NUR 211 EXAM 3 Study Guide new update 2022
Postpartum Adaptations and Nursing Care
Reproductive System Changes: Involution of Uterus
˜ Contraction of muscle
Ø Controls bleeding from site of placental attachment Ø Decreases size of
uterus
˜ Catabolism
Ø Reduction in cell size
Ø Byproducts are excreted in urine
˜ Regeneration of uterine epithelium Ø First layer: Decidua
Ø Basal layer
Ø Endometrial layer
Reproductive System Changes: Descent of Uterine Fundus
˜ Assess fundal height
˜ Subinvolution can cause postpartum hemorrhage
˜ Document in relation to umbilicus
Reproductive System Changes: After Pains
˜ Etiology
ØMore acute for multiparas
ØMore severe with overdistention
ØMore severe during breastfeeding caused by release of oxytocin
˜ Nursing considerations
Ø Analgesic frequently used
Ø Medicate before breastfeeding.
Ø Enhance comfort and relaxation to facilitate letdown of milk.
Reproductive System Changes: Lochia
˜ Changes in color
NUR 211 EXAM 3 Study Guide new update 2022
,NUR 211 EXAM 3 Study Guide new update 2022
ØLochia rubra: Days 1 to 3
ØLochia serosa: Days 3 to 10
Ø Lochia alba: After day 10
˜ Amount difficult to quantify
• Ø Scant: Less than a 2.5-cm (1-inch) stain on the peripad
• Ø Light: Less than 10-cm (4-inch) stain
• Ø Moderate: Less than 15-cm (6-inch) stain
• Ø Heavy: Saturated peripad in 1 hour
• Ø Excessive: Saturated peripad in 15 minutes
Reproductive System Changes: Cervix
˜ Dilated, edematous, and bruised
˜ Small tears or lacerations may be present ˜ Rapid healing takes place
Reproductive System Changes: Vagina
˜ Greatly stretched
˜ Walls appear edematous
˜ May have multiple small lacerations
˜ Few vaginal rugae (folds) are present. Ø Rugae begin to
reappear by 3 to 4 weeks. Ø Vaginal epithelium restored 6 to
10 weeks.
˜ Vaginal wall regains thickness.
˜ Dyspareunia (discomfort during intercourse)
Reproductive System Changes: Perineum
˜ Pelvic floor muscles stretch and thin. ˜ May be edematous and bruised
˜ Laceration and episiotomy
˜ Discomfort
˜ Nursing considerations
NUR 211 EXAM 3 Study Guide new update 2022
,NUR 211 EXAM 3 Study Guide new update 2022
Ø Relief of perineal discomfort
Ø Teaching self-care measures
NUR 211 EXAM 3 Study Guide new update 2022
, NUR 211 EXAM 3 Study Guide new update 2022
Reproductive System Changes: Resumption of Ovulation and Menstruation
• ˜ First few cycles for lactating and nonlactating
women are often anovulatory.
• ˜ Ovulation may resume before first postpartum follow up visit to
provider.
• ˜ Contraceptive measures important
• ˜ Nonlactating women usually resume menstruation in 6 to
10 weeks
• ˜ Breastfeeding delays ovulation and the return of menstruation; menses
usually returns between 10 weeks and 6 months.
Reproductive System Changes: Lactation
• ˜ Estrogen and progesterone prepare breasts for lactation during
pregnancy.
• ˜ After expulsion of placenta, estrogen and progesterone levels
decline rapidly.
• ˜ Prolactin initiates milk production in 2 to 3 days after
childbirth.
