chapter 12: postpartum nursing care

Question 1

support family dynamic

Answer 1

• include family members in teaching and care
• provide info about sibling rivalry
• observe interactions: identify problems, make recommendations and referrals

Question 2

puerperium

Answer 2

period following delivery of placenta until reproductive organs return to a nonpregnant state
- usually about 6 weeks

Question 3

body begins to change immediately after delivery

Answer 3

postpartum shivering: uncontrollable, exact cause unknown, provide w/ a warm blanket, reassure shivering will pass

Question 4

uterus involution

Answer 4

process where oxytocin continues to be released after placenta delivery, causing uterus to contract and shrink
- size and weight decreases
- fundus descents
- afterpains (intermittent uterine contractions)
- exfoliation: sloughing of dead tissue at the placental site

Question 5

lochia

Answer 5

vaginal discharge made up of blood, mucus, and tissue
- may last up to 6 wks
- should get lghter in color and amount over time
- cervical os closes slowly and by day 14 is barely dilated
- vagina: after delivery lacks tone, over 4 wks edema decreases and rugae appear

Question 6

perineum

Answer 6

• bruised and edematous after delivery
• muscle tone restored over 4-6 wks
• kegel exercises promote the return of tone

Question 7

ovaries and ovulation

Answer 7

• normal function after delivery variable and influenced by breastfeeding
• menstruation delayed and may not resume for weeks or months if breastfeeding
• not breastfeeding: may ovulate as early as 27 days after delivery
• menstruation begins 6-12 wks for bottle feeding women

Question 8

breasts postpartum

Answer 8

• breasts secrete colostrum before milk is produced
• nipple stimulation causes prolactin to be released, intiating milk production
• between second and fourth day breasts engorged with milk
• breasts may feel warm and tender
• if not breastfeeding needs interventions to suppress milk production

Question 9

integumentary system

Answer 9

• abdominal skin resumes its pre pregnancy state except for stretch marks
• linea nigra fadesbut may never go away
• melasma fades over days or weeks
• hair loss resolves

Question 10

Gi system

Answer 10

• hungry and thirsty after delivery
• may have sluggish intestinal peristalsis and constipation
• hemorrhoids can cause pain w/ defecation: stool softener may be prescribed to prevent straining

Question 11

cardiovascular system

Answer 11

60-80% increase in cardiac output after delivery
- loss of plasma volume causes temporary rise in HGB and HCT
fibrinogen levels increase and remain increased for several days after delivery: increases risk for blood clot development

Question 12

removal of excess fluid stored during pregnancy:

Answer 12

• diuresis: secretion and passage of large amounts of urine

diaphoresis: excessive perspiration

Question 13

respiratory system

Answer 13

• diaphragm returns to normal position
• respiratory rate returns to prepregnancy level
• pregnancy nasal congestion disappears quickly

Question 14

urinary system

Answer 14

• bladder tone decreases
• bladder becomes distended and pushes uterus up andto the side
• displaced uterus can interfere w/ involution and can lead to hemorrhage

Question 15

musculoskeletal system

Answer 15

• hormone relaxin begins to subside
• hip pain may continue for a few days
• diastis recti of abdominal muscles may occur: separation of abd wall muscles, corrected w/ exercises or surgery

Question 16

uterine assessment

Answer 16

• palpate fundus: note position and location, never palpate without supporting lower segment
• assess consistency

Question 17

boggy uterus

Answer 17

support lower uterine segment and massage in circular pattern with flattened other hand until uterus becomes firm
- if massage not effective, large blood clot or extreme uterine atony which can lead to postpartum hemorrhage
- full bladder can lead to uterine atony

Question 18

lochia assessment

Answer 18

• inspect amount and character during uterine massage
• should be getting better not worse
• no big clots

