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What is the term for the period of 6 weeks after childbirth?
What is the term for the period of 6 weeks after childbirth?
Involution is the process of the uterus returning to its non-pregnant state.
Involution is the process of the uterus returning to its non-pregnant state.
True
What physiological changes occur in the reproductive system during the postpartum period?
What physiological changes occur in the reproductive system during the postpartum period?
Involution of the cervix, vagina, uterus, and perineum.
The process by which the uterus returns to its prepregnancy state is called __________.
The process by which the uterus returns to its prepregnancy state is called __________.
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Match each reproductive system change with its description:
Match each reproductive system change with its description:
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Which of the following is NOT a systemic change during the postpartum period?
Which of the following is NOT a systemic change during the postpartum period?
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The external os remains open for a prolonged time after childbirth.
The external os remains open for a prolonged time after childbirth.
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What role does the hormonal system play in the postpartum period?
What role does the hormonal system play in the postpartum period?
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What is colostrum primarily composed of?
What is colostrum primarily composed of?
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Breast milk production begins in response to an increase in Estrogen and Progesterone levels after delivery.
Breast milk production begins in response to an increase in Estrogen and Progesterone levels after delivery.
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What sensation is primarily associated with primary engorgement in the breasts following childbirth?
What sensation is primarily associated with primary engorgement in the breasts following childbirth?
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Engorgement occurs on the ___ or ___ day after birth.
Engorgement occurs on the ___ or ___ day after birth.
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Match the signs of breast engorgement with their descriptions:
Match the signs of breast engorgement with their descriptions:
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Which method can be used to relieve breast engorgement?
Which method can be used to relieve breast engorgement?
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It is necessary for women to wash their breasts multiple times a day for proper hygiene.
It is necessary for women to wash their breasts multiple times a day for proper hygiene.
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To begin milk flow, one recommended method is ___ to the breast.
To begin milk flow, one recommended method is ___ to the breast.
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What shape does the external os of the cervix appear after vaginal birth?
What shape does the external os of the cervix appear after vaginal birth?
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The internal os of the cervix remains open after vaginal birth.
The internal os of the cervix remains open after vaginal birth.
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What is a nonpharmacologic comfort measure to reduce perineal edema in the first 24 hours post-birth?
What is a nonpharmacologic comfort measure to reduce perineal edema in the first 24 hours post-birth?
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The cervix involves the formation of new muscle cells, resulting in the cervix not returning to its __________ state.
The cervix involves the formation of new muscle cells, resulting in the cervix not returning to its __________ state.
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Match the following nursing responsibilities with their corresponding actions:
Match the following nursing responsibilities with their corresponding actions:
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Which of the following conditions can result from pressure experienced during birth?
Which of the following conditions can result from pressure experienced during birth?
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The perineal area heals slowly and discomfort can last for weeks after birth.
The perineal area heals slowly and discomfort can last for weeks after birth.
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How often should Kegel exercises be performed to improve circulation and decrease perineal edema?
How often should Kegel exercises be performed to improve circulation and decrease perineal edema?
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What is a primary nursing responsibility during the Taking-In Phase?
What is a primary nursing responsibility during the Taking-In Phase?
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The Taking-Hold Phase is characterized by the mother's dependence on healthcare providers.
The Taking-Hold Phase is characterized by the mother's dependence on healthcare providers.
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What are the three phases of the puerperium according to Reva Rubin?
What are the three phases of the puerperium according to Reva Rubin?
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The mother feels a sense of ______ during the Taking-In Phase.
The mother feels a sense of ______ during the Taking-In Phase.
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Match the following phases with their descriptions:
Match the following phases with their descriptions:
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Which psychological change is NOT associated with the Taking-In Phase?
Which psychological change is NOT associated with the Taking-In Phase?
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The Letting-Go Phase involves the acceptance of a new role and adjustment of relationships.
The Letting-Go Phase involves the acceptance of a new role and adjustment of relationships.
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List one cause of physical discomfort during the Taking-In Phase.
List one cause of physical discomfort during the Taking-In Phase.
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What color does lochia appear on the 10th day postpartum?
What color does lochia appear on the 10th day postpartum?
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Lochia should have an abnormal color and contain large clots before notifying a doctor.
Lochia should have an abnormal color and contain large clots before notifying a doctor.
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What is the purpose of checking the episiotomy for REEDA?
What is the purpose of checking the episiotomy for REEDA?
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If the patient experiences pain or tenderness in the calf, it indicates a positive ____________ sign.
If the patient experiences pain or tenderness in the calf, it indicates a positive ____________ sign.
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Match the following lochia stages with their descriptions:
Match the following lochia stages with their descriptions:
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Which of the following is NOT a factor that may affect emotional status postpartum?
