Class 7: Postpartum Assessment - 4th Stage

Question 1

define: postpartum period

Answer 1

• the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state

Question 2

what is the postpartum period also referred to as?

Answer 2

• puerperium

Question 3

what is the approx length of the postpartum period

Answer 3

• approx 6 weeks

Question 4

what are important aspects of the postpartum period for health care providers to consider? (5)

Answer 4

• assessment of normal physiological and psychological processes and interventions as needed
• awareness of cultural safety, determinants of health, needs of the family in supporting care during the postpartum period & transition to home enviro for both birther & newborn
• education regarding ongoing care of self & newborn care needs –> includes S&S that require further attention
• help mother rest
• address clinical concerns that arise for fetus & mother

Question 5

what is the goal of education during the postpartum period

Answer 5

• prep parents to safely transitions home with newborns

Question 6

in the hospital, the usual postpartum stay for a vaginal delivery is approx ____ after birth? what does this depend on?

Answer 6

• approx 24-48 h
• depends on complications involved during pregnancy and/or delivery and/or with the newborn

Question 7

how long might the postpartum period be for a c-section

Answer 7

• 72 hrs

Question 8

what is 1 of the main goals of the postpartum stay

Answer 8

• prep for transition to the home enviro and supporting new mothers/parents to confidently care for themselves and their newborn

Question 9

what is the 4th stage of labor

Answer 9

• first 1-2 hrs postpartum

Question 10

what assessments are done in 4th stage if labor (5)

Answer 10

• physical assess of birther (VS, targeted assess)
• assist PCP w perineal repair & assess perineum
• assess placenta
• remove epidural cath, post-epidural assess
• encourage & monitor for void

Question 11

what is initiated in the 4th stage of labor (2)

Answer 11

• skin-to-skin contact
• breast/chest feeding

Question 12

what meds are admin during 4th stage of labor (2)

Answer 12

• uterotonic meds
• analgesics

Question 13

what is the important of establishing skin-to-skin contact in the 4th stage of labor (5)

Answer 13

• helps w bonding
• temp stabilization
• helps w transition to extrauterine
• increases oxytocin lvls
• helps w breast feeding

Question 14

when should chest feeding be initiated in the 4th stage of labor

Answer 14

• first 1-2 hrs

Question 15

what are uterotonic meds

Answer 15

• meds that promote uterine tone/contractions –> control bleeding

Question 16

what is included post-epidural assessment

Answer 16

• make sure epidural is intact after removal

Question 17

if the birther experienced a laceration or required an episiotomy it will need to be…

Answer 17

• sutured

Question 18

what is the nurses role in assisting w perineal repair (4)

Answer 18

• assist w positionin
• help w lighting
• hand sutures
• assess for pain mngmt needs (ex. lidocaine)

Question 19

describe pain mngmt for perineal repair for birthers who received an epidural

Answer 19

• may not need additional meds for pain mngmt, but they might

Question 20

describe skin-to-skin between the birther and newborn during perineal repair

Answer 20

• can be skin-to-skin and bonding w mom as long as pain is controlled

Question 21

what is especially imp when assisting w perineal repair

Answer 21

• remember sponge & needle counts –> may be placed inside vagina d/t bleeding

Question 22

what must be included in the assessment of the placenta

Answer 22

• both fetal and maternal sides by both PCP and us

Question 23

what is to be assessed r/t the fetal side of the placenta (2)

Answer 23

• vessels
• location of umbilical cord on placenta

Question 24

what is battle door insertion of the umbilical cord of placenta

Answer 24

• inserted on periphery of placenta

Question 25

what is assessed r/t the maternal side of the placenta (3)

Answer 25

• intactness
• ensure no fragments of placenta are missing
• should be lobular

Question 26

why is it imp to ensure there are no fragments of the placenta missing and therefore still in uterus

Answer 26

• prevents ligature of vessels for bleeding

Question 27

what should be assessed r/t membranes of the placenta (3)

Answer 27

• do the membranes appear to be compelte?
• should be a hole
• should not be jagged, indicates pieces left behind

Question 28

describe the freq of assessment of the BP and P during the 4th stage of labor

Answer 28

• BP: q15 min for first hour, then q30 min for remainder of 4th stage
• P: same as BP

Question 29

describe freq of assessment of T in 4th stage of labor

Answer 29

• initially and once more before transfer to postpartum unit

Question 30

what is assessed r/t the fundus in 4th stage of labor? what is this assessed in combo with?

Answer 30

• assessment of fundal height
• firmness
• in combo w assessment of vaginal bleeding

Question 31

describe freq of assessment of fundus in 4th stage of labor

Answer 31

• • q15 min for first hour
• usually q30 for remainder of 4th period

Question 32

what is assessed r/t lochia in 4th stage of labor (5)

Answer 32

• color
• amt
• size & number of clots
• odour
• observe perineum for other sources of bleeding (laceration? episiotomy?)

Question 33

what is assessed r/t bladder in 4th stage of labor

Answer 33

• assess for distension
• if bladder apparent, higher fundal height = indication of distension

Question 34

what is assessed r/t perineum in 4th stage of labor (6)

Answer 34

assess laceration for:
- redness
- edema
- bruising
- drainage
- approximation
- presence of hemorrhoids

Question 35

mngmt of ____ is one of the most signif concerns of the early postpartum period

Answer 35

• mngmt of postpartum bleeding

Question 36

see slides for info on report from birthing unit to postpartum unit

Answer 36

• lotssss of stuff, too much info for cards