Postpartal Care

Question 1

Postpartum

Involution:
Fundal descent:
Cervix:

Answer 1

INVOLUTION- return of reproductive organs to pre-pregnancy size and condition.rapid reduction in size of the uterus and return to a condition similar to pre-pregnant state

FUNDAL DESCENT- descends @ 1 cm/day for 10 days after birth. Breastfeeding and an empty bladder facilitate fundal descent and involution.Within 6-12 hrs after birth the fundus rises to the level of the umbilicus. A fundus that is above the umbilicus and boggy is associated with excessive bleeding.

CERVIX- regains its shape by 18 hours after birth.

Question 2

Lochia

Answer 2

uterine/vaginal discharge after birth.uterus ability to rid itself of debris remaining after birth.

Lochia Rubra- first three days, mostly blood with pieces of decidua and mucus. dark red color; present for 2-3 days postpartum, should not contain large clots.

Lochia Serosa- fourth day amount decreases and color changes to pink/pinkish brown. pinkish to brownish color, follows from about 3-10 day.

Lochia alba- after 10th day, discharge becomes yellowish white. May last for 6 weeks or more.

Question 3

THREE STAGES OF FETAL DEVELOPMENT

Answer 3

1. Pre-embryonic/germinal; first fourteen days.
2. Embryonic; day fifteen through week eight.
3. Fetal; week nine to full term (38-40 wks)

Question 4

UMBILICAL CORD

Answer 4

21 inches in length. Contains 2 umbilical arteries that carry deoxygenated blood from the fetus to the mother and 1 vein carrying oxygenated blood. All vessels are surrounded, protected by Wharton’s jelly.

eliminates waste and carbon dioxide from the infant and deliver nutrients, hormones, antibodies etc to the fetus.

Question 5

The placenta secretes five hormones that are essential to pregnancy. What are they?

What are the 3 functions of placenta?

Answer 5

Placenta develops in response to progesterone secreted by the corpus luteum.
Three major functions: transport, endocrine, and metabolic.

1. HCG- human chorionic gonadotropin: responsible for positive pregnancy tests.
2. estrogen
3. progesterone
4. Relaxin.
5. HPL human placental lactogen

The placenta also produces fatty acids, glycogen, and cholesterol for fetal use and hormone production.

Question 6

Changes in respiratory system after birth

Answer 6

during birth the fetal chest is compressed and fluid is squeezed from the lungs and intrathoracic pressure increases.
Chest recoil at birth creates negative intrathoracic pressure which stimulates air movement into the lungs and fluid movement into the interstitial tissue.
Change in temperature from intrauterine to extrauterine stimulates breathing too.

Question 7

Changes in circulatory system after birth

Answer 7

lower pulmonary resistance aids blood flow to the lungs to be oxygenated.
Ductus arteriosus has a reversal of blood flow because of increased aortic pressure and increased O2 in the blood.
Pressure in the R atrium decreases and the L atrium increase. Blood flow to the liver begins and filtration of the blood begins.

Question 8

• Thermoregulation after birth. Heat is lost through four mechanisms:

Answer 8

o Convection- heat flows from the body surface to cooler surrounding air.

o Conduction- heat transfer to a cooler solid object in direct contact.

o Radiation- body heat transfer to a cooler solid object not in contact.

o Evaporation- heat loss through conversion of a liquid to vapor.

{heat is generated through metabolism, muscular activity and nonshivering thermogenesis (metabolism of brown fat). }

Question 9

Changes in Gastrointestinal system after birth

Answer 9

sterile at birth, does not provide necessary bacteria to synthesis vitamin K.

Limited ability to digest fat and starch.

Immature cardiac sphincter allows for easy regurgitation.

First stool is meconium, thick, sticky and tar-like.

Question 10

Hyperbilirubinemia

Answer 10

Excessive bilirubin in the blood. Can cause yellow staining in the brain (kernicterus) at levels of 20/mg/dL.
Common cause Rh incompatibility.
Phototherapy and fluid intake are used to treat jaundice.

