Postpartum

Question 1

What are 2 life-threatening postpartum complications of cesarean section?

(Immediate complication)

Answer 1

Bleeding and Infection.

Question 2

How many saturated pads per hour is considered hemorrhage?

(Immediate complication)

Answer 2

• > than 1 pad per hour or
• one pad that gets saturated within 15 minutes

Question 3

How much blood loss is considered hemorrhage for a vaginal delivery and a cesarean delivery?

(Immediate complication)

Answer 3

• Vaginal delivery: > 500 mL after delivery
• Cesarean delivery: > 1000 mL after delivery

Question 4

How should pads be measured for postpartum hemorrhage?

Answer 4

• weigh pad before and after use
• note time in between pad changes

Question 5

Interventions:

Postpartum hemorrhage

Answer 5

• measure pads
• give oxytocin

Question 6

What maternal temperature is considered normal during the first 24 hours after birth?

Answer 6

98.6^o - 100.4^o F (36^o - 38^o C)

Question 7

Interventions:

Postpartum infection

Answer 7

• assess vital signs
• get cultures of blood, sputum, or lochia
• antibiotics

Question 8

What are the normal assessment findings for the fundus on day one after delivery?

Answer 8

Should be firm, midline, and at the umbilicus.

Question 9

How far down should the fundus decrease per day?

Answer 9

1 cm downward per day.

Question 10

What are the interventions if the fundus is boggy or NOT midline?

Answer 10

• have the client urinate
• gently massage the fundus until firm

Question 11

What is lochia?

Answer 11

The vaginal discharge after pregnancy.

Question 12

Describe:

Lochia rubra

Answer 12

The first vaginal discharge that is red that occurs from birth of baby to about 5 days postpartum.

Question 13

Describe:

Lochia serosa

Answer 13

The second vaginal discharge that is brownish-pink or brown that occurs from 4 - 10 days postpartum.

Question 14

Describe:

Lochia alba

Answer 14

The third vaginal discharge that is yellow to white in color that occurs from about 11 - 14 days postpartum.

Question 15

Describe abnormal postpartum lochia that indicates infection.

Answer 15

• a very bad odor
• yellow/green/gray in color

Question 16

When do postpartum clients start ovulating again?

Answer 16

Soon after birth even without having their period yet and while breastfeeding.

Teach clients about contraceptives to prevent pregnancy too soon.

Question 17

What is colostrum?

Answer 17

The first milk that comes in for breastfeeding:

• it starts about 24 - 72 hours after birth
• it is a yellow-ish color

Question 18

What is engorgement?

Answer 18

When the breasts are very full of milk.

It can be painful and uncomfortable for the mother.

Question 19

How can engorgement be prevented in a breastfeeding mother?

Answer 19

Breastfeed the baby every 2-3 hours to prevent the breasts from over-filling.

Question 20

What are the interventions for engorgement if the client will not be breastfeeding?

Answer 20

• wear a binder and/or a very snug bra
• apply ice packs
• analgesics

Question 21

When will engorgement resolve?

Answer 21

About 36 hours after it started.

Question 22

What is the correct way a newborn should latch onto a breast?

Answer 22

Newborn mouth should be over entire areola.

Question 23

How long should a breastfeeding baby feed for each breast?

Answer 23

Baby feeds on each breast for 15 - 20 minutes.

A breastfeeding session would last between 30 and 40 minutes.

Question 24

How often should moms breastfeed a newborn?

Answer 24

Every 2 - 3 hours.

Question 25

How often should caretakers **bottle feed a newborn**?

Answer 25

Every **3 - 4 hours**.

Question 26

If a newborn has to breastfeed every 2 hours and the client started breastfeeding at 1 PM, **when would the next breastfeeding session start?**

Answer 26

At **3 PM**. ## Footnote Start at the time of when the client started breastfeeding, not when it ended.

Question 27

How does the mom **break the suction** from a breastfeeding baby?

Answer 27

By **inserting a finger between the mouth and the breast.**

Question 28

How **long** is breastmilk or formula the only food given to the baby?

Answer 28

For **4 - 6 months**. ## Footnote Nothing else should be given up until that time.

Question 29

Can breastfeeding mothers take **medications**?

Answer 29

When breastfeeding, all medications and over-the-counter medications need to be **approved by the HCP first** before taking.

Question 30

What are the **complications** of breastfeeding?

Answer 30

* cracked nipples * mastitis

Question 31

What are the **interventions** for cracked nipples?

Answer 31

* no soap (dries out the skin) * expose breasts to air for part of the day * use different breastfeeding positions for baby * apply lanolin (emollient)

Question 32

# Describe: Mastitis

Answer 32

An infection of the breast with clogged milk ducts.

Question 33

# Interventions: Mastitis

Answer 33

* heat or cold packs (to decrease inflammation) * supportive bra (no wire bras - too much constriction) * still breastfeed or pump every 4 hours

Question 34

# Medications: Mastitis

Answer 34

* analgesics * antibiotics

Question 35

What are the general **assessments** postpartum?

Answer 35

* bleeding * infection * pain * perineal hematoma * incision for cesarean delivery * depression * DVT (thrombophlebitis) * fungal height

Question 36

What are the general **interventions** postpartum?

Answer 36

* vital signs * intake and urinary output * encourage fluids/fiber/walking * pain relief

Question 37

What are the specific **assessments and interventions** for the **renal** system postpartum?

Answer 37

1. assess urine output 2. may have retention if anesthesia was used - encourage urination or straight cath ## Footnote Client will have frequent urination to get rid of extra fluids.

Question 38

What are the specific **assessments and interventions** for the **gastrointestinal** system postpartum?

Answer 38

1. assess for constipation * encourage fluids/fiber/walking * stool softeners 2. give extra 500 calories per day due to breastfeeding 3. multivitamin for deficiencies

Question 39

What are the specific **assessments and interventions** for **mental health** postpartum?

Answer 39

1. assess for postpartum depression - therapeutic communication, possible group therapy, and medications 2. assess for mom/baby bonding

Question 40

What are the specific **assessments and interventions** for the **cardiac** system postpartum?

Answer 40

If client underwent a cesarean section: assess for **DVT** (thrombophlebitis) and **pulmonary embolism**. ## Footnote Provide life-saving interventions and notify HCP.

Question 41

What are the specific **assessments and interventions** for **pain** postpartum?

Answer 41

* ice packs to perineum * sitz baths * analgesics * suppositories if client had episiotomy

Question 42

What are the specific **assessments and interventions** for **Cesarean delivery?**

Answer 42

1. assess incision 2. encourage walking - prevent DVT and constipation 3. encourage cough and deep breathing - prevent pneumonia

Question 43

What is the **teaching** to a client that needs to get the MMR vaccination postpartum?

Answer 43

Teach client to **use contraceptives for 1 - 3 months** after vaccination due to risk of harm to fetus.

Question 43

How can engorgement be **prevented** in a breastfeeding mother?

Answer 43

Breastfeed the baby **every 2-3 hours** to prevent the breasts from over-filling.

Question 44

After birth of a baby, when can sex be resumed by the woman?

Answer 44

Woman can resume sex when bleeding has stopped and client is on contraceptives (if woman does not want to get pregnant).