Nursing 209

N209: Reproductive Health Study Guide

Breasts • Lactogenesis: Initially triggered by the delivery of the placenta • If not breastfeeding, prolactin levels decrease and return to normal within 2-3 weeks • Colostrum is produced the first 2-4 days • Suckling stimulates milk ejection and oxytocin release, which stimulates milk production Cardiovascular Changes • Increase in blood volume of 50% at the time of delivery • Average blood loss is 400-500 ml for vaginal delivery; 750-1000 ml for C-section • Blood loss replaced with “autotransfusion” of approximately 500-750 ml • Risks for thrombus formation; plasma fibrinogen and ESR are elevated (will begin to decrease to normal after 7 days) • Cardiac output increases for 24 hours • Blood pressure usually stabilizes by PPD day two • WBC is increased in first 24 hours; returns to normal within one week • Immediate PP period is critical for anyone with decreased cardiac function Renal Changes • Dilated ureters (normal pregnancy changes) persist for five days PP but can last longer • Increase in urinary output in first week PP; may have rapid diuresis after Pitocin is discontinued • Urinary retention can occur depending upon extent of repair and anesthesia • May see displacement of uterus above umbilicus and off midline if the bladder is full • Can cause uterine atony and increase in bleeding Gastrointestinal Changes • Anesthesia and perineal trauma can delay ambulation and cause constipation • If extended repair is done into the anal sphincter or rectum, stool softeners and mild cathartics are ordered • May have hemorrhoids as a result of pushing; topicals and sitz baths provide relief 5.2 Psychosocial Adaptation Postpartum Depression • Depression lasting longer than two weeks after delivery that interferes with ADLs and ability to care for the newborn

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