Which of the following is NOT a factor that may affect emotional status postpartum?
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What should be done if hemorrhoids are present postpartum?
What should be done if hemorrhoids are present postpartum?
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It is common for a postpartum mother to experience stable emotions without fluctuations.
It is common for a postpartum mother to experience stable emotions without fluctuations.
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What should the uterus feel like during a postpartum assessment?
What should the uterus feel like during a postpartum assessment?
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Engorgement is a common occurrence during breast milk production.
Engorgement is a common occurrence during breast milk production.
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What should be the minimum volume of urine during the first three postpartum voids?
What should be the minimum volume of urine during the first three postpartum voids?
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Lochia rubra refers to the _____ type of discharge experienced in the first three days postpartum.
Lochia rubra refers to the _____ type of discharge experienced in the first three days postpartum.
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Match the postpartum assessments with their descriptions:
Match the postpartum assessments with their descriptions:
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Which of the following is NOT an indicator of bladder distention?
Which of the following is NOT an indicator of bladder distention?
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Patients should wipe from back to front after voiding and defecating.
Patients should wipe from back to front after voiding and defecating.
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What action may the doctor take if bowel movements have not occurred by the second postpartum day?
What action may the doctor take if bowel movements have not occurred by the second postpartum day?
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Study Notes
Postpartum Changes
- Postpartum period (Puerperium) refers to the 6 weeks after childbirth.
- The Latin word "puer" means "child."
- "Parere" means "to bring forth."
- The fourth trimester of pregnancy is the same as the postpartum period.
Physiological Changes of the Postpartum Period
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Involution (Retrogressive): The process of the uterus and vagina returning to their non-pregnant state.
- Involution is complete by 6 weeks.
- The uterus returns to its prepregnancy size.
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Progressive Changes:
- Milk production for lactation.
- Restoration of normal menstrual cycle.
- Beginning of parenting role.
Reproductive System Changes
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Cervix:
- Becomes soft and malleable to palpation.
- Both internal and external os are open.
- Contraction towards the prepregnant state begins, within 7 days.
- External os narrows to the size of a pencil opening.
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Perineum:
- Often edematous and tender after childbirth.
- Ecchymosis patches may develop from ruptured capillaries.
- Labia majora and minora can be atrophic and softened.
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Nursing Responsibilities for the Perineum:
- Perineal Care: Inspect the perineum.
- Check for ecchymosis, hematoma, erythema, edema, drainage or bleeding from episiotomy stitches.
- Check for hemorrhoids.
- Nonpharmacologic comfort measures: Apply ice or cold pack for the first 24 hours to reduce edema and the possibility of hematoma formation.
- Post 24 hours: consider heat (perineal hot pack or sitz bath) to increase circulation.
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Episiotomy Care:
- Discomfort typically lasts 5 - 6 days.
- Apply soothing creams or sprays to reduce discomfort.
- Encourage Kegel exercises.
- 3-4 times/day to improve circulation and decrease perineal edema.
- Help regain prepregnant muscle tone, preventing urinary incontinence.
- Back Rubs: Effective for relieving muscular aches. Aches are usually due to excessive energy used pushing during labor.
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Vagina:
- Soft with fewer rugae and greater diameter than normal.
- Hymen is permanently torn and heals with small tissue tags.
- Vaginal wall thickening occurs. The entirety of the postpartum period is required for vaginal involution to occur.
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Uterus:
- Involves two processes:
- The placental site seals off by rapid contraction to prevent bleeding.
- The organ reduces to its approximate pregestational size.
- Uterus in the First few postpartum days: The fundus is palpable midway between the umbilicus and symphysis pubis approximately 1 hour post-delivery. It remains at this level for 24 hours. Post-partum, the fundus decreases in size by approximately 1 cm a day. By days 9 -10 the fundus is no longer palpable.
- Uterus Involution: Immediately after birth, the uterus weighs approximately 1,000 grams. By the end of the first week it weighs approximately 500 grams. During complete involution (around 6 weeks), the uterus weighs approximately 50 grams (pre-pregnancy size).
- Uterus in breastfeeding mothers: Oxytocin release from the baby's nursing may cause the uterus to contract more quickly.
- Involves two processes:
-
Uterus– Delayed Involution:
- Possible causes: multiple fetuses, hydramnios, prolonged labor, grand multiparity, physiologic effect of analgesia, retained placenta or membrane.
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Uterine Atony:
- Failure of the uterus to contract adequately after delivery.
- The first hour after birth is potentially the most dangerous time.
- Lax uterus can cause rapid blood loss.
Systemic Changes
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Hormonal System:
- Hormones decrease as the placenta is no longer present.
