ch. 12 from notes

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silvisaj44
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201255
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ch. 12 from notes
Updated:
2013-02-17 18:31:15
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12
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maternity
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  1. postpartum
    • 6 weeks after birth
    • physical and psychological adjustments
    • body returns to pre pregnant state
  2. 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
  3. 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
  4. under and above umbilicus
    • under=u/2
    • above=2/u
  5. factors that inhibit involution
    • -difficult, prolonged labor
    • -anesthesia
    • -grand multiparity
    • -imcomplete expulsion of products of conception (pieces of placenta)
    • -full bladder
  6. factors that enhance involution
    • -uncomplicated labor and delivery
    • -complete expulsion of products of conception
    • -early ambulation
    • -breast feeding (stimulates uterine contractions)
  7. lochia
    discharge of exfoliated tissue from healing placental site
  8. 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
  9. when does menstruation return after birth?
    4-6 weeks
  10. breast changes
    • -colostrum
    • -primary engorgement
    • -subsequent engorgement (once milk comes in)
    • -mastitis (inflammation and infection of breast through cracks in nipples
    • -nipple irritation
  11. 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
  12. respiratory changes
    diaphragm moves down, resp. wall moves back
  13. 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
  14. 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
  15. 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.
  16. 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
  17. gastrointestinal changes
    constipation, motility, physical activity, dehydration/fluid loss, pain, hemorrhoids, appetite, weight loss
  18. 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
  19. 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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