CARE OF MOTHER 11-24

Question 1

Postpartum care This period constitutes a physical and psychological
adjustment to the process of childbearing and is
sometimes referred to as the

Answer 1

fourth trimester of
pregnancy.

Question 2

medical and nursing care given to a
woman during the puerperium, which is the 6-week
period after delivery, beginning with termination of labor
and ending with the return of the reproductive organs to
the nonpregnant state.

Answer 2

Postpartum care

Question 3

Risk factors for postpartum complications, risk factors
may include:

Answer 3

may include:
Preeclampsia or eclampsia
Diabetes
Cardiac problems
Uterine overdistention (as a result of multiple
births or hydramnios)

Abruptio placentae or placenta previa

Precipitous or prolonged labor, difficult delivery, or
extended time spent in stirrups

Question 4

Goals of Postpartum Care

Answer 4

period following labor during which the maternal
body in general, and the genital organs, in particular
return to the pre-pregnant condition

Duration - 40 days or 6-8 weeks.
Another 4-6 weeks is needed for complete involution

Question 5

The puerperal period is much shorter after abortion.

Answer 5

First 10 days - early postpartum
days after - late postpartum

Question 6

B. U. B. B.. L. E. - H. E. Maternal Assessment

Answer 6

B - Breast size, shape, and engorgement
U - Uterus: firm or boggy
B - Bladder: tender or distended
B - Bowel movement
L - Lochia: amount, odor, color, clots
E - Episiotomy location, stiches, edema and redness
H - Homan’s sign - positive
E - Emotional status and bonding

Question 7

DVT and Homan’s Sign

Answer 7

A positive Homan’s sign is indicative of a DVT

The patient’s leg is positioned at a 90° angle (either
while in supine or sitting)

Dorsiflexion of the foot reveals pain in the calf if
positive|

: redness, sudden sharp pain, and
warmth in the leg

Question 8

Postpartum Biophysical Changes

The uterus contracts firmly after delivery of the
newborn, reducing its size by _____. It
remains this size for about ____days, then decreases in
size (involution) and descends about ____
fingerbreadth per day.

Answer 8

more than half
2

one

Question 9

Reproductive System changes

At _____ postpartum days, the uterus cannot be
palpated abdominally.

Answer 9

10 to 14

Question 10

Reproductive System changes

It returns to near its
prepregnant size by ______ postpartum weeks.

Answer 10

4 to 6

Question 11

Reproductive System changes|

The
site of placental attachment requires ____weeks
to heal;

Answer 11

6 to 7

Question 12

Reproductive System changes

endometrial regeneration requires ___
weeks.

Answer 12

6

Question 13

• discharge from the uterus lining during
  the first 3 weeks after delivery

Answer 13

Lochia

Question 14

Lochia - discharge from the uterus lining during
the first 3 weeks after delivery, occurs in three
types.

Answer 14

Lochia rubra
Lochia serosa
Lochia alba

Question 15

Lochia:
|

• dark red discharge occurring in
  the first 2 to 3 days.

Answer 15

Lochia rubra

It contains epithelial cells,
erythrocytes, leukocytes, and decidua, and has
a characteristic human odor.

Question 16

Lochia:
|

• pink to brownish discharge,
  occurring from 3 to 10 days after delivery.

Answer 16

Lochia serosa

. It is a
serosanguinous discharge containing decidua,
erythrocytes, leukocytes, cervical mucus, and
microorganisms; lochia serosa has a strong
odor.

Question 17

Lochia:
|

• almost colorless to creamy
  yellowish discharge occurring from 10 days to 3
  weeks after delivery

Answer 17

Lochia alba

It contains leukocytes,
decidua, epithelial cells. Fat, cervical mucus,
cholesterol crystals and bacteria. Lochia alba
should have no odor.

Question 18

Complete cervical involution may take

Answer 18

3 to 4 months.

Question 19

Rugae reappear by ____postpartum
weeks.

Answer 19

3 to 4

Question 20

The estrogen index returns in

Answer 20

6 to 10 weeks

Question 21

The abdomen remains _______ for some time
after delivery

Answer 21

soft and flabby

Question 22

(separation of abdominal recti
muscles)

Answer 22

Diastasis recti

Question 23

Breasts changes include the following:

Answer 23

Rapid drop in estrogen and progesterone, increase in secretion of prolactin after delivery

Colostrum is present at the time of delivery; breast
milk is produced by the third or fourth postpartum
day.

