OB Chapter 12: Postpartum

Women are at risk for constipation due to:

*Decreased GI motility due to the effects of progesterone *Decreased physical activity *Dehydration and fluid loss from labor *Fear of having a BM after perineal lacertation or episiotomy *Perineal pain and trauma

____________ scale will allow identification of potential complications such as infection, hematoma, and excess bleeding

REEDA

Lochia is less than 1in. on the pad

Scant

Three days postpartum, a lactating mother has full, warm, taut, tender breasts. What nursing action should be taken?

She is engorged. Have NB suckle freq.; take measures to increase milk flow: warm water, breast massage, and supportive bra

On postpartum day 2, the breasts are

Slightly firm and non-tender

_________ clots should be noted in the patients chart

Small

A __________ uterus indicates that the uterus is not contracting and places the woman at risk for excessive blood loss

Soft (boggy)

In the first 24 hours postpartum, the breast are

Soft and non-tender

Women who breastfeed experience ____________ _____________ engorgement r/t distention of milk glands that is relieved by having the baby suckle or by expressing milk.

Subsequent breast

The woman should be in a _______ position for uterine assessment

Supine

After delivery there may be a transient 5% elevation in the womans

Systolic and diastolic blood pressure

TRUE or FALSE: Multiparous women or women who are breastfeeding may experience "afterpains" during the first few post-partum days.

TRUE

A woman has decided to take birth control pills as her contraceptive method. What should she do if she misses taking the pill for 2 consecutive days?

Take 2 pills for 2 days and use an alternative form of birth control

Upon admission to the postpartum room, 3 hours after delivery, a client has a temp. of 99.5. What nursing actions are indicated?

Temp. is probably elevated due to dehydration and work of labor; force fluids and retake temp. in an hour; notify physician if above 100.4

After birth, the uterine fundus is palpated midway between the _________ and ________ ________ and is firm and midline

Umbilicus and symphysis pubis

Within 12hrs. after birth of the placenta, the fundus is located at the level of ___________ or ____cm. above the umbilicus and is firm and midline

Umbilicus; 1

A woman asks why she is urinating so much in the postpartum period. The nurse bases the response on what information?

Up to 300mL per day can be voided because of the reduciton in the 40% plasma volume increase during pregnancy

Large clots should be ___________ and findings reported to the physician or midwife. **10g = 10 ml of blood loss **Should be examined for the presence of tissue

Weighed

Instuct the woman who is experiencing engorgement for NON-BREAST FEEDING WOMEN to:

*Apply ice to the breasts *Not express milk because this stimulates milk production *AVOID HEAT to the breast because this can stimulate milk production *Take an analgesic for pain

After dishcharge, report any of the signs to the physician or midwife:

*Excessive lochia (saturating more than one pad in an hour) *Blurry vision, severe headaches may be associated with preeclampsia *Thoughts of harming self or infant *Increased temperature *Breasts warm, tender, & reddend *Freq., urgency, or burning on urination *Leg pain *Pelvic or abdominal tenderness/pain

Temperature elevations 100.4 or higher after 24-hours post-birth:

*Hydrate the woman *Notify the physician or midwife for further evaluation

Temperature elevations less than 100.4 during the first 24hours post-birth:

*Hydrate the woman *Promote relaxation and rest *Reassess in 1 hour after interventions

After the third stage of labor, assess the uterus, pulse, BP, RR, and temperature

-Q15min. for the first hour -Q30min. for the second hour -Q4hr. for the next 22hours -Every shift after the first 24hrs. or as stated in hospital/unit protocols

24hrs. after birth of placenta, the fundus is located at ______cm. below the umbilicus and is firm and midline

1

The uterus returns to a pre-pregnant size, shape, and location; and the placental site heals. This occurs through uterine contractions, atrophy of the uterine muscle, and decrease in the size of the uterine cells

Involution

Hemoglobin decreases by

1.0 - 1.5 g/dL

If voiding is less than ______mL, the nurse neds to

150; palpate for bladder distention

The RR in the postpartum period is typically in the range of ________ breaths per minute

16-24

The uterus descends ____cm. per day; by day ______ the fundus has descended into the pelvis and is NOT palpable

1; 14

Bowel funtion usually returns ______ days after delivery

2-3

The ______________ period is the 6-week period after childbirth and is a time of rapid physiological changes within the woman's body as it returns to a pre-pregnant stage

Postpartum

Woman have an average blood loss of _______ - _______ mL r/t vaginal birthing experience

200-500

It is recommened that women wait ______months after birth until the next pregnancy is attempted

24

Instruct the woman to take warm sitz baths starting ______hrs. after delivery twice a day for _______min.

