cat 1
The time immediately after birth and continues for 6 weeks. The assessment is based on understanding of normal anatomic and physiologic processes during this time.
Puerperium/postpartum period
The fundus position first postpartum day?
Descends ___ fingerbreadth per day?
1 cm. below umbilicus
1
Lochia is greater in the _____, after _____ and ____.
morning, breastfeeding and activity
Intense tremors. the result of sudden release of pressure on the pelvic nerves. A response to fetus-to-mother transfusion at placental separation Reaction to maternal epinephrine production during labor and birth.Reaction to epidural anesthesia.
Postpartum chill
•2nd or 3rd day after birth
•Ready to resume control of body, mothering, her life in general
•Requires assurance that she is doing well as a mother
Taking-hold
The rapid reduction in size of uterus. The return of the uterus to a non-pregnant state.
Involution
dark red, last 2-3 days
Lochia Rubra
Why is lochia evaluated?
Determine the presence of hemorrhage
Assess uterine involution
Type, amount, consistency determines the stage of healing
Persistent discharge of lochia rubra or return to lochia rubra indicates subinvolution or late PPH
•Woman passive, somewhat dependent
•Follows suggestions
•Hesitates to make decisions
•Preoccupied with HER needs
•Need to talk about her perceptions of her labor and birth
•Food and sleep major needs
Taking-in
What are some symptoms of PPD?
•Intense & pervasive sadness
•Severe & labile mood swings
•Persistent
•Intense fear and anxiety
•Worries about being an incompetent parent
•Irritability
•Easily flared
•Can be violent
•REJECTION OF INFANT
•Abnormal jealousy
•Obsessed about baby taking her place in spouse’s affection
•Attitudes toward baby: disinterest, annoyance of care demands, blaming
•Appears AWKWARD with baby
Obsessive thoughts about harming baby
What factors enhance involution?
•Uncomplicated labor and birth
•Complete expulsion of the placenta or membranes
•Breastfeeding
•Manual removal of placenta during C/S
•Early ambulation
•Creamy/yellowish
Lochia Alba
The separation of the abdominal muscle. Occurs in women with poor muscle tone. Happens more with c-sections. Improvement depends on physical condition of mom, total number of pregnancies, pregnancy spacing, type/amount of exercise. Responds well to exercise.
Diastasis recti abdominus
Normal functioning not impaired.
Symptoms: mood swings, feelings of sadness/anxiety, crying, difficulty sleeping, loss of appetite
Baby Blues
symptoms: hallucinations, unwillingness to sleep, delusions, hyperactivity, irritable, Paranoia
Postpartum Psychosis
A Boggy uterus
Uterine atony
pinkish, day 3-day 10
Lochia serosa
Occurs in the 1st 12-24 hours; kidneys need to empty 2000 to 3000 ml of extracellular fluid associated with normal pregnancy
puerperal diuresis
What are the causes of postpartum depression?
•Biologic, psychologic, situational, multifactorial
•Estrogen fluctuations
•Postpartum hypogonadism
What SSRI's for PPD?
Paroxetine, sertraline, nortriptyline=less infant exposure
Fluoxetine & Citalopram (Pass through breast milk in small amount & NO affect bad effect on infant)
Monitor infant for signs of irritability, poor feeding, alterations in sleep pattern
A deviation to the right equals a ___?
Have the patient ___ ____ and ___?
distention of the bladder
empty bladder and reassess
What factors slow involution?
•Prolonged labor
•Anesthesia
•Difficult birth
•Grand multiparity
•Full Bladder
•Incomplete expulsion of placenta or membranes
•Infection
•Overdistention of uterus
It is more common in multiparas. Intermittent uterine contractions. Occurs if uterus overdistended. May cause severe discomfort for 2-3 days. Oxytoxic agents make it worse. Breastfeeding.
afterpains
What are risk factors for PPD?
•Hx. of anxiety or depression
•Younger age
•Unintended pregnancy
•Preterm or sick infant
What are other treatments for PPD?
Hormone therapy
Alternative therapy ( yoga, massage, relaxation techniques)
ECT- used for women who have not improved with antidepressant therapy
Psychotherapy – group