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Questions and Answers
What is the weight of the uterus immediately after birth?
What is the weight of the uterus immediately after birth?
What stimulates uterine contractions during breastfeeding?
What stimulates uterine contractions during breastfeeding?
How much does the uterus decrease in size per day during involution after childbirth?
How much does the uterus decrease in size per day during involution after childbirth?
Which condition may delay the involution of the uterus?
Which condition may delay the involution of the uterus?
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When is the fundus of the uterus typically palpated after birth?
When is the fundus of the uterus typically palpated after birth?
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What might occur if the bladder is full shortly after birth?
What might occur if the bladder is full shortly after birth?
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By how much does the uterus weigh at the end of the involution process?
By how much does the uterus weigh at the end of the involution process?
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What may happen if there are retained placenta or membranes?
What may happen if there are retained placenta or membranes?
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What is a primary reason for the chills a woman may experience after childbirth?
What is a primary reason for the chills a woman may experience after childbirth?
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During which phase of the puerperium is a woman likely to be more passive and prefer others to make decisions for her?
During which phase of the puerperium is a woman likely to be more passive and prefer others to make decisions for her?
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What behavior is characteristic of the taking-hold phase?
What behavior is characteristic of the taking-hold phase?
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What emotional state is common during the taking-in phase of the puerperium?
What emotional state is common during the taking-in phase of the puerperium?
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How can nursing staff assist a woman in the taking-in phase?
How can nursing staff assist a woman in the taking-in phase?
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What physiological change may contribute to postpartum chills?
What physiological change may contribute to postpartum chills?
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How long does the taking-in phase typically last after childbirth?
How long does the taking-in phase typically last after childbirth?
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What might a woman naturally feel during the taking-in phase?
What might a woman naturally feel during the taking-in phase?
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What happens to the external os after a vaginal birth?
What happens to the external os after a vaginal birth?
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What is a characteristic change in the vagina after vaginal birth?
What is a characteristic change in the vagina after vaginal birth?
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What effect does breastfeeding have on the vaginal walls during the postpartum period?
What effect does breastfeeding have on the vaginal walls during the postpartum period?
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What primary process occurs in the cervix after birth?
What primary process occurs in the cervix after birth?
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What can mothers do to improve the strength and tone of the vagina post-birth?
What can mothers do to improve the strength and tone of the vagina post-birth?
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What symptom might mothers experience in the perineum immediately after birth?
What symptom might mothers experience in the perineum immediately after birth?
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How do the labia majora and minora change after birth?
How do the labia majora and minora change after birth?
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What nonpharmacologic measures may be suggested for perineal comfort post-birth?
What nonpharmacologic measures may be suggested for perineal comfort post-birth?
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What pharmacologic pain relievers should nurses discuss with the mother’s provider after birth?
What pharmacologic pain relievers should nurses discuss with the mother’s provider after birth?
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What happens to levels of hCG and hPL within 24 hours after the placenta is no longer present?
What happens to levels of hCG and hPL within 24 hours after the placenta is no longer present?
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What is the normal daily urine output for a woman during the second to fifth day after birth?
What is the normal daily urine output for a woman during the second to fifth day after birth?
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How does the urinary system function in postpartum women shortly after childbirth?
How does the urinary system function in postpartum women shortly after childbirth?
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How long does follicle-stimulating hormone (FSH) remain low after childbirth?
How long does follicle-stimulating hormone (FSH) remain low after childbirth?
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What is the typical blood loss range for a vaginal delivery?
What is the typical blood loss range for a vaginal delivery?
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What change is observed in the white blood cell count after childbirth?
What change is observed in the white blood cell count after childbirth?
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What is an essential consideration for the bladder during the immediate postpartal period?
What is an essential consideration for the bladder during the immediate postpartal period?
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What happens to varicosities after pregnancy?
What happens to varicosities after pregnancy?
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Which hormone primarily drives milk production during lactation?
Which hormone primarily drives milk production during lactation?
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What effect does relaxin have on bowel function after childbirth?
What effect does relaxin have on bowel function after childbirth?
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What is the significance of encouraging the consumption of fruits and soluble fiber post-delivery?
What is the significance of encouraging the consumption of fruits and soluble fiber post-delivery?
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What might occur if diastasis recti is present after delivery?
What might occur if diastasis recti is present after delivery?
