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PP Ch. 17
Study guide- PP physiologic adaptations
| Question | Answer |
|---|---|
| Describe PP changes in uterine muscle | Stretched uterine muscle fibers contract & gradually regain former size & contour |
| Describe PP changes in uterine muscle cells | # of uterine cells remains the same, but each cell decreases in size through catabolism |
| Describe PP changes in uterine lining | outer area of endometrium(decidua) is expelled w/ placenta. Remaining decidua separates into 2 layers: Superficial layer is shed in lochia & basal layer regenerates new epithelium |
| contains blood, mucus & bits of decidua, is red or red-brown color & has a duration of approximately 3 days | Rubra |
| Contains serous exudate, erythrocytes, leukocytes & cervical mucus, is pinkish or brown-tinged, duration from day 4- day 10 | Serosa |
| Contains leukocytes, decidual cells, epithelial cells, fat, mucus & bacteria, is white, yellow or cream color & duration is from day 11 & can last 3-6wks PP | Alba |
| Describe effects of BF on uterine involution | BF stimulates oxytocin from pituitary gland which intensifies afterpains, bt also maintains better uterine contraction which facilitates uterine involution |
| Describe effects of BF on sexaul intercourse | Lactation suppresses ovulation & estrogen secretion, causing more vaginal dryness than nonlactating moms have. May cause pain during intercourse unless a lubricant is added |
| What is significance of bradycardia during early PP period? | Normal. Blood volume & cardiac output increase as blood from uteroplacental unit returns to central ciruclation & as excess extracellular fluid enters vascular compartment for excretion. Because stroke volume increases, pulse decreases |
| What makes any pregant or PP woman at risk for bentous thrombosis & what factors increase risk? | higer fibrenogen levels increase ability to form clots, but factors that break down clots are not increased. Vericose veins, hx of thrombophlebitis or C/S birth have additional risks above baseline |
| How does leukocyte level change during early PP period & how would this leve be interpreted for nonpregnant woman? | Leukocytes(WBC) increase up to 30,000, with an avg of 14-16,000. In a nonpregnant women the level is 5-10,000 so the higher level would indicate infection |
| Explain how a full bladder shortly after birth can lead to PPH. | Full bladder moves uterus from normal position & interferes with uterus ability to contract firmly & occlude open vessels at placental sites, allowing them to bleed freely. (it allows uterine atony) |
| Why are PP women at risk for UTI? | Increased bladder capacity & decreased bladder tone along w/ rapid diuresis may cause urinary retention. Stasis of urine increases risk of bacterial growth. |
| When can women expect their menses to resume if they are BF? If not planning to breastfeed?? | BF moms may not resume menses for 12wks-18mths, depending on length & frequency of BF, but lactation is not a good form of contraception. Formula feed will prob begin menses between 7-9wks PP. |
| Describe influence of hormones on lactation | Estrogen & progesterone prep the breasts for lactation, Porlactin initiates milk production in alveolis, Oxytocin causes milk ejection from alveoli into lactiferous ducts |
| What RN measures help suppress lactation & manage discomfort of breast engorgement? | Tell mom to wear well-fitting bra/sports bra 24h/day. Ice & analgesics reduce discomfort & need to avoid actions that stimulate milk production such as spraying with warm water during showers or pumping/massaging breasts |
| Describe proper technique to massage a soft fundus. How should the nurse expel clots? | NONDOMINANT hand above symphysis pubis, massage fundus with DOMINANT hand until firm. When firm, press firmly to expel clots. DO NOT EXPEL CLOTS BEFORE FIRM. (see pg. 403 table 17-1) |
| What teaching should you provide the PP woman to prevent constipation? | Increase activity progressively, drink adequate fluids(min 8 glasses water/day, add dietary fiber(fruits, veggies,whot grains, bread & pasta) to prevent constipation. Prunes are a natural laxative |
| What S/S should the PP woman repot to MD/midwife? | Fever, localized area of redness, sweling or in pain in breast unrelieved by support/analgesics, presistent abd tenderness or feelings of pelvic fullness/pressure, persistent perineal pain, s/s uti, change in lochia(full list pg 418) |
| PP Assessment | Look over pgs 400-406 |
Created by:
L.moore
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