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Chapter 21: p 446 |
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Reproductive:
Involution – rapid ↓ in size of uterus to nonpregnant state.
Decidua sheds as lochia; placental site is exfoliated. Cells grow smaller,
reversing the uterine hyperplasia. Factors slowing down process:
prolonged labor, anesthesia or excessive analgesia, difficult birth, full
bladder, multiparity, incomplete expulsion of the placenta or membrane
fragments. Factors enhancing involution: breastfeeding, early
ambulation, & uncomplicated birth. Changes
in fundal position:
/p placental delivery: uterus grapefruit-size. Fundus midline; at
level of umbilicus at 6 -12 hrs /p. Boggy uterus: blood & clots collect, uterus rises,
contractions interrupted; moves to R side: suspect distended bladder.
PP day #1: 1 cm ↓ umbilicus; descends 1 fingerbreath/day. Breastfeeding
→ pitocin → faster; nonpregnant size @ 5-6wks Lochia: uterine debris /p birth. rubra – 3-4 days – dark red, bloody, fleshy, musty, stale
non-offensive odor; clots < nickle; composition: blood /c sm amts mucus,
shreds of diciua, epithelial cells, leukocytes; may contain fetal meconium,
lanugo, or vernix caseosa serosa
– 4 – 10 days – pink,or brownish; watery; odorless. Composition: serum,
erythrocytes, shreds of degenerating decidua, leukocytes, cervical mucus,
numerours bacteria Cervical
changes: soft,
irregular, edematous; bruised-looking /c multiple small lacerations; closes to 2 -3 cm /p few days; admits
fingertip /p 1 wk; permanent change to os /p 1st delivery to
slit-like Vaginal
changes: smooth
walls, edematous, multiple small lacerations; perineal pain d/c /p 2 wks;
↓ PP estrogen → ↓ vaginal lubrication &
vasoconstricition 6 – 10 wks → painful intercourse. Chp 9,
Figure 9-9, p 197 : Perineal muscle tightening, also
called Kegel exercises
strengthen the pubococcygeus muscle, which improves support to the
pelvic organs. p 195: how to teach: compare to elevator, 1-4 floors; properly
done, does not contract the buttocks & thighs; done any time Perineal: bruising; episiotomy edges
together; separation Recurrence
of ovulation & menstruation: nonlactating: 6-8 wks; 1st
cycle usually anovulatory;
breastfeeding: delayed, but not reliable form of birth control.
Exclusive breastfeeding → wider spacing of pregnancies |
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Abdominal: soft, flabby; striae or stretch
marks; diastisis recti, separation of rectus muscle, may improve PP
r/t woman’s physical condition, gravidity, exercise Cardiovascular/blood
values: returns
to prepreg. Within 2 wks; 40% inc in blood volume eliminated through
diuresis; 1st 48 hrs greatest risk for PP hemorrhage; BP - baseline; Inc in fibrinogen → ↑ risk of
thrombophlebitis; inc WBCs
25-30,000/mm3 - nonpathologic
leukocytosis; an ↑ of > 30% in 6 hrs indicate pathology GI: hunger & thirst common; risk
for constipation ↑ d/t ↓
peristatlsis, narcotics, dehydration & ↓ mobility; risk for
hemorrhoids ↑ d/t pressure of pushing Urinary: inc bladder capacity &
↓ bladder tone → ↓sensation & ↑ risk of urinary
retention & UTI; PP diuresis 1st
12-24 hrs of 2,000 – 3,000 ml urine; 5
lb loss; full bladder displaces uterus, usually R side; fluids lost through
diaphoresis, esp at night Endocirine: estrogen & progesterone drop
rapidly; Lactation: nipple stimulation → pitocin release → release of
prolactin → milk production & let-down reflex & release
of milk by contractions of alveoli of breast; colostrum - 1st
milk, rich in protein & immunoglobulins; engorgement occurs 2nd/3rd
day; usually 2-5 days; mature milk produced after 2 weeks Afterpains: intermittent uterine
contractions; > common in multigrav than primi (“rubber band”), esp
when breastfeeding |
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Taking-in: 1st PP day or 2 ; preoccupied /c own needs;
tells her story; passive, independent;
touches & explores infant Taking-hold:
2nd or 3rd day ready to resume control; obsessed with
body functions; anticipatory guidance most effective; rapid mood swings Taking-hold – in other texts:
mothering functioning established; sees infant as unique person Your text:
Maternal role attainment: takes abour 3 – 10 months Anticipatory
stage during pregnancy; role model Formal
stage – birth of child; influenced by others; tries to please everybody Informal –
mother begins making own decisions Personal
stage – final; comfortable with her concept of maternal role Challenges:
finding time for self; feelings of incompetence; fatigue from sleep
deprivation; loss of freedom/added responsibility; challenge caring for
active baby. Nurses can give anticipatory guidance Postpartum
blues: transient depression 1st few days &/or within 1st
2 wks, manifested by mood swings, anger, tearfulness, felling let-down,
anorexia, & insomnia; usually resolves spontaneously; evaluation
necessary if persistent Bonding:
also known as
attachment: process by which parents form emotional relationship with infant
over time; influenced by many factors: family, stability of home environment,
nurturing she received as child. Certain characteristics important: level of
trust, level of self esteem, reactions to present pregnancy; interest in
child rearing. Initial
attachment behavior: mother explores infant with fingertips, then palms,
& then enfolding newborn with whole hands & arms; holds infant in en
face position, face-to-face position about 20cm , same plane; mother uses
soft, high-pitched voice; engrossment
- father’s absorption, preoccupation, & interest in infant;
stimulated by active participation in the birth Cultural
influences:
remember that mother’s expectations may be different from what the nurse or
physician expect; foods, hygiene practices, support from family members vary |
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Breasts: breast or bottle? Palpate for
engorgement; inspect nipples for redness, cracks, erectility, if nursing Uterus: fundal height, firmness, position
r/t abdominal midline; fundal location r/t expected descent’ inspect
abdominal incisions, c-sec, or BTL for REEDA: redness, edema, ecchymosis,
discharge, & approximation of skin edges Bladder: void within 6 - 8hrs of delivery;
assess frequency , burning, urgency (UTI); retention, distension Bowel: passage of flatus; signs of
distension Lochia: type, quantity, amount, &
presence of odor; expected findings? C-sec pts may have < bleeding; refer
to Figure 21-6, p 457 Episiotomy: inspect perineum for REEDA;
hemorrhoids Assess
for lacerations: 1. 1st degree: ; limited
to perineal skin & vaginal mucous membrane2. 2nd degree:
involves perineal skin, vaginal mucous membrane, underlying fascia, &
muscles; 3. 3rd degree: through perineal skin, vaginal mucous
membrane, involves anal sphincter, possibly anterior wall of rectum 4. 4th
degree: same as 3rd but extends through rectal mucosa to lumen of
rectum Homan’s
sign: pain in
calf upon dorsiflexion of foot – possible thrombophlebitis; pedal edema/pedal
pulse Emotional
Status:
appropriate for situation; phase of psychological adjustment; “postpartum
blues” Bonding: interactions with infant |