Postpartum & Newborn - Vocabulary Flashcards (Video Notes)

Involution and Reproductive System Changes

• Involution: the uterus returning to its pre-pregnant state; the primary mechanism that restores uterine size after birth.
• Uterine position changes:
  • Within the first 12 hours postpartum, the uterus may rise above the umbilicus by 1\,\text{cm}.
  • Within 24 hours postpartum, the uterus should be at the level of the umbilicus.
  • Involution occurs at a rate of 1-2\,\text{cm/day}.
• Bladder:
  • By 2 weeks postpartum, the uterus should not be felt externally.
• Bowel:
  • Auscultate for bowel sounds; they should be present (not absent).
• Nourishment:
  • Breastfeeding moms need an additional +300\,\text{calories} per day.
• Activity & Rest:
  • Encourage early and frequent ambulation to promote recovery.
• Elimination:
  • Assess voiding and bowel pattern regularly.
• Perineal Care:
  • Ice pack for 24 hours, then sitz bath.
  • Can use Tucks pad, epifoam, or Dermoplast spray to promote healing and comfort.
• Episiotomy/Epidural Site/Emotional Status:
  • Monitor perineal integrity and pain; assess mood and emotional responses.
• Bowel & Bladder:
  • COCA: Color, Odor, Consistency, Amount of lochia; Last void/Last BM.
  • Assess for an overdistended bladder; if distended, encourage urination (pee).
• Uterine status and gas passage:
  • Mom should be passing gas; monitor for normal voiding patterns.
• Lochia (lochia discharge) assessment:
  • Rubra: first 1-4\,\text{days}; bright red.
  • Serosa: 4-10\,\text{days}; pink to brown.
  • Alba: 10\,\text{days}-6\,\text{weeks}; white to yellow.
  • Foul odor could indicate infection.
  • Assess for presence of clots.

Lochia and Perineal Care (Expanded)

• Lochia progression reflects normal recovery and should be monitored for changes outside expected ranges.
• Report any foul odor, large clots, or saturating a pad rapidly.

Early Postpartum Hemorrhage (PPH)

• Defines as hemorrhage occurring within the first 24\,\text{hours} after birth.
• Most common cause: uterine atony (loss of uterine tone).
• Risk factors:
  • Macrosomia (big baby)
  • Multiple gestation (twins/triplets)
  • Polyhydramnios (too much amniotic fluid)
  • Chorioamnionitis (infection of amniotic fluid)
  • Prolonged labor
  • Use of MgSO₄ (magnesium sulfate)
  • Use of oxytocin
  • Unrepaired lacerations of perineum or vaginal canal
  • Hematomas in perineal area or vagina; may be hidden and painful but not easily visible
• Signs suggestive of ongoing bleeding or uterine atony:
  • Continuous trickles of bright red blood
  • Severe or unrelieved pain/pressure; may not be readily visible
  • Possible formation of hematomas
• Interventions and medications:
  • Monitor for ongoing brisk bleeding and ensure hemodynamic stability
  • Oxytocin: 20\ \text{units} in 1000\,\text{mL} of LR or NS (Pitocin)
  • Methylergonovine Maleate (Methergine) IM; contraindicated or used with caution in hypertensive, preeclamptic, or diabetic patients
  • Cytotec (Misoprostol): Rectal or sublingual; caution in patients with asthma
  • Carboprost (Hemabate): IM or intrauterine; can cause N/V and severe diarrhea
  • Consider corrections for hypovolemia (fluids), blood products if needed, and surgical intervention if status worsens
• Early PPH requires rapid assessment and coordinated response to prevent progression to hypovolemia and shock.

Late Postpartum Hemorrhage

• Occurs more than 24 hours but less than one week after birth.
• Common cause: retained placenta or placental fragments.
• Nursing assessment:
  • Check lochia for clots; clots larger than a dime or fragments that cannot be easily separated suggest retained placental tissue; report to PCP.

