1229 Exam 4: Postpartum

Question 1

postpartum

Answer 1

(puerperium) begins after the delivery of the placenta and ends when the body returns to the prepregnant state. (aprox. 6 weeks)

Question 2

physiological maternal changes during postpartum:

Answer 2

uterine involution
lochia flow
cervical involution
decrease in vaginal distention
changes in ovarian function and menstration
breast changes
urinary tract changes
GI tract changes
cardiovascular changes

Question 3

Physical Risk during the postpartum period:

Answer 3

hemorrhage
shock
infection
constipation
fatigue
UTI
Thrombophlebitis

Question 4

Hormone released from the pituitary gland, coordinates and strengthens uterine contractions

Answer 4

Oxytocin

Question 5

A firm and contracted uterus prevents what?

Answer 5

bleeding and hemorrhage

Question 6

afterpains

Answer 6

uncomfortable uterine pains during postpartum

Question 7

Decreased estrogen is associated with:

Answer 7

breast engorgement
diaphoresis
diuresis
diminished vaginal lubrication

Question 8

focused physical assessment:

Answer 8

breast
uterus (fundal height, uterine placement and consistency)
bowel and GI function
bladder function
lochia (color, odor, consistency, and amount)
episiotomy (edema, ecchymosis, approximation)
vitals and pain
teaching needs

Question 9

fudus immediately after delivery

Answer 9

firm, midline with the umbilicus, and approximately at the level of the umbilicus

Question 10

fudus 12 hours postpartum

Answer 10

1 cm above umbilicus midline and firm

Question 11

fundus every 24 hours postpartum

Answer 11

should descend approx. 1 to 2 cm (finger breaths)

Question 12

fundus by day six

Answer 12

should be half way between the symphysis pubis and he umbilicus

Question 13

fundus by day ten

Answer 13

should lie within the true pelvis and should not be palpable.

Question 14

uterine involution

Answer 14

uterus returns to its prepregnant state. (aprox 1000g to 60g)

Question 15

locating the fundus

Answer 15

1. explain procedure to pt.
2. wears gloves
3. cup non dominant hand just about the symphysis pubis to support the lower segment of the uterus
4. with dominant hand, palpate the pt’s abdoomen to locate.
   (usually start a few inches above umbilicus)
   *document fundal height, location, and uterine consistency

Question 16

Lochia stages

Answer 16

lochia ruba, lochia serosa, lochia alba

Question 17

bright red color, bloody consistency, fleshy odor, may contain small clots, transient flow increases during breastfeeding and upon rising last 1 to 3 days after deliver

Answer 17

lochia ruba

Question 18

pinkish brown color and serosanguineous consistency. last from approximately day 4 -10 after delivery.

Answer 18

lochia serosa

Question 19

yellowish, white creamy color, fleshy odor. lasts from approximately day 11 up to and beyond 6 weeks postpartum.

Answer 19

lochia alba

Question 20

< 2.5 cm of blood

Answer 20

scant

Question 21

< 10 cm of blood

Answer 21

light

Question 22

> 10 cm of blood

Answer 22

moderate

Question 23

one pad saturated within 2 hours

Answer 23

heavy

Question 24

one pad saturated in fifteen mins or less/ pooling of blood under buttocks

Answer 24

excessive blood loss

Question 25

excessive spurting of bright red blood from the vagina

Answer 25

possibly indicating a cervical or vaginal tear

Question 26

numerous large clots and excessive blood loss

Answer 26

hemorrhage

Question 27

fould odor

Answer 27

infection

Question 28

persistent lochia ruba in the early postpartum period beyond day three:

Answer 28

retained placental fragments

Question 29

continued flow of lochia serosa or alba beyond the normal length of time (esp. if it is accompanied by a fever, pain, or abdominal tenderness)

Answer 29

endometritis

Question 30

Nursing interventions for perineal tenderness, laceration, and episotomy:

Answer 30

promote measures for the client to help to soften her stools educate the client about proper cleansing to prevent infection promote comfort measures

Question 31

educate the client about proper cleansing to prevent infection:

Answer 31

wash hands before/after voiding pt should use a squeeze bottle filled with warm water after each voiding to cleanse the area pt should clean perineal area from front to back pt should blot dry, not wipe pt should sparingly use topical cream or spray pt perineal pad should be changed from the front to the back.

Question 32

Comfort measures:

Answer 32

``` apply ice packs to the clients perineum for the first 24-48 hours to reduce swelling encourage sitz bath twice daily administer analgesia opioid analgesia topical anestehetics ```

Question 33

Sitz bath (remember everyone is different)

Answer 33

gather materials and apply gloves. clamp tubing of bag. add warm water to both bag and bowl of sitz bath. raise toilet lid, and place bowl hang bag above toilet (IV pole or hanger) insert tubing into bowl (make sure tubing is right side up) slowly unclamp tubing. **usually takes about 15-20 mins

Question 34

Fundal Massage

Answer 34

massage if fundus is boggy. can cause a temporary increase in the amount of vaginal bleeding seen as pooled blood leaves the uterus very uncomfortable procedure

Question 35

Homan's sign and postpartum

Answer 35

(I couldn't find anything in the book, but I learned at clinical) Homan's sign is important for C-section patients. (just like any other surgery patient)

Question 36

peri colace

Answer 36

stool softener/ laxitive

Question 37

stadol

Answer 37

pain medication

Question 38

rhogam

Answer 38

rh negative mothers with rh positive babies ( given 72 hours after delivery)

Question 39

mylicon

Answer 39

gas relief

Question 40

dilaudid

Answer 40

pain

Question 41

toradol

Answer 41

pain

Question 42

percocet

Answer 42

pain

Question 43

Psycholsocial risk:

Answer 43

