Postpartum Physiological Assessments and Nursing Care- 12

Question 1

postpartum period

Answer 1

6-week period after childbirth

Question 2

Maternal mortality

Answer 2

death of a woman from complications of pregnancy and childbirth occurring up to 1 year postpartum

Question 3

Postpartum Assessment

Answer 3

● Vital signs, pain, breath and heart sounds

● Laboratory findings, such as CBC, rubella status, and Rh status

● Breasts

● Uterus

● Bladder

● Bowel

● Lochia

● Episiotomy, lacerations, perineum, hemorrhoids

● Lower extremities

● Emotions, bonding with infant, fatigue, psychosocial factors

Question 4

Changes of uterus

Answer 4

uterus goes back to placement and size prepregnancy takes 6-8 weeks
uterine contractions, atrophy of muscles, decrease in size of uterine cells

Question 5

Afterpains

Answer 5

moderate to severe cramp-like pains related to the uterus working to remain contracted and/or the increase of oxytocin released in response to infant suckling.

occur first few days after birth

Question 6

Nursing actions- uterus

Answer 6

assess for size, location, tone

instruct the woman to void every two hours

Question 7

Uterine Atony (Boggy Uterus)

Answer 7

Uterine atony is the most common cause of postpartum hemorrhage.

Question 8

Treating atony

Answer 8

uterine massage
drugs that promote uterine contraction-oxytocin
notify provider
measure distance between fundus and umbilicus
have patient void if uterus is not in place

Question 9

oxytocin (pitocin)

Answer 9

Oxytocin stimulates the upper segment of the myometrium to contract rhythmically, which constricts spiral arteries and decreases blood flow through the uterus.

Question 10

Subinvolution

Answer 10

failure of the uterus to involute/descend as expected

Question 11

movement of uterus

Answer 11

1cm a day for about 14 days

Question 12

endometrium, the mucous membrane that lines the uterus

Answer 12

undergoes exfoliation and regeneration after birth of placenta- prevents scarring

Question 13

Lochia

Answer 13

bloody discharge from the uterus that contains red blood cells, sloughed off decidual tissue, epithelial cells, and bacteria

Question 14

nursing actions- lochia

Answer 14

assess color amount and odor

assess for clots (egg sized or larger should be weighed)

Question 15

seeing a clot- why

Answer 15

lochia has been pooling in the lower uterine segment.

Question 16

Retained placental tissue causes what

Answer 16

interferes with uterine involution and lead to excessive bleeding

Question 17

measuring blood conversion

Answer 17

1 g equals 1 mL of fluid

Question 18

good void amount

Answer 18

300cc

Question 19

Vital sign warning signs

Answer 19

BP <90or>160/>100
BPM <50 >120
resp <10 >30
O2 <95
Oliguria <35

agitation, confusion, unresponsiveness

Question 20

vagina and perineum changes

Answer 20

may include edema, mild stretching, minor lacerations, major tears, and/or episiotomies.

Question 21

midline episiotomy

Answer 21

incision that is midline on the perineum. heals quicker

Question 22

mediolateral episiotomy

Answer 22

incision that is made at a 45-degree angle to the perineum.

Question 23

nursing action peri area

Answer 23

assess
swelling,bruising,mild/mod pain
provide comfort measures
ice first 24-48, then heat
medication as ordered
reduce risk for infection

Question 24

nonpharmacological interventions

Answer 24

• Ice packs
• Warm compresses
• Sitz baths
• Repositioning
• Showering
• Topical treatments

Question 25

Pharmacological interventions

Answer 25

* NSAIDs- mild to moderate pain | * Opioid analgesics may be used for moderate to severe pain.

Question 26

changes in breasts

Answer 26

decrease in estrogen and progesterone and an increase in prolactin When the infant suckles, the posterior pituitary releases oxytocin, resulting in the milk ejection reflex, also called the let-down reflex

Question 27

Colostrum

Answer 27

a clear, yellowish fluid, precedes milk production and is secreted after delivery.