Endocrine Changes

• Insulin needs: decrease after delivery; gestational diabetics may remain diabetic for a period after delivery.
• Estrogen and progesterone: drop rapidly after delivery, causing breast engorgement.
• Diuresis: increased urine production to help remove excess fluid accumulated during pregnancy.
• Pituitary and ovarian function:
  • Prolactin levels increase; if the mother breastfeeds, prolactin remains elevated; first ovulation after delivery varies.
• Urinary elimination changes:
  • Within 12\,\text{hrs} of delivery, excess tissue fluid is lost due to decreased hormones and venous return.
  • Ovulation can occur as early as day\ 27\ PP.
  • Blood loss is normal and helps remove excess fluid.
  • Bottle-feeding mothers: average time to return of ovulation/menstruation is about 10\,\text{weeks}.
  • Breastfeeding mothers: average time to return of ovulation/menstruation is about 6\,\text{months}.
• Anesthesia effects:
  • Anesthesia can cause a decreased need to void; patients should void within 4\,\text{hours} of delivery.
• Pelvic rest and contraception note:
  • Breastfeeding is NOT a reliable form of birth control; discuss contraception options if applicable.

Changes in Urinary Elimination

• Postpartum fluid shifts and diuresis lead to large urine outputs in the early hours/days.
• Ovulation, if it occurs, can occur early (as early as day\ 27\ PP), depending on feeding methods and hormonal milieu.
• Bottle-feeding moms may resume menses around 10\,\text{weeks}; breastfeeding mothers around 6\,\text{months}.
• Urine output goals and risks:
  • Able to void up to 3000\,\text{mL/day} as a maximum in healthy postpartum women.
  • If urine output is less than 100\,\text{mL} per void, assess for urinary retention.

Urinary Tract Infection (UTI)

• Increased risk for UTIs due to reduced urge to void and possible childbirth-related trauma.
• Signs to teach patient to report to HCP:
  • Burning, foul odor, cloudy urine, vaginal irritation.
• Prevention tips:
  • Wipe from front to back.
  • Hydration and regular voiding.

Breast Changes and Lactation

• Colostrum: clear/yellow fluid seen in the first 1-3\,\text{days} after birth.
• Milk coming in: around 3-4\,\text{days}; wear a supportive bra 24 hours a day.
• Common issues:
  • Sore nipples due to improper latch.
  • Inverted nipples may require a breast shield.
  • Engorgement typically occurs 72-96\,\text{hours} after birth; management includes feeding and other measures.
• Bottle-feeding mothers:
  • Feed baby every 3-4\,\text{hours}.
  • Wear a tight sports bra; avoid nipple stimulation; turn away from water when showering.
  • Use ice packs to reduce swelling; cabbage leaves can help with engorgement by reducing vein congestion; keep baby in a semi-upright position (about 45^{\circ}).
• Mastitis (infection of the breast):
  • Usually occurs in the first 2-4\,\text{weeks}; often unilateral; flu-like symptoms; localized pain.
  • Management: feed frequently, warm compresses, antibiotics.
• Plugged duct: swollen, tender area; feed on the affected side first and pump until the breast is empty.
• General note: proper latch is essential to prevent cracked or sore nipples.

Gastrointestinal (GI) Changes

• May not have a bowel movement for 2-3\,\text{days} due to:
  • Decreased abdominal muscle tone after labor.
  • Pre-labor diarrhea, dehydration, fear of pain, lack of food.
• Rectal sphincter tear risk: potential for fecal incontinence.

Cardiovascular Changes and Blood Values

• Cardiovascular function generally returns toward pre-pregnant state; vital signs stabilize.
• Vascular size reduces by 10-15\% after birth, reducing the need for vasodilation.
• Normal blood loss: 500\,\text{mL} (vaginal) or 1000\,\text{mL} (C-section).
• Extravascular water shifts after delivery, leading to a transient increase in clotting factors for about 2\,\text{weeks} postpartum.
• Cardiac output is increased for at least 48\,\text{hours} and typically normalizes by about 3\,\text{months}.
• Hematology:
  • Hematocrit (Hct) decreases in the first 3-4\,\text{days} postpartum.
  • WBC counts can be elevated, up to 25{,}000\,/\mu L in the immediate postpartum period.
  • Normal ranges: \text{Hct} = 37\%-47\%; \text{WBC} \approx 12{,}000/\mu L.

