Healthy Postpartum Period (1)

Question 1

how long does it take for the uterus and placenta to return to the pre-pregnancy state?

Answer 1

6 weeks

Question 2

when is the return of menstruation after birth?

Answer 2

variable 6-10 weeks (if not breastfeeding, usually longer)

Question 3

can the patient get pregnant again before her period returns?

Answer 3

yes!! can still ovulate

Question 4

what is the initial milk produced during pregnancy?

Answer 4

colostrum

Question 5

milk may come in __-__ days postpartum

Answer 5

3-5

Question 6

what to look out for abdomen/GI postpartum

Answer 6

• dec. bowel sounds
• distention
• decreased peristalsis (progesterone)
• may have anxiety about BM (stool softener)

Question 7

how urinary output is there usually postpartum

Answer 7

increases (2000-3000ml)
-had fluids running during labor

Question 8

why can it be difficult to void after birth

Answer 8

edema in the perineal area

Question 9

how long does it take for cardiac output to stabilize after birth

Answer 9

about an hour

Question 10

why is there hypervolemia after birth?

Answer 10

• excess bloodflow no longer going to placenta
• protective mechanism
• corrects diuresis (no more extra volume)

Question 11

how are H&H, WBCs, and platelets looking after pregnancy?

Answer 11

• H&H difficult to interpret at first
• WBC elevated
• platelets decreased (placenta given away)

Question 12

what is the estimated blood loss for vag and c/s delivery

Answer 12

200-500ml vag
1000 ml c/s

Question 13

what is temp like postpartum?

Answer 13

can get up to 38 (from exertion/dehydration)
afebrile after 24h

Question 14

what can a postpartum fever indicate?

Answer 14

infection

Question 15

what does a postpartum BP normally look like?

Answer 15

slightly elevated

Question 16

what can a low postpartum BP mean?

Answer 16

hypovolemia/hemorrhage

Question 17

what does a postpartum pulse look like

Answer 17

slightly decreased

Question 18

what neuro change happens postpartum and what causes it?

Answer 18

Headache
-fluid shifts
-HTN
-spinal HA (epidural)

Question 19

what is the initial weight loss PP?

Answer 19

10-12 lbs (infant, placenta, fluid)

Question 20

how much weight is lost from PP diuresis?

Answer 20

5 lbs

Question 21

how much weight is lost 8 weeks PP?

Answer 21

the rest of the gained weight

Question 22

when can an exercise regimen be resumed PP?

Answer 22

after follow-up PP visit (4-8 weeks)

Question 23

what is exacerbating PP contractions/cramping?

Answer 23

pitocin, breastfeeding (oxytocin)

Question 24

what are the 2 Rubin stages of psychological adjustment to parenthood

Answer 24

taking in and taking hold

Question 25

what is the Rubin phase of “taking in”

Answer 25

passive
allows others to make decisions for her
(can end 2 days PP)

Question 26

what is the Rubin phase of “taking hold”

Answer 26

assumes active role
provide mother with reassurance

Question 27

what is the acronym for PP assessment and what does it stand for?

Answer 27

BUBBLE HE
* B= breasts (latching, scabbing)
* U= uterus (fundus, texture)
* B= bowel
* B= bladder
* L= lochia (vag drainage)
* E= episiotomy
* H= Homan’s (DVT!!!!)
* E= emotional status

Question 28

what 2 things are looked for in breast assessment?

Answer 28

• consistency
• intactness of nipple (if breastfeeding)

Question 29

what does it mean if the nipple is not intact?

Answer 29

the baby is not latching properly

Question 30

what are tips for breast care?

Answer 30

• supportive bra
• nurse on demand
• use lanolin/hydrogel dressings
• if not breastfeeding, avoid nipple stim. and use ice packs!

Question 31

what to look for in a uterine assessment?

Answer 31

location (fundus)
consistency (firm/boggy (bad))

Question 32

how is fundus location measures?

Answer 32

finger lengths, above umbilical = +, under = -

Question 33

how to assess bowels PP?

Answer 33

-ask last BM
-passing gas?
-assess BS/distention
-fear of BM = stool softener

Question 34

how to assess bladder PP?

Answer 34

-PP diuresis
-difficult urinate (Edema)
-frequency, urgency, burning?
-why are they at risk for UTI? (straight cath/epidural)

Question 35

where does lochia come from?

Answer 35

placental site / uterine debris

Question 36

what is lochia composed of, and do c/s deliveries have it too?

Answer 36

• epithelial cells, erythrocytes, bacteria, fetal meconium, lanugo
• yes!

Question 37

what color is the lochia throughout the days PP?

Answer 37

• rubra (red)= 2-3 days
• serosa (pink)= 3-10 days
• alba (clear/white)= 1-2 weeks

Question 38

describe scant lochia pad saturation

Answer 38

blood only when wiped or less than 1 inch stain within an hour

Question 39

describe light lochia pad saturation

Answer 39

less than 4 inch stain within an hour

Question 40

describe moderate lochia pad saturation

Answer 40

less than 6 inch stain within an hour

Question 41

describe heavy lochia pad saturation

Answer 41

completely saturated within an hour

Question 42

what position should a patient be in for parineal assessment?

Answer 42

side-lying

Question 43

what is the acronym and meaning for perineal assessment?

Answer 43

REEDA
* redness
* edema
* ecchymosis
* drainage
* approximation

Question 44

when else should REEDA assesment be done besides a peri exam?

Answer 44

c/s incision

Question 45

what can happen emotionally PP?

Answer 45

• postpartum blues/depression
• mood swings/weepy
• hormones

Question 46

why is pitocin ordered PP? how is it given diff. in c/s and vag deliveries

Answer 46

to firm the uterus
c/s= until next morning
vag= 1 bag only

Question 47

what pain meds are given PP?

Answer 47

• IBU
• tylenol (watch liver)
• percocet (watch liver)
• vicodin

Question 48

what 2 meds (not pitocin/pain) are given PP?

Answer 48

-rubella vaccine
rhogam

Question 49

when should a pt contact the provider PP?

Answer 49

• sore/red breasts
• saturating pads more than 1/hr
• purulent drainage
• urgency, dysuria, hematuria, difficulty
• HA, CP, SOB, vision
• incision probs
• fever
• depression