Unit 33 Postpartum

Question 1

What is involution?

Answer 1

Reduction in the size of uterus after delivery to pre-pregnant size cause by uterine contractions that constrict and occlude blood vessels at the placental site.

Question 2

What are factors that enhance involution?

Answer 2

• Uncomplicated labor and delivery
• Breastfeeding
• Early ambulation
• Complete expulsion of placenta and membranes

Question 3

What factors slow involution?

Answer 3

• Infection
• Full urinary bladder
• Anestesia
• Prolonged labor and delivery
• Grand mutiparty
• Retained placental fragments

Question 4

What is the top part of the uterus called?

Answer 4

the fundus (palpable indicator of involution)

Question 5

What is a boggy uterus and how is it corrected?

Answer 5

• A boggy uterus is one that is soft , relaxed, and likely to cause hemorrhage
• To correct you would massage the uterus to tighten and expel clots

Question 6

What will a full bladder do to the uterus?
How could you check for a full bladder?
How long until you should void postpartum?

Answer 6

-A full bladder will shift the uterus left or right (displace it) increasing the risk for postpartum hemorrhage

• With a bladder scanner
• Palpate for full bladder
• Should void within 6-8 hours postpartum
• *Encourage voiding every 2-3 hrs even if no urge

Question 7

What medication is used in cases of hypertension in pregnancy and to prevent seizures?

Answer 7

Magnesium sulfate

Question 8

What is are medications used in treatment of premature labor?

Answer 8

Terbutaline and Magnesium sulfate

Question 9

Post delivery the normal placement of the fundus should be where? If raised or to either side what could happen?

Answer 9

At the umbilicus
(1 finger a day goes down)

Then the uterus could continue to bleed

Question 10

What is Lochia, the types, and what should it not contain?

Answer 10

• It is the discharge of blood and debris following delivery
• Musty fleshy odor, small amount of mucus

Rubra: 1-3 days, dark red, may have clots smaller than nickel

Serosa: 4-10 days, pink or brownish, watery, odorless

Alba: 11-21 days yellow to white, slight stale odor

Should NOT contain large clots
C-sections have decreased lochia due to suctioning in surgery

Question 11

What is a procedure to remove clots?

Answer 11

[Dilation and curettage]

-Refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping

Question 12

What could be an indication of hemorrhage regarding chuck pads?

Answer 12

If you are changing them more than 3 times in an hour = abnormal

Question 13

What are the terms used to document the amount of Lochia flow?

Answer 13

Scant: 1-2 inch stain or only on tissue when wiped [< than 10 ml in one hour]

Light: 4 inches or less stain [10-25 ml in one hour]

Moderate: Less than 6 inch stain [25-50ml in one hour]

Heavy: saturated pad [50-80ml in one hour]

Question 14

What are afterpains and how are they counteracted?

Answer 14

• Intermittent uterine contractions
• Stimulated by breastfeed
• More painful in breastfeeding/multiparous women

Counteracted with 600mg Ibuprofen and one or two Percocet tabs

Question 15

Briefly describe the cervix, vagina, and abdominal wall postpartum.

Answer 15

Cervix:

• Closes to 2-3 cm after several days/finger after 1 week
• Shape permanently changes after first delivery from round dimple to lateral slit
• May appear bruised and edematous with small lacerations

Vagina:

• Edematous with small lacerations
• Should be free from pain within 2 weeks
• Low estrogen levels decreases vaginal lubrication meaning painful sex for 6-10 weeks

Abdominal Wall:

• Soft and flabby with decreased muscle tone
• Striae or stretch marks once red fade to silver

Question 16

How should the perineum be postpartum? What are ways to reduce perineum pain?

Answer 16

• Edematous and painful to pressure, perhaps displaying hemorrhoids
• Pain relieved though use of Tucks, Nupercainal ointment, ice (20 min on and 10 min off), Sitzs baths

Question 17

Postpartum how should the breasts be?

Answer 17

-Soft and secreting colostrum

Question 18

How does uterine involution occur?

Answer 18

Autolysis of protein material within the uterine wall

Question 19

What decreased the risk of slots after Sx such as a C-section?

Answer 19

Walking

Question 20

What does a fever of 100.4F or below postpartum indicate?

Answer 20

Simply that fluids are needed

Question 21

What is considered a normal WBC lab value postpartum?

Answer 21

Could be up to 30,000 because placenta site is healing

Question 22

Describe the cardiovascular system postpartum.