Thromboembolic Disorders (VTE)

• Venous thromboembolism can be superficial, deep, or pulmonary embolism (PE).
• Signs and symptoms:
  • Lower-extremity pain and tenderness, warmth, redness, swelling in a leg; a hardened vein.
  • PE signs: dyspnea, tachypnea, tachycardia, fever, anxiety.
• Prevention:
  • Early ambulation
  • Compression stockings
  • Sequential Compression Devices (SCDs)
• Treatment:
  • Anticoagulant therapy (e.g., aspirin, heparin)
  • Bed rest as indicated; analgesia (e.g., acetaminophen/Tylenol)

Role Development in the Postpartum Period (Rubin's Stages)

• Expectations:
  • Adaptation to new reality; transition from birth to motherhood requires mastery of new roles.
• Rubin's Stages:
  • Stage 1: Taking-in phase – focused on birth experiences and immediate needs.
  • Stage 2: Taking-hold – focused on care of the baby and beginning to master caregiving tasks.
  • Stage 3: Letting-go – focused on forming a family unit and adjustments.
• Key concepts:
  • Claiming: identifying the baby in terms of likeness to other family members.
  • Mutuality: infant behavior aligns with mother’s behavior (e.g., baby cries and mother responds).
• Bonding:
  • Early breastfeeding, Kangaroo care, holding baby close, talking to the baby, eye contact, naming and responding to baby.
  • Always assess father/partner bonding with baby.
• Cultural considerations:
  • Care must respect cultural beliefs about diet, activity, rest, and temperature.

Teen Mothers

• Teens may be more self-centered with concrete thinking and may have difficulty adjusting to parental responsibilities.
• They may feel forced to grow up quickly and may show less responsiveness and positive interaction with the baby.
• Emphasize verbal and nonverbal communication between mother and baby; tailor support to developmental stage and cultural context.

Mood Disorders and Postpartum Mental Health

• Mood disorders affect about 70\% of postpartum women and include:
  • Baby blues
  • Postpartum depression (with and without psychotic features)
  • Postpartum psychotic disorders
• Baby blues:
  • Sudden mood swings, tearfulness, fatigue; does not markedly impair functioning or bonding; typically resolves within a couple of weeks post-birth.
• Postpartum Depression (PPD):
  • Intense, persistent sadness lasting longer than 2\,\text{weeks}; requires external support and intervention to recover.
  • Higher risk with limited social support or history of depression.
  • Education for patient and family about signs and when to seek help is essential.
• Postpartum Depression with Psychotic Features:
  • PPD with delusions about harming the baby; can occur as early as within 2\,\text{days} of birth, but more commonly in the first 2-3\,\text{weeks} postpartum.
  • Symptoms: emotional lability, restlessness, insomnia.
  • Needs a supportive family system; may require antipsychotics and mood stabilizers; hospitalization may be necessary.

Immediate Care at Birth

• APGAR score: rapid assessment based on 5 categories:
  • Appearance (color)
  • Pulse (heart rate)
  • Grimace (reflex irritability)
  • Activity (muscle tone)
  • Respiratory effort
• APGAR scoring table:
  • Appearance:
  • 0 = Blue/pale
  • 1 = Blue extremities
  • 2 = Pink all over
  • Pulse:
  • 0 = Absent
  • 1 = Below 100\,/\text{min}
  • 2 = Above 100\,/\text{min}
  • Grimace:
  • 0 = None
  • 1 = Minimal response
  • 2 = Grimace/strong cry or good response
  • Activity:
  • 0 = Absent
  • 1 = Extremities flexed
  • 2 = Active
  • Respirations:
  • 0 = Absent
  • 1 = Slow/irregular
  • 2 = Crying
• Eye prophylaxis: to prevent inflammation from Gonorrheal or Chlamydia infections.
• Vitamin K (phytonadione) IM injection: to aid in clotting.

Notes:

• All pharmacologic interventions require clinical judgment and should align with institutional protocols and patient-specific factors (e.g., hypertension, asthma, diabetes).
• The postpartum period involves rapid physiological and psychosocial changes; ongoing monitoring, patient education, and family involvement are essential for safe recovery and bonding.