NURS 3526 EXAM REVIEW STUDY GUIDE-MATERNAL
PHYSIOLOGIC CHANGES 2023 A+
Uterus: involution – return of uterus to a nonpreg state.
• 1 cm above or at umbilicus at 12h
• Descends 1-2 cm q24h
• No longer palpable by 2wks
• Nonpreg state by 6wks
Uterus subinvolution – the uterus does not return to its normal size; most common causes are retained
placental fragments and infection
Uterus contraction – hemostasis by compression of intra-myometrial blood vessels. Mediated by
oxytocin
• Uterine atony – fail to contract after the delivery; most common cause of excessive
bleeding (hemorrhage)
• After-pains – worse for multigravida, large baby and multiple
births. Uterus – Lochia: post-birth uterine discharge.
• Rubra: blood, decidua, trophoblastic debris; 3-4 days
• Serosa: old blood, serum, leukocytes, debris; 4-10 days
• Alba: leukocytes, decidua, epithelial cells, mucus, serum, bacteria: 2-6 wks
Uterus – cervix: soft after birth; bruised
• 12-18h regains short, firm form
• Os 1cm by 1wk; External os never regains pre-preg form
Vagina & Perineum: walls thin and dry – thicken with ovarian func return
• Rugae absent; reappear in 3wks
• Perineum – edematous & erythematous. Lacerations/episiotomy (4-6 wks to heal
fully). Hemorrhoids (decrease by 6wks)
• Pelvic muscles: torn/stretched during delivery. Poor tone – 6m to regains; Kegels to help
o Lift pelvic floor and contract muscles. They have been proven effective in
reducing urinary incontinence
o Squeeze muscles use to hold urine hold 10 secs, let go, 10 repetitions
Endocrine system – placental hormones: dramatic decrease in placental derived hormones – estrogen
and progesterone levels lowest at 1wk
• Decreases in hCS, estrogens, cortisol, insulinase reverse effects of pregnancy
• Diabetic mothers will likely req much less insulin for several days
Endocrine sys – pituitary & ovarian: cont increase in prolactin
• 70% of non-breastfeeding mothers menstruate by 12th week
1
, NURS 3526 EXAM REVIEW STUDY GUIDE-MATERNAL
PHYSIOLOGIC CHANGES 2023 A+
• Return of ovulation depends on breastfeeding patterns for breast-feeders
o Persistence of prolactin suppresses ovulation
o Contraception
Urinary sys – fluid loss
• diuresis (increase peeing) within 12h of birth greater than 3L per day in first 2-3 days
• profuse diaphoresis (sweating) at night – up to 6.6lb wt loss in early days
urinary sys – urethra and bladder
• decreased urge to void = bladder distention = excessive bleeding
o encourage frequent voiding
• stress incontinence – Kegels
GI sys: increase appetite. Bowel evacuation delayed for 2-3 days
• decrease muscle tone, anesthesia, pre-labor diarrhea, NPO, dehydration, psychological
factors, encourage regular bowel habits/appropriate diet
Breasts:
• breastfeeding: 24h – no change in breast tissue. Colostrum expressed; 72-96h – breast
enlargement (warm, tender, lumpy – increased blood and lymphatics). True milk
production
• non-breastfeeding: same as breast feeding mother. Engorgement resolves spontaneously
and discomfort decreases within 24-36 h
cardiovascular sys - blood vol
• CO increased 60-80% from pre-labor; drop within 1h. pregnancy-induced hypervolemia (up
40- 45%)
• Avg blood loss: 300-500ml (Vagina); 500-1000ml (C-section); additional loss via
diuresis Cardio – vs:
• Temp up to 100.4 in first 24h due to dehydration; return to normal afterwards
• Pulse remain elevated for 1st hr; gradual decrease over 48h
• Resp – no changes
• BP transient – increase by 5% for few days, return to normal over wks or months,
orthostatic hypo possible
Cardio – blood components:
• Hematocrit and hemoglobin decrease – rise in HCT and Hgb by 7th day; WBC count
increase; coagulation factors increase
Integumentary sys:
• Melasma usually disappears
• Hyperpigmentation may persists – areola. Linea nigra.