Question 11

Respiratory distress-in newborn

Answer 11

Transient tachypnea that is the result of the newborn’s failure to clear the airway of fluid and mucus or aspiration of amniotic fluid.
Treatment is supportive and may include humidified O2, CPAP or mechanical ventilation.

Question 12

normal full-term Caucasian avg. weight

Answer 12

3405g (7 lb. 8 oz)

Question 13

Preterm infant-what are increased risks?

Answer 13

higher risk for respiratory distress syndrome, hypoglycemia and intracranial hemorrhage.

Question 14

Post-term infants- risks?

Answer 14

beyond 42 weeks the placenta loses its ability to effectively carry nutrients to the fetus.

Question 15

Newborn risk for infection

Answer 15

(GBS) group B streptococcal organism. 
Symptomatic infants (lethargy, fever, loss of appetite, increase ICP) receive antibiotics (ampicillin, gentamicin or penicillin)

Question 16

Hypoglycemia risk in newborns

Answer 16

Serum glucose less than 40 mg/dL. Infants at risk include born to diabetic mothers, large for gestational age infants.
Treatment feed early with formula or admin IV glucose, bolus not recommended.

Question 17

Risk of cold stress in newborn

Answer 17

Keep in warm environment to prevent increased O2 needs due to increased metabolism to stay warm.

Question 18

Feta alcohol syndrome

Answer 18

FAS- growth restriction, CNS depression, cognitive impairment etc demonstrated with tremors, fidgetiness, and irritability.

Weak sucking reflex and sleep disturbances.

Question 19

Which meds must be given soon after birth?

Answer 19

• Vitamin K- intestine is sterile and cannot synthesize initially after birth. Needed for clotting process.

Most newborns produce enough by day 8. Given within first hour of birth to prevent hemorrhagic disorders.

• Hep B vaccine should be given within 12 hours of birth.
• Erythromycin administered as prophylactic ophthalmic ointment. It is mandatory in the United States. May be delayed to promote bonding and attachment.

Question 20

NEONATE-

Answer 20

birth through the first 28 days of life.

Question 21

Timing of APGAR SCORING

Answer 21

assessment of wellness of newborn at 1 minute and repeated at 5 minutes.

Question 22

Acrocyanosis:

Mottling:

Harlequin Sign:

Jaundice:

Answer 22

• Acrocyanosis – bluish discoloration of hand and feet, may be present in 1 st 2-6 hours due to poor peripheral circulation.
• Mottling – lacy pattern of dilated blood vessels under the skin, occurs as a result of circulation fluctuations, may be related to chilling or prolonged apnea.
• Harlequin Sign – color change, deep color develops over one side while other side remains pale; transient and not of clinical significance.
• Jaundice – evaluate by blanching the tip of nose, forehead or gum line – determine cause immediately to prevent possible serious sequelae.

Question 23

Erythema Toxicum:

Milia:

Skin turgor:

Vernix Caseosa:

Answer 23

• Erythema Toxicum – firm lesions 103 cm white or pale yellow papule – may appear suddenly 24-48 hours after birth – no treatment necessary.
• Milia - exposed sebaceous glands – raised white spots on face – no treatment necessary.
• Skin turgor – asses to determine hydration status – over abdomen or thigh
• Vernix Caseosa – white cheese-like substance - peeling is common

Question 24

Normal vitals in newborn

Answer 24

• Blood pressure – at birth: 80-60/45-40 mmHg, day 10: 100/50 mmHg
• Pulse – 120-160 bpm, if asleep 100bpm, if crying > 180 bpm
• Respirations – 30-60 breaths/min – observe chest/abdominal movement
• Crying – Strong & lusty, moderate tone & pitch, cries vary in length from 3-7 min after consoling measures used.
• Temperature – Axilla 36.4-37.2C (97.5 – 99F), Rectal 36.6-37.2C (97.8-99F) 36.8 (98.8F) is desired.

Heavier neonates tend to have higher body temps.