``` depression altered family processes disturbance in body image/self-esteem role conflict altered sexuality patterns ```

Question 44

Report from L&D nurse will include:

Answer 44

``` OBGYN (provider) Age gravida, para anesthetic labor induced type of birth and repair Rh status feeding abnormalities bonding group B strep status rubella iv fluids sex/wt of the infant description of the fundus, lochia, bladder, and perineum ```

Question 45

Vital signs

Answer 45

check q15 mins first hour, q30 mins second hour bp up slightly first hour pulse increased first few hours temp may go up to 100.4 first 24 hours respirations remain normal assessments done twice a day until discharge

Question 46

uterine involution

Answer 46

take 4-6 weeks occurs by decrease in size of the muscle cells should be firm and midline

Question 47

cervix

Answer 47

soft immediately after birth | within 2 to 3 postpartum days it has shortened, become firm, and regained form

Question 48

urinary incontinence higher in

Answer 48

women who have given birth increased parity increased age

Question 49

evaluation of episiotomy healing

Answer 49

``` redness edema ecchymosis discharge, drainage approximation ```

Question 50

examining the perineum

Answer 50

ask woman to lie in the Sim's position wear nonsterile gloves make sure there is good lighting gently lift the buttocks to expose the perineum and anus

Question 51

breastfeeding

Answer 51

before lactation a yellowish fluid, colostrum, can be expressed from nipples tenderness may persist for 48 hours after start of lactation

Question 52

nonbreastfeeding

Answer 52

engorgement resolves spontaneoulsy and discomfort decreases within 24-36 hours breast binder or tight bra, ice packs, or mild analgesics may be used to relieve discomfort

Question 53

length of stay

Answer 53

48 hours after uncomplicated vaginal | 72-96 hours after uncomplicated c-section

Question 54

hemorrhage

Answer 54

500mL or greater in vaginal | 1000mL or greater in C-section

Question 55

uterine atony

Answer 55

lack of tone treatment: massage fundus, increase pitocin, make sure bladder empty **If uterus fails to respond to oxytocin: ERGOTRATE, METHERGINE, CARBOPROST TROMETHAMINE

Question 56

Other causes of hemorrhage

Answer 56

``` retained placental fragments: Tx: D&C cervical or vaginal tear: Tx: surgical repair Inversion of uterus subinvolution of the uterus hemorrhagic shock-- EMERGENCY ```

Question 57

orthostatic hypotension

Answer 57

occurs in first 48 hours, due to sudden changes in blood circulation many faint *assist first one or two times up out of bed 1st shower must be assisted

Question 58

SVT (Superficial venous thrombosis)

Answer 58

swelling, redness, tenderness, warmth, pain or asymptomatic Tx: analgesia, elevation of ext., TEDS

Question 59

DVT (Deep venous thrombosis)

Answer 59

same as SVT plus, pedal edema, + homans sign, extr cool, pale, decreased pedal pushes TX; anticoagulant therapy, bedrest, and analgesia

Question 60

Pulmonary Embolism

Answer 60

S&S: DVT, abdominal pains, chest pain, dyspnea, tachypnea, hypotension Nursing care: elevate the head of the bed, administer oxygen, apply pulse oxymetry, IV fluids, initiation of heparin, bed rest, frequent VS

Question 61

Nutritional aspects

Answer 61

usually very thirsty and hungry after delivery vaginal delivery-regular diet c-section- asses bowel sounds, clear liquids and progress

Question 62

Taking In

Answer 62

1 to 2 days after delivery mother is passive and somewhat dependent as she sorts reality from fantasy in birth experience food and sleep are major needs

Question 63

taking hold

Answer 63

2 to 3 days after delivery mother ready to resume control over her life she is focused on baby and may need reassurance

Question 64

postpartum blues and depression S&S

Answer 64

``` cry easily lose appetite insomnia feel anxious begin 2-3 days after birth and disappear witin a week or two ```

Question 65

causes of postpartum blues

Answer 65

hormonal changes emotional reaction discomfort fatigue

Question 66

postpartum depresion

Answer 66

decrease interest in food, decreased interest in surroundings, unable to feel pleasure, fatigue, sleep disturbance, obsessive thinking, decrease hygiene, decrease ability to concentrate, odd food cravings, irritability, rejection of infant, panic attack Tx: antidepressants, sedatives, mood stabilizers

Question 67

Postpartal psychosis

Answer 67

**EMERGENCY rare associated w fatigue and not caring for baby may develop symptoms similar to bipolar disorder or schizophrenic reaction S&S: depression, reject baby, jealous of husband, refuses to care for baby, agitation, volatile

Question 68

discharge teaching

Answer 68

rest, hygiene, incision care/sitz baths, avoid heavy lifting, sexual intercourse, use of contraceptive, follow up, exercise