24; 20

WBC may increse to _________/mm within a few hours of birth as a result of stress r/t labor and birth, and return to normal levels within _______ days

25,000; 7

An increase in the vascular and lymphatic system of the breasts, precedes the initiation of milk production. This causes the woman's breasts to become larger, firm, warm, and tender, and the woman may feel pain in the breasts *Subsides within 24-48 hours

Primary engorgement

Hematocrit decrease

3%-4% per 500 mL of blood loss

CO returns to pre-pregant levels within _______hrs.

48

Assist the woman to the bathroom and encourage her to void withing _____hrs. post-birth

6

_____________ are moderate to severe cramp-like pains that are r/t the uterus working harder to remain contracted and/or to the increasing of oxytocin that is released in response to infant sucking

Afterpains

Use ___________ if the woman experiences orthostatic hypotension and faints

Ammonia Ampule

A client feels faint on the way to the bathroom. What nursing assessments should be made?

Assess BP sitting and lying; assess Hgb and Hct for anemia

What information should be given to a client regarding resumption of sexual intercourse after delivery?

Avoid until postpartum examination. Use water-soluble jelly. Expect slight discomfort due to vaginal changes

Which women experience afterpains more than others?

Breastfeeding women and multiparas

______________ slowly decrease after the birth of the placenta and return to normal ranges within the first ______ postpartum weeks

Clotting factors; 2

A clear, yellowish fluid that preceeds milk produciton

Colostrum

A woman's WBC is 17,000: she is afebrile and has no symptoms of infection. What nursing action is indicated?

Continue routine assessments; normal leukocytosis occurs during postpartal period because of placental site healing

Bladder inflammation/infection

Cystitis

After the delivery of the placenta, the uterus begins the process of ___________

Involution

A Foley Catheter is reccomended when inability to void is r/t

Edema

On postpartum day 3, the breasts are

Firm, tender, and warm to touch

A breastfeeding woman complains of very tender nipples. What nursing actions should be taken?

Have her demonstrate infant position on breast (incorrection position causes tenderness). Leave bra open to air-dry nipples for 15 minutes 3x a daily. Express colotrum and rub on nipples

Lochia is when the pad is saturated within 1hr

Heavy

The risk for postpartum hemorrhage is the greatest within the first __________ following delivers

Hour

Skin breakdown of the nipples is often associated with an:

Improper infant latch

There is an ____________ in cardiac output during the first few postpartum hours r/t blood that was shunted through the uteroplacental unit returning to the maternal system.

Increase

What factor places the pt. at risk for thromboembolism?

Increased clotting factors

Foul smelling lochia could indicate the development of an __________.

Infection

The primary complication of subsequent breast engorgement is ________________ of the breast

Infection

Women who are experiencing chills with elevated temperature need to be evaluated for further possible __________

Infection

Lochia is less than 4in. on the pad

Light

A bloody discharge from the uterus that contains sloughed off necrotic tissue, undergoes changes that reflect the healing stage of the uterine placental site

Lochia

Lochia is less than 6in. on the pad

Moderate

A nurse discovers a postpartum client with a boggy uterus that is displaced above and to the right of the umbilicus. What nursing action is indicated?

Perform immediate fundal massage. Ambulate to the bathroom or use bedpan to empty bladder because cardinal signs of bladder distention are present

The ________ is assessed every shift using the acronym REEDA

Perineum

Are associated with inadequate emptying of the breast, wearing overly tight bras, and/or failute to change the infant into different feeding positions

Plugged milk ducts