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refers to the 6week period between delivery or termination of pregnancy and return of reproductive organs to their pre pregnant state
puerperium
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this is the time of emotional, social and physical adjustment
puerperium
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this takes palce the first 30 - 60 minutes after birth
bonding
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what is enhanced for bonding?
enhanced when the parent and infant touch and interact
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When the family finds likeness and differences to other family members
claiming process
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What factors affect family adaptation?
parental fatigue, previous experience w newborn, parental expectations, knowledge of and confidence in providing for newborn needs, temperament of the newborn
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intense interest and preoccupation in the newborn
engrossment
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what are soem engrossment factors?
fingertipping, mothers voice and high pitched voices
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does the father go thru engrossment period?
yes! he wants to touch, and share an active role in the process
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when is it most difficult for a sibling to adaption to a neonate?
toddler age
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what do neonates have the ability to do?
make eye contact and move eyes to follow the parents, mutual gazing, grasp parents fingers and hold on, move in rhythm to parents voice
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return of the uterus to its pre pregnancy size and condition?
involution
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vaginal discharge after childbirth
lochia
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how long does it take for the vagina to regain its pre pregnancy size?
6 weeks
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how does the fundus descend?
1 cm each day for 10 days
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a full bladder will do what?
push the uterus upward
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the lochia is usually what color?
first red, then pink, yellow and then white
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is the odor the same after labor?
yes
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how long is the lochia red?
1st 3 days
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after the red, what color does the lochia turn and when?
it turns a pink on the 4th day and decreases color changes
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the 10th day the color turns what?
yellowish white
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how long after birth is the fundus firm?
18hrs
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when does the cervical os close?
2 weeks
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decreased levels of estrogen=?
decreased vaginal lubrication
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what are the degrees of lacerations?
- 1st degree= skin and kucous membrane
- 2nd =skin, mucous and muscle
- 3rd=skin, mucous, muscle and anal sphinter
- 4th=skin, mucous, muscle, anal sphinter and rectal muscosa
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neuro-hormonal relfec that causes milk to be expressed?
let down reflex
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ovulation takes place as early as what after birth in non breast feeding women?
27 days
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when is milk production initiated after birth?
2-3 days
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non breastfeeind women start their menstrul cycle when?
3 months
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ovulation does take place in breastfeeding women so how long should a woman wait to have sex with out birth control
190 days
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yellowish fluid rich in antibodies and high in protein?
colostrum
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when does engorgement take place?
day 3 or 4 after birth
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when does lactation cease if not used?
about a week
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what do rural indian women believe about their colostrum?
they believe it harms the baby and discard it
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what is the average time a mother breastfeeds?
2 years
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what culture has the lower rate of breastfeeding?
african american
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blood loss average of vaginal birth? cescarean birth?
500ml, 1000 ml
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what does the pregnant mothers temp right after labor?
100.4
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what should remain consistant with baseline?
BP
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pulse should remain where?
less than 100 and there are times of bradycardia
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women have a increased WBC what are they?
20m-30m X 10-12 days
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what levels increase due to loss of plasma?
H AND H
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there are increased clotting factors and fibrogen for a few days postpartume causing what?
a thrombus formation
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what causes bladder distention?
rapid diuresis
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what results in UTI for postpartum?
urinary stasis or incomplete emptying
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what may cause edema on the urinary structures?
L and D
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during L and D cause cause what?
Dysuria
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adequate bladder emptying can help involution in how many days?
5-7
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a distended bladder can displace the uterus and prevent contraction and cause what?
boggy uterus
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what parts of the body return to pre normal state except what?
the feet
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how long will the abd muscles protrude ?
6 weeks, exercuse will help muscle tone
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stiumulating hormone declines?
melanocyte
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True or falso?
strai may still be visible?
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when estrogen levels decrease what else will fade?
spider angiomas and palmar erythema
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what is a huge symptom we can watch for after surgery? and what disease can worsen?
headache and PIH
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weight loss after pregnancy?
13lb for fetus
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what is the weight loss and returning of the uterus in the 6 wks?
8-9 lbs
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how long does it take a woman to return back to normal prepregnant weight?
6mo - 1year
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what helps the mother loose weight?
breastfeeding
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how long does the mothers passive phase last and what phase is this?
