test 2 review
Uterine involution:
- Uterine involution - natural process that involves your pregnant uterus returning to it’s pre-pregnancy state
- How? by lil contractions (to keep it firm)
- It has to stay contracted bc when the placenta tore off the wall, the vessels on the maternal
side are wide open
- Nurse gives pitocin
- Helps uterus to contract
- Want uterus to stay contracted & tight to clamp off these vessels so the vessels don't bleed &
mom doesn’t hemorrhage
- Uterus location:
- Every 24 hrs, shrinks 1 cm
- @ 6 hrs: @ the umbilicus
- Day 1: U-1 (1 cm ⬇ umbilicus)
- Day 2: U-2 (2 cm ⬇ umbilicus)
- Day 10: goes back behind the pubic bone (10 cm ⬇ umbilicus)
- Returns to a nonpregnant state by 6 wks
- Mess w the uterus NOW?: it WON’T contract
- You don't want uterus to relax bc the vessels will open again
- Relax uterus (boggy) ▶ hemorrhage
- Hard = contracted
Fundal assessment:
Nursing action: massage the fundus (IF boggy)
- AFTER you massage back to firm, you have to figure out WHAT is causing it to relax (won’t involute properly)
- What it could be:
- 1. Could be a full bladder
- How do you know?: fundus is deviated or pushed ⬆)
- Nursing action: make mom pee (bedpan or bathroom)
- She can't pee?: straight cath her (NEVER choose this first, it is invasive)
- 2. Mom lying down for an hr-ish, the lochia would have pulled there. Sitting blood ▶ congeals = clots
- 3. Piece of placenta
- 4. Infection inside the uterus
- Choorioamminoittis - get antibiotics
How to express clots from uterus: put 1 hand on pubic bone & press down really hard in belly on her uterus… you will see gush of clots
go out the vagina
postpartum changes in the body:
postpartum - Interval between birth & return of reproductive organs to their nonpregnant state
- This is referred to the 4th stage of labor
- Time period: delivery of placenta ▶ 6 wks
- Biggest problem? Hemorrhaging
- This is WHY we want the uterus to contract & even give pitocin to contract
- 20 units w 1000 mL
- Hospital stay:
- Vaginal birth: 48 hrs
- C-section: 96 hrs
lochia - Inner lining of uterus sheds
- Uterine flow consisting of blood flow, decidua, WBCs, bacteria
, - Measured according to color & amt
- Rubra: 1st 3-5 days; consists mainly of blood
- Normal bleeding, like your period
- Serosa: about 5-10 days consisting of blood & white blood cells
- Alba: from 10th day up to 3-6 wks consisting of mucus & white blood cells mainly
- Amt:
- Scant/light - dime size
- Moderate - fills middle of pad
- Heavy - pad soaked means you’re not involuting properly
Fundus is firm, midline (nothing is wrong w it) BUT soaked pad w blood ▶ reason for bleeding = uterus is firm, there
might be a laceration
- Constant flow = perennial or cervical tear
Signs of subinvolution (uterus is relaxing)
- ⬆ in lochia
- Return to rubra lochia days AFTER serosa
- Shouldn’t go backwards
- Inform doc
- Could be due to relaxed uterus
Report any foul smelling lochia = indicates infection
vitals Temp:
- Slight ⬆ in the first 24 hrs bc of dehydration intrapartum
- Body feels dehydrated, body feels like it lost a bunch of fluid
- Febrile = > 100.4F (38C)
- Might be an infection
Pulse:
- Slightly ⬇ than normal evaluate according to baseline norms of postpartum
- ♥️ isn’t pumping enough now bc a lot of the fluid came out (less work bc baby is gone)
BP:
- Compare w pre-birth levels
- Watch for:
- PIH = ⬆ 140/90
- Nursing action: mom has to get on meds to ⬇ BP
- Magnesium sulfate
- Orthostatic hypotension
- Mom has been on the bed for a LONG time
- Mom used a massive amt of energy to push baby out
Blood clotting - New mothers need to be aware of the fact that during their pregnancy their body went through some
changes that were meant to protect them from hemorrhage & losing the baby
- Collection of the ⬆ fluids
- Development of an ⬆ ability to clot blood
- Mom no longer needs this protection & it will soon reverse itself, however, for a few wks she is @ a higher
risk for forming blood clots in her legs
- WHY the nurse/midwife will ask her to dorsiflex her foot & ask about pain in her calf
- ➕
Homan sign - if they say yes = sign; NOT GOOD
- DVT
- Pain could indicate a possible clot formation which could pose a danger to the mother
- During this period, it is best if the mother:
- NOT cross her legs
- Sit for long periods in 1 position
, - Wear stockings that bind (thigh or knee highs)
