Exam 2: Postpartum Care

Question 1

What is the postpartum (puerperium) period?

Answer 1

Period after childbirth up to ~6 weeks where the PT gradually returns to pre-pregnant state

Question 2

Uterine involution

Answer 2

Changes that occur within the uterus to return to its pre-pregnancy state
Contraction
Catabolism
Regeneration

Question 3

Fundus assessment

Answer 3

Assess uterine tone. fundal height, uterine placement, and uterine consistency at least every 8 hours after recovery period has ended
1 hour after delivery the fundus should rise to the level of the umbilicus
Every 24 hours the fundus should descend approx. 1-2 cm
Fundus should be firm, not boggy

Question 4

Lochia

Answer 4

Post-birth uterine discharge (blood, mucus, uterine tissue)
Amount is similar to a heavy menstrual period about 2 hours after delivery then decreases gradually and consistently

Question 5

Three stages of Lochia

Answer 5

Lochia rubra: Dark red, bloody consistency. Fleshy odor, can contain small clots. 1-3 days after delivery
Lochia serosa: Pinkish brown and serosanguineous consistency. Can contain small clots and leukocytes. 4-10 days after delivery
Lochia alba: Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes. 10 days -8 weeks after delivery

Question 6

What must you always do when assessing the fundus?

Answer 6

Support the lower uterine segment

Question 7

Cardiovascular system

Answer 7

Decrease in blood/fluid volume
Gradual decrease in cardiac output
Lower pulse rate common, hemorrhage
Blood pressure returns to pre-pregnant levels by 6 weeks
Increased coagulation factors puts PTs at risk for DVT

Question 8

Urinary system

Answer 8

Diuresis = rapid bladder filling
Difficulty voiding
Swelling/bruised perineum, lacerations
Decreased bladder tone

Question 9

Parental role attainment phases

Answer 9

Taking in
Taking hold
Letting go

Question 10

What is the difference between attachment and bonding?

Answer 10

Attachment takes place overtime and is mutually satisfying
Bonding is the initial, undirectional attraction

Question 11

What are the goals of postpartum care?

Answer 11

Promote comfort
Promote effective coping
Encourage bonding
Relieve pain
Promote healing
Education

Question 12

What education topics are important for new parents?

Answer 12

Care at home
Care of the infant
Follow up visits
Immunizations
Birth control

Question 13

How often should vital signs be taken in the postpartum period?

Answer 13

Q15 minutes (1st hour)
Q30 minutes (2nd hour)
Q4 hours (1st 24 hours)
Q8 hours thereafter

Question 14

BUBBLEHE Focused Postpartum Physical Assessment

Answer 14

Breasts
Uterus
Bowel
Bladder
Lochia
Episiotomy/edema
Homan’s
Emotional status/extremities (DVT)

Question 15

REEDA Incision Assessment

Answer 15

Redness
Edema
Ecchymosis
Discharge, Drainage
Approximation

Question 16

Measures to promote comfort

Answer 16

Ice to perineum for 1st 24 hours (on and off 20 minutes)
Sitz bath after 24 hours
PRN local medications for perineum

Question 17

Avoid what for 4 weeks after rubella immunization?

Answer 17

Pregnancy

Question 18

Rh(d) immune globulin

Answer 18

Given to PT who is Rh negative and has a newborn who is Rh positive

Question 19

Factors influencing attachment

Answer 19

Family background
Care practices
Policies discouraging exploring infant
Infant temperament and health at birth
Separation immediately after birth
Intensive care environment
Staff indifference or lack of support for family

Question 20

Cultural adaptations

Answer 20

Rest, seclusion, dietary restraints, ceremonies
Adjustment of couple
Adaptation of siblings, grandparents
Conduct a cultural assessment accomplished through conversation with new family

Question 21

Supporting a patient’s choice: Lactation

Answer 21

Initiate as soon as newborn is dried, assessed, and stable
Exclusive chest feeding for 1st 6 months
Should be continued for 1st year and beyond

Question 22

Supporting a patient’s choice: Bottle feeding - Suppression

Answer 22

Milk will come in 2-4 even if not chest feeding
Engorgement will resolve
Ice/tight bra
Acetaminophen for discomfort
No stimulation of breasts/nipples

Question 23

Engorgement causes

Answer 23

Infrequent feeding
Incomplete emptying
Non-chest feeding mother

Question 24

Engorgement symptoms

Answer 24

Hard and tender
Swollen and inflamed
Difficult for infant to grasp

Question 25

Engorgement treatment

Answer 25

Encourage feeding every 2-4 hours Apply warm compress before feed Cold compress after to reduce swelling Express small amount of milk to soften and promote lactation Feed on affected side first Check for proper nipple placement Chest massage Ultrasound Pumping Anti-inflammatories Cabbage leaf compress Maintain milk supply!