Larger and firmer breasts occur with lactation
(primary engorgement). 1-2 congestion subside

In the breast, prolactin stimulates alveolar cells to
produce milk.

Question 24

Sucking of the newborn triggers a
release of _______of the
myoepithelial cells, which stimulate milk flow; this
is known

Answer 24

oxytocin and contractility

|

asthe let down-down reflex

Question 25

The average
amount of milk produced in 24 hours increases
with time.

First week –
1 to 4 weeks –
After 4 week –

Answer 25

6 to 10 oz
|
20 oz

30 oz

Question 26

Estrogen and progesterone levels ______ rapidly
after delivery

Answer 26

decrease

Question 27

45% of lactating women resume menstruation by

Answer 27

12
week

Question 28

The cervix becomes thicker and firmer; by the end of
the first postpartum week, it is still dilated about 1 cm,
Complete cervical involution may take

Answer 28

3 to 4 months

Question 29

Complete cervical involution may take 3 to 4 months.
Childbirth results in a permanent change in the
cervical os from round to

Answer 29

elongated.

Question 30

The vagina is ____
after delivery.

Answer 30

smooth and swollen, with poor tone

Question 31

Rugae reappear by ____ postpartum
weeks.

Answer 31

3 to 4

Question 32

The estrogen index returns in ____ weeks

Answer 32

6 to 10

Question 33

Ovulation and resumption of menstruation are
influenced by whether or not the client breast feeds

45% of lactating women resume menstruation by ___
weeks; 80% have one or more anovulatory cycles
before the first ovulation

Answer 33

12

Question 34

Ovulation and resumption of menstruation are
influenced by whether or not the client breast feeds

40% of nonlactating women resume menstruation
by ___ after delivery; 65% by ___; and 90%
by ___ s. Fifty percent ovulate during the first
cycle.

Answer 34

6 weeks

12 weeks

24 week

Question 35

Transient bradycardia (_____beats per minute)
occurs for ____hours after delivery and may
persist for_____days.

Answer 35

50 to 70

24 to 48

6 to 8

Question 36

Blood volume decreases to nonpregnant levels by ____
weeks after delivery.

Answer 36

4

Question 37

Hematocrit rises by the ______ postpartum
day

Answer 37

third to seventh

Question 38

Leukocytosis (______) continues for several days after delivery

Answer 38

20,000 to 30,000 white blood cells per
mm*

Question 39

Blood pressure remains stable and the pulse returns
to nonpregnant rate by ____ months postpartum.

Answer 39

3

Question 40

Any mother whose temperature reaches ______
in any_____, during the
first ___ postpartum days, excluding the first 24
postpartum hours, is considered to be febrile.

Answer 40

38C (100.4F)

two consecutive 24-hour periods

10

Question 41

Pulmonary functions return to nonpregnant status by
___ months after delivery.

Answer 41

6

Question 42

A full bladder displaces the uterus and can cause

Answer 42

postpartum hemorrhage;

Question 43

bladder distention can
lead to

Answer 43

urinary retention.

Question 44

Adequate bladder emptying generally resumes in
______ days after tissue swelling and bruising
resolve.

Answer 44

5 to 7

Question 45

the glomerular filtration rate remains elevated for
about _____ days after delivery

Answer 45

7

Question 46

Dilated ureters and renal pelvis return to their
nonpregnant states within _____ weeks after delivery

Answer 46

6 to 10

Question 47

Puerperal diaphoresis and diuresis occur within the
first ____ hours after delivery.

Answer 47

24

Question 48

Gastrointestinal motility and tone return to the
nonpregnant state within ___ weeks after delivery.

Answer 48

2

Question 49

Constipation commonly occurs during the _______ period due to decreased intestinal muscle
tone, perineal discomfort, and anxiety.

Answer 49

early
prepartum

Question 50

he client may return to her prepregnant weight in_____ weeks, if weight gain during pregnancy was
within the normal range.

Answer 50

6
to 8

Question 51

are a common problem in the early
postpartum period, due to pressure on the pelvic floor
and straining during labor.

