After Delivery

Engrossment

Engrossment refers to the bond that develops between the father and the newborn.

The nursing instructor is leading a discussion on the physical changes to a woman's body after the birth of the baby. The instructor determines the session is successful after the students correctly point out which process results in the return of nonpregnant size and function of the female organs? 1 Evolution 2 Involution 3 Decrement 4 Progression

2 Involution is the term used to describe the process of the return to nonpregnancy size and function of reproductive organs (6-8 weeks). NOT 1 Evolution is change in the genetic material of a population of organisms from one generation to the next. 3 Decrement is the act or process of decreasing. 4 Progression is defined as movement through stages such as the progression of labor.

Postpartum gestational hypertension

An elevation above 140 mm Hg systolic or 90 mm Hg diastolic may indicate the development of postpartum gestational hypertension, an unusual but serious complication of the puerperium

Lochia serosa

Pink, serous, and blood-tinged vaginal discharge that follows lochia rubra and lasts 10 - 14 days.

Lochia rubra

Reddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood. Abnormal of last more than 4 days

Lochia alba

White, cream-colored, or light yellow vaginal discharge that follows lochia serosa. Occurs when the amount of blood is decreased and the number of leukocytes is increased. Last 2-4 weeks

Lochia ________________ is the lighter red, pink, or brown appearing vaginal discharge that lasts approximately 10 to 14 days.

serosa

uterine involution

the return of the uterus to its normal size and former condition after delivery

When monitoring a postpartum client 2 hours after birth, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially? 1 massaging the fundus firmly 2 performing bimanual compressions 3 administering ergonovine 4 notifying the primary care provider

1 Initial management of excessive postpartum bleeding is firm massage of the fundus and administration of oxytocin. NOT 2 Bimanual compression is performed by a primary health care provider. 3 Ergonovine maleate should be used only if the bleeding does not respond to massage and oxytocin. 4 The primary health care provider should be notified if the client does not respond to fundal massage, but other measures can be taken in the meantime.

The nurse is preparing a new mother to be discharged home after an uncomplicated delivery. During discharge education, which type of lochia pattern should the nurse tell the woman is abnormal and needs to be reported to her health care provider immediately? 1 moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5 2 moderate flow of lochia rubra on day 3 postpartum, changing to serosa on day 5 3 lochia progresses from rubra to serosa to alba within 10 days 4 moderate lochia rubra on day 3, mixed serosa and rubra on day 4, light serosa on day 5

1 Lochia by day 4 should be decreasing in amount, and the color should be changing to pink tinge. Red rubra on day 4 may indicate bleeding, and the health care provider should be notified. NOT 2 A moderate flow of lochia rubra on day 3 postpartum, changing to serosa on day 5, is a normal finding. 3 Lochia progressing from rubra to serosa to alba within 10 days of delivery is a normal finding. 4 Moderate lochia rubra on day 3, mixed serosa and rubra on day 4, and light serosa on day 5 is a normal finding.

Which postpartum client will the nurse assess first? 1 an 18-year-old who wants to sleep until 10:00 before the nurse brings the infant for a visit 2 a 35-year-old who had estimated blood loss of 700 ml and has a supine BP of 130/80 mm Hg and BP of 100/65 mm Hg when head of the bed is elevated 3 a 22-year-old who has been up, showered, and packing for discharge later today 4 a 30-year-old postpartum client who had a cesarean birth and is sleeping following pain medication administration

2 A major complication in women who have lost an appreciable amount of blood with birth is orthostatic hypotension, or dizziness that occurs on standing because of the lack of adequate blood volume to maintain nourishment of brain cells. If blood pressure is 15 to 20 mm Hg lower after raising the head of the bed upright compared with the supine reading, the woman might be susceptible to dizziness and fainting when she ambulates.

The nurse working on a postpartum client must check lochia in terms of amount, color, change with activity and time, and: 1 burning. 2 odor. 3 specific gravity. 4 pH.

2 The nurse when assessing lochia must do so in terms of amount, color, odor, and change with activity and time. NOT 1 The client should not feel any burning sensation, however. This would more likely be a sign of a urinary tract infection.

A postpartum client is having difficulty stopping her urine stream. Which should the nurse do next?

Clients should begin Kegel exercises on the first postpartum day to increase the strength of the perineal floor muscles. Priority for this client would be to educate her how to perform Kegel exercises as strengthening these muscles will allow her to stop her urine stream.

Taking in phase

During the first 24 to 48 hours after giving birth, mothers often assume a very passive and dependent role in meeting their own basic needs, and allow others to take care of them. This is referred to as the taking-in phase

The nurse is assessing the fundus of a client on postpartum day 2. What should the nurse expect when palpating the fundus?