Question 26

Cracked nipples

Answer 26

Cracked, blistered, fissures, bleeding Improper positioning and latch Assessment: Are they soft, filling, engorged? May need lactation consultant Analgesics for pain Lift infant's head, face nipple directly

Question 27

Lactation suppression treatment

Answer 27

Tight supportive bra around the clock Ice for 15-20 minutes ever other hour Avoid sexual stimulation Do not squeeze or manually suppress Avoid warmth (face away in shower) Cabbage leaves in bras

Question 28

Postpartum danger signs

Answer 28

Fever greater than 100.4 after 1st 24 hours Foul smelling lochia Change in color or amount of lochia Large blood clots Saturated pad in 1 hour Severe headache Visual changes Calf pain with dorsiflexion Swelling, redness, discharge at incision site Dysuria, burning, incomplete emptying of bladder Shortness of breath or dyspnea with exertion Depression or extreme mood swings

Question 29

What is Mastitis

Answer 29

Inflammation of chest connective tissue Plugged duct going unnoticed Cracks in nipple providing pathway for pathogens Tissue trauma

Question 30

Symptoms of mastitis

Answer 30

Red, hot, hard, tender to touch Produces fever/flu-like symptoms Localized outside of duct

Question 31

Mastitis is a result of

Answer 31

Parental fatigue, overextended Chest not emptying Abrupt weaning or changes in feeding patterns

Question 32

Management of mastitis

Answer 32

Lactation consultant Warm soaks and massage area Antibiotic therapy Analgesics/NSAIDs, Rest, fluids, proper nutrition Empty chest and CONTINUE TO NURSE ON AFFECTED SIDE Reassurance Practice cleanliness

Question 33

What is postpartum hemorrhage

Answer 33

Early or late onset Life threatening Leading cause of pregnancy mortality Most within 4 hours of birth

Question 34

Risk factors of postpartum hemorrhage

Answer 34

C-section Operative vaginal delivery Precipitous labor Atypically attached placenta Retained placenta fragments Fetal demise Anesthesia Previous history of PPH Multiparity (more than 5 pregnancies) Multiple gestations Placenta previa

Question 35

Pathophysiology of postpartum hemorrhage

Answer 35

Excessive bleeding More than 500 ml vaginal birth and 1000 ml c-section Causes: Tone (uterine atony = early) Tissue Trauma Thrombin Traction

Question 36

What is subinvolution?

Answer 36

Failure for uterus to go back to pre-pregnancy state often caused by placental fragments May occur without warning 1-6 weeks postpartum

Question 37

What is uterine atony?

Answer 37

Most commonly within first hour of birth Overdistention of uterus Uterine anomaly Assessment findings: Excessive bleeding, boggy fundus

Question 38

Nursing management of postpartum hemorrhage

Answer 38

Identify and correct the source Massage the fundus if uterine atony Administer uterotonic meds: Oxytocin, Cytotec (rectally), Methergine (cannot give if BP elevated in labor), Hemabate. Assess quantity and quality of bleeding Frequent VS and fundal height assessment Determine if placental fragments and prepare for D&C if late onset subinvolution Assess signs of hypovolemic shock Bleeding protocol

Question 39

Methergine

Answer 39

Used postpartum to sustain uterine contractions promoting involution and preventing/controlling PPH Should NOT be used to induce labor Contraindicated for hypertension or preeclampsia

Question 40

Cytotec

Answer 40

Prevent peptic ulcers, off-label effective in controlling uterine bleeding Given rectally Contraindicated for hypersensitivity to prostaglandins or additives in gel or suppository

Question 41

Postpartum infection

Answer 41

Puerperal infection: Fever of 100.4+ occurring on at least 2 days within first 10 days post childbirth (excludes first 24 hours) Risk factors: C-section or operative vaginal birth Prolonged labor or prolonged rupture of membranes Chorioamnionitis Vaginal/perineal lacerations Postpartum hemorrhage Retained placental fragments Diabetes Compromised health status

Question 42

Endometritis (metritis)

Answer 42

Infection of uterine lining Can extend to ovaries, fallopian tubes, pelvic thrombophlebitis

Question 43

Wound infections

Answer 43

C-section incision site Episiotomy Perineal or genital tract laceration

Question 44

UTI

Answer 44

Catheterization Trauma from delivery

Question 45

Nursing management of infections

Answer 45

Administer broad-spectrum IV antibiotics Manage pain Monitor for possible complications or worsening of condition PT education: S/S worsening condition, compliance with therapy, self care, follow up care