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First six weeks after birth of infant
Puerperium
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–Newborn from birth to 28 days
neonate
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–Rapid process of attachment for parent and child
bonding
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Long-term process that establishes enduring bond between parent and child
attachment
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Parents identify likenesses and differences
claiming
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factors affecting adaptation of newborn
•Parental fatigue
•Previous experience with newborn
•Parental expectations of newborn
- •Knowledge of and confidence in providing
- for newborn needs
•Temperament of newborn
•Temperament of parents
•Age of parents
•Available support system
•Unexpected events
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Return of uterus to pre-pregnancy size and condition
involution
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–Vaginal discharge after childbirth
lochia
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Maternal Physiologic Changes: Reproductive System
•Involution
•Lochia
- •Takes six weeks for vagina to regain
- pre-pregnancy contour
•Many women have episiotomy
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Maternal Physiologic Changes: Endocrine System
•Let-down reflex
- •Breastfeeding not reliable method of
- birth control
- •Ovulation in non-breastfeeding mothers
- takes place as early as 27 days after birth
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–Neurohormonal reflex that causes milk to be
expressed
Let-down reflex
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•Ovulation in non-breastfeeding mothers
takes place as early as ______ days after birth
27 days after birth
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Yellowish fluid rich in antibodies and high in protein first two to three days after birth
colostrum
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occurs by day three or four and caused by vasocongestion of breast tissues as milk production begins
–Breasts distended, swollen, and tender
engorgement
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ceases within one week if breastfeeding stopped or never begun
lactation
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when do BF clients menstruel period return
BF clients menstrual cycle’s return is largely dependent on BF pattern
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can mom eta or drink after anesthesia or analgesia
yes
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why might a BM be difficult to acheive after delivery
Decreased peristalsis, prelabor diarrhea, lack of food during labor, dehydration, perineal trauma, hemorrhoids, mother’s anticipation of discomfort, and some pain medications
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vaginal birth avg. blood loss
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c-section avg. blood loss
1000 ml
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what should the nurse do if a client is going to ambulate the first time after surgery
stay with her bc of VS changes or cardiac output
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cardiovascular maternal physiologic changes
- Blood volume
- Monitor blood values
- Coagulation
- Varicosities
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Maternal Physiologic Changes:
Urinary System
- •Mother may have problem with overdistention and emptying of bladder
- •Urinary stasis can cause infection
- •Full bladder displaces uterus up and to side
- –Results in uterine atony
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Uterine involution may cause
mild proteinuria, ketonuria, and elevated blood urea nitrogen (BUN)
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As level of hormone relaxin decreases what will happen
ligaments and cartilage begin to revert to pre-pregnant position
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Takes ____ weeks for abdominal muscles to return to pre-pregnant state
6
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All joints return to normal pre-pregnant state except _____
FEET–May have permanent increase in shoe size
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Hyperpigmentation lightens because
Melanocyte-stimulating hormone declines
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neurologic maternal discomfort may be caused by
Fatigue, afterpains, muscle aches, episiotomy or abdominal incision pain, and breast engorgement
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Carefully assess mother who has headache bc?
Pregnancy-induced hypertension (PIH) can worsen after delivery
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Immediate weight loss of
- 13 lbs bc of
- –Infant, placenta, amniotic fluid, and blood loss
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how many punds are lost during the next 6 weeks after birth
- 8-9 lbs
- –Result of diuresis, diaphoresis, and involution
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Takes about _____ months to return to pre-pregnant weight
6
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maternal psychosocial changes
- •Taking-in phase
- •Taking-hold phase
- •Letting-go phase
- •Postpartum blues
- •Unplanned cesarean birth
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look for signs of hurting herself or baby. Decreased concentration. Insomnia. Spontaneous crying.
postpartum depression
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Obsessive concerns about the newborns health and wellness
postpartum psychosis
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nursing process will focus on ____ areas
BUBBLE
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normal assessment for fundus
firm and midline
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Normal assessment should for fundus should reveal:
(1) After delivery at _____
(2) 12 hours PP uterus will be @ ___
(3) 1 week PP uterus should be ___ below the level documented on the day of delivery
- 1. 2 fbbu
- 2. umbilicus
- 3. 7 cm
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With mother in Sims’ position, assess episiotomy:
- –Redness indicating inflammation
- –Ecchymosis indicating bruising
- –Edema indicating swelling
- –Discharge from incision
- –Approximation of suture line
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•Temperature may increase to 100.4º F during first 24 hours
–After first 24 hours, may indicate _______
infection
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Pulse rate may decrease to 50 to 70 beats per minute after first hour
–Elevation may indicate ____
pain, anxiety, and hemorrhage
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Blood pressure should remain consistent with baseline
–Increased B/P May indicate ____
–Decreased B/P May indicate _____
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Bonding should be seen and assessed within _____ AFTER delivery
30-60 min
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RH immunization Given when if Rh-negative mothers who gave birth to Rh-positive infants
within 72 hours after birth to prevent sensitization
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Classic s/s of PP hemorrhage is?
increased pulse rate and decreased B/P
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The nurse caring for an expectant mother would monitor for the following predisposing risk of bleeding:
- (1) Decreased platelet level
- (2) History of alcohol abuse
- (3) Obesity
- (4) NSAID use
- (5) Herbal supplement use
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Puerperal (postpartum) infection occurs when and treated how?
–Occurs between birth and six weeks postpartum
–Usually treated with IV Abx
•Defined as temperature of 100.4º F or more on two separate occasions after first 24 hours
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risk factors for thrombophlebitis: inflammation in vein
Maternal age over 35
cesarean birth
prolonged time in stirrups
obesity
smoking
history of varicosities or venous thromboses
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The best nursing intervention to prevent thromboembolic conditions is to?
encourage client to ambulate early & frequently AFTER delivery
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DIC Main “medical management goal” is
to treat and correct the underlying cause
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