• Striae gravidarum (stretch marks) fades
2
, NURS 3526 EXAM REVIEW STUDY GUIDE-MATERNAL
PHYSIOLOGIC CHANGES 2023 A+
• Vascular abnormalities regress – varicosities, palmar erythema, angiomattas
• Hair loss
• Nails return to consistency and
strength Musculoskeletal sys:
• Decreased abd wall tone – returns by 6wk
o Muscle tone is restored by diet, rest, exercise, and good body mechanics.
• Joints stabilize by 6-8 wks
• Often shoe size up
• Neurologic changes reversed – BP req careful assessment
CHAPTER 19: Nursing care during the postpartum period
Priorities of nursing care:
• Assess physiologic and psychologic adaptation
• Prevent complications
• Assist with rest and recovery after birth
• Educate: self-management and infant care
• Support transition to parenthood
Nursing dx in postpartum:
• Risk for hemorrhage, infection, urinary retention, constipation
• Acute pain
• Impaired attachment
• Knowledge deficit
Transfer to postpartum – criteria:
• Completely recovered from anesthesia, stable, the first 1-2h after birth aka the 4th stage of
labor is the crucial time for mother and newborn.
• Pulse, resp, and BP are assessed q15min – hemorrhage is likely to
occur Ongoing physical assessment
• BUBBLE-HE: Breasts Uterus Bladder Bowel Lochia Episiotomy Homan’s sign (no) – legs circulation
Emotions and bonding
• L-R: scant (<2.5cm); light (<10cm); moderate (>10cm); heavy (saturated in 2h)
Promote comfort – relieve pain with non-pharm (cold packs, heating pads, prone position, massage) and
pharm (NSAIDS, narcotics)
Promote elimination – encourage voiding. Measure voids; catheterize if non invasive measures fail
• Measures to avoid constipation – fluids, ambulation, stool
softener Promote healthy lifestyle – rest, exercise, ambulation, nutrition
3
PHYSIOLOGIC CHANGES 2023 A+
Uterus: involution – return of uterus to a nonpreg state.
• 1 cm above or at umbilicus at 12h
• Descends 1-2 cm q24h
• No longer palpable by 2wks
• Nonpreg state by 6wks
Uterus subinvolution – the uterus does not return to its normal size; most common causes are retained
placental fragments and infection
Uterus contraction – hemostasis by compression of intra-myometrial blood vessels. Mediated by
oxytocin
• Uterine atony – fail to contract after the delivery; most common cause of excessive
bleeding (hemorrhage)
• After-pains – worse for multigravida, large baby and multiple
births. Uterus – Lochia: post-birth uterine discharge.
• Rubra: blood, decidua, trophoblastic debris; 3-4 days
• Serosa: old blood, serum, leukocytes, debris; 4-10 days
• Alba: leukocytes, decidua, epithelial cells, mucus, serum, bacteria: 2-6 wks
Uterus – cervix: soft after birth; bruised
• 12-18h regains short, firm form
• Os 1cm by 1wk; External os never regains pre-preg form
Vagina & Perineum: walls thin and dry – thicken with ovarian func return
• Rugae absent; reappear in 3wks
• Perineum – edematous & erythematous. Lacerations/episiotomy (4-6 wks to heal
fully). Hemorrhoids (decrease by 6wks)
• Pelvic muscles: torn/stretched during delivery. Poor tone – 6m to regains; Kegels to help
o Lift pelvic floor and contract muscles. They have been proven effective in
reducing urinary incontinence
o Squeeze muscles use to hold urine hold 10 secs, let go, 10 repetitions
Endocrine system – placental hormones: dramatic decrease in placental derived hormones – estrogen
and progesterone levels lowest at 1wk
• Decreases in hCS, estrogens, cortisol, insulinase reverse effects of pregnancy
• Diabetic mothers will likely req much less insulin for several days
Endocrine sys – pituitary & ovarian: cont increase in prolactin
• 70% of non-breastfeeding mothers menstruate by 12th week
