Name: Ballesteros Jan Vincent F

Course and Section: BSN 2G

Group: Group 5

Organ system Physiological Changes Nursing

Care/Responsibilities
- coagulation - there is a gradual increase in - Women require
concentrations of Factors I, II, VII, VIII, IX and frequent monitoring of
X during pregnancy. There is consumption of the signs and
coagulation factors and platelets at the symptoms of
placental site after placental separation. cardiovascular disease,
These changes in concentrations of including the
coagulation factors may predispose to development of
thrombosis in the puerperium (especially if shortness of breath or
complicated by trauma, sepsis, or cough, using pulse
immobility). oximetry, lung
blood volume changes - plasma volume: assessments, and
there is a loss of 1000 ml (approx.) after monitoring intake and
delivery (mostly due to loss at the 3rd stage). output.
Over the next few days the volume may - Provide health
increase by 900-1200 ml due to transfer of education and teaching
fluids from the cellular compartments. on what the things that
Normal plasma volume is established by 6-8 needs to maintain, to
weeks. - red cell volume: there is an average do in order for fast
14% red cell at delivery. Normal values are recovery
achieved at about 8 weeks. - Monitor Vital signs for
Cardiovascular hemodynamic changes - cardiac output: this changes
is elevated in pregnancy and has returned to
System normal by 6 weeks. - heart rate: this has
returned to normal values by about 6 weeks.
- blood pressure: returns to pre-pregnancy
levels early in the puerperium.

Vital Signs

- Temperature
The woman’s temperature during the first 24
hours after delivery may rise to 38° C (100.4°
F) as a result of the dehydration and exertion
of labor. After the first 24 hours, the woman
should be afebrile, and any temperature
greater than 38° C suggests infection.
- Pulse
The heart rate often decreases to a rate of
50 to 60 beats/min (bradycardia, or slow
pulse) for the first 6 to 8 days’ postpartum.
An elevated heart rate may indicate undue
blood loss, infection, pain, anxiety, or cardiac
disease.
-Blood Pressure
Name: Ballesteros Jan Vincent F
Course and Section: BSN 2G
Group: Group 5

Blood pressure readings should remain

stable after birth. A decrease in blood
pressure may be related to excessive blood
loss. Blood pressure elevation—especially
when accompanied by a headache—
suggests gestational hypertension and
indicates the need for further evaluation
- Involution occurs during postpartum
wherein the reproductive organs return
to their nonpregnant state.
- The area where the placenta was - Assess the color, texture,
implanted is sealed off to avoid bleeding. smell of the urine,
- The uterus returns to its prepregnant bowel, and blood of the
size. patient to determine if
- Involution occurs more quickly in there’s abnormality
women who are well nourished and - Monitor Blood Pressure
ambulate early after birth. and signs of Orthostatic
- Contraction plays a very important role hypotension and the
in the postpartum period for it allows level of pain of the
the uterus to return to its former size patient
quickly and also prevents hemorrhage. - Always Practice the
Reproductive - Lochia starts to appear as a bloody agencies protocols,
discharge for the first 3 days after birth Hand Hygiene, and
System and is termed as lochia rubra. Gloving.
- Lochia serosa or the brownish to pinkish - Health Educate the
discharge starts on the fourth day, and mother on how to clean
the amount of blood and tissue the Reproductive organ
decreases. and what are the
- Lochia alba appears on the tenth day and necessary actions to do if
the discharge decreases and almost there’s excessive
looks colorless or whitish. It may last bleeding.
until the third week after birth. - Teach the Patient to
- The cervix is soft and malleable Have a proper bed rest.
immediately after birth, but once
contraction of the cervix takes place it
also returns to its prepregnant state.
- At the end of seven days, the external os
has narrowed to the size of a pencil
opening but appears slitlike or star
shaped compared to its round shape
before childbirth occurred.
- The vagina returns to its prepregnant
state through contractions after the
entire postpartum period but remains
slightly distended than before.
Name: Ballesteros Jan Vincent F
Course and Section: BSN 2G
Group: Group 5

- Kegels exercise helps return the strength

and muscle tone of the vagina.
- The labia minora and majora are still
atrophic and soft after birth and would
never return to its prepregnant state.
- The perineum is edematous and tender
immediately after birth.

