Care of the Postpartum Patient

Question 1

Postpartum period

Answer 1

Birth to return of reproductive organs to prepregnant state (about 6 weeks).

Question 2

Puerperium

Answer 2

4th trimester of pregnancy

Question 3

Involution

Answer 3

Return of the uterus to non pregnant state

Question 4

At full term the uterus weighs____ times its prepregnant weight. At 6 wks, it is ______ grams

Answer 4

11,60-80

Question 5

Subinvolution

Answer 5

Failure of the uterus to return to its prepregnant state

Question 6

Posterior pituitary release___ and its two functions are_____

Answer 6

Releases oxytocin
Promotes homeostasis
Prevents hemorrhage

Question 7

Oxytocin

Answer 7

• Causes contractions which compresses blood vessels and helps stop bleeding
• Helps uterus get smaller
• Plays a role in breastfeeding and milk ejection

Question 8

Afterpains

Answer 8

Contractions that occur after birth and are more noticeable in 2nd and subsequent pregnancies

Question 9

Lochia

Answer 9

Uterine Discharge

Question 10

Lochia rubra

Answer 10

(Red) from birth to 3-4 days

Question 11

Lochia serosa

Answer 11

(pink) day 3 or 4 until about 10 days

Question 12

Lochia alba

Answer 12

(white/yellow) can continue until 4-8 wks after delivery

Question 13

Fundus

Answer 13

At about the umbilicus after delivery

Decreased about 1cm/day

Question 14

Fluid loss for vaginal delivery

Answer 14

500 cc

Question 15

Fluid loss for c-section

Answer 15

1000 cc

Question 16

1st degree laceration

Answer 16

involve only the skin of the perineal are

Question 17

2nd degree laceration

Answer 17

involves the skin, and the perineal muscles of the perineal area

Question 18

3rd degree laceration

Answer 18

involves the skin, perineal muscles and the anal sphincter

Question 19

4th degree laceration

Answer 19

skin, perineal muscles, complete tear of anal sphincter and involves the tissue lining the rectum, extensive repair needed

Question 20

Ovulation

Answer 20

• If not breastfeeding, ovulations returns in 7-9 weeks.

- If breastfeeding, ovulation returns in 2-18 months depending on exclusivity of breastfeeding

Question 21

Interventions for mom’s not breastfeeding

Answer 21

• Tight supportive bra
• Back to shower water is stimulating
• ice packs

Question 22

Clotting factors and fibrinogen are ____ during pregnancy

Answer 22

increased

Question 23

BUBBLE HE

Answer 23

• Breasts
• Uterus
• Bladder
• Bowel
• Lochia
• Episiotomy
• Homer’s sign
• Emotional status

Question 24

Focused assessment- breasts

Answer 24

-Assess for engorgement and sore or cracked nipples

Question 25

Focused assessment-uterus

Answer 25

- Should be at about the level of the umbilicus shortly after delivery - Prevention of uterine atony

Question 26

Focused assessment- bladder

Answer 26

-Assess for emptying, burning, ability to void

Question 27

Focused assessment- bowel

Answer 27

-May not have BM until 2-3 days

Question 28

Focused assessment- Lochia

Answer 28

- Assess for amount, color - Excessive is more than a pad an hour. - Expression of clots may occur with fundal massage

Question 29

Focused assessment- episiotomy

Answer 29

Assess for approximation, also assess perineum for swelling or bruising.

Question 30

Focused assessment- Homans sign

Answer 30

- Performing human's sign is controversial so check with your institution or provider. Performed by quickly dorsiflexing the foot upward. - C/S patients will typically have mechanical SCDs

Question 31

Rubella

Answer 31

Vaccination during the postpartum period if not immune. Informed consent is important. Women must not become pregnant for at least 1 month after administration. Side effects can be problematic.

Question 32

Rhogam

Answer 32

-Given to Rh negative moms at about 28 wks gestation

Question 33

Vaginal delivery hospitalization stay

Answer 33

48 hours

Question 34

C-section delivery hospitalization stay

Answer 34

96 hours

Question 35

Uterine atony-starts

Answer 35

(Early) Immediately postpartum within 24 hrs

Question 36

Uterine atony-etiology

Answer 36

Failure of uterus to regain tone caused by stretching (macrosomia, multiple gestation), anesthesia, MGSO4

Question 37

Uterine atony-comments

Answer 37

uterus never feels firm, even after fundal massage; very dangerous, Large, boggy uterus

Question 38

Lacerations-starts

Answer 38

Immediately postpartum, but continues to trickle

Question 39

Lacerations-etiology

Answer 39

Difficult birth (i.e. forceps)

Question 40

Lacerations- comments

Answer 40

Uterus is firm | Lacerations might need suturing

Question 41

Subinvolution of the uterus or of placental site-starts

Answer 41

(late) Later in postpartum, lochia remains heavy after 24 hours

Question 42

Subinvolution of the uterus or of placental site-etiology

Answer 42

- Retained placental fragments | - Abnormal placental attachment

Question 43

Subinvolution of the uterus or of placental site- comments

Answer 43

Uterus may be firm, but higher than appropriate level

Question 44

Endometritis- starts

Answer 44

1-2 days postpartum

Question 45

Endometritis- etiology

Answer 45

Is an infective process, so cause is anything that might lead to infection (C/S, STI)

Question 46

Endometritis- comments

Answer 46

Classic infective symptoms: - Increased temp and WBC - Abdominal pain and foul smelling lochia also may have NO lochia.

Question 47

Hematoma-starts

Answer 47

1-2 days postpartum

Question 48

Hematoma-etiology

Answer 48

Internal bleed into perineal tissue; Caused by unlighted lacerations, episotomy

Question 49

Hematoma-comments

Answer 49

C/o perineal pressure, pain