Question 25

Colostrum

Answer 25

yellowish or creamy fluid thicker than later milk.
contains more protein, fat-soluble vitamins and minerals,

high levels of antibodies.
can be a source of passive immunity for the newborn.

Question 26

What action to take for Elevated temp of mom immediately postpartum

Answer 26

temp should be taken every 4 hours while awake. Temp up to 100.4° F (38.0° C) in the first 24 hours after birth often are related to dehydrating effects of labor.
Appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading.

Question 27

Why shouldn’t nursing mom wash nipples with soap?

Answer 27

Soap is drying and could lead to cracking of the nipples, and the mother should be instructed to avoid the use of soap on the nipples during breast-feeding.
The mother is taught about the importance of hand washing and that she should breast-feed every 2 to 3 hours.

Question 28

Risks for developing vulvar hematoma

Answer 28

The use of an epidural, prolonged second-stage labor, and forceps delivery are predisposing factors for hematoma formation, and a collection of up to 500 mL of blood can occur in the vaginal area. Although the other options may be implemented, the immediate action would be to prepare the client for surgery to stop the bleeding.

Question 29

risks for postpartum hemorrhage

Answer 29

large fetus

oxytocin induction

Question 30

Symptoms and management of Thrombosis of superficial veins

Answer 30

usually accompanied by signs and symptoms of inflammation: swelling, redness, tenderness, and warmth. May be possible to palpate the enlarged, hard vein. Sometimes pain when they walk.

Thrombosis that is limited to the superficial veins of the saphenous system is treated with analgesics, rest, and elastic support stockings. Elevation of the affected lower extremity to improve venous return also may be recommended. Warm packs may be applied to the affected area to promote healing.
There is no need for anticoagulants or antiinflammatory agents unless the condition persists. After 5 to 7 days of bed rest, and when symptoms disappear, the woman may ambulate gradually.

Question 31

Infant foreskin

Answer 31

In male newborn infants, the prepuce is continuous with the epidermis of the glans and is not retractable. If retraction is forced, this may cause adhesions to develop. The mother should be told to allow separation to occur naturally, which usually occurs between 3 years and puberty. Most foreskins are retractable by 3 years of age and should be pushed back gently at this time for cleaning.

Question 32

How to assess Moro reflex

Answer 32

is elicited by a loud noise such as a hand clap or slap on the mattress to startle the newborn infant. Symmetrical extension and abduction of the arms are seen, fingers fan out and form a “C” with the thumb and forefinger, a slight tremor may be noted, and the arms are adducted in an embracing motion and then return to a relaxed flexion state. Legs may follow a similar pattern of response. This reflex disappears at 6 months of age.
The rooting reflex is elicited by stimulating the perioral area with the finger. The palmar grasp reflex is elicited by stimulating the palm of the hand by firm pressure, and the plantar grasp reflex is elicited by stimulating the ball of the foot by firm pressure.

Question 33

preferred injection site for vitamin K in the newborn infant?

Answer 33

lateral aspect of the middle third of the vastus lateralis muscle in the infant’s thigh. This muscle is the preferred injection site because it is free of major blood vessels and nerves and is large enough to absorb the medication.
The preferred site is the lateral aspect of the middle third of the vastus lateralis muscle.

Question 34

Symptoms of infection of umbilical cord

Answer 34

moistness, oozing, discharge, and a reddened base around the cord.
If symptoms of infection occur, mother should be instructed to notify a health care provider.
If these symptoms occur, antibiotics are necessary.

Question 35

The neonate born to a diabetic mother is at risk for which complications

Answer 35

Hypoglycemia: risk for injury related to low blood glucose levels would be a priority nursing diagnosis.
The infant would also be at risk for hyperbilirubinemia, respiratory distress, hypocalcemia, and congenital anomalies.

Hyperthermia, risk for delayed development, and risk for aspiration are NOT expected problems.

Question 36

Phototherapy is the use of intense fluorescent lights to reduce serum bilirubin levels in the newborn.
What are some nursing considerations?

