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Normal Postpartum
Normal postpartum terms and definitions
61
Nursing
Undergraduate 3
03/31/2016

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Term
Postpartum phase
Definition
The 6 week interval b/w the birth of the baby and return of the reproductive organs to a non-pregnant state
Term
Immediate postpartum phase
Definition
First 24 hours after birth
Term
Early postpartum phase
Definition
First week after birth
Term
Late postpartum phase
Definition
2nd to 6th week after birth
Term
3 Stages of PP Period
Definition
  • Taking in
  • Taking hold
  • Letting go (taking over)
Term
Taking In Phase
Definition
  • Focus on self (not infant)
  • Depends on others for help 
  • Needs assistance
  • Difficulty making deicions
  • Comfort-rest-food--> paramount !
  • Relives delivery experience (talk, pictures, etc.)
  • Lasts several hours or 2-3 days
Term
Taking Hold Phase
Definition
  • Move from dependent to independent
  • Increased energy
  • Increased focus on infant
  • Self care, focus on bowels, bladder, breastfeeding
  • Responds to instruction and praise
  • Lasts 2 days - 1 week
Term
Letting Go/ Taking Over Phase
Definition
  • Giving up previous role (new mom !)
  • Sees self as separate from infant
  • Gives up fantasy delivery and fantasy baby
  • Readjusts to change in roles
  • Depression and grief work (if needed)
  • From week 1 onwards !
Term
Attachment
Definition
Process where parents come to love/ accept a child and a child comes to love/ accept a parent
Term
Bonding
Definition

Sensitive period in first few minutes to hours when parents must have close contact with infant for later development to be optimal 

Depends on situation; NICU babies will not necessarily be impacted negatively

Term
Proximity
Definition

Physical and emotional experience of the parents being close to their infant

Infant can see face when 12 inches or closer away from parent

Term
Reciprocity
Definition
Process by which the infant's behaviors elicit parents' response
Term
Commitment
Definition
Enduring nature of the attachment relationship
Term
Parental behaviors that affect attachment
Definition
  • Refusal to interact/ care for baby
  • Disappointment expressed over baby's sex
  • Sees baby as messy or unattractive
  • Baby reminds mom of someone she doesn't like
  • Doesn't incorporate infant into her life
Term
Infant behaviors that affect attachment
Definition
  • Sleepy, eyes closed most of the time
  • Crying constantly (colicky)
  • Feeds poorly, vomits often
  • Resists holding/ cuddling by stiffening body (due to pain, brain injury, withdrawl)
  • Unresponsive to parents' approaches
Term
Postpartal Blues
Definition
  • Experienced by up to 80% of women
  • Hormones and exhaustion may be causes
  • Assure mom that this is normal and explain to her that it may occur before discharge
Term
Weight Loss PP
Definition
15-17 lbs, possibly more if breastfeeding
Term
Involution
Definition
  • Return of uterus to normal size and condition (returns to prepregnant state)
  • Starts immediately after birth of placenta
  • Due to uterine contractions
Term
Subinvolution
Definition
Failure of uterus to return to normal size
Term
Location of Fundus PP
Definition
  • Immediately after birth: halfway b/w umbilicus and symphysis pubis
  • One hour after birth: 1 cm above umbilicus
  • 24 hours: at level of umbilicus
  • Each day thereafter: decreases 1 cm each day
  • 10th-14th day PP: no longer palpable; withdrawn into pelvis
Term
Weight of Uterus
Definition
  • At birth: 1000 g
  • End of 1st week: 500 g
  • End of PP: 50 g
Term
Uterine atony
Definition
A boggy- feeling uterus
Term
After Pains
Definition
  • Cramp-like pains due to contractions after birth
  • More acute with:
    • Pitcoin or breastfeeding
  • More common with:
    • Multipara, large baby, or multi-gestation (twins)
Term
Drugs to manage PP hemorrhage
Definition
  • Pitocin (most common !)
  • Methergine
  • Prostaglandins
Term
Healing of Placental Site
Definition
  • Exfoliation--growth of endometrium from bottom to top
  • Scars prevented to help with future gestations
  • Returns to normal by 6 weeks PP
Term
Return to Normal Menstrual Cycle
Definition
  • Not breastfeeding:
    • 1 month (27 days)
  • Breastfeeding:
    • 6-8 weeks or more
Term
Lochia
Definition

Blood flow postpartum

Made of blood, fragments of the decidua (mucous layer in uterus in pregnancy), WBCs, mucus, and some bacteria

Term
Lochia rubra
Definition

Bright red, fading to pinkish over time

Lasts 3-4 days

Term
Lochia serosa
Definition

4th day PP through 10th-14th day

Pinkish brown, becoming whiter as time goes on

Term
Lochia alba
Definition

From 10th/14th day through 4th-8th week PP

Becomes colorless with time

Term
Lochia documentation (per hour)
Definition
  • Scant: 1-2" stain on pad
  • Light: 3-4" stain
  • Moderate: 4-6" stain
  • Heavy: saturated
Term
Lochial bleeding vs. Non Lochial bleeding
Definition
  • Lochial:
    • Trickles from vaginal opening (introitus)
    • Steady flow, increases with uterine contractions
  • Non Lochial:
    • Bloody discharge spurting from the vagina
    • Indicates cervical or vaginal tears 
Term
Lochia increases with...
Definition
  • Ambulation
  • Gush upon standing up after pooled in vagina (not hemorrhage !)
Term
Lochia decreases with...
Definition
  • Breastfeeding
  • Pitocin administration
  • After C-section birth (due to suctioning of uterus during surgery)
Term
Closing of the Cervical Os
Definition

External os--size of a pencil and firm by 7th day PP (never completely closes and becomes slit-like, not round)

Internal os--closes completely by 5th day PP

Term
Vaginal Involution
Definition

Takes entire PP period (6 weeks) to return to pre-pregnancy state

Kegal exercises speed up this process

Encourage use of water-soluble lube during sex (may experience dryness)

Term
Changes in Labia
Definition

Slightly change but never fully return to pre-pregnant state

Remain atrophic and softened

Term
Lacerations Instruction
Definition

Hygiene is top priority !!