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Which condition is described as excessive pigment on the face and neck during pregnancy?
Which condition is described as excessive pigment on the face and neck during pregnancy?
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What is the role of oxytocin in the lactation process?
What is the role of oxytocin in the lactation process?
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What does bilateral ankle edema indicate during the postpartum period?
What does bilateral ankle edema indicate during the postpartum period?
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Study Notes
Postpartum Assessment and Nursing Care
- Postpartum women often experience chills and a shaking sensation 10 to 15 minutes after birth. This is a normal phenomenon, often resulting from the release of pressure on pelvic nerves or increased epinephrine production during labor.
- Reassure women that these chills are temporary, common, and pass quickly.
- Behavioral Adjustment: Reva Rubin's three phases of the puerperium: Taking-in, Taking-hold, and Letting-go.
- Taking-in Phase: (1-3 days)
- Characterized by a passive and reflective period.
- The woman prefers assistance with her needs and decision-making.
- This phase is influenced by physical discomfort, uncertainty about caring for the newborn, and exhaustion.
- Encourage conversations about the labor and birth to help the woman integrate the experience.
-
Taking-hold Phase:
- The woman transitions from passive reliance to initiating action.
- She shows more interest in her infant.
- She exhibits maternal role behaviors and takes ownership of tasks.
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Uterine Involution: The process of the uterus returning to its pre-pregnancy size
- Begins immediately after placental delivery.
-
Fundal Height:
- The fundus is palpable through the abdominal wall.
- It descends one fingerbreadth (1 cm) daily.
- Factors Influencing Involution:
- Breastfeeding: Oxytocin release stimulates uterine contractions.
- Bladder: A full bladder can displace the uterus.
- Nutrition and Ambulation: Proper nutrition and early ambulation are essential.
- Delayed Involution: Can be caused by multiple births, hydramnios, prolonged labor, multiparity, excessive analgesia, or retained placenta.
- Cervical Involution: The cervix returns to its pre-pregnancy state.
- The external os narrows to a pencil opening by day seven.
- The internal os closes, while the external os remains slightly open, appearing slit-like or star-shaped.
- Perineum:
- May exhibit edema and tenderness due to pressure during labor.
- Ecchymosis patches from ruptured capillaries may be visible.
- Pain Management:
- Provide comfort measures such as ice or warm packs, pillows, and donut cushions.
- Discuss and administer pharmacologic pain relievers as prescribed.
Systemic Changes
-
Hormonal System:
- Pregnancy hormones decline rapidly after the placenta is delivered.
- hCG and hPL levels are nearly negligible by 24 hours.
- Estrogen, progesterone, and estradiol return to pre-pregnancy levels by week one.
- FSH remains low for 12 days before rising, indicating the start of a new menstrual cycle.
-
Urinary System:
- Diaphoresis and diuresis begin almost immediately to eliminate excess fluid.
- Urine production can increase significantly in the first few days.
- Reassure the woman that increased urine production is normal.
- Assess Bladder: Frequently monitor bladder fullness and empty it regularly to prevent overdistention.
-
Circulatory System:
- Blood volume returns to pre-pregnancy levels by the first or second week post birth due to diuresis and blood loss.
- Normal blood loss during vaginal birth: 300-500 ml
- Normal blood loss during cesarean delivery: 500-1000 ml.
- Leukocytosis:
- White blood cell count rises (mainly granulocytes) due to the body's defense system against infection and healing.
- Vascular Blemishes: Spider angiomas may fade but not disappear entirely.
-
Gastrointestinal System:
- Digestion and absorption resume quickly.
- Bowel Function:
- Passage of stool may be delayed due to relaxin effects.
- Encourage fiber-rich foods and fluids for easy bowel movements.
-
Integumentary System:
- Stretch marks remain prominent.
- Chloasma and linea nigra will fade by 6 weeks.
- Diastasis recti, requires strengthening of abdominal muscles to restore abdominal support.
- Lactation:
- Four phases of lactogenesis (milk production).
- Prolactin is responsible for milk production, and oxytocin is responsible for the let-down reflex.
- A retained placenta can inhibit this process.
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Description
This quiz covers essential postpartum assessment and nursing care strategies for new mothers. It highlights common physical responses after birth, such as chills, and outlines Reva Rubin's three phases of the puerperium. Understanding these concepts is crucial for providing effective care and support during this transitional period.