Answer 36

Injury from treatment, such as eye damage, dehydration, or sensory deprivation, can occur.
Interventions include exposing as much of the newborn’s skin as possible; however, the genital area is covered. The newborn’s eyes are also covered with eye shields or patches, ensuring that the eyelids are closed when shields or patches are applied. The shields or patches are removed at least once per shift to inspect the eyes for infection or irritation and to allow eye contact. The nurse measures the quantity of light every 8 hours, monitors skin temperature closely, and increases fluids to compensate for water loss. The newborn will have loose green stools and green-colored urine.
The newborn’s skin color is monitored with the fluorescent light turned off every 4 to 8 hours and is monitored for bronze baby syndrome, a grayish-brown discoloration of the skin. The newborn is repositioned every 2 hours and stimulation is provided. After treatment, the newborn is monitored for signs of hyperbilirubinemia, because rebound elevations are normal after therapy is discontinued. Injury from treatment, such as eye damage, dehydration, or sensory deprivation, can occur .

Question 37

What is the use for Methylergonovine? And nursing considerations

Answer 37

an ergot alkaloid, used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The physician should be notified if hypertension is present

Question 38

How is surfactant deficiency treated?

Answer 38

Respiratory distress is common in premature neonates and may be due to lung immaturity as a result of surfactant deficiency.
The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route.

Question 39

Is bright red bleeding normal?

Answer 39

At any point in the postpartum period, the lochia should be dark in color, rather than bright red. The volume should not be great enough to trickle or run from the vagina.
The information provided states the fundus is firm, midline, and at the umbilicus, which are the expected outcomes at this point postpartum. These findings would indicate to the nurse that the bleeding is not coming from the uterus or from uterine atony. The bladder is not palpable, which indicates the that the bleeding is not related to a full bladder, which is further validated by the fundus being at the umbilicus. The most likely etiology is cervical or vaginal lacerations or tears.
The nurse is unable to do anything to stop this type of bleeding and must notify the health care provider.

Question 40

Immediately after delivery of the placenta, where would the nurse would expect to palpate the fundus?

Answer 40

halfway between the umbilicus and the symphysis pubis.

Within 2 hours postpartum, the fundus should be palpated at the level of the umbilicus.

The fundus remains at this level or may rise slightly above the umbilicus for approximately 12 hours.

After the first 12 hours, the fundus should decrease one fingerbreadth (1 cm) per day in size.

By the ninth or tenth day, the fundus usually is no longer palpable.

Question 41

Treatment for hematoma

Answer 41

During the first 24 hours postpartum, ice packs can reduce swelling and discomfort. Ice packs usually are not effective after first 24 hours.
Although vital signs, including temperature, are important assessments, taking the client’s temperature is unrelated to the hematoma and would provide no additional information about swelling.
After 24 hours, the client may obtain more relief by taking a warm sitz bath. This moist heat is an effective way to increase circulation to the perineum and provide comfort.
Usually, hematomas resolve without further treatment within 6 weeks. Additionally, the nurse should measure the hematoma to provide a baseline for subsequent measurements and should notify the physician of its presence.
An antibiotic is not warranted at this point because the client is not exhibiting any signs or symptoms of infection.

Question 42

How far can newborn see?

Answer 42

The neonate has immature oculomotor coordination, an inability to accommodate for distance, and poorly developed eyes, visual nerves, brain.
Normal neonate can see objects clearly within a range of 9 to 12 inches, whether or not they are moving. Visual acuity at birth is 20/100 to 20/150, but it improves rapidly during infancy and toddlerhood.
Newborns can distinguish colors as well as light from dark.

Question 43

What nursing action if funds is off to the side?

Answer 43

A uterine fundus located off to one side and above level of umbilicus is commonly the result of a full bladder. If client has just voided, the client may be experiencing urinary retention with overflow.
If anesthesia has been used for delivery, the inability to void may be related to the lingering effects of anesthesia; however, that is not the case here.
Physicians commonly write a onetime order for catheterization. After which, typically, enough edema has subsided making it easier and less painful for the client to void and completely empty her bladder.