Instruct mom NOT to scratch ! (will feel itchy)

Term
Hemorrhoids
Definition

Often occur during delivery

Witch hazel wipes, creams, etc. will help ease pain

Term
Nursing Interventions: Episiotomy/ Laceration care
Definition
  • Pain relief (administer meds as ordered)
  • Ice packs--first 24 hours at least
  • Promote perineal cleansing and exercises
  • Cold and hot therapy
  • Sitz baths
Term
Changes in Breasts
Definition
  • Breastfeeding:
    • Soft--> firm--> engorged in 2-3 days
    • Colostrum--> milk in 2-3 days
  • Non-breastfeeding:
    • Colstrum lasts 2-3 days
    • Engorgement possible, decreases in 24-36 hours
    • Avoid nipple stimulation (will produce more milk)
Term
Changes in Hormonal/ Endocrine System
Definition
  • hCG and HPL undetectable by 24 hours PP
  • Estrone and estradiol at pre-pregnancy level by 1 week PP
  • FSH low for about 12 days then rises to initiate menstrual cycle
    • Faster in non-breastfeeding moms
Term
Prolactin: Lactating vs. Non-Lactating Moms
Definition
  • Continues to rise during pregnancy, peaks when breastfeeding
  • Highest in 1st month PP, elevated during breastfeeding
Term
Changes in Urinary System
Definition
  • Decreased sensation to void (encourage q2h)
  • Ureters larger--> return to normal 4 weeks PP
  • Urinary stasis and UTIs more common !
Term
Changes in Circulatory System
Definition
  • Blood volume--> returns to normal 1-2 weeks PP
  • H&H return by 6 weeks PP
  • Plasma fibrinogen remains elevated during PP period
  • Increased WBCs
  • Varicosities recede slightly
  • CO remains elevated for 48 hours
Term
Changes in GI system
Definition
  • Immediately after birth--> very hungry and thirsty !
  • Hemorrhoids common
  • Decreased bowel activity (due to relaxin)
  • Painful BMs due to lacerations or hemorrhoids
Term
Changes in Integumentary System
Definition
  • Chloasma disappears
  • Striae get smaller and lighter but do not disappear
  • Pigmentation of areola and linea nigra may decrease but not disappear
  • Hair growth slows, can cause hair loss 
Term
Change in Vital Signs
Definition
  • Temperature elevated right after birth
    • 100.4 or greater indicates infection, less is normal
  • Pulse slightly decreased
  • BP returns to normal baseline
Term
Lactation Progression
Definition
  • Colostrum produced for first 2 days
  • 3rd day, milk forms
    • Primary engorgement
    • Continuation depends on nipple stimulation
Term
Postpartum Admission Assessment
Definition
  • Vital signs
  • Bladder palpation
  • Urinary output: color, odor (may be pink tinged from lochia)
  • Incision
  • Lochia: amount, odor, color, clots
Term
Nursing Intervention: Shaking after Birth
Definition
  • Normal due to excitement, reversal of events, tension, hormonal shift, internal temperature higher than external b/c of exertion
  • Provide warmed blankets !
  • If last longer than 10 minutes, consider other causes
Term
Fundal Checks
Definition
  • Every 15 min for 1st hour PP
  • Use side of your hand while supporting base at symphysis pubis
  • Document position and consistency
  • If off midline, have patient void then reassess
Term
Nursing Interventions: Pain
Definition
  • General aches and pains
    • Tylenol or analgesics
  • Lacerations
    • Ice
    • Medication
Term
Nursing Interventions: Hygiene Teaching
Definition
  • Handwashing
  • Cleaning perineal area regularly (use peri bottle)
  • Sitz baths
Term
Discharge Teaching: Self-care
Definition
  • Discuss bleeding, infection
  • Emotional response
    • Support systems necessary
    • Normal to feel overwhelmed
    • Discuss PP blues
Term
Discharge Teaching: Sex
Definition
  • Recommended that women wait 6 weeks
  • Risk of hemorrhage and infection minimal at 2 weeks
  • Contraception 
    • May be ovulating before they get a period
    • If they do not want to get pregnant again, must use contraceptive immediately !
Term
Discharge Teaching: Prescribed Medications
Definition
  • What they are
  • What they're for
  • Possible side effects
Term
Discharge Teaching: Routine Checkups
Definition
  • Vaginal delivery--> 6 weeks
  • C-section--> 2 weeks
  • Newborn first visit--> 2 weeks
Term
Nursing Interventions: PP Period
Definition
  • Promote:
    • Rest (sleep when the baby sleeps !)
    • Fluid intake (increase if breastfeeding)
    • Urinary elimination (try at least q2h)
  • Prevent constipation and hemorrhoids
    • Fiber-rich foods
    • Witch hazel pads, creams
Term
BUBBLEHE
Definition
  • Breast
  • Uterus
  • Bladder
  • Bowels
  • Lochia
  • Episiotomy
  • Hormones
  • Emotions/ Bonding
Term
Rubella Vaccine
Definition
  • Give PP to non-immune women
    • If titer < 1:8 or EIA level < 0.8
  • If titer is positive, warn her against pregnancy for at least 3 months
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