Postpartum

Question 1

What is the postpartum goal?

Answer 1

assisst women & their partners during initial transition to parenthood.

Question 2

When does postpartum start?

Answer 2

delivery of placenta to about 6wks later

Question 3

How long is the typical postpartum hospital stay?

Answer 3

Up to 48hrs

Question 4

What is a concern of postpartum care?

Answer 4

Shorter stays d/t the need of providing important info on how to care for themselves and the baby in such a short period of time

Question 5

What is couplet care?

Answer 5

-mother/baby care
-a primary nurse for both mom and baby

Question 6

What does couplet care provide?

Answer 6

-an opportunity for bonding/attachment
- more time for the mother to learn how to care for the baby with the help of a nurse

Question 7

What is rooming in?

Answer 7

Mother and nurse share care of the baby

Question 8

What are benefits of rooming in?

Answer 8

• increases breast feeding success
• mom can breast feed on demand and learn baby’s early feeding cues

Question 9

What is a late feeding cue?

Answer 9

Crying; harder to latch after this sign

Question 10

What to do if mother temperature is elevated?

Answer 10

Determine if mom is dehydrated or developing an infection

Question 11

What temperature is common during the first 24hrs after birth?

Answer 11

-100.4 F
- usually elevated w/in first hr after birth then decreases

Question 12

What v/s may fluctuate d/t changes of the cardiovascular system

Answer 12

Pulse and blood pressure

Question 13

What is the normal range of respirations ?

Answer 13

• 16-24
• need to monitor closely if narcotics are used for pain relief

Question 14

What may be a reason for elevated blood pressure?

Answer 14

Pain; assess

Question 15

Why might most mom experience Bradycardia after delivery?

Answer 15

There is less blood flow to the uterus causing an increase in maternal blood volume

Question 16

What might tachycardia indicate ?

Answer 16

Blood loss or dehydration

Question 17

What are 3 physiological changes that protect women form excessive blood loss?

Answer 17

1. Elimination of uteroplacental circulation
2. Loss of placental endocrine function
3. Fluid shift

Question 18

By how much is the maternal vascular bed reduced?

Answer 18

15%

Question 19

Without baby and placenta, the uterus doesn’t need much ____

Answer 19

Blood

Question 20

Why does the placenta generate hormones that causes mom to vasodilate (increase size of blood vessel) ?

Answer 20

To accommodate for the increase in blood volume

Question 21

What happens when the placenta is delivered?

Answer 21

Stimulus for vasodilation is gone -> blood vessels go back to normal size

Question 22

Why does blood pressure increase as blood vessel return to normal size?

Answer 22

To compensate for loss of volume during initial postpartum period

Question 23

Why is there an increase in blood volume during fluid shift?

Answer 23

During pregnancy fluid is store in tissue and when its over fluid is shoved back into the circulatory system

Question 24

What keeps women from going into hypovolemic shock?

Answer 24

-Sustaining a normal amount of blood loss
- no more than 500 for vaginal deliver
- no more than 1000 for C section

Question 25

What gets rid of extra fluid?

Answer 25

- excessive peeing - sweating

Question 26

Why does HGB/ HCT increase?

Answer 26

D/t the decrease in plasma volume

Question 27

Why is there fluctuations in HGB and HCT?

Answer 27

Fluid shift after pregnancy is over causes fluctuation of concentration on rbc’s

Question 28

Why are RBC values hard to interpret during the first 2 days Postpartum?

Answer 28

Changes in blood volume d/t heavy bleeding

Question 29

What does rbc’s look like on days 3-4? What should you do?

Answer 29

-Rbc’s look like they are decreasing d/t the increase in plasma volume -monitor bleeding, clots, asses fundus (boggy?), and lab values

Question 30

WBC will be increased. What is the normal values?

Answer 30

-normal value is 12,000 -first 10-12days wbc may be anywhere from 25,000 - 30,000

Question 31

T/F wbc count of 30,000 means infection

Answer 31

- false - look at the whole patient. Fever? -Only high wbc? Most likely not an infection

Question 32

Coagulation factors will be increased which mean uterus clotting easily= good. Where do we not want to clot?

Answer 32

-calves or thighs - this means DVT

Question 33

What does BUBBLE-EEE stand for?

Answer 33

Breasts, uterus, bladder, bowel, lochia, episiotomy/ laceration, extremities, edema, emotional status

Question 34

What are the components of breasts?

Answer 34

-lactating -no lactating -engorgement -discharge teaching

Question 35

Should the mom be worried she is not producing milk the first two days?

Answer 35

No, a small amount of colostrum will be produced which is beneficial for the baby

Question 36

What is colostrum?

Answer 36

Thick and yellow premature milk that is full of antibodies and helps baby pass meconium stool

Question 37

What do you assess the nipple for ?

Answer 37

Inversion, flatness, eversion, cracks, blisters and redness of skin

Question 38

What can nipple pain indicate?

Answer 38

Baby is latched wrong

Question 39

When does mature milk come?

Answer 39

Day 3-5, causes engorgement

Question 40

If a mother chooses not to breastfeed, should they express the milk from their breasts?

Answer 40

NO! The more pumped out the more the body will make

Question 41

What should a non-lactating mother avoid?