Question 44

Breast feeding positions and descriptions

Answer 44

Football hold:After a cesarean, in a semi-Fowler position, supporting the neonate’s head in her hand and resting the neonate’s body on pillows alongside her hip. This position prevents pressure on the uterine incision yet allows the neonate easy access to the mother’s breast.

The scissors hold: where the mother places her hand well back on the breast to prevent touching the areola and interfering with the neonate’s mouth placement, is used by the mother to hold the breast and support it during breast-feeding.

The cross-cradle: hold is done when the mother holds the neonate’s head in the hand opposite from the breast on which the neonate will feed and the mother’s arm supports the neonate’s body across her lap. This position can be uncomfortable because of the pressure placed on the client’s incision line.

For the cradle hold, the mother cradles the infant alongside the arm at the breast on which the neonate will feed. This position also can be uncomfortable because of the pressure placed on the incision line.

Question 45

Normal respiratory rate and heart rate for newborn

Answer 45

The normal respiratory rate is 30 to 60 breaths/min.

The normal heart rate at rest is 110 to 160. A rate of 170 is tachycardia, which is not normal after birth, and may indicate neonatal sepsis.

Question 46

Is Caput succedaneum a normal finding in newborn?

Circumoral cyanosis?

Answer 46

Caput succedaneumis edema over the back of the fetal head caused by pressure over the presenting part of the fetal head and resolves spontaneously.

Circumoral cyanosis, a bluish color around the mouth, is an abnormal finding.

Question 47

Why is erythromycin used in newborn?

Answer 47

Erythromycin prevents blindness due to gonorrhea and chlamydia.

Erythromycin does not treat syphilis, herpes simplex virus, hepatitis, and human immunodeficiency virus. None of these illnesses causes blindness in the newborn.

Question 48

The Moro reflex is assessed by:

Answer 48

lift the newborn’s body slightly above the crib, followed by suddenly lowering the body and observing for bilateral arm extension and leg flexion.

Question 49

The Babinski reflex is tested by:

Answer 49

firmly stroking the plantar surface.

The anticipated outcome is the incurving of the toes with uncurling and fanning out of the toes.

Question 50

The Gallant reflex is performed by

Answer 50

by holding an infant prone and stroking the lateral aspect of the leg from below the knee superiorly to the buttocks.
The infant reacts by moving the buttocks toward the side that is stroked in a curving movement.

Question 51

What Does “Apgar” Mean?

Answer 51

Apgar stands for “Appearance, Pulse, Grimace, Activity, and Respiration.”
Each is scored on a scale of 0 to 2, with 2 being the best score:

Appearance (skin color)
Pulse (heart rate)
Grimace response (reflexes)
Activity (muscle tone)
Respiration (breathing rate and effort)

Ten is the highest score possible, but few babies get it. That’s because most babies’ hands and feet remain blue until they have warmed up.

Question 52

Scoring for Apgar

Answer 52

Appearance (skin color)
2-Normal color all over (hands and feet are pink)
1-Normal color (but hands and feet are bluish)
0-Bluish-gray or pale all over

Pulse
2-Normal (above 100 beats per minute)
1-Below 100 beats per minute
0-Absent

Grimace(“reflex irritability”)
2-Pulls away, sneezes, coughs, or cries with stimulation
1-Facial movement only (grimace) with stimulation
0-Absent (no response to stimulation)

Activity (muscle tone)
2-Active, spontaneous movement
1-Arms and legs flexed with little movement
0-No movement, “floppy” tone

Respiration (breathing rate and effort)
2-Normal rate and effort, good cry
1-Slow or irregular breathing, weak cry
0-Absent (no breathing)

Question 53

Mom with HIV should be told not to do what?

Answer 53

Breast feed

Question 54

What is TPAL

Answer 54

Term (born alive or stillborn at 37 weeks or more) (twins =1 birth)

Premature (born 20-37 weeks alive or stillborn)

Abortion (pregnancy loss before 20 weeks)

Living children