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postpartum
- 6 weeks after birth
- physical and psychological adjustments
- body returns to pre pregnant state
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immediate care
- -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
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uterus
- -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
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under and above umbilicus
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factors that inhibit involution
- -difficult, prolonged labor
- -anesthesia
- -grand multiparity
- -imcomplete expulsion of products of conception (pieces of placenta)
- -full bladder
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factors that enhance involution
- -uncomplicated labor and delivery
- -complete expulsion of products of conception
- -early ambulation
- -breast feeding (stimulates uterine contractions)
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lochia
discharge of exfoliated tissue from healing placental site
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3 types of lochia
- 1) rubra-dark red 1-3 days with clots
- 2) serosa- pinkish 4-10 days
- 3) alba- creamy yellow white discharge
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when does menstruation return after birth?
4-6 weeks
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breast changes
- -colostrum
- -primary engorgement
- -subsequent engorgement (once milk comes in)
- -mastitis (inflammation and infection of breast through cracks in nipples
- -nipple irritation
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cardiovascular changes
- -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
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respiratory changes
diaphragm moves down, resp. wall moves back
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immune system changes
- -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
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Rh incompatibilities (isoimmunizations)
- -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
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ABO Incompatibility
- -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.
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urinary system changes
bladder distention, incomplete emptying, inability to void, cystitis
diuresis-decreased estrogen, oxytocin, occurs with 12 hours after birth, eliminates excess tissue fluids
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gastrointestinal changes
constipation, motility, physical activity, dehydration/fluid loss, pain, hemorrhoids, appetite, weight loss
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endocrine system changes
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
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muscular system changes
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
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