Answer 41

-Avoid stimulating the breasts -do not touch and avoid heat

Question 42

What should you teach the mother regarding her breast at the time of discharge?

Answer 42

-S/S of mastitis - warmth, fever, pain and redness

Question 43

What can a mom do to ease the pain with engorgement?

Answer 43

-wear a well fitting bra -take Motrin

Question 44

What is uterine involution?

Answer 44

The return of the uterus to its non-pregnant state

Question 45

Where is the uterus palpable right after birth?

Answer 45

Midline; 2cm below belly button

Question 46

How much should the fundus shrink everyday?

Answer 46

1cm

Question 47

When is there no longer a risk for postpartum bleeding?

Answer 47

When the endometrial lining is back in place

Question 48

What does a fundal massage help?

Answer 48

A boggy uterus

Question 49

how do you perform a fundal massage?

Answer 49

Put hand on pubis, right above pubic bone, massaging uterine fundus right on top

Question 50

Why is it important for the uterus to be firm?

Answer 50

To prevent excess bleeding

Question 51

Why does the uterus contract after birth?

Answer 51

Contracts in response to endogenous and exogenous oxytocin

Question 52

Where does endogenous oxytocin come from?

Answer 52

Postpartum and breastfeeding

Question 53

What increases pain intensity?

Answer 53

Parity, large baby, multi fetal gestation, and breastfeeding

Question 54

How long should a mother refrain from inserting anything in the vagina?

Answer 54

6wks or until it returns to its normal consistency

Question 55

After birth how does the cervix appear?

Answer 55

No longer a circular shape, now its slit like

Question 56

How does the body excrete excess fluid

Answer 56

Diuresis and diaphoresis

Question 57

When should the mom void by? How much?

Answer 57

-6-8hrs after birth or removal of catheter - 150cc each time

Question 58

Why should you be concerned about bladder distention?

Answer 58

-can cause a boggy uterus which leads to increase bleeding -can develop uti

Question 59

Nursing interventions to promote voiding

Answer 59

-poor warm water while mom voids to minimize burning -insert a catheter if mom is still unable to void

Question 60

When will a bowel movement occur ?

Answer 60

May take 2-3days

Question 61

Non-pharmacological interventions for Bowels

Answer 61

Ambulate, increase fluids and fiber

Question 62

Pharmacological interventions for bowels

Answer 62

Stool softener for the first few days

Question 63

What color is lochia ruba? How long does it last?

Answer 63

-bright red, reddish brown -lasts 2-3 days

Question 64

What color is lochia serousa? How long does it last?

Answer 64

-pink or brown -lasts 3-10days

Question 65

What color is lochia alba? How long does it last?

Answer 65

-yellow or white -lasts 10days to 6wks

Question 66

What factors can influence lochial flow?

Answer 66

-c section -ambulation

Question 67

Why do you notify doctor if fundus is firm but mom is still bleeding?

Answer 67

May indicate laceration of cervix/vagina that needs to be sutured

Question 68

What is uterine Atony ?

Answer 68

Boggy uterus due to failure of uterine to fully contract

Question 69

What does REEDA stand for ?

Answer 69

Redness, edema, ecchymosis, discharge and approximation of laceration edges

Question 70

How long does it take for a episiotomy to heal?

Answer 70

2-3wks

Question 71

What should you check for during perineal care?

Answer 71

-signs of hematoma, discoloration or swelling

Question 72

What shoud you include in teaching about good hygiene?

Answer 72

-sitz baths, chuck pad w/ witch hazel, fluids, fiber, stool softner, kegels

Question 73

What should you assess for in the extremities

Answer 73

Redness, warmth, pain, differences in size between extremities and diminished peripheral pulses

Question 74

Why dont we massage?

Answer 74

Can cause pulmonary embolus

Question 75

Why is ambulation beneficial?

Answer 75

Decreases risk of thromboembolism Increases strength Helps with constipation

Question 76

What should you assess for if edema is facial or sacral?

Answer 76

Preeclampsia

Question 77

How often does baby blues occur?

Answer 77

In 85% postpartum women

Question 78

What do you ask regarding moms emotional status?

Answer 78

Birth experience, self image, sleep, attachment

Question 79

What are maternal behaviors that demonstrate successful attachment ?

Answer 79

Holding, touching, talking, responding to baby’s cries

Question 80

What are nursing interventions to facilitate attachment ?

Answer 80

Rooming in, skin to skin

Question 81

What are the phases of reva rubins stage of maternal adjustment

Answer 81

Taking in (first 48hrs) Taking hold (2-4days) Letting go

Question 82

Physical changes

Answer 82

Sciatica relives Joint pain relief Stretch marks Hair loss

Question 83

What helps protect baby from infection?

Answer 83

Breastfeeding and good hand washing

Question 84

Non-pharmacological ways to comfort mom

Answer 84

Warm pack, deep breathing, relaxation

Question 85

Pharmacological ways to comfort mom

Answer 85

Oral pain meds, IM, IV, narcotics Reassess after pain med is given

Question 86

Pharmacological interventions

Answer 86

Rubella (immunity status) Rh isoimmunization prevention Rhogam with in 72hrs of birth