Maternity Nursing: Postpartum Q 33


Which of the following physiological responses is considered normal in the early postpartum period?
  
     A. Urinary urgency and dysuria
     B. Rapid diuresis
     C. Decrease in blood pressure
     D. Increase motility of the GI system
    
    

Correct Answer: B. Rapid diuresis
In the early PP period, there’s an increase in the glomerular filtration rate and a drop in the progesterone levels, which result in rapid diuresis. During pregnancy, the compressive forces of the gravid uterus and the progesterone-induced decrease in ureteral tone, peristalsis, and contraction pressure lead to the dilation of the calyceal system, increasing the volume of kidneys by 30% from the pre-pregnant state. The dilated ureters and renal pelvis usually return to the pre-pregnant state within four-eight weeks.
Options A: There should be no urinary urgency, though a woman may feel anxious about voiding. Conversely, urinary incontinence, especially urge incontinence, affects 30% of postpartum females and is attributed most commonly to psychological stress associated with childbirth. The mother may complain of painful micturition or dysuria that could be due to tears, laceration of the cervix or vagina, or episiotomy.
Option C: There’s a minimal change in blood pressure following childbirth. The blood pressure could be elevated due to pain or excitement but is generally in the normal range. A significant decrease (> 20% below baseline) in blood pressure could be a sign of postpartum hemorrhage or septic shock. Conversely, high blood pressure could be a sign of pain or pre-eclampsia.
Option D: A residual decrease in GI motility occurs postpartum. The compressive effects of the gravid uterus on the stomach, a decrease in lower esophageal sphincter tone due to high progesterone levels, and hypersecretion of acid due to high gastrin levels cause an increase in the incidence of acid reflux during pregnancy. After delivery, the levels of progesterone and gastrin drop within 24 hours, and the acid reflux and associated symptoms resolve in the next three to four days.