Answer 22

• Returns to pre-pregnant state within 2 weeks
• First 48 are greatest risk especially with clients with heart disease
• BP should remain consistent with pregnancy baseline
• Bradycardia 50-70 bpm common during first 6-10 days
• Tachycardia related to increased blood loss, temp elevation, of difficult labor and birth
• Increased fibrinogen continues for 1 week with increased chance for thrombophlebitis
• Decreased Hgb is related to amount of blood loss during delivery, should return to prelabor value in 2-6 weeks
• Hct increases by 3-5 days related to diuresis

Question 23

Due to lower Hgb, diuresis, and volume shifting postpartum, what is the patient at risk for?

Answer 23

Syncope/fainting

Falls

Question 24

If a patient has voided five times in a morning, what would the nurse initially do?

Answer 24

• Collect the next voiding/measure the amount of urine to assess for retention with overflow

Question 25

What does eating lots of ice do postpartum?

Answer 25

Decreases Hgb

Question 26

Why is there a risk of constipation and hemorrhoids postpartum?

Answer 26

Risk for constipation related to decreased peristalsis, use of analgesics, dehydration and decreased mobility during labor, and fear of pain from having a bowel movement Risk for hemorrhoids increases because of pressure from pushing

Question 27

Describe endocrine function and lactation postpartum.

Answer 27

Endocrine: - Estrogen and progesterone drop rapidly after delivery of placenta - Menstruation usually resumes at 7-9 weeks for non lactating women - Ovulation and menstruation return time is prolonged in lactating women Lactation: -They have let down reflex which is the release of milk by contractions of the alveoli of the breast -Colostrum is first milk secreted, rich in protein and immunoglobulins -Mature milk produced after 2 weeks -Primary engorgement occurs in second or third day as the supply of blood and lymph is increased and traditional milk produced (use cabbage leaves to help with engorgement)

Question 28

What helps with lactation suppression?

Answer 28

- Applying ice bags for 20 minutes, four times a day if engorgement occurs - Use of snug bra or breast binder continuously for 5-7 days to prevent engorgement - Avoiding heat and stimulation of breasts

Question 29

What is the normal urinary output per hour?

Answer 29

30-50 ml/hr

Question 30

Regarding psychosocial postpartum changes what are the phases of maternal adjustment?

Answer 30

1. Taking in phase: 0-3 days; focus to self, passive and dependent, touches and explores newborn (reflecting) 2. Taking hold phase: 3-10 days, obsessed with body functions, rapid mood swings 3. Letting go phase: 10 days to 6 weeks: mother functions established

Question 31

What is bonding and what is engrossment?

Answer 31

Bonding is the process which the parents form an emotional attachment -Use en face position, soft low pitched tone of voice Engrossment is the father's absorption, preoccupation, and interest in the infant

Question 32

What is true regarding laxatives postpartum?

Answer 32

Careful with them as they can transfer to baby via breastmilk

Question 33

How would you provide pain comfort postpartum?

Answer 33

- Ibuprofen 600-800mg along with Precocet to decrease inflammation/edema and pain - Benadryl is given for reaction to spinal and epidural anesthesia

Question 34

How to promote bowel elimination postpartum?

Answer 34

- Encourage early and frequent ambulation - Encourage increased fluids and fiber - Administer stool softeners as ordered (suppositories contraindicated if third or fourth degree perineal laceration involving rectum) - No straining at stool, normal patterns returns in 2-3 weeks

Question 35

What are postpartum warning signs?

Answer 35

-Bright red bleeding saturation more than 1 pad per hour or passing large clots - Temp > 100.4F - Chills - Excessive pain - Reddened or warm areas of breasts: mastitis - Foul smelling Lochia - Inability to urinate, burning, frequency, - Calf pain, tenderness, swelling

Question 36

What is engorgement?

Answer 36

Breasts are painfully overfull of milk.

Question 37

Wha are ways to establish lactation and important information regarding breastfeeding?

Answer 37

- Utilize well fitting nursing bra for support day/night - Teach breast care including no use of soap and air drying nipples after feeding - Encourage nursing on demand, more they feed, more milk supply - Nurse 10-15 on first breast and until baby lets go on second, next nursing vice-versa - No caffeine, no chocolate, no gassy foods, no spicy, no soda - Higher stress leads to less milk supply

Question 38

What is of the most importance before performing any assessment, intervention, etc with the mother and baby?

Answer 38

Identify baby ID to mother ID before giving or leaving baby in room (baby always transported by bassinet)

Question 39

What are a few important rest and gradual return to activity/nutrition information for discharge?

Answer 39

-Teach woman to resume activity gradually over 4-5 weeks; avoid lifting, stairclimbing, strenuous activity - Encourage 2000ml/day fluid intake - Encourage prenatal vitamins

Question 40

what is the biggest complication with cystic fibrosis?

Answer 40

pneumothorax