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What is the process in which the uterus returns to its pre-pregnancy state?
Rate at which the uterus returns to normal:
- immediately after birth, uterus is the size of a grapefruit w/ fundus halway between umbilicus and symphysis pubis
- fundus then raises to umbilicus and stays for 12 hrs
- fundus descends 1 cm every day for 10 days, when its again in the pelvis & can't be palpated
After pains: the descent of the uterus cause discomfort because __________ is released and stimulates strong contractions or "__________" reflex.
Different types of lochia:
- Lochia rubra: mostly bloody w/ small pieces of deciduas and mucus
- Lochia serosa: color changes to pink/pinkish brown. Mostly serous exudates w/ cervical mucus, erythrocytes, and leukocytes
- Lochia alba: erythrocyte level decreases. Discharge becomes yellowish.
The vaginal/uterine discharge after childbirth is called __________ and may last up to __ weeks or more.
Postpartum complication: hemorrhage:
How much blood loss?
- blood loss >500mL after 3rd stage of labor or 1,000 mL after c-section.
- within first 24 hrs; late can occur 1-6 weeks after birth
- cause: uterine anonty, retained placental fragments, lacerations of the birth canal, and hematomas
__________ is discomfort during intercourse due to decreased vaginal lubrication as a result of reduced estrogen levels.
Peurperal (postpartum) infection:
- following child birth and 6 weeks postpartum
- temp 100.4 or > on two separate occasions on 2 of the 1st 10 postpartum days
Wound infections after birth could be due to:
- surgical incisions
Metritis after birth is:
- inflammation of the uterus
- can spread to the fallopian tubes
- chills and fever
__________ is inflammation of the breasts (usually during breast feeding).
__________ is usually the cause, but candida albicans can also cause it.
When do s/s appear?
- appear 2-4 weeks after birth
- Contributing factors: crack/fissue in nipple and allowing milk stasis
__________ is an abnormal stimulation of the clotting mechanism, which consumes clotting factors, causing small clots throughout the vascular system and wide spread bleeding (internally and externally)
DIC (disseminated intravascular coagulation
DIC can be caused by pre-existing problems like:
- placenta abruption
- severe reclampsia
- dead fetus
What is the tx for DIC?
What are the effects of an epidural/spinal anesthesia on a bladder?
- distention/difficulty voiding until anesthesia wears off
- ketonuria and elevated BUN may be present
- urinary stasis provides bacteria w/ enough time to multiply and cause infection
Uterine involution causes mild __________ for 1-2 days in 50% of women.
Ovulation returns in breast feeding women w/in __ months and non-breast feeding women as early as __ days.
Vital signs should be taken every __ min for the first 1-2 hrs after birth, then q8h if no problems are identified.
Post partum assessment:
- BUBBLE completed every shift
- c-section; also assess resp rate/depth q15 min for first hr and 30 min for next 4-5 hrs, then every hr for the remainder.
BUBBLE assessment: breasts
- abnormalitites/reddened areas
- gently palpate for softness/firmness, engorgement, warmth, & tenderness
- REEDA: redness, ecchymosis, edema, discharge, approximation of suture line
BUBBLE assessment: uterus
- palpate abd to find fundus (press in and down w/ side of 1 hand and place other above symphysis to support uterus)
- note size, consistency, and placement.
- should be firm and in midline
- should descend 1 cm qd
- documented in relation to umbilicus
BUBBLE assessment: bowels
inspect abd for distention and auscultate for bowel sounds
BUBBLE assessment: lochia
- mother lies on back w/ knees flexted and apart so pad can be lowered in front
- lochia assessed for color, amt, odor, and presence of clots
- mother then asked to turn to side so you can see if lochia has pooled
BUBBLE assessment: episiotomy
- while checking for lochia, raise upper buttocks enough to see episiotomy.
- note redness, echymosis, edema, discharge, and approximation of suture line.
- inspect labia for bruising/swelling
- check for hemorrhoids
BUBBLE assessment: REEDA
- approximation of suture line
Nursing management of post-partum pt:
- uterine ht, firmness and position
- blood loss (pad count)
- assess bladder for distention
- assess pain level, BUBBLE qshift
- meds as ordered
- encourage BR
- encourage fl intake
- asist pt to feed/interact w/ baby
Normal findings of the uterus after delivery:
- size of grapefruit w/ fundus halway between umbilicus and symphysis pubis
- rundus raises to umbilicus and stays for 12 hrs
- firm, not boggy
- in the midline
Post-partum teaching (self care):
- assessing fundus
- breast care
- encourage to bathe, feed herself, toilet herself to support recovery
Rh and RhoGAM: __ injections are given to protect the fetuses of future pregnancies.
It is given w/in __ hrs after birth to preven sensitization of Rh negative mothers who gave birth to Rh __________ infants.
Promotes __________ of fetal Rh positive red blood cells before mothers body is able to form antibodies against them.
- 2 injections
- 72 hrs
Degrees of lacerations:
- 1st: skin and mucous membrane
- 2nd: skin, mucous membrane, and muscle
- 3rd: skin, mucous membrane, muscle, and rectal sphincter
- 4th: skin, mucous membrane, muscle, rectal sphincter, and rectal mucousa
Changes women go through w/ the birth of a child:
- touch: finger tipping- uses fingertips to explore infants face, fingers, and toes
- engrossment: parents intense interest and preoccupation in the newborn
Father's changes w/ the birth of a child:
- may exhibit engrossment and has desire to touch/hold baby
- most want to be involved, but may lack confidence in caring for an infant
Taking in phase:
focus on mother's needs (takes in attention from others/depends on others to meet needs) 24 hrs-3days
Taking hold phase:
- mother becomes more independent as she takes an interest in and responsibility for her own care.
- focus shifts to infant
- welcomes opportunities to learn behavior of infant and practice care for her baby
- father in similar, but may be anxious
- lasts approx. 10 days
Letting go phase:
- first baby- mother/father must give up role/carefree life of being only a couple
- must let go of planned experience
- baby may not fit their expectations
Normal findings after an epidural/spinal:
- bladder distention
- spinal h/a
- weak w/ first ambulation