Module 7 (Exam 1)

Question 1

Puerperium

Answer 1

The period of time after completion of the third stage of labor until uterine involution is complete (usually six weeks)

Question 2

Focus of the Puerperium

Answer 2

1. Physical and psychological adjustment to the process of childbirth
2. Attention to learning needs

Question 3

Involution

Answer 3

Rapid reduction in uterine size following childbirth

Question 4

What does the reproductive system do after placental delivery?

Answer 4

1. Uterus contracts immediately after placental delivery
2. Uterine arteries are compressed and bleeding is controlled
3. The cervix closes rapidly
4. The vagina and perineum are usually edematous, bruised

Question 5

Fundus

Answer 5

Upper portionof the uterus, superior to the fallopian tubes

Question 6

Boggy Uterus

Answer 6

Term used to discuss the uterine fundus when it is not firmly contracted

Question 7

Uterine Atony

Answer 7

Relaxation of uterine muscle tone following childbirth

Question 8

Engorgement

Answer 8

Physiologic swelling of the breast tissue resulting from increased blood and lymph supply during transition to mature breast milk

Question 9

BUBBLE HE

Answer 9

Breasts

Uterus/Fundus

Bladder

Bowel

Lochia

Episiotomy/Peruneum

Homan’s sign

Emotional Stability

Question 10

When does the endometrium regenerate?

Answer 10

2-3 weeks after birth

6 weeks at placenta site

Question 11

BP PP Assessment

Answer 11

BP should be less than 140/90

• Preeclampsia may be happening if BP is over this
• BP should be consistent with baseline

Question 12

Pulse Assessment PP

Answer 12

Pulse should be less than 90

• PP woman is mildly tachycardic r/t dehydration (loss of 500mL fluid vaginal birth and 1000mL(1L) C-section)

Question 13

Cardiovascular System PP

Answer 13

• Rapidly returns to pre-pregnant state
• Diaphoretic
• Diuresis

Question 14

Physiologic Anemia

Answer 14

1. During pregnancy, plasma increased 50%
2. RBC increases 1/3
3. The difference between plasma increase and RBC is uneven; there is more plasma than there are RBCs
4. RBC are diluted in the amount of plasma volume
5. Decline in maternal Hgb and Hct results
6. Hence, physiologic anemia
7. Must be distinguished from true anemia

Question 15

Temperature PP

Answer 15

Less than 38C

Temperature 38C or higher indicates infection

Question 16

When is a mild elevation in temperature expected and why does it occur?

Answer 16

• Mild elevation (less than 38C) occurs during the initial 24 hours PP
• Primary reason is dehydration
• Secondary reason is exertion
• Physiolgic breast engorgement

Question 17

Hct and Hgb PP

Answer 17

• Gradual Recovery
• Less than or equal to 30% Hct (during pregnancy)
• Hct is normal by days 3-5 PP *Normal is 35-50%*
• Hgb greater than or equal to 10.5 g/dL (during pregnancy) is normal until the end of puerperium (six weeks) *normal is 12-18*
• Hgb is low

Question 18

WBC PP Assessment

Answer 18

25,000-30,000 (Normal is 5,000-9,000)

1. Increased after delivery because the body is healing; it is a healing response. WBC rush to the scene
2. WBC also increase due to pain and stress
3. Returns to baseline within 1 week PP
4. *Considered normal unless there are other signs of infection

Question 19

Coagulation Factors

Answer 19

• Blood hypercoagulation occurs during pregnancy
  
  • Clotting increases
  • Increased ability to form clots
  • Break down of clots decreases during pregnancy
  • Offers protection from hemorrhage during child birth
  • Increases the risk of thrombus formation
• Continues for 3-4 weeks
• Diameter of deep veins remains increased for up to 6 weeks
  
  • Increases risk for thromboembolic disease (pulmonary embolus)
  • Weight of uterus puts pressure on the vena cava and iliac veins and partially obstructs blood return from veins in the legs, causing venous distention

Question 20

Breast Assessment

Answer 20

1. Observe latch to breast
2. Observe effective transfer of colostrum (swallowing)
3. Assess skin integrity of nipples/areolae for brusing/excoriation
4. Assess lactogenesis to lactation..look for filling and firming

Question 21

Interventions for Nipple Tenderness

Answer 21

1. Facilitate deep, effective latch to breast
2. Protect nipple and promote milk transfer
3. Let colostrum dry on nipples following BF

Question 22

Interventions for Physiologic Engorgement

Answer 22

1. Increase BF frequency to 1.5-3hours per infant cues
2. Coolpacks following BF

Question 23

How long does it take to establish supply of breast milk?

Answer 23

3-4 weeks

Volume is related to frequency of feedings

Question 24

Nursing management to help mothers produce copious milk supply

Answer 24

• Encourage freqent breastfeeding per infant cues
• Avoid supplementation unless medically indicated

Question 25

How many calories does the breastfeeding mother burn?

Answer 25

1. Need additional 500calories/day to support full lactation
2. 170 of those calories are drawn directly from fat stores
3. 330 calories additional intake
4. Teach mother to drink fluids as they become thisty