Integumentary Striae - appear reddened & more prominent
changes - This will fade into pale white streaks in white ppl or darker pigmentation in black ppl
- Linea negra & chloasma will also disappear slowly
Diastasis recti - overstretching &/or separation of the musculature
- Area appears indented or bluish tinged
- Its an indentation
Vagina changes - The hymen is permanently torn
- Immediately after birth, the mucosa is soft w few rugae
- Thickened walls or dryness is due to decreased estrogen & may cause dyspareunia
- Dyspareunia - painful sex
- Teaching: KY jelly for 1st time again, so it’s not painful (its dry)... “KY Jelly, not vaseline”
Cervix changes - Following a vaginal birth the external os will contract by the 7th day
- It remains slightly open w a slip like shape
- The smiley face
Perineum - Maybe swollen, tender or bruised from trauma of birth & pushing
changes - Kegel exercises helpful
- Helps w TIGHTENING everything down there
- Use ice packs down there
- Perineal care:
- Use peri bottle; wash v carefully
- Especially if they have a tear or a laceration, mom must keep it clean bc they can get
an infection
GI changes - If not under the influence of anesthesia, the mother is usually v hungry & thirsty
- May have hemorrhoids
- Mom needs to turn on her side. Pull 1 leg ⬇ & 1 leg ⬆
- W gloves, separate the butt cheeks & look in there
- Vag delivery: once you have done the 1st couple vital signs, you can go ahead & give her
juice & feed her
- Make her nice & comfy
- Encourage her to REST
- Look for REEDA
- Give them “tucks”
- Stiz bath
- Show mom how to
- Put like a lil bucket, get like an IV bag & hang up w VERY warm fluid in there. Has a
tubing that goes into the part you’re sitting on. Warm as long as you can take it.
Hemorrhoids are prooturing vessels, SO, the heat will sent the blood back into
circulation
- Also helps healing process
- Due to the effects of relaxin the bowels may be sluggish
- Mom gets constipated
- Pain from an episiotomy or hemorrhoids may cause or hinder bowel movement
- Prune juice
- Mom has c-section & has gas - give them ginger ale
uterus
menstruation - Once the placenta has been delivered the effects of estrogen & progesterone no longer inhibit the FSH
Uterine involution:
- Uterine involution - natural process that involves your pregnant uterus returning to it’s pre-pregnancy state
- How? by lil contractions (to keep it firm)
- It has to stay contracted bc when the placenta tore off the wall, the vessels on the maternal
side are wide open
- Nurse gives pitocin
- Helps uterus to contract
- Want uterus to stay contracted & tight to clamp off these vessels so the vessels don't bleed &
mom doesn’t hemorrhage
- Uterus location:
- Every 24 hrs, shrinks 1 cm
- @ 6 hrs: @ the umbilicus
- Day 1: U-1 (1 cm ⬇ umbilicus)
- Day 2: U-2 (2 cm ⬇ umbilicus)
- Day 10: goes back behind the pubic bone (10 cm ⬇ umbilicus)
- Returns to a nonpregnant state by 6 wks
- Mess w the uterus NOW?: it WON’T contract
- You don't want uterus to relax bc the vessels will open again
- Relax uterus (boggy) ▶ hemorrhage
- Hard = contracted
Fundal assessment:
Nursing action: massage the fundus (IF boggy)
- AFTER you massage back to firm, you have to figure out WHAT is causing it to relax (won’t involute properly)
- What it could be:
- 1. Could be a full bladder
- How do you know?: fundus is deviated or pushed ⬆)
- Nursing action: make mom pee (bedpan or bathroom)
- She can't pee?: straight cath her (NEVER choose this first, it is invasive)
- 2. Mom lying down for an hr-ish, the lochia would have pulled there. Sitting blood ▶ congeals = clots
- 3. Piece of placenta
- 4. Infection inside the uterus
- Choorioamminoittis - get antibiotics
How to express clots from uterus: put 1 hand on pubic bone & press down really hard in belly on her uterus… you will see gush of clots
go out the vagina
postpartum changes in the body:
postpartum - Interval between birth & return of reproductive organs to their nonpregnant state
- This is referred to the 4th stage of labor
- Time period: delivery of placenta ▶ 6 wks
- Biggest problem? Hemorrhaging
- This is WHY we want the uterus to contract & even give pitocin to contract
- 20 units w 1000 mL
- Hospital stay:
- Vaginal birth: 48 hrs
- C-section: 96 hrs
lochia - Inner lining of uterus sheds
- Uterine flow consisting of blood flow, decidua, WBCs, bacteria
, - Measured according to color & amt