• ˜ Oxytocin required for milk-ejection or “let-down” Cardiovascular
System Changes: Cardiac Output
• ˜ Increased flow of blood back to the heart
• ˜ Decreased pressure from the pregnant uterus on the vessels
• ˜ Mobilization of excess extracellular fluid into the vascular
compartment
• ˜ Cardiac output returns to prepregnancy levels in
most women by 6 to 12 weeks
Cardiovascular System Changes: Plasma Volume
NUR 211 EXAM 3 Study Guide new update 2022
Postpartum Adaptations and Nursing Care
Reproductive System Changes: Involution of Uterus
˜ Contraction of muscle
Ø Controls bleeding from site of placental attachment Ø Decreases size of
uterus
˜ Catabolism
Ø Reduction in cell size
Ø Byproducts are excreted in urine
˜ Regeneration of uterine epithelium Ø First layer: Decidua
Ø Basal layer
Ø Endometrial layer
Reproductive System Changes: Descent of Uterine Fundus
˜ Assess fundal height
˜ Subinvolution can cause postpartum hemorrhage
˜ Document in relation to umbilicus
Reproductive System Changes: After Pains
˜ Etiology
ØMore acute for multiparas
ØMore severe with overdistention
ØMore severe during breastfeeding caused by release of oxytocin
˜ Nursing considerations
Ø Analgesic frequently used
Ø Medicate before breastfeeding.
Ø Enhance comfort and relaxation to facilitate letdown of milk.
Reproductive System Changes: Lochia
˜ Changes in color
NUR 211 EXAM 3 Study Guide new update 2022
,NUR 211 EXAM 3 Study Guide new update 2022
ØLochia rubra: Days 1 to 3
ØLochia serosa: Days 3 to 10
Ø Lochia alba: After day 10
˜ Amount difficult to quantify
• Ø Scant: Less than a 2.5-cm (1-inch) stain on the peripad
• Ø Light: Less than 10-cm (4-inch) stain
• Ø Moderate: Less than 15-cm (6-inch) stain
• Ø Heavy: Saturated peripad in 1 hour
• Ø Excessive: Saturated peripad in 15 minutes
Reproductive System Changes: Cervix
˜ Dilated, edematous, and bruised
˜ Small tears or lacerations may be present ˜ Rapid healing takes place
Reproductive System Changes: Vagina
˜ Greatly stretched
˜ Walls appear edematous
˜ May have multiple small lacerations
˜ Few vaginal rugae (folds) are present. Ø Rugae begin to
reappear by 3 to 4 weeks. Ø Vaginal epithelium restored 6 to
10 weeks.
˜ Vaginal wall regains thickness.
˜ Dyspareunia (discomfort during intercourse)
Reproductive System Changes: Perineum
˜ Pelvic floor muscles stretch and thin. ˜ May be edematous and bruised
˜ Laceration and episiotomy
˜ Discomfort
˜ Nursing considerations
NUR 211 EXAM 3 Study Guide new update 2022
,NUR 211 EXAM 3 Study Guide new update 2022
Ø Relief of perineal discomfort
Ø Teaching self-care measures
NUR 211 EXAM 3 Study Guide new update 2022
, NUR 211 EXAM 3 Study Guide new update 2022
Reproductive System Changes: Resumption of Ovulation and Menstruation
• ˜ First few cycles for lactating and nonlactating
women are often anovulatory.
• ˜ Ovulation may resume before first postpartum follow up visit to
provider.
• ˜ Contraceptive measures important
• ˜ Nonlactating women usually resume menstruation in 6 to
10 weeks
• ˜ Breastfeeding delays ovulation and the return of menstruation; menses
usually returns between 10 weeks and 6 months.
Reproductive System Changes: Lactation
• ˜ Estrogen and progesterone prepare breasts for lactation during
pregnancy.
• ˜ After expulsion of placenta, estrogen and progesterone levels
decline rapidly.
• ˜ Prolactin initiates milk production in 2 to 3 days after
childbirth.
• ˜ Oxytocin required for milk-ejection or “let-down” Cardiovascular
System Changes: Cardiac Output
• ˜ Increased flow of blood back to the heart
• ˜ Decreased pressure from the pregnant uterus on the vessels
• ˜ Mobilization of excess extracellular fluid into the vascular
compartment
• ˜ Cardiac output returns to prepregnancy levels in
most women by 6 to 12 weeks
Cardiovascular System Changes: Plasma Volume
NUR 211 EXAM 3 Study Guide new update 2022