Answer 51

Hemorrhoids

Question 52

Most women ambulate _____ hours after delivery;

Answer 52

4 to 8

Question 53

early ambulation is encouraged to avoid

Answer 53

complications, promote involution, and improve
emotional outlook.

Question 54

Relaxation and increased mobility of pelvic
articulations occur ____ weeks after delivery.

Answer 54

6 to 8

Question 55

Visible vascular changes of pregnancy disappear as

Answer 55

estrogen levels decreases.

Question 56

decreases gradually after delivery, causing a
decrease in hyperpigmentation

Answer 56

Melanin

Question 57

Taking-in period

Answer 57

occurring 1 to 2 days after delivery

Question 58

Taking-hold period

Answer 58

extending from 2 to 4 days after
delivery

Question 59

Letting-go period

Answer 59

This period generally occurs after the new mother
returns home; it involves a time of family
reorganization.

Question 60

Factors Influencing Successful Transition to
Parenthood During the Postpartum Period:

Answer 60

Response and support of family and friends

Relationship of the birthing experience to
expectations and aspirations

Previous childbearing and childrearing experiences

Cultural influences

Question 61

Within 24 hours after birth, the newborn’s _____ must function sufficiently for
progression to, and maintenance to extrauterine life.

Answer 61

renal,
gastrointestinal (GI), hematologic, metabolic, and
neurologic systems

Question 62

This is a phase of instability during the first 6 to 8
hours of life through which all the newborns pass,
regardless of gestational age or nature of labor and
delivery.

Answer 62

Transition Period

Question 63

Transition Period

In the first period of reactivity, (immediately after
birth),

Answer 63

respiration is rapid, (may reach 80 breaths per
minute), and transient nostril flaring, retractions and
grunting may occur. The heart rate may reach 180
beats per minute during the first few minutes of life

Question 64

this first sleep (known
as ____) occurs within ____hours of birth and
lasts from a few minutes to several hours’

Answer 64

sleep phase. 2

Question 65

Transition Period

The second period of reactivity, starting when the
newborn awakes, is marked by

Answer 65

hyperresponsiveness
to stimuli, skin color changes from pink to slightly
cyanotic, and a rapid heart rate

Question 66

Respiratory Adaptation

Initial respirations are triggered by physical -
sensory-
and
chemical factors-

Answer 66

Physical factors include the effort required to expand
the lungs and fill the collapsed alveoli (e.g. change in
pressure gradients)

Sensory factors include temperature, noise, light,
sound, and a drop in temperature.|

Chemical factors include changes in the blood (e.g.
decreased O2 level, increased CO2 level, and
decreased pH) as a result of the transitory asphyxia
during delivery.

Question 67

The newborn respiratory rate ranges between _____ breaths per minute.

Answer 67

30 and
60

Question 68

Oral mucous secretions may cause the newborn to
_____, especially during the first 12 to 18
hours.

Answer 68

cough and gag

Question 69

Newborns are obligatory nose breathers. The reflex
response to nasal obstruction, opening of the mouth
to maintain an airway, is not present in most
newborns until ____ weeks after birth.

Answer 69

3

Question 70

(cyanosis of the hands and feet and
around the mouth).

Answer 70

acrocyanosis (

Question 71

Cardiovascular Adaptation

Answer 71

acrocyanosis

PR IS 120-160
100(SLEEP)
BP - 80/46

Question 72

Respiratory Adaptation

Answer 72

physical, sensory,
and chemical factors

rr 30-60 breath/pm\

ORAL MUCOS 12-18 HRS OF BIRTH

obligatory nose bleeders

Question 73

Cardiovascular Adaptation

Answer 73

limited supply of subcutaneous fat

Rapid heat loss in a cool environment occurs by
conduction, convection, radiation, and evaporation.

Question 74

Neurologic adaptation

Answer 74

neurologic system is not fully
developed

uncoordinated movements

labile temperature regulation
Newborn reflexes- for development

Question 75

Gastrointestinal adaptation

Answer 75

Digestive enzymes are active at birth can supp 36 to 38 weeks’ gestation

muscular and reflex for transporting food are present at birth.

Digestion of protein and carbohydrates is readily
accomplished

Salivary glands are immature at birth, little saliva until the newborn is 3 months old

meconium bowel movement contains occult blood is excreted
within 24 hours in 90% of normal newborns.