Question 28

Immediately after delivery-breasts

Answer 28

fullness tissue may be swollen, it is soft and nontender 24-48 hr

Question 29

around third day- breasts

Answer 29

The woman’s breasts become larger, firm, warm, and tender, and the woman may feel a throbbing pain in the breasts.

Question 30

Nursing action-breastfeeding

Answer 30

● Inspect and palpate the breasts for signs of engorgement ● Assess the nipples for signs of irritation and nipple tissue breakdown. ● Assess for plugged milk ducts

Question 31

Nursing action-nonbreast feeding

Answer 31

● Assess the breasts for primary engorgement. | milk leakage, breast pain, and engorgement may be experienced between 1 and 4 days postdelivery

Question 32

Treatment for breastfeeding women

Answer 32

● Frequent feedings to empty the breasts and to prevent milk stasis ● Warm compresses to the breast and breast massage to facilitate the flow of milk prior to feeding sessions ● Express milk by breast pump or manually if the infant is unable to nurse (i.e., preterm infant) ● Ice packs after feedings to reduce inflammation and discomfort ● Analgesics for pain management ● Wear a supportive bra

Question 33

Prevention and treatment for nonbreastfeeding women

Answer 33

● Wear a supportive bra ● Avoid stimulating the breast ● Ice packs to breast ● Analgesics for pain management ● Subsides within 48 to 72 hours

Question 34

mastitis

Answer 34

infection may be caused by bacterial entry through cracks in the nipples and is associated with milk stasis, engorgement, long intervals between feedings, stress, and fatigue Symptoms include fever, chills, malaise, flulike symptoms, unilateral breast pain, and redness and tenderness in the infected area.

Question 35

Average blood loss in labor

Answer 35

200 to 500 mL through vaginal birth

Question 36

risk for orthostatic hypotension

Answer 36

increases during the first postpartum week due to decreased vascular resistance in the pelvis.

Question 37

thromboembolism

Answer 37

women at risk for two weeks postpartum due to clotting factors

Question 38

postpartum chills

Answer 38

vascular instability leads to chills

Question 39

venous thrombosis

Answer 39

thrombosis in a vein, caused by a thrombus (blood clot)

Question 40

increase of coagulability

Answer 40

puts mom at risk for blood clots

Question 41

Respiratory system changes

Answer 41

Chest wall compliance returns after the birth of the infant

Question 42

Rubella Immunization

Answer 42

● Postpartum women who are rubella-nonimmune should be immunized for rubella before discharge. ● Women who contract rubella during the first trimester have a 90% chance of transmitting the virus to their fetuses. ● Fetuses exposed to rubella during the first trimester are at risk for birth defects ● Women who are immunized should avoid pregnancy for 4 weeks

Question 43

immune system changes

Answer 43

suppressed during pregnancy, returns to normal in postpartum period mild temp elevations first 24hr

Question 44

Rh isoimmunization

Answer 44

Rh-negative woman develops antibodies to Rh-positive blood related to exposure to Rh-positive blood either by blood transfusion or during pregnancy with a Rh-positive fetus.

Question 45

Rho immune globulin

Answer 45

● Indication: Administered to Rh-negative women who have given birth to an Rh-positive neonate ● Action: Prevents production of anti-Rh (D) antibodies

Question 46

Transient stress incontinence

Answer 46

associated with impaired pelvic muscle function involving the urethra may occur in the first 6 weeks postpartum

Question 47

Common bladder problems first few days post birth

Answer 47

Bladder distention, rapid bladder filling, incomplete emptying, and inability to void

Question 48

bladder problems-why

Answer 48

administration of intravenous fluids in the postdelivery period, decreased sensation of the urge to void due to anesthesia or analgesia, edema around the urethra, perineal lacerations or episiotomy, operative vaginal delivery, or bladder trauma