Fundus two fingerbreadths below umbilicus and firm Because uterine contraction begins immediately after placental delivery, the fundus of the uterus is palpable through the abdominal wall, halfway between the umbilicus and the symphysis pubis, within a few minutes after birth. One hour later, it will rise to the level of the umbilicus, where it remains for approximately the next 24 hours. From then on, it decreases one fingerbreadth or centimeter per day and will be palpable 1 cm below the umbilicus. For the second postpartal day, the uterus will be two fingerbreadths or centimeters below the umbilicus. The fundus should not be hard.

When palpating for fundal height on a postpartum woman, which technique is preferable? 1 placing one hand at the base of the uterus, one on the fundus 2 placing one hand on the fundus, one on the perineum 3 resting both hands on the fundus 4 palpating the fundus with only fingertip pressure

Supporting the base of the uterus before palpation prevents the possibility of uterine inversion with palpation. To assess the progress of uterine involution, the nurse should stabilize the lower uterus with one hand while feeling for the fundus of the uterus with the other. Uterine inversion, a condition in which the fundus of the uterus prolapses toward or even through the cervix, is an extremely rare condition but a theoretical risk of applying force to the fundus without also providing support to the lower uterine segment. When feeling for the fundus, the nurse should start at the umbilicus and move down, palpating deeply but gently until locating it.

Acquaintance/attachment phase

The acquaintance/attachment phase is a newer term that refers to the first 2 to 6 weeks following birth when the mother is learning to care for her baby and is physically recuperating from the pregnancy and birth. Attachment is a formation of a relationship between a parent and her/his newborn through a process of physical and emotional interactions.

Letting go phase

The last phase, the letting-go phase, is more inclusive of other people. She acknowledges the new normal, the baby as a person instead of a much-speculated upon idea, and her altered position in her new life. The letting-go phase occurs when the woman has assumed the responsibility for caring for herself and her infant.

puerperium

The time from the delivery of the placenta through approximately the first 6 weeks after the delivery in which the uterus involutes

Breast ________________ occurs as colostrum transitions to milk and volume increases.

engorgement •Primary breast engorgement occurs as lactation transitions from colostrum to milk and the volume increases. •If breast fullness prevents latch, express milk before feeding. •If not breastfeeding, avoid breast stimulation and wear a supportive bra around the clock for several days.

episiotomy

surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth

Lochia Discharge

vaginal discharge after childbirth (primarily blood, followed by a more mucousy fluid that contains dried blood, and finally a clear-to-yellow discharge)

During a routine assessment the nurse notes the postpartum client is tachycardic. What is a possible cause of tachycardia? 1 delayed hemorrhage 2 bladder distention 3 extreme diaphoresis 4 uterine atony

1 Tachycardia in the postpartum woman can suggest anxiety, excitement, fatigue, pain, excessive blood loss or delayed hemorrhage, infection, or underlying cardiac problems. Further investigation is always warranted to rule out complications. NOT 2 An inability to void would suggest bladder distention. 3 Extreme diaphoresis would be expected as the body rids itself of excess fluid. 4 Uterine atony would be associated with a boggy uterus and excess lochia flow.

Which finding would lead the nurse to suspect that a woman is developing a postpartum complication? 1 an absence of lochia 2 red-colored lochia for the first 24 hours 3 lochia that is the color of menstrual blood 4 lochia appearing pinkish-brown on the fourth day

1 Women should have a lochia flow following birth. Absence of a flow is abnormal; it suggests dehydration from infection and fever.

A postpartum hemorrhage following a cesarean birth is the loss of more than ________ mL of blood.

1,000

A nurse is caring for a non-breastfeeding client in the postpartum period. The client reports engorgement. What suggestion should the nurse provide to alleviate breast discomfort? 1 Apply warm compresses. 2 Wear a well-fitting bra. 3 Express milk frequently. 4 Apply hydrogel dressing.

2 The nurse should suggest the client wear a well-fitting bra to provide support and help alleviate breast discomfort. NOT 1.3. Application of warm compresses and expressing milk frequently are suggested to alleviate breast engorgement in breastfeeding clients. 4 Hydrogel dressings are used prophylactically in treating nipple pain.

A woman who delivered her infant 2 days ago asks the nurse why she wakes up at night drenched in sweat. She is concerned that this is a problem. The nurse's best reply would be: 1 "Many women sweat after delivery but you seem to be perspiring far more than normal. I'll call the doctor." 2 "Often, when a postpartum woman perspires like you are reporting, it means that they have an infection." 3 "I need to get your vital signs and check your fundus to be sure you are not going into shock." 4 "Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy."

