Normal Post-partal Period

Question 1

In the postpartum period the Temperature may raise to what and when ?

Answer 1

100.4 during the first 4 hours

Question 2

What is the BP like in the postpartum period ?

Answer 2

Stable

Question 3

A HR of what is common in the 6 to 10 days after a delivery ?

Answer 3

HR of 50 to 70 bpm

Question 4

Tachycardia + Postpartum = ?

Answer 4

Think Hemorrhage

pregnancy = increased blood volume, so… should see less after birth

Question 5

How are the Breasts postpartum ?

Answer 5

Soft for 2 to 3 days, then the dreaded engorgement occurs

Question 6

What is the Abdomen like Postpartum ?

Answer 6

Soft/loose

Question 7

Is hunger common in the mom in the postpartum period ?

Answer 7

Yes!

Can’t eat when in labor

Question 8

What does FB stand for ?

Answer 8

Finger breadths

Question 9

What is the fungus like in the postpartum period ?

Answer 9

The funds is midline 2 to 3 finger breadths (FB) below the umbilicus

Question 10

Where is the fundus located a few hours after birth ?

Answer 10

It rises to the level of the umbilicus or to one FB above

Question 11

What do you want the funds to be in the postpartum period ?

Answer 11

Firm***

Question 12

What is the first thing you do if the Funds is boggy ?

Answer 12

massage the funds until it is firm and then check for bladder distention

Question 13

In the Postpartum period, bladder distention is suspected when ?

Answer 13

When the uterus is above the expected level or is not in the midline
(usually moved to the right)

Question 14

A distended bladder will not do what ? And increases the chance of what ?

Answer 14

Will not allow the uterus to contract normally

Which increases the chance of hemorrhage

Question 15

Fundal height will decrease how ?

Answer 15

Will decent one finger breadth/day

Question 16

What is the proper term used the the funds descends and the uterus returns to it’s pre-pregnancy size ?

Answer 16

Involution

if doesn’t happen, worry about hemorrhage

Question 17

Afterpains are common when ? And will continue if what ?

Answer 17

For the first 2 to 3 days & will continue to be common if the mother chooses to breastfeed

(every time mom nurses, the body releases oxytocin which makes the uterus contract)

Question 18

Rubra Lochia is seen when ? and is what color ?

Answer 18

3 to 4 days & is dark red

Question 19

Serosa Lochia is seen when ? And is what color ?

Answer 19

4 to 10 days & is Pinkish brown

Question 20

Alba Lochia is seen when ? And is what color ?

Answer 20

10 to 28 days (can be as long as 6 weeks) & is Whiteish yellow

Question 21

You can have ________ Lochia up to 6 weeks ?

Answer 21

Alba

Question 22

Clots are okay postpartum as long as they are what ?

Answer 22

No larger than a Nickel

Question 23

Urine output:

After delivery, you should diuresis the excess fluid around when ?

Answer 23

Around 24 hours

Question 24

Is Dehydration possible postpartum ?

Answer 24

Yes

Question 25

Why should the legs be inspected so closely following delivery ?

Answer 25

For a DVT

Question 26

What are Tx's for Perineal Care in the postpartum period ?

Answer 26

- Intermittent ice packs for the first 24 hours (to decrease edema) - Warm water rinses - Sitz baths 2 to 4 times/day - Anesthetic sprays - Change pads frequently - Teach to report foul smell and any loch changes

Question 27

What is the Peripad rule in the Postpartum period ?

Answer 27

We do not want the client to saturate more than one peripad/hour

Question 28

Bonding with parents in the Postpartum period develops what ?

Answer 28

Trust in the infant

Question 29

In the infant, trust is not only an emotional need, but also a what ?

Answer 29

Physiologic need (Maslow's)

Question 30

How does the Newborn benefit physiologically from bonding ?

Answer 30

Skin to skin contact - stabilizes HR - improves O2 stats - regulates the infants temp - Conserves calories - Breasts can change in temp to warm or cool the infant

Question 31

True or False: The moms breast can change in temperature to warm or cool the infant ?

Answer 31

True

Question 32

Skin to skin contact is called what ?

Answer 32

Kangaroo care

Question 33

What is Kangaroo care & how is it done ?