2-3 days, and Takin in phase where the mother must replenish her sleep, fluid and food
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what is the taking hold phase?
last appx 10 days and where the mother wants to learn
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letting go phase?
may be disappointed with gender, size or formaties and they must let go of pexpectations and take the role of parent
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"Baby blues"
postpartum blues the are mild and may consist of crying for no reason, fatigue, anxiety, restlessness, let down feeling
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how long do the "baby blues" last? and what percent of women?
2 weeks and 80 %
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for the cescarean birth what phase last longer?
taking in phase
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postpartum depression? what percent does it affect? and how many phases?
more severe than the blues, 12%, mild, mdoerate and severe
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level 1 of postpartum depression?
mild- able to care but not feel love, irritable, sense of loss of self, last first few weeks?
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level 2 of postpartum depression?
moderate- sleep disturbances, fatigue, decreased concentration
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3 stage of postpartum depression?
severe- violent outbursts, neg feeling toward infant or other family members, wont discuss symptoms, and have harming thoughts
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postpartum psychosis?
most dangerous with thoughts of harming self and infant and may be comes irrational, obbsesive
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what is the percentage of births that cause psotpartum psychosis?
0.1-0.2 %
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what percent commit suicide from postpartum psychosis?
5%
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what percent of postpartum psychosis cause infanticide?
4%
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when postpartum psyhchosis happens abotu how long after birth?
after 24 hrs
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how long do women stay in the hospital ?
48 hrs vaginal, and 96 c-section
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are home visits an option now?
YES! to see how mother are acting and their bonding techniques
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what is BUBBLE?
Breast, Uterus, Bladder, Bowel, Lochia, Episiotomy
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what are standard precautions in post partum care?
wearing gloves when touching anything that is the mothers fluid
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when should we assess bubble?
every shift
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what should we note in breast postpartum?
note size, shape, abnormalities, mastitis, check nipples for cracks, fissures, warmth and tenderness
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waht shouldw e note of the uterus postpartum?
palpate to note consistancy, size, placement, firm, midline
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how should the uterus feel?
firm, grapefruit size
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how does the uterus move?
it rises to the umbillicus and then descends 1 finger breadth daily for 10 days
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assess for signs of what on the uterus?
metritis
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when movement occurs postpartum what is normal??
fever, chills, tenderness
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a full bladder can displace the fundus where?
to the side
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how long are I and O kept?
first 24 hours
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when checking the episiostomy, check what?
the anus and for constipation
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are clots normal after birth
yes a few
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for an episiotomy what position should the mother be in?
sims
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what can be done to decrease discomfort levels after episiotomy?
tighten but before sitting, and release when sat down, rest daily with feet elevated, kegal exercise, use peri bottle to ease pain and cleaning
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the Rh immune globulin given when to prevent what?
72 hrs to prevetn sensitization of rh negitive mothers who gave birth to rh pos infants
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when is the rubella vaccine given?
postpartum if innsufficient titer to prevent fetal anomolies in future pregnancies
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what can cause early hemorrhage?
uterine atony, retained placental fragments, laceration, hematomas
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late hemorrhage?
subinvolution, retained palcental fragments
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what meds cause contraction or uterine smooth muscle?
pitocin, methergine, prostaglandins
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what to do for hematomas?
apply ice, assess pain, size assessment
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infectino occuring between birth and 6 wks postpartum?
peurperal infection
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peurperal include what?
wound infection, metritis, mastitis and UTI
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inflammation of the uterus?
metritis
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'inflammation of inside the uterus?
endometriosis
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inflammation of the outside of the uterus?
parametritis
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metritis spead through fallopian tubes
slapingitis
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metritis spread through out the ovaries?
oophoritis
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the only symptom may be fever spikes?
metritis
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inflammed breast
mastitis
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when does masttits occur? and what does it cause? symptoms?
generally during breastfeeding, staph aureus or cadnida albicans and symptoms are 2-4 weeks of cracks, fissures in the nopple for port of entry
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whats the odds of a pregnant woman having UTI?
2-4%
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how are UTI caused
by tauma to bladder and urethra or urinary stasis
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risk factors for thromboembolic ?
venous stasis, hypercoagulation, older than 35, csection, obese, smoking, long time in stirrups, variscosities, history of
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treatments of thromboembolic
analgesia, rest, evlevation of affected leg, local heat application, elastic stockings, coumadin
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DIC?
disseminated intravascular coagulation, abnormal stimulation of clotting mechanism, preexsisting problem, urine of 30ml/hr, blood and products can be given
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how is DIC caused?
when the morther starts to hemmorhage
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