Some newborns nurse immediately when put to the
breast, others take up to 48 hours for effective
feeding

Random hand-to-mouth movement and finger
sucking have been observed in utero

Question 76

fat digestion and absorption are poor
due to the inadequacy of

Answer 76

pancreatic enzymes and
lipase.

Question 77

Immune system adaptation

Answer 77

cannot limit an invading organism at
the portal of entry.

The immaturity of a number of protective systems increases the risk of infection

inflammatory response is reduced qualitatively
and quantitatively

Phagocytosis is sluggish.

The acidity of the stomach and the production of
pepsin and trypsin are not fully developed until 3 to 4
weeks of age

Immunoglobulin A (IgA) is missing from the respiratory
and urinary tracts, unless the newborn is breast fed.

Infection represents a leading cause of morbidity and
mortality during the neonatal period.

3 immunoglobins:
IgA
IgG
IgM

Question 78

Immune system adaptation

IgA
IgG
IgM

Answer 78

IgG crosses the placenta and is found in the fetus by
the 3rd trimester. It [protects the newborn against
bacterial and viral infections the mother has
developed antibodies for (tetanus, measles, mumps)

IgM is found in the blood and lymph nodes and is the
first immunoglobin to respond to infection. Production
starts at birth. If elevated at birth may indicate
exposure to intrauterine infection

IgA is found in colostrum and can contribute to
passive immunity. It limits bacterial growth in the GI
trac and is produced gradually.

Question 79

Skin Appearance of Newborn

Pale and cyanotic

Answer 79

• poor central nervous system
  control

Question 80

Gray color

Answer 80

• indicates infection

Question 81

Cyanosis

Answer 81

– newborn’s lips, hands and feet are likely to
appear cyanotic from immature peripheral circulation

Question 82

Acrocyanosis

Answer 82

– a line seems to be drawn across the wrist
or ankle with pink skin on one side and blue on the othernormal 24 to 48 hours after birth.

Question 83

Jaundice

Answer 83

e - the skin and the eyes appear to be yellow

immature liver function-

Question 84

Physiologic jaundice occurs ___ day of life in
about 50% of all newborn as a result of

Answer 84

2nd or 3rd

breakdown of
fetal RBC.

Question 85

in terms of jaundice

More than 7 mg/100ml -

More than 10 to 12 mg/100ml

Above 20mg/100ml -

Answer 85

can cause jaundice

treatment is considered.
Phototherapy is a common therapy.

damage to the brain( kernicterus)

Question 86

Cephalhematoma -

Answer 86

a collection of blood under the
periosteum of the skull bone

Question 87

Intestinal obstruction

Answer 87

stool cannot be evacuated,
intestinal flora may break down bile leading to the
release of indirect bilirubin into the bloodstream again.

Question 88

Kernicterus

Answer 88

form of brain damage caused by excessive
jaundice

Question 89

Phototherapy -

Answer 89

exposure of the infant to light to initiate
maturation of liver enzymes

Question 90

Pallor

Answer 90

– a result of anemia caused by excessive blood
loss during the cutting of the cord

Question 90

Harlequin sign

Answer 90

reddish appearance on the dependent
side of the body and pale on the upper side because of
immature circulatio

Question 91

Hemangiomas

Answer 91

vascular tumors of the skin

Question 92

Hemangiomas

Nevus flammeus

Answer 92

called portwine stain

macular purple or dark-red lesion that is
present at birth

stork’s beak marks or telangiectasia
(occur as
lighter, pink patches at the nape of the neck.)

Question 93

Hemangiomas

Strawberry hemangioma

Answer 93

refers to elevated areas formed by immature
capillaries and endothelial cells

high estrogen
levels of pregnancy

, may appear up to 2 weeks

after the first year ,they tend to be absorbed
and shrink in size

hydrocortisone ointment-may speed the
disappearance by interfering with the binding
of estrogen to its receptor sites
surgery rarely recommended

Question 94

Hemangiomas

Cavernous hemangioma

Answer 94

dilated vascular spaces

usually raised and resemble a strawberry
hemangioma in appearance

steriods,interferon-alfa-2a ,or vincristine –used
to reduce size

surgical removal of lesion

Assess hematocrit levels for possible internal
blood loss / bleeding of lesion located maybe
on the internal organs

