After Birth
What is the postpartum period 6 weeks following childbirth called?
Puerperium
What are the changes that the reproductive organs, particularly the uterus, under go after birth to return them to their prepregnancy size and condition called?
Involution
What is the uterine lining called during pregnancy?
Decidua
What is the uterine lining called when not pregnant?
Endometrium
What is the upper portion of the uterus called?
Fundus
Where is the fundus located immediately after the placenta is expelled?
At or below the level of the umbilicus
When should the fundus no longer be palpable?
Ten days after birth
Afterpains
Vaginal discharge that is red, composed mostly of blood, lasting for about 3 days after birth
Lochia rubra
Vaginal discharge after delivery that is pinkish because of its blood and mucus content that lasts from about the third through the 10th day after birth
Lochia serosa
Vaginal discharge that is mostly mucus and is clear and colorless or white lasting from the 10th through the 21st day after birth
Lochia alba
What are some abnormal characteristics of lochia that should be reported?
Foul-smelling lochia with or without fever
Lochia rubra that persists after the third day
Unusually heavy flow of lochia
Lochia that returns to bright red color after it had progressed to serosa or alba
Rugae
An incision to enlarge the vaginal opening
The perineum should be assessed for normal healing and signs of complications including:
R - Redness
E - Edema
E - Ecchymosis
D - Discharge
A - Approximation
When do menstrual cycles resume after delivery?
About 5 weeks
How many weeks after delivery can combined oral or transdermal estrogen-progesterone contraceptives be started?
About 2 - 3 weeks
What changes occur in the breasts after delivery?
First 2 - 3 days - breasts full and soft
3rd day - breasts engorge in both nursing and non-nursing mothers
Engorged breast is hard, erect, and uncomfortable
Return to normal 1 - 2 weeks after birt in non-nursing mothers
Because of 50% increase in blood volume during pregnancy, how much blood loss can a woman tolerate during delivery?
500 mL in a vaginal birth
1000 mL in cesarean birth
To reestablish normal fluid balance, the body rids itself of excess fluid in the following two ways:
1 - Diuresis - can reach 3000 mL/day
2 - Diaphoresis - sweating
For 4 - 6 weeks of the puerperium, the woman is more prone to what?
Clots
What is he nursing care offered up after the 4th stage of labor?
Vitals taken every 4 hours for the first 24
Higher temperature after 24 hours suggests infection
Help patient shower or wash if diaphoresis is a problem
Assess for edema which could mean hypertension
Assess reddened, tender areas or pain and pallor in lower extremities for the presence of clots
What measures can be taken to assist a postpartum mother to urinate?
Provide privacy
Remain nearby but do not hover
Run water in sink
Place woman's hands in warm water
Use peribottle to squirt warm water on perineum
What should be encouraged in order to prevent constipation?
Drink lots of fluids
Add fiber to her diet
Ambulate
After cesarean section, when should the catheter be removed?
Within 24 hours
In Rubin's "Taking-In Phase", what happens?
Mother is passive and willing to let others do things for her
In Rubin's "Taking-Hold Phase", what happens?
Mother begins to initiate action and becomes interested in caring for her newborn
In Rubin's "Letting-Go Phase", what happens?
Mothers and partners work through giving up their previous lifestyle to incorporate newborn.
Conflicting feelings of joyand emotional letdown during the first few weeks after birth is called what?
Postpartum blues
A persistent mood of unhappiness that is not expected is called?
Postpartum depression
If the newborn dies, the nurse is likely to encounter what kind of reactions typical of any grieving?
Shock and disbelief
Anger
Guilt
Sadness and depression
Gradual resolution of the sadness
What kind of problems can hypothermia cause in a newborn?
Hypoglycemia
Respiratory distress
Most babies pass meconium within how many hours?
12
What does the passage of meconium before discharge assure?
A patent gastrointestinal tract
Normal vital signs for a newborn should be measured at 15- and 30-minute intervals at first, then hourly, and then every 4-8 hours while the newborn is stable. What are the normal values?
Respirations = 30 - 60 breaths/min
Heart rate = 110 - 160 bpm
Temperature = normal under radiant warmer
Blood pressure = 65 - 95 / 30 - 60
In the newborn, the unbilical cord should have how many vessels?
Two arteries and one vein
What does a two-vessel cord point to?
Other internal anomalies often in the genitourinary tract.
What is the goal of umbilical cord care?
Preventing infection
Signs of hypoglycemia in a newborn?
Poor muscle tone
Sweating
Respiratory difficulty
Low temperature
Poor suck
High pitched cry
Lethargy
Seizures
A strong emotional tie that forms soon after birth between the parents and the newborn
Bonding
The nursing mother needs how many additional calories each day?
500 extra calories
When is mature milk secreted?
By day 14 after birth
What is a galactogogue and give me an example?
Breastmilk stimulators such as beer, brewer's yeast, rice, gruel, fenugreek tea
Signs breastfeeding is successful
Breast feels firm before feeding and softer after
Newborn nurses 10-15 minutes per breast 8-10 times daily
Audible swallow is heard when newborn sucks
Newborn demands feeding and appears relaxed after feeding
Newborn has six to eight wet diapers per day
Newborn passes stool several times a day
How to recognize hunger in a newborn
Hand-to-mouth movements
Mouth and tongue movements
Sucking motions
Rooting movements
Clenched fists
Kicking of legs
Crying