1
, NURS 3526 EXAM REVIEW STUDY GUIDE-MATERNAL
PHYSIOLOGIC CHANGES 2023 A+
• Return of ovulation depends on breastfeeding patterns for breast-feeders
o Persistence of prolactin suppresses ovulation
o Contraception
Urinary sys – fluid loss
• diuresis (increase peeing) within 12h of birth greater than 3L per day in first 2-3 days
• profuse diaphoresis (sweating) at night – up to 6.6lb wt loss in early days
urinary sys – urethra and bladder
• decreased urge to void = bladder distention = excessive bleeding
o encourage frequent voiding
• stress incontinence – Kegels
GI sys: increase appetite. Bowel evacuation delayed for 2-3 days
• decrease muscle tone, anesthesia, pre-labor diarrhea, NPO, dehydration, psychological
factors, encourage regular bowel habits/appropriate diet
Breasts:
• breastfeeding: 24h – no change in breast tissue. Colostrum expressed; 72-96h – breast
enlargement (warm, tender, lumpy – increased blood and lymphatics). True milk
production
• non-breastfeeding: same as breast feeding mother. Engorgement resolves spontaneously
and discomfort decreases within 24-36 h
cardiovascular sys - blood vol
• CO increased 60-80% from pre-labor; drop within 1h. pregnancy-induced hypervolemia (up
40- 45%)
• Avg blood loss: 300-500ml (Vagina); 500-1000ml (C-section); additional loss via
diuresis Cardio – vs:
• Temp up to 100.4 in first 24h due to dehydration; return to normal afterwards
• Pulse remain elevated for 1st hr; gradual decrease over 48h
• Resp – no changes
• BP transient – increase by 5% for few days, return to normal over wks or months,
orthostatic hypo possible
Cardio – blood components:
• Hematocrit and hemoglobin decrease – rise in HCT and Hgb by 7th day; WBC count
increase; coagulation factors increase
Integumentary sys:
• Melasma usually disappears
• Hyperpigmentation may persists – areola. Linea nigra.
• Striae gravidarum (stretch marks) fades
2
, NURS 3526 EXAM REVIEW STUDY GUIDE-MATERNAL
PHYSIOLOGIC CHANGES 2023 A+
• Vascular abnormalities regress – varicosities, palmar erythema, angiomattas
• Hair loss
• Nails return to consistency and
strength Musculoskeletal sys:
• Decreased abd wall tone – returns by 6wk
o Muscle tone is restored by diet, rest, exercise, and good body mechanics.
• Joints stabilize by 6-8 wks
• Often shoe size up
• Neurologic changes reversed – BP req careful assessment
CHAPTER 19: Nursing care during the postpartum period
Priorities of nursing care:
• Assess physiologic and psychologic adaptation
• Prevent complications
• Assist with rest and recovery after birth
• Educate: self-management and infant care
• Support transition to parenthood
Nursing dx in postpartum:
• Risk for hemorrhage, infection, urinary retention, constipation
• Acute pain
• Impaired attachment
• Knowledge deficit
Transfer to postpartum – criteria:
• Completely recovered from anesthesia, stable, the first 1-2h after birth aka the 4th stage of
labor is the crucial time for mother and newborn.
• Pulse, resp, and BP are assessed q15min – hemorrhage is likely to
occur Ongoing physical assessment
• BUBBLE-HE: Breasts Uterus Bladder Bowel Lochia Episiotomy Homan’s sign (no) – legs circulation
Emotions and bonding
• L-R: scant (<2.5cm); light (<10cm); moderate (>10cm); heavy (saturated in 2h)
Promote comfort – relieve pain with non-pharm (cold packs, heating pads, prone position, massage) and
pharm (NSAIDS, narcotics)
Promote elimination – encourage voiding. Measure voids; catheterize if non invasive measures fail
• Measures to avoid constipation – fluids, ambulation, stool
softener Promote healthy lifestyle – rest, exercise, ambulation, nutrition
3
