Postpartum Assessment

Question 1

What is a sign of a cervical laceration?

Answer 1

Free flowing bright red blood

Question 2

What is a normal place to palpate the fundus immediately postpartum?

Answer 2

Between the umbilicus and the symphysis pubis

Question 3

True or False: It is normal to palpate the fundus 1 cm above the umbilicus at 12 hours postpartum?

Answer 3

True

Question 4

At how many days postpartum should the uterus be no longer palpable?

Answer 4

10 days

Question 5

What is a factor that can increase involution of the uterus?

Answer 5

Breastfeeding- increase in oxytocin

Question 6

What are three things that can slow down involution?

Answer 6

1. Over distended uterus
2. Retained placenta
3. C-section delivery

Question 7

What is lochia?

Answer 7

This is the decidua (thick layer of mucous membranes that lines the uterus in pregnancy) that is dead and sloughing off.

Question 8

In which time should the placenta detach from the uterus?

Answer 8

Within 30 minutes

Question 9

What are the three types of lochia?

Answer 9

Rubra
Serosa
Alba

Question 10

What is a concern with patients that had a c-section that has to do with bowel sounds?

Answer 10

Ileus- the bowel sounds will be heard high but not low

Question 12

What can be a normal range of WBCs postpartum?

Answer 12

25-30, 000

Question 13

What are three reasons for diuresis in the mother?

Answer 13

1. Decrease in aldosterone
2. Low estrogen levels
3. Hypervolemia compensation to get rid of fluid.

Question 14

When is a normal time for menses to return?

Answer 14

1. 7-9 weeks for bottle- feeding mothers
2. 2-18 months for breastfeeding mothers

Question 15

What is the only birth control pill that is safe for breastfeeding mothers?

Answer 15

Progestin-only. Estrogen decreases milk production.

Question 16

What are the four warning signs of inflammation for DVT?

Answer 16

Red, hard, tender, and warm

Question 17

What is the measurement difference for swelling in the leg?

Answer 17

2 cm

Question 18

What are the three criteria for Virchow’s triad?

Answer 18

Venous stasis, hypercoagulation, and blood vessel trauma

Question 19

What are the three main risk factors for developing a DVT in pregnancy?

Answer 19

Left leg
Edema
First Trimester

Question 20

Who is the most common person to get postpartum endometritis?

Answer 20

Those women who labored and then went to c-section.

Question 21

What does the TIME acronym stand for in regard to sepsis?

Answer 21

T: temperature
I: infection
M: mental decline
E: extremely ill

Question 22

What are the two phases of Sepsis?

Answer 22

Phase 1 (early): warm stage- fever, tachycardia, nausea, vomiting, diarrhea, temp of 102.
Phase 2 (late): cool stage-cold, clammy, bradycardia, hypotension, temp of 93.

Question 23

What are the blood pressure parameter goal for sepsis?

Answer 23

SBP: >100
DBP: >65

Question 24

What is the difference between “Baby Blues” and Postpartum Depression?

Answer 24

Baby Blues: can last 1 day or up to 3 weeks- this has more to de with labile emotions.
Postpartum Depression: can last weeks to months

Question 25

What are the three stages of Family Adaptation?

Answer 25

1. Taking In: the mother is focused on herself and the infant’s immediate well-being. This can last 2 days.
2. Taking Hold: the mother is taking initiative and has mood swings. This can last 10 days.
3. Letting Go: relationships are reestablished and the mother is confident in taking care of the infant.

Question 26

How do you assess for symphysis pubis separation?

Answer 26

They can’t walk forwards, they can walk backward.

Question 27

What are symptoms to watch for with a hematoma?

Answer 27

Disproportionate pain in the perineum.

Question 28

Which conditions are safe to take the Progestin-only birth control pill with?

Answer 28

Breastfeeding, hx of DVT, and elevated blood pressure.

Question 29

What are two antibiotics that a woman should take back-up forms for birth control with?

Answer 29

Penicillin and tetracyclineWha

Question 30

What are the two types of Postpartum Thyroiditis?

Answer 30

Autoimmune: this is from an underlying condition that flares after childbirth. This can lead to chronic hypothyroidism.
Non-Immune: transient and can go away

Question 31

Which hormone is responsible for the production of breastmilk?

Answer 31

Prolactin

Question 32

Which hormone is responsible for the letdown and uterine contractions?

Answer 32

Oxytocin

Question 33

What are the Three stages of breastmilk?

Answer 33

1. Colostrum (2-4 days)- high in protein and antibodies
2. Transitional (2 weeks)- this is high in fat, calories, and lactose
3. Mature (2+ weeks)- this includes foremilk (the first milk) and hindmilk (this is thick and creamy and high in fat).

Question 34

What is most important for supply of breastmilk?

Answer 34

The length of time and strength of the suck.

Question 35

What is the 5:5:5 rule for breastmilk?

Answer 35

5 hours left out on the counter
5 days in the fridge
5 months in the freezer

Question 36

What are benefits of kangaroo care/ skin-to-skin?

Answer 36

Stabilization of the infant’s heart rate, stabilization of temperature, improved and more regular breathing pattern, and improved O2 saturation.

Question 37

What is the major cause of mastitis?

Answer 37

Staph infection

Question 38

How does mastitis differ from engorgement?

Answer 38

Mastitis is unilateral and engorgement is bilateral.

Question 39

What are the signs and symptoms of mastitis?

Answer 39

Fever, chills, body aches, tachycardia, malaise, headaches, swollen, red, hard, and tender breast

Question 40

True or False: you should not feed while you are being treated for mastitis?

Answer 40

False: you should feed when being treated because it avoids stasis.