Chapter 17 Postpartum physioloigical changes

Ch 17 Postpartum physiological changes. Puerperium It is the first 6 weeks after birth. Most changes that are occurring during this
time is just returning the body back to pre-pregnancy state. Involution refers to the changes the reproductive
organs, especially the uterus, undergo after childbirth to return to their prepregnancy
state. Three processes
1. contraction of muscle fibers
2. Catabolism- process of converting cells into
simplier compounds 3. Regeneration of the uterine epithelium. This process begins immediately after delivery
of the placenta. That is why you are doing fundal checks so
frequently. You want to make sure this process is working
correctly. When fundus is not firm (contracted), blood
vessels are not compressed and excessive bleeding occurs. A new endometrium begins to form from the
fundi of the uterus. By 21 days postpartum the entire endometrium
is regenerated except over the placental site which takes 6 to 7 weeks. The location of the fundus helps us determine
if involution is progressing correctly. Right after birth the fundus about the size
of a large grapefruit or softball and weighs about 2.2 pounds. AT this time it can be palpated midway between
the symphis pubis and the umbilicus and it should be midline. Within 12 hours the fundus rises to the height
of the umbilicus. It typically descends about 1 cm or 1 fingerbreadth
per day. By day 14, it is into the pelvic cavity and
can no longer be palpated. Remember when documenting fundal checks you
include where it is in relation to the umbilicus (below or above and how much), is it midline
or to one of the sides and is it firm or boggy. We want it to be firm! Subinvolution is when the process of involution
does not occur. Subinvolution can cause postpartum hemorrhage
Afterpains are intermittent uterine contractions that occur during the involution process. They discomfort is more severe in multipara
because of the repeated stretching of the uterine fibers. The primpara may not notice the afterpains
as much. These pains are more severe during breastfeeding
due to the release of oxytocin. NI: analgesics may be needed. NSAIDS are best. Some woman are worried about taking them if
they are breast feeding but they are safe for short periods of time during ther few
days they experience the discomfort. Some factors that make a patient at risk for
hypotonic (not staying firm) uterus are: Over distended uterus which can be caused
by a large baby, twins and a mom who had polyhydramnios Either a very rapid labor or a prolonged labor
can also be at risk for hypotonic uterus. The rapid labor is more of a hard labor so
the contractions are typically stronger from the beginning so the uterus doesn’t get
that gradual stretching of the uterus. The prolonged labor is because the uterus
has spent so much time stretching with contractions that is has a hard time firming back up. Another risk factor would be if mom had prolonged
general anesthesia. This is due to the relaxation effects of the
anesthesia so the uterus stays relaxed and doesn’t contract as quickly. Lochia is the discharge mom will have after
birth. It is the necrotic superficial layer of the
myometrium and blood from the uterine sinuses at the placental site
Lochia rubra- bright red blood, cells from the outer decidua and cells remaining from
the amniotic fluid. 1st 3 days postpartum
Lochia serosa- day 3 to day 10—lighter in color and amount. More serous—less blood—erythrocytes, leukocytes,
shreds of decidua, mucus from the cervix and microorganisms. Lochia alba- day 3 to day 10—lighter in
color and amount. More serous—less blood—erythrocytes, leukocytes,
shreds of decidua, mucus from the cervix and microorganisms. There is a picture in your book of the pads
to give you a visual. The hard part is sometimes it is not always
pooled in one area like that. The main things you need to know is how long
has it been since they changed their pad. We get worried if they saturate a pad in less
than an hour. If they slept for 4 hours and the pad is saturated,
you don’t get as worried. Also, you don’t a person to go from light
rubra to heavy rubra. One question you can ask is “do you feel
your bleeding is lighter now than right after you delivered.” After delivery the cervix remains dilated,
edematous and possibly bruised. There could be small tears or lacerations. Some will be sutured per the provider and
other superficial ones will just heal on its own. Rapid healing will take place and typically
with no complications The vagina will be stretched with a vaginal
delivery. The walls can be edematous and possibly have
some bruising as well. There can be small lacerations as well. A few vaginal rugae are present and many times
woman will complain of dyspareunia once they begin having intercourse again. Some nursing interventions we can do for perineum
discomfort is ice first 24 hours, heat or sitz bath after 24 hours
Teaching self-care measures – analgesics, continue using peri bottle and dermoplast
spray, stool softener, plenty of water, increase fiber,

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