- HCG and HPL decrease within the first 24 hrs.
- FSH remains low for approximately 12 days, then begins to rise to initiate a new menstrual cycle, with Progestin, estrone, and estradiol all returning to prepregnancy levels by week 1.
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Urinary System:
- Substantial diuresis (increased urine output) from 2000–3000 mL occurs post delivery as the body rids excess fluid.
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Circulatory System:
-Blood volume returns to normal levels within 1 to 2 weeks post-delivery.
- Blood loss after delivery:
- Vaginal birth: 300-500 mL
- Cesarean birth: 500-1000 mL
- 4-point decrease in hematocrit (proportion of red blood cells to circulating plasma).
- Blood loss after delivery:
- 1-g decrease in hemoglobin/ 250 ml of blood loss.
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Gastrointestinal System:
- Digestion and absorption resume post-delivery.
- Bowel sounds are active but stool passage may be slow due to relaxin's effect on the bowel.
- Bowel evacuation may be difficult due to discomfort from episiotomy sutures or hemorrhoids.
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Integumentary System:
- Striae gravidarum (stretch marks): still reddish at birth, will fade to a pale white in 3-6 months.
- Melasma (Chloasma): excessive pigmentation on face and neck; barely detectable by 6 weeks.
- Linea nigra: barely detectable by 6 weeks.
- Diastasis recti: partial or complete separation of rectus abdominis muscles; appearance is slight indentation or bluish area in mid-abdomen.
Progressive Changes of the Puerperium
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Lactation:
- Formation of breast milk. Begins during pregnancy as secretion of colostrum.
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Colostrum: Thin, watery, yellow fluid rich in antibodies, protein, sugar, fat, minerals, and vitamins.
- Breast milk develops as estrogen and progesterone levels decrease after delivery, stimulating prolactin release.
- Breast engorgement is a sensation of tension in the breasts. Typically occurs 3-4 days postpartum.
- Causes include insufficient removal of milk by the infant, swollen or engorged milk ducts.
- Prevention/Relief of Engorgement:
- Frequent baby suckling.
- Pain relief (mild analgesic).
- Breast support (well-fitting bra).
- Warm packs/ Warm shower to improve milk flow.
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Breast care during postpartum
- Daily washing with clear water, avoiding soap
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Return of Menstrual flow:
- Ovulation may be delayed. A breastfeeding woman may not have a return of a menstrual period until 3 - 4 months or longer and absence of menstrual period doesn't eliminate risk for pregnancy. Non-breastfeeding women typically have menstrual return between 6 -10 weeks.
Vital Signs
- Temperature: Slight increase is normal in the first 24 hrs. or a 3rd/4th day increase from baby suckling milk. If temp exceeds 100.4F post 24hrs., suspect infection.
- Pulse: Slightly slower than normal; returns to normal in first week: If pulse is rapid and thready, suspect blood loss.
- Blood Pressure: Should be monitored. Decreased BP may indicate bleeding. Increased BP (140/90 mm Hg or higher) may indicate pre-existing pregnancy hypertension or oxytocin medication.
Postpartum Nursing Assessment
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BUBBLE-HE mnemonic:
- Breast, Uterus, Bowel, Bladder, Lochia, Episiotomy, Homan's sign, Emotional status.
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BUBBLE-HE assessment:
- Performed for hospitalized patients.
- Vital signs taken every 15 minutes in the first hour post-delivery and gradually less frequently.
- Often used as assessment time to provide education to patients.
8-Point Postpartum Assessment Instructions
- Detailed instructions are provided for assessing breasts, uterus, bladder, bowels, lochia, episiotomy, Homan's sign, and emotional status.
Psychological Changes of the Postpartum Period
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Phases of Puerperium: Taking in, Taking hold, Letting go
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Taking-in phase: Woman is passive, dependent, focus is on her own experience.
- Common concerns: physical discomfort (afterpains, hemorrhoids), uncertainty caring to newborn, exhaustion from delivery.
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Taking-hold phase: Woman asserts more active role to care for child
- Increased interest and development of maternal behavior, but potentially associated with feeling insecure about the ability to care for the child.
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Letting-go phase: Mother redefines her role in her life and accepts real image of child, readjusts relationships.
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Maternal Concerns: Abandonment, Disappointment (in baby), Postpartum Blues (50% of women experience overwhelming sadness with symptoms of tearfulness, mood lability, feelings of inadequacy, anorexia, and sleep disturbances)
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Description
Explore the physiological and reproductive changes that occur during the postpartum period, also known as the puerperium. This quiz covers involution, cervical changes, and the transition into parenting roles. Test your knowledge on this critical phase after childbirth.