Answer 33

- Mom or dad places baby "skin to skin" on their chest - The baby is wrapped inside the parent's shirt or covered with a blanket and held for 1 hour at least 3 times a week (focus on premies, but now standard for all)

Question 34

How should the mom cleanse the breast after each feeding ?

Answer 34

With warm water & let air dry

Question 35

Should moms use a Support bra postpartum for Breast care ?

Answer 35

Yes

Question 36

can postpartum moms use ointment for breast soreness ?

Answer 36

Yes

Question 37

Breastfeeding moms should do what postpartum in relation to Breast care ?

Answer 37

Express some colostrum and let it dry

Question 38

Breast pads can be used Postpartum to do what ?

Answer 38

Absorb moisture

Question 39

What does the mother need to initiate ASAP after giving birth ?

Answer 39

Need to initiate breastfeeding ASAP after birth & alternate breasts

Question 40

If breastfeeding is interrupted, the mom can do what ?

Answer 40

Pump

Question 41

Moms should increase their caloric intake by what postpartum ?

Answer 41

By 500 calories/day

Question 42

The postpartum mother should have how much fluid/milk intake a day ?

Answer 42

Eight to ten 8 ounce glasses of fluid a day

Question 43

What is the goal of non-breastfeeding mothers ?

Answer 43

To decrease engorgement

Question 44

What are ways that Engorgement can be decreased in postpartum non-breastfeeding mothers ?

Answer 44

- Ice packs - Breast binders (or ace wraps) - Chilled cabbage leaves - No stimulation of the breasts

Question 45

Why are chilled Cabbage leaves a Tx for decreasing engorgement in non-breastfeeding mothers ?

Answer 45

B/c chilled cabbage leaves decrease inflammation and decrease engorgement

Question 46

What are postpartum infections ?

Answer 46

Infections within 10 days after birth | E.coli, beta hemolytic strep

Question 47

What do you want to teach to moms to reduce postpartum infections after birth ?

Answer 47

Proper hygiene (front and back cleansing)

Question 48

For postpartum infections what do you usually get ?

Answer 48

Usually get cultures and Antibiotics

Question 49

What is early postpartum hemorrhage defined as ?

Answer 49

More than 500mL of blood lost in the first 24 hours accompanied by a 10% drop from admission hematocrit (you must have both to be true! (dual definition) )

Question 50

What is late postpartum hemorrhage defined as ?

Answer 50

After 24 hours and up to 6 weeks postpartum

Question 51

What are causes of Postpartum Hemorrhage ?

Answer 51

- Uterine atony (no tone = uterus will bleed) - Lacerations - Retained fragments and forceps delivery

Question 52

What can cause Uterine atony ?

Answer 52

A full bladder

Question 53

NCLEX TIP: If get a OB question & don't know the answer.... Pick Hemorrhage!!

Question 54

What are Medications used to Halt Excessive Postpartum Hemorrhage ?

Answer 54

- Oxytocin (Pitocin) - Methylergonovine maleate (Methergine) - Carboprost tromethamine (Hemabate) - Misoprostol (cytotec)

Question 55

What can Mastitis be caused by ?

Answer 55

Poor hygiene or not feeding properly

Question 56

What is the major bacteria with Mastitis ?

Answer 56

Staphylococcus

Question 57

When does Mastitis usually occur ?

Answer 57

Around 2 to 4 weeks

Question 58

What are the signs and symptoms of Mastitis ?

Answer 58

- Rapid onset of fever and chills - The breast will be swollen, hard, and tender to touch - Malaise

Question 59

What is the Treatment for Mastitis ?

Answer 59

- Bed rest - Support bra - Binding and chilled cabbage leaves (are only to be used if breastfeeding is being discontinued permanently) - Initiate breastfeeding frequently or pump (if going to continue breastfeeding) - Penicillin (PCN) - Pain medications (depends on what it is and when you take it) - Heat (will cause breast to leak) - Feed baby frequently - Always offer the affected breast first

Question 60

How should Penicillin be taken for the Tx of Mastitis ?

Answer 60

Feed baby then take it

Question 61

What is the drug of choice for Mastitis ?

Answer 61

Penicillin

Question 62

What may be given alternatively in a mom with Mastitis who is allergic to penicillin ?

Answer 62

Eythromyacin