4 Diaphoresis often occurs in postpartum women as a way to get rid of both excess water and waste through the skin. It is not uncommon for a woman to wake up drenched in sweat during the first few days following delivery. This is a normal finding and is not a cause for concern.

Taking hold phase

The taking-hold phase is a period of transition from dependent to independent behavior and may last several weeks. In this phase, the mother is growing used to her new reality and is focused on taking charge of the care of herself and her newborn. She may require reassurance that her actions are correct and her care of herself and the newborn is sufficient. The taking-hold phase occurs when the client begins to assume control over her bodily functions. She is also showing strong interest in caring for the infant by herself.

The typical blood loss for vaginal birth & cesarean section

The typical blood loss for a vaginal birth is between 200 and 500 mL The typical blood loss for cesarean section is 500 to 1,000 mL

Position of the uterus in a postpartum client

The uterus in a postpartum client should be midline and firm. A boggy or relaxed uterus signifies uterine atony, which can predispose the woman to hemorrhage.

A newly delivered mother asks the nurse "What can I do to help my womb to get back to a normal size more quickly?" The nurse's best response would be ... (3)

There are several things that a new mother can do to assist in uterine involution. 1 The most well-known one is breastfeeding the infant. Whenever a new mother breastfeeds her infant, it stimulates the release of oxytocin, which stimulates the uterus to contract. 2 The mother is also advised to eat a well-balanced diet 3 And ambulate early in the postpartum period.

When the nurse is assessing a postpartum client approximately 6 hours after birth, which finding would warrant further investigation? 1 deep red, fleshy-smelling lochia 2 voiding of 350 cc 3 blood pressure 90/50 mm Hg 4 profuse sweating

3 In most instances of postpartum hemorrhage, blood pressure and cardiac output remain increased because of the compensatory increase in heart rate. Thus, a decrease in blood pressure and cardiac output are not expected changes during the postpartum period. Early identification is essential to ensure prompt intervention. NOT 1 Deep red, fleshy-smelling lochia is a normal finding 6 hours postpartum. 2 Voiding in small amounts such as less than 150 cc would indicate a problem, but 350 cc would be appropriate. 4 Profuse sweating also is normal during the postpartum period.

The nurse can expect a client who had a cesarean birth to have less lochia discharge than the client who had a vaginal birth. 1 True 2 False

1 Women who had a cesarean birth will have less lochia discharge than those who had a vaginal birth, but stages and color changes remain the same.

A postpartum client is experiencing painful hemorrhoids. Which position should the nurse suggest the client use when resting? 1 supine 2 Sims position 3 knee-chest position 4 Trendelenburg position

2 Assuming a Sims position several times a day aids in good venous return to the rectal area and reduces the discomfort of hemorrhoids. NOT 1.3.4. Supine, knee-chest, and Trendelenburg are not recommended positions to aid in the pain of hemorrhoids.

A new mother is concerned because it is 24 hours after birth and her breasts have still not become engorged with breast milk. How should the nurse respond to this concern? 1 "It takes about 3 days after birth for milk to begin forming." 2 "I'm sorry to hear that. There are some excellent formulas on the market now, so you will still be able to provide for your infant's nutritional needs." 3 "You may have developed mastitis. I'll ask the primary care provider to examine you." 4 "You are experiencing lactational amenorrhea. It may be several weeks before your milk comes in."

1 The formation of breast milk (lactation) begins in a postpartal woman regardless of her plans for feeding. For the first 2 days after birth, an average woman notices little change in her breasts from the way they were during pregnancy, since midway through pregnancy she has been secreting colostrum, a thin, watery, prelactation secretion. On the third day postpartum, her breasts become full and feel tense or tender as milk forms within breast ducts and replaces colostrum. NOT 2 There is no need to recommend formula feeding to the mother. 3 Mastitis is inflammation of the lactiferous (milk-producing) glands of the breast; there is no indication that the client has this condition. 4 Lactational amenorrhea is the absence of menstrual flow that occurs in many women during the lactation period.

A nurse is assessing a postpartum client. Which measure is appropriate? 1 Place the client in a supine position with her arms overhead for the examination of her breasts and fundus. 2 Instruct the client to empty her bladder before the examination. 3 Wear sterile gloves when assessing the pad and perineum. 4 Perform the examination as quickly as possible.

2 An empty bladder facilitates examination of the fundus. NOT 1 The client should be supine with arms at her sides and her knees bent. The arms-overhead position is unnecessary. 3 Clean gloves should be used when assessing the perineum; sterile gloves are not