Chapter 21: Physiological changes in postpartum patient Flashcards
- A patient gave birth to an infant 12 hours ago. Where would a nurse expect to locate this patient’s fundus?
a. At the umbilicus
b. Two centimetres below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally
ANS: A
The fundus descends about 1 to 2 cm every 24 hours. Within 12 hours after birth the fundus may be approximately at the level of the umbilicus. By the sixth postpartum week the fundus normally is halfway between the symphysis pubis and the umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference point.
- Which patient is most likely to experience strong afterpains?
a. A patient who experienced oligohydramnios
b. A patient who gave birth to twins
c. A patient who is bottle-feeding their infant
d. A patient whose infant weighed 3500 g
ANS: B
Afterpains are more noticeable after births in which the uterus was overdistended (e.g., large baby, multifetal gestation, polyhydramnios). Breastfeeding may cause afterpains to intensify, not bottle-feeding. An average-weight baby does not intensify afterpains.
- A patient gave birth to a healthy newborn 5 days ago. What type of lochia would the nurse expect to find when assessing this patient?
a. Lochia rubra
b. Lochia sangra
c. Lochia alba
d. Lochia serosa
ANS: D
Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally occurs around day 3 or 4 after childbirth. Lochia rubra consists of blood and decidual and trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or brown. There is no such term as lochia sangra. Lochia alba occurs in most patients after day 14 and can continue up to 6 weeks after childbirth.
- Which hormone remains elevated in the immediate postpartum period of the breastfeeding patient?
a. Estrogen
b. Progesterone
c. Prolactin
d. Human placental lactogen
ANS: C
Prolactin levels in the blood increase progressively throughout pregnancy. In patients who breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. Human placental lactogen levels decrease dramatically after expulsion of the placenta.
- Two days ago a patient gave birth to a full-term infant. Last night they awakened several times to urinate and noted that their pajamas and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this patient is experiencing during the early after birth period is
a. elevated temperature caused by after birth infection.
b. increased basal metabolic rate after giving birth.
c. loss of increased blood volume associated with pregnancy.
d. increased venous pressure in the lower extremities.
ANS: C
Within 12 hours of birth patients begin to lose the excess tissue fluid that accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid. An elevated temperature would cause chills and may cause dehydration, not diaphoresis and diuresis. Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate. Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.
- A patient gave birth to a 2850 g newborn 2 hours ago. The nurse determines that the patient’s bladder is distended because their fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, what is the most serious consequence likely to occur from bladder distension?
a. Urinary tract infection
b. Excessive uterine bleeding
c. A ruptured bladder
d. Bladder wall atony
ANS: B
Excessive bleeding can occur immediately after birth if the bladder becomes distended, because it pushes the uterus up and to the side and prevents it from contracting firmly. A urinary tract infection may result from overdistension of the bladder, but it is not the most serious consequence. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistension. Bladder distension may result from bladder wall atony. The most serious concern associated with bladder distension is excessive uterine bleeding.
- Which is the cause of breast engorgement?
a. Overproduction of colostrum
b. Accumulation of milk in the lactiferous ducts
c. Hyperplasia of mammary tissue
d. Congestion of veins and lymphatic
ANS: D
Breast engorgement is caused by the temporary congestion of veins and lymphatics, not by overproduction of colostrum, overproduction of milk, or hyperplasia of mammary tissue.
- What information would indicate to the nurse that the new postpartum patient knows what to expect about their menstrual activity after childbirth?
a. The first menstrual cycle will be lighter than normal and then will get heavier
every month thereafter.
b. The first menstrual cycle will be heavier than normal and will return to
prepregnant volume within three or four cycles.
c. There will be no menstrual cycle for 6 months after childbirth.
d. The first menstrual cycle will be heavier than normal and then will be light for
several months thereafter.
ANS: B
They can expect her first menstrual cycle to be heavier than normal (which occurs by 3 months after childbirth), and the volume of their subsequent cycles will return to prepregnant levels within three or four cycles.
- Which is the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state?
a. Involutionary period, because of what happens to the uterus
b. Lochia period, because of the nature of the vaginal discharge
c. Mini-tri period, because it lasts only 3 to 6 weeks
d. Puerperium, or fourth trimester of pregnancy
ANS: D
The puerperium, also called the fourth trimester or the postpartum period of pregnancy, was traditionally thought to be 6 to 12 weeks, but it varies from patient to patient. Involution marks the end of the puerperium, or the fourth trimester of pregnancy. Lochia refers to the various vaginal discharges during the puerperium.
- What is the term that refers to the self-destruction of excess hypertrophied tissue in the uterus? a. Autolysis
b. Subinvolution c. Afterpain
d. Diastasis
ANS: A
Autolysis is caused by a decrease in hormone levels. Subinvolution is failure of the uterus to return to a nonpregnant state. Afterpain is caused by uterine cramps 2 to 3 days after birth. Diastasis refers to the separation of muscles.
- What should the nurse be aware of with regard to the postpartum uterus?
a. At the end of the third stage of labour it weighs approximately 500 g.
b. After 2 weeks postpartum it should not be palpable abdominally.
c. After 2 weeks postpartum it weighs 100 g.
d. It returns to its original (prepregnancy) size by 6 weeks postpartum.
ANS: B
After 2 weeks postpartum, the uterus should not be palpable abdominally; however, it does not return to its original size. At the end of the third stage of labour, the uterus weighs approximately 1000 g. After 2 weeks postpartum the uterus weighs about 350 g. The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.
- A nurse understands that which is accurate with regard to afterbirth pains?
a. They are caused by mild, continuous contractions for the duration of the
postpartum period.
b. They are more common in first-time mothers.
c. They are more noticeable in births in which the uterus was overdistended.
d. They are alleviated somewhat when the mother breastfeeds.
ANS: C
A large baby or multiple babies over-distend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations, which persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous patients; first-time mothers have better uterine tone. Breastfeeding intensifies afterbirth pain because it stimulates contractions.
- A nurse teaches a postpartum patient what information about lochia?
a. It is similar to a light menstrual period for the first 6 to 12 hours.
b. It is usually greater after Caesarean births.
c. It will usually decrease with ambulation and breastfeeding.
d. It should smell like normal menstrual flow, unless an infection is present.
ANS: D
An offensive odour usually indicates an infection. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after Caesarean births and usually increases with ambulation and breastfeeding.
- Which description of postpartum restoration or healing times is accurate?
a. The cervix shortens, becomes firm, and returns to form within a month
postpartum.
b. The vaginal rugae gradually reappear starting about 3 weeks after childbirth.
c. Most episiotomies heal within a week.
d. Hemorrhoids usually decrease in size within 2 weeks of childbirth.
ANS: B
The greatly distended, smooth-walled vagina gradually decreases in size and regains tone, although it never completely returns to its prepregnancy state. Rugae reappear within 3 weeks. The cervix regains its form within days; the cervical os may take longer. Most episiotomies take about 2 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.
- What should a nurse teach a postpartum patient regarding to postpartum ovarian function?
a. Almost 75% of patients who do not breastfeed resume menstruating within a
month after birth.
b. Ovulation occurs slightly earlier for breastfeeding patients.
c. Because of menstruation/ovulation schedules, contraception considerations can be
postponed until after the puerperium.
d. The first menstrual flow after childbirth usually is heavier than normal.
ANS: D
The first flow is heavier, but within three or four cycles, it is back to normal. Ovulation can occur within the first month, but for 70% of non-lactating patients, it returns in about 3 months. Breastfeeding patients take longer to resume ovulation. Because many patients ovulate before their first postpartum menstrual period, contraceptive options need to be discussed early in the puerperium.