- Rubra: 1st 3-5 days; consists mainly of blood
- Normal bleeding, like your period
- Serosa: about 5-10 days consisting of blood & white blood cells
- Alba: from 10th day up to 3-6 wks consisting of mucus & white blood cells mainly
- Amt:
- Scant/light - dime size
- Moderate - fills middle of pad
- Heavy - pad soaked means you’re not involuting properly
Fundus is firm, midline (nothing is wrong w it) BUT soaked pad w blood ▶ reason for bleeding = uterus is firm, there
might be a laceration
- Constant flow = perennial or cervical tear
Signs of subinvolution (uterus is relaxing)
- ⬆ in lochia
- Return to rubra lochia days AFTER serosa
- Shouldn’t go backwards
- Inform doc
- Could be due to relaxed uterus
Report any foul smelling lochia = indicates infection
vitals Temp:
- Slight ⬆ in the first 24 hrs bc of dehydration intrapartum
- Body feels dehydrated, body feels like it lost a bunch of fluid
- Febrile = > 100.4F (38C)
- Might be an infection
Pulse:
- Slightly ⬇ than normal evaluate according to baseline norms of postpartum
- ♥️ isn’t pumping enough now bc a lot of the fluid came out (less work bc baby is gone)
BP:
- Compare w pre-birth levels
- Watch for:
- PIH = ⬆ 140/90
- Nursing action: mom has to get on meds to ⬇ BP
- Magnesium sulfate
- Orthostatic hypotension
- Mom has been on the bed for a LONG time
- Mom used a massive amt of energy to push baby out
Blood clotting - New mothers need to be aware of the fact that during their pregnancy their body went through some
changes that were meant to protect them from hemorrhage & losing the baby
- Collection of the ⬆ fluids
- Development of an ⬆ ability to clot blood
- Mom no longer needs this protection & it will soon reverse itself, however, for a few wks she is @ a higher
risk for forming blood clots in her legs
- WHY the nurse/midwife will ask her to dorsiflex her foot & ask about pain in her calf
- ➕
Homan sign - if they say yes = sign; NOT GOOD
- DVT
- Pain could indicate a possible clot formation which could pose a danger to the mother
- During this period, it is best if the mother:
- NOT cross her legs
- Sit for long periods in 1 position
, - Wear stockings that bind (thigh or knee highs)
Integumentary Striae - appear reddened & more prominent
changes - This will fade into pale white streaks in white ppl or darker pigmentation in black ppl
- Linea negra & chloasma will also disappear slowly
Diastasis recti - overstretching &/or separation of the musculature
- Area appears indented or bluish tinged
- Its an indentation
Vagina changes - The hymen is permanently torn
- Immediately after birth, the mucosa is soft w few rugae
- Thickened walls or dryness is due to decreased estrogen & may cause dyspareunia
- Dyspareunia - painful sex
- Teaching: KY jelly for 1st time again, so it’s not painful (its dry)... “KY Jelly, not vaseline”
Cervix changes - Following a vaginal birth the external os will contract by the 7th day
- It remains slightly open w a slip like shape
- The smiley face
Perineum - Maybe swollen, tender or bruised from trauma of birth & pushing
changes - Kegel exercises helpful
- Helps w TIGHTENING everything down there
- Use ice packs down there
- Perineal care:
- Use peri bottle; wash v carefully
- Especially if they have a tear or a laceration, mom must keep it clean bc they can get
an infection
GI changes - If not under the influence of anesthesia, the mother is usually v hungry & thirsty
- May have hemorrhoids
- Mom needs to turn on her side. Pull 1 leg ⬇ & 1 leg ⬆
- W gloves, separate the butt cheeks & look in there
- Vag delivery: once you have done the 1st couple vital signs, you can go ahead & give her
juice & feed her
- Make her nice & comfy
- Encourage her to REST
- Look for REEDA
- Give them “tucks”
- Stiz bath
- Show mom how to
- Put like a lil bucket, get like an IV bag & hang up w VERY warm fluid in there. Has a
tubing that goes into the part you’re sitting on. Warm as long as you can take it.
Hemorrhoids are prooturing vessels, SO, the heat will sent the blood back into
circulation
- Also helps healing process
- Due to the effects of relaxin the bowels may be sluggish
- Mom gets constipated
- Pain from an episiotomy or hemorrhoids may cause or hinder bowel movement
- Prune juice
- Mom has c-section & has gas - give them ginger ale
uterus
menstruation - Once the placenta has been delivered the effects of estrogen & progesterone no longer inhibit the FSH