Question 19

lochia lasts…

Answer 19

3-6 wks, occurs in three stages:
lochia rubra
lochia serosa
lochia alba

Question 20

lochia rubra

Answer 20

first discharge, dark red blood

Question 21

lochia serosa

Answer 21

3-4th day, brownish red, lighter color

Question 22

lochia alba

Answer 22

over 1-2 wks, lighter and yellowish color

Question 23

amount of lochia

Answer 23

• scant: less than 1 in of lochia on pad
• light: less than 4 in of lochia on the pad
• moderate: less than 6 in of lochia on pad
• moderate: less than 6 in of lochia on the pad
• heavy: pad is saturated within an hr (should not happen)

Question 24

nursing care during first hour after delivery

Answer 24

• most dangerous hour: due to risk of hemorrhage
• check vital signs every 15 min
• palpate fundus
• assess uterine tone and amount of vaginal bleeding
• when stable, transfer to postpartum or mother baby unit

Question 25

Bubble

Answer 25

breasts, uterus, bladder, bowels, lochia, episiotomy/laceration, legs, and emotions

Question 26

breasts

Answer 26

- assess for breast and nipple pain - pt teaching guidelines: managing engorgement for the non breastfeeding pt

Question 27

uterus

Answer 27

palpate for location and consistency: firm and in the midline document location of fundus in relationship to umbilicus

Question 28

bladder

Answer 28

palpate when assessing the fundus distention should not be present

Question 29

bowels

Answer 29

- auscultate bowel sounds

Question 30

lochia

Answer 30

assess and document amount and type

Question 31

episiotomy/laceration

Answer 31

inspect perineum for bruising, erythema, edema, hematoma (collection of blood in subcutaneous space), intactness of repair

Question 32

legs

Answer 32

assess for leg pain, adequate circulation, edema, temp

Question 33

emotions

Answer 33

- when placenta is expelled, sudden drop in progesterone - notice emotions and postpartum blues

Question 34

nursing care following cesarean birth

Answer 34

- monitor uterine involution and lochia - postop care to prevent complications - assess pain and cesarean incision

Question 35

nursing care of the adolescent postpartum

Answer 35

- same assessment and physical care - more structured teaching: care of the newborn and herself - treat as an adult - encourage questions - direct teaching to teenager, not parents, and include father in teaching if present - role model infant care - encourage bonding during the taking in phase - at higher risk for postpartum depression

Question 36

nursing care for the woman who relinquishes her infant for adoption

Answer 36

- find out the pts birth plan: may want the adoptive parents present at the birth or called after the birth - may want to hold the infant then ask infant be kept in nursery - may not want to see or hold infant at all - provide empathetic care - requires same physical care and teaching as any postpartum pt - higher than average risk of postpartum depression

Question 37

three phases of postpartum adjustment

Answer 37

1. taking in phase 2. taking hold phase 3. letting go phase

Question 38

taking in phase

Answer 38

- mother centered on own needs - feels dependent and needs mothering - may not initiate interaction w/ the newborn - use the en face position - identify the infant - begin the bonding process: start of lifelong relationship - taking in phase may last a day or two

Question 39

taking hold phase

Answer 39

- mother initiates care of the baby - wants to be more independent - concerned and anxious about own physical care, breastfeeding, and abby care - requires praise and positive reinforcement - open to learning - may last up to 10 or more days - may experience postpartum blues

Question 40

letting go phase

Answer 40

- letting go of being childless and more independent - attachment w/ newborn occurs - learnsto understand her infant's cries and body language - receives positive feedback from the infant when needs are met - learns to trust herself and instincts

Question 41

development of family attachment

Answer 41

- family attachment may take more time

Question 42

prep for discharge

Answer 42

- administer MMR to woman found suscpetible to rubella during pregnancy - those in contact w/ newborn should have up to date Tdap - teaching should occur in small segments throughout hospital stay - self care instructions should be written and verbal

Question 43

self care instructions

Answer 43

- sutures for lacerations and the episiotomy repair will dissolve - perineal care: ibuprofen/acetaminohen for pain, sitz baths - menstrual pad changes, no tampons or douche until follow up - breast care: supportive bra - hand hygiene before breastfeeding and every diaper change