Question 49

nursing actions- bladder

Answer 49

assist to bathroom assess for disturbances measure voids- at least 300cc within 2-4hr post birth use bladder scan if voids are less than 150ml assess for UTI signs instruct 10 glasses water a day edema should decrease in 24 hr

Question 50

Cystitis-bladder inflammation/infection | s/s and treatment

Answer 50

● Symptoms: Frequency, urgency, pain/burning on urination, suprapubic tenderness, hematuria, and malaise ● Treatment: Antibiotic therapy, increased hydration, rest

Question 51

Diaphoresis

Answer 51

This profuse sweating, which often occurs at night, assists the body in excreting the increased fluid accumulated during pregnancy

Question 52

endocrine changes

Answer 52

Estrogen, progesterone, and prolactin levels decrease. Estrogen levels begin to rise after the first week post-partum.

Question 53

diastasis recti abdominis

Answer 53

separation of the rectus muscle

Question 54

muscular/nervous system changes

Answer 54

abdominal muscles experience reduced tone and the abdomen appears soft and flabby. soreness loss of nerve sensation temporarily from epidural

Question 55

expected findings muscle

Answer 55

``` some soreness full sensation for moms without epidural diminished sensation for moms with epidural fatigue no headache ```

Question 56

GI changes/risks

Answer 56

mobility returns to normal by end of week 2 constipation hemorrhoids appetite may vary weight- most experience significant loss during 2-3 weeks post

Question 57

constipation nursing actions

Answer 57

``` ask about bowel movements increase fluids increase fiber look at past treatment encourage ambulation medication as ordered ```

Question 58

hemorrhoids nursing action

Answer 58

avoid sitting for long periods lay on side witch hazel sitz baths

Question 59

fourth trimester

Answer 59

lack of sleep, fatigue, pain, breastfeeding difficulties, stress, depression, lack of sexual desire, and urinary incontinence.

Question 60

postpartum visit

Answer 60

full assessment of physical, social, and psychological well-being, with screening for postpartum depression

Question 61

Postpartum Discharge Teaching Project: Warning Signs | Call 911

Answer 61

Pain in the chest Obstructed breathing or shortness of breath Seizures Thoughts of hurting yourself or baby Call your provider for: Bleeding soaking though one pad/hour or passing a clot the size of an egg. Incision that is not healing Red or swollen leg that is warm or painful to touch Temperature of 100.4 or higher Headache that does not get better even after taking medicine, or bad headache with changes in vision

Question 62

Expected physical changes

Answer 62

● Uterine involution, afterpains, progression of lochia ● Breast changes, engorgement ● Diaphoresis and diuresis ● Weight loss ● Women can expect to lose approximately 12 pounds immediately after delivery, and an additional 5 to 8 pounds due to fluid losses associated with uterine involution and diuresis

Question 63

Self care for mom

Answer 63

● Hygiene ● Perineal care, continue to change pad frequently and use peri-bottle until lochia has stopped ● Breast care for lactating and nonlactating women ● Pharmacological and nonpharmacological pain control measures

Question 64

Lactating women nutrition

Answer 64

increase their caloric intake by 500 to 1,000 calories per day and have a fluid intake of approximately 2 to 3 liters per day.

Question 65

Exercise

Answer 65

activity decreases constipation appropriate post part exercises- walking kegel exercises- strengthen pelvic floor

Question 66

Tobacco use

Answer 66

teach about dangers never allow smoking around baby encourage women to stay abstinent from smoking or stop

Question 67

weight loss after childbirth- how

Answer 67

exercise in combination with diet | diet alone

Question 68

sexual activity- talk with physician

Answer 68

● General guidelines are to resume sexual intercourse when the lochia has stopped, perineum has healed, and the woman is physically and emotionally ready.

Question 69

Contraception

Answer 69

● Assess the couple’s desire for future pregnancies. ● Assess satisfaction with previous method of contraception. ●encourage talking with doctor ●provide info on different types