NU 7511 - OB exam 3 Study Guide.

OB exam 3
Chapter 15

- Uterine involution
o Process of uterus returning to its normal size
 Starts close in, folds on itself
 Allows clamping down and constriction of blood vessels to stop bleeding
o After birth uterus weighs 1000g – one week half its size- back to norm in 6 weeks
o Contractions of smooth uterine muscles start to help it involute on itself (clamp down)
 Related to decrease in estrogen and progesterone
 oxytocin- released by pituitary during breast feeding
 Pitocin- give in hospital
o After pains (below)
- Subinvolution
o Caused by: full bladder
 Uterus is up and deviated to the right
o Retained placental fragments
o Atony (stretching of the uterus)
 Multiple births, macrosomia, hydramnios
- Fundal checks
o Fundus goes down one finger breadth each day of postpartum
o U/U after birth- at umbilicus at 24 hrs
o Typically descends from level of umbilicus at a rate of 1 cm per day
 1/U- one above umbilicus
 u/1- one below umbilicus
o
- after pains
o part of involution
o contractions- occur to constrict blood vessels in uterine muscles
 oxytocin contributes to this (natural)
 secreted from pituitary gland
 breastfeeding can contribute to oxytocin release
o stimulated uterine contractions which in turn help the uterus fold
on itself
 mild analgesic may be administered due to pain of contractions- Tylenol,
motrin
 standing order: Pitocin directly after birth
- lochia
o sloughing off of endometrial tissue- due to low progesterone
o amount: scant, small, moderate, large
o should have: fleshy smell
o should not have: foul smell (infection), bright red (laceration: not sutured enough)
 rubra- dark red, 3-4 days
 deep-red mix of mucus, tissue, debris, and blood
 serosa- dark brown/ pink- 10 days

,  leukocytes, decidual tissue, RBC, and serous fluid
 alba- white, 2-6 weeks
 consists of leukocytes, decidual tissue, and reduced fluid content
- cervix
o external: os never goes back to pre-pregnancy state
 before kids: circular
 after kids- slit-like, never fully closes
o interna:
 return to normal after 2 weeks
- vagina
o returns to normal at end of postpartum (6 weeks)
o normal mucus production and thickening of mucosa return with ovulation
 lactation amenorrhea- no period r/t breastfeeding, not a good contraceptive
o dyspareunia (painful sex) may occur until menstruation returns
 use water soluble lubricants
- perineum
o assess for hemorrhoids, episiotomy, laceration, bruised, and edematous
o ice pack- first 24 hours (vasoconstriction)
o sitz bath- warm water (vasodilation)
 hazal pads, anesthetic spray, peri bottle
o episiotomy- pain, strain, BM, tear sutures
 fl, walking, fiber, colace
o episiotomy or laceration may take 4-6 months to heal in the absence of complications
(hematoma and infection)
o KEGALS- improve pelvic floor tone
- Cardiovascular system
o Blood volume
 Vaginal- 500 ml blood loss
 C-section- 1000 ml blood loss
 More than that = hemorrhage risk
o Pulse
 Slower = may be bradycardic
 It can run from 40-60 bpm
 It will then return to baseline
 Worry about tachycardia
 First sign of hemorrhage
 Dehydration can occur
o Blood pressure
 Should return to pre-pregnancy level
 Can be slightly lower the first two days PP
 Preeclampsia
 May take longer to return to normal
 Decreased bp
 May suggest an infection or a uterine hemorrhage
o Coagulation
 Pooling and stasis of blood in the lower limbs

,  Place women at risk for blood clots
 2-3 weeks PP stay elevated- still hypercoaguable
 Blood clots
 SCD’s, walk, fluid, s/s to watch for, DVT, PE, chest pain, SOB, dyspnea
 Greater risk with history of smoking, obesity, immobility (c-section)
- Urinary system
o Increased bladder capacity, swelling, bruising
o Your body retains extra fluids during pregnancy, so large volumes of urine is one way it
rids itself of excess fluid
o Urine stasis- increased risk for UTI
o Epidural- decreases urine output
 May not feel full bladder- straight cath
o Puerperal diuresis- excessive fluid excretion after childbirth
 Causes: large amounts of IV fluids, d/c Pitocin, buildup/retention of fluid during
pregnancy
 Pitocin- antidiuretic property (causes mom to hold onto fluid), wont diuresis as
much until Pitocin d/c
 Sweating a lot (while they shower- change sheets and gown)
- GI system
o NPO after labor
o Bowels sluggish following birth
 Regardless of vaginal or cesarean
o GI usually returns to normal quickly
o Bowel sounds can be hypo when listening at first
 Decreased peristalsis due to analgesic, surgery, diminished intra-abdominal
pressure, low- fiber diet, insufficient fluid intake, diminished muscle tone
o Constipation is common
 Encourage fluid, food, fiber, walking
 Stool softener can be ordered
- Musculoskeletal
o Joints return to prepregnant state except for feet (can be ½ size larger)
o Fatigue and activity intolerance may occur
o NANDA nursing diagnosis: distorted body image
 Women feel better now that they are no longer pregnant, but they have the
appearance of pregnancy- support
 Remind them it took 9 months to get there so its going to take time to get back to
normal
o Good body mechanics and correct positioning are important during this time
 Prevent low back pain and injury to joints
 After birth, muscle tone is diminished and the abdominal muscles are
soft and flabby
- Integumentary system
o Pigmentation fades (linea nigra, chloasma)
 Due to estrogen/progesterone levels going back to normal
o Stretch marks fade to silvery lines
 Typically on abdomen and breasts