Postpartum Period Flashcards

Puerperium: 6-week period for the birthing parent's body/reproductive organs to return to a pre-pregnant state.

Immediate Postpartum Period: First 1-4 hours, focusing on assessment, support, physiologic & psychologic adaptation, and bonding. Monitor for hemorrhage, infection, and newborn transition.

Physiologic Changes:

• Uterine Involution: Rapid size reduction via muscle contraction and oxytocin release. No longer palpable around 10 days postpartum.

• Cervix: Remains spongy, flabby, and permanently altered after childbirth. By week one, only fingertip dilated.

• Vaginal Bleeding (Lochia): Shedding of decidua, decreasing daily. Report large clots. Types: rubra (1-3 days, red), serosa (4-10 days, pink-brown), alba (11 days-6 weeks, white-yellow).

• Vagina: Returns to near-normal by 6 weeks. Lactation causes hypoestrogenism, potentially leading to decreased vaginal mucosa and dyspareunia.

• Perineum: May be edematous and bruised. Assess episiotomy/laceration for hematoma. Healing may take 4-6 months. Assess using REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation).

• Breasts: Hormonal changes stimulate milk production. Engorgement may occur 48-96 hours postpartum. Colostrum transitions to milk. Breastmilk provides passive immunity (IgA).

• Urinary Tract: May experience urinary retention. Diuresis begins within 12 hours.

• GI Tract: Bowel movements return in 1-2 days. Promote fiber, activity, and fluids.

• Ovarian Function: Varies based on breastfeeding. Menstruation resumes 1-2 months (non-breastfeeding) or 3-6 months (breastfeeding).

Infant Feeding: Breastmilk preferred but formula acceptable. Contraindication: HIV positive.

Uterine Healing: Placental site heals by exfoliation, taking up to 6 weeks. Bleeding controlled by uterine muscle compression.

Fundal Assessment: Should be FIRM, near umbilicus and midline by 24 hours, descending 1 cm/day. Boggy uterus indicates bleeding risk.

Factors Slowing Involution: Full bladder, lacerations, complications during pregnancy/labor, overdistended uterus, infection, coagulopathies.

The 4 Ts: Tone, Tissue, Trauma, Thrombin (causes of postpartum hemorrhage).

Manifestations of Postpartum Hemorrhage: Pad saturation in 15 min, large clots, hematomas, boggy uterus, persistent lochia rubra, altered consciousness, shock.

Nursing Interventions for Hemorrhage: Assess bleeding source, monitor vitals, assess bladder, IV fluids, medications (oxytocin, ergotrate, prostaglandins, TXA), monitor LOC/UO, administer oxygen.

Abdomen: Afterpains common; diastasis recti responds to exercise; striae fade but remain visible.

Vital Signs: Temp may increase in 1st 24 hours. BP slight increase then may drop. HR: bradycardia common (elevated pulse indicates hypovolemia/infection).

Blood Volume: Hypervolemia protects against blood loss. Monitor for thromboembolism.

Cardiac Output: Stabilizes within an hour after birth.

Fluid Shifts: Immediate 10-12 lb loss (infant, etc.), additional 5 lb loss via diuresis, diaphoresis. Chills common.

Labs/Immunizations: RPR, CBC, Rho[D] immune globulin, vaccines (influenza, pneumonia, Tdap, rubella).

Lab Values: WBC > up to 1 week (25,000-30,000). H&H affected by blood loss/hydration.

Clotting Factors: Increased fibrin, platelets drop, risk for DVTs up to 6 weeks.

BUBBLE HERV: Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy, Hemorrhoids, Emotions, Rubella/Rhogam, Vaccines.

Neurologic Changes: Headaches common (fluid shifts, CSF leak). Increased seizure risk with history/preeclampsia.

Bonding: En face position, skin-to-skin contact, interest/attachment signs.

Accepting New Role (Reva Rubin): Taking in (self-focused), taking hold (focus on newborn care), letting go (acceptance of new role).

Nursing Interventions: Educate on sleep, exercise, nutrition, support. Follow-up call/visit within 3-7 days. Screen for PP depression.

Trouble Adapting: Maladaptation (abuse/neglect), PP depression vs. baby blues (short-term, self-limiting).

Postpartum Depression: Occurs in 10-15%, onset within 1st year, S/S: persistent depression, unable to care for self/baby. Collaborative care: screening, teaching, intervention, medication.

Postpartum Psychosis: Serious mental illness, emergent situation.

Developmental Influences: Adolescent (Identity vs. Role Confusion), Young adult (Intimacy vs. Isolation), Middle-aged adult (Generativity vs. Stagnation).

Culturally Competent Care: Self-educate, preserve dignity, integrate norms into care.