Question 95

Mongolian spots

Answer 95

gray patches across the sacrum or buttocks and
possibly on the arms and legs

They disappear by school age without treatment

Be sure to inform parents that these are not bruises

Question 96

Vernix caseosa

Answer 96

– a white cream cheese-like substance
that serves as a skin lubricant in utero

document color of vernix, because it takes the color
of the amniotic fluid
yellow from bilirubin, green from meconium

Question 97

Lanugo

Answer 97

fine downy hair that covers a newborn’s
shoulders, back and upper arms

rubbed away by the friction of bedding and clothes
against the newborn’s skin
by 2 weeks of age, it has disappeared

Question 98

Desquamation

Answer 98

within 24 hours the skin of the newborns
becomes extremely dry which may result in peeling
similar to a sunburn

Question 99

Milia

Answer 99

– pinpoint white papule that can be found on the
cheek across the bridge of the nose due to plugged
sebaceous gland

Disappear by 2 to 4 weeks of age
Reminder: avoid scratching or squeezing to prevent
infection

Question 100

Erythema toxicum

Answer 100

a newborn rash , called flea-bite
rash

Begins with a papule, increase in severity to become
erythema on the 2nd day, and then disappears by the
3rd day

caused by a newborn’s eosinophils reacting to the
environment as the immune system matures

it requires no treatment

Question 101

GI tract is usually sterile after birth, bacteria may be
cultured from the intestinal tract in most babies within ____ hours of life.

Answer 101

5
hours to 24

Question 102

Accumulation of bacteria in the GI tract is necessary fo

Answer 102

digestion and for the synthesis of Vitamin K

Question 103

Newborn’s stomach holds about _ ml

Answer 103

60 to 90 ml

Question 104

Newborn regurgitates easily because of an immature _

Answer 104

cardiac sphincter between the stomach and esophagus

Question 105

Immature liver functions may lead to

Answer 105

lowered glucose
and protein serum levels

Question 106

First stool of a newborn is usually passed within 24
hours after birth

Answer 106

(meconium)

Question 107

If a newborn does not pass a meconium stool by 24 to
48 hours after birth, the possibility of some factor such
as

Answer 107

meconium ileus, imperforate anus ,or volvulus
should be suspected

Question 108

Meconium

Answer 108

a sticky tar like, blackish-green, odorless
material

fromm

mucus, vernix, lanugo,
hormones and carbohydrates(intra uetrin life)

Question 109

Meconium

2nd or 3rd day of life is termed

Answer 109

transitional stool
(green and loose resemble diarrhea to the
untrained eye)

Question 110

4th day of life breastfed babies passes what kind of stool

Answer 110

3 or 4 light yellow
stools per day, sweet-smelling

Question 111

Formula fed babies passes what kind of stool

Answer 111

2 or 3 bright yellow stools a
day, slightly more noticeable odor

Question 112

A newborn placed under phototherapy lights as a
treatment for jaundice has what kind of stool

Answer 112

bright green stools because
of increased bilirubin excretion

Question 113

Newborn with bile duct obstruction have what kind of stool

Answer 113

clay-colored
(gray) stools, because pigment are not entering the
intestinal tract

Question 114

Black/Tarry stoo

Answer 114

– after 2 or more days indicates
intestinal bleeding

Question 115

flecked stools usually indicate an anal fissure

indicates what

Answer 115

Blood

Question 116

Mucus is mixed with stool or stool is watery and loose

indicates what

Answer 116

(milk allergy, lactose intolerance )

Question 117

Blink Reflex

Answer 117

this reflex serves a protective
function against hurting the eye

Question 118

Rooting Reflex

Answer 118

Brushing the cheek or stroking near the mouth of the
newborn will cause the head of the newborn to turn to
that direction.

Dissapear kn 6 weeks

Question 119

Sucking Reflex

Answer 119

Touching the newborn’s lips causes the baby to make
sucking motions.

Dissapear 6 months

Question 120

Extrusion Reflex

Answer 120

Until 4 months of age, any food placed on the anterior
portion of the tongue of babies will be expelled by
them

Question 121

Palmar Grasp Reflex

Answer 121

Objects placed on newborns’ palms will be grasped
by newborns.

Dissapear 6 weeks to 3 months

Question 122

Walk-in-Place Reflex

Answer 122

If newborns are held in a vertical position with their
feet touching a hard solid surface, newborns will take
few, alternating steps.