation

• -increase cardiac output
• -increase in WBC's (flight or flight response)
• -orthostatic hypotension
• -postpartum chills
• -diuresis in the first 2-5 days
• -failure can lease to pulmonary edem-LISTEN TO LUNGS AND HEART

diaphragm moves down, resp. wall moves back

• -mild temp is common
• -muscular exertion
• -dehydration
• -hormonal changes
• -if greater than 100.4 after 24 hrs-may be pp infection
• -rubella-MMR shot if not breast feeding
• -Rh isoimmunization

• -Rh sensitization results from antigen antibody immunologic reaction
• -occurs when Rh negative women carries a Rh positive fetus
• -RBC's of fetus invade moms circulation, stimulate production of Rh antibodies
• -FIRST BABY IS NOT AFFECTED
• -subsequent pregnancies may lead to severe hemolysis in fetus-can cause still birth or miscarriage

• -type o=no antigens
• -never affected regardless of mothers blood type

• -limited to type o mothers who become pregnant with A, B, AB infants
• -moms with type a or b infants rarely causes significant hemolysis
• -FIRST INFANT CAN BE INVOLVED
• -observe for hyperbilirubinemia
• -unlike Rh incompatibility
• -antepartal treatment is not warranted because it does not cause severe anemia

• -indirect COOMBS test
• -determines if Rh negative mom has developed antibodies
• -if mom has (-) coombs-give rhogam within 72 hours of delivery to prevent antibody production
• -also given to Rh negative woman at 28 weeks gestation, amniocentesis, ectopic preg, abortion, GIVE RHOGAM IS BABY IS RH POS.

bladder distention, incomplete emptying, inability to void, cystitis

diuresis-decreased estrogen, oxytocin, occurs with 12 hours after birth, eliminates excess tissue fluids

constipation, motility, physical activity, dehydration/fluid loss, pain, hemorrhoids, appetite, weight loss

after placental delivery: estrogen decreases, progesterone decreases, prolactin decreases, estrogen then begins to rise after pp week 1, nonlactating prolactin levels decrease through first 3 weeks, menses 6-10 pp, ovulation by 4th cycle, lactating-prolactin levels increase, lactation can supress menses

uterine ligaments are stretched, abdominal wall looks loose and flabby, responds to exercise in 2-3 months, longer in multiparity, striae (stretch marks), leg and abdominal muscles are sore