- The bladder of the postpartum woman - Assess if the patient

has increased in capacity and has lost urinates, overdistended
some of its muscle tone. In addition, bladder possibly causing
during the birth, the urethra, bladder, uterine atony, excessive
and tissue around the urinary meatus lochia, dysuria,
may become edematous and frequency, urgency and
traumatized. Urination is also impeded infection
by anesthetic drugs. The diminished - Assess the urinary
awareness of the need to urinate may Output and Health
result in decreased sensitivity to fluid educate the Patient to
pressure, and the woman may not feel drink water to prevent
an urge to void. This is important to dehydration.
remember because the bladder fills - The bladder should be
rapidly as a result of intravenous fluids palpated every 4 hours
administered during labor and after to assess for urinary
Urinary System birth. With bladder distention, the retention.
uterus is displaced (often over to one
side, usually the right) and has a reduced
ability to contract. When the uterus fails
to contract, blood vessels are free to
bleed. Therefore, it is important that the
nurse monitor the woman for voiding.
The urinary output in the early
postpartum period can be great
(diuresis). Tenderness over the
costovertebral angle, fever, urinary
retention, and dysuria with urinary
frequency signify potential urinary
infection, and further evaluation is
necessary. Glomerular filtration may
remain elevated for up to 8 weeks
postpartum.
- The woman will feel hungry and thirsty - Ask the Patient to Drink
almost immediately after giving birth, plenty of fluids, milk and
Gastrointestinal - Digestion and absorption are active fruit juice
System again after birth except for women who - Protein rich foods are
underwent a caesarean section. important to help you
recover from childbirth
Name: Ballesteros Jan Vincent F
Course and Section: BSN 2G
Group: Group 5

- Passage of stool may still be slow and keep your body

because of the relaxin that is still strong
present in the bowels.
- Bowel evacuation may still be difficult
because of the pain of episiotomy.

-The dermis stretches extensively to - Assess the

accommodate the growing uterus, Reproductive organ if
breast tissue, and fat deposits on the there is Excessive
thighs and hips. Torn connective tissue bleeding, Assess if
beneath the dermis can cause striae there is lacerations,
(stretch marks) on the abdomen, episiotomy
which appear as red or purple marks - Monitor the skin Daily
during pregnancy that fade to a silvery if there are
Integumentary white color in the months after abnormalities
system childbirth. - Apply sunscreen
- An increase in melanocyte-stimulating - Keep well moisturized
hormone, in conjunction with - Assess the capillary
estrogens, darkens the areolae and refill to monitor
creates a line of pigment from the dehydration and the
umbilicus to the pubis called the linea amount of blood flow
nigra. Melanin production during to tissue.
pregnancy may also darken or discolor
skin on the face to create a chloasma,
or “mask of pregnancy.”
Expulsion of the placenta results in dramatic - monitors the health
decreases of hormones produced by status of the mother
placenta. and foetus, provides
- The placental enzyme causes the emotional support,
diabetogenic effects of pregnancy to and teaches the
be reversed, resulting in significantly pregnant woman and
lower blood sugar levels in the her family about
immediate postpartum period physiological and
Endocrine - Estrogen and progesterone levels psychological changes
System decrease markedly after expulsion of during pregnancy,
the placenta, reaching their lowest foetal development,
levels 1 week into the postpartum labour and childbirth,
period. and care for the
- The estrogen levels in non lactating newborn.
women begin to increase by 2 weeks
after birth, and higher by postpartum
day 17.
- Return to normal cellular immune - Health educates the
function may take 3 to 4 months in mother to eat
the postpartum. Some aspects of early nutritious foods and
immunology (hsCRP and IL-6)
Name: Ballesteros Jan Vincent F
Course and Section: BSN 2G
Group: Group 5

probably reflect the latter stage of avoid drinking alcohol

pregnancy, the stress of birth and the and smoking
inflammation associated with - Health educates to
PImmune involution. Dysphoric moods are exclusively breastfeed
higher in the early postpartum but are the baby for 6 months
System not related to immune factors or and with
hormones. complementary foods
after 6 months
- Promote skin to skin
with the baby for
colonization of good
bacteria
- During the first few days, levels of the - Assess if there is a
hormone relaxin decrease and presence of Homans
ligaments and cartilage of the pelvis signs and other signs
begin to return to the pre-pregnancy of DVT such as
state. With the delivery of the redness, sudden sharp
placenta, the effect pain, and warmth in
of progesterone on muscle tone is the legs.
removed. Therefore, muscle tone - inspection, palpation,
begins to be restored throughout the and observing the
body. In particular, the tone in the range of motion of the
rectus abdominis muscles and the joints.
Musculoskeletal pubococcygeal muscle is restored. The
System abdominal muscles, including the
rectus abdominis muscles, may be
separated, and diastasis recti can
occur. Special exercises can strengthen
the abdominal wall. Women need to
be advised that with proper diet,
exercise, and rest, the abdominal
muscle tone is usually regained more
rapidly. Good body mechanics and
correct posture are important to help
relieve low back pain. Kegel exercises
help the pubococcygeal muscle
(muscle that aids bowel and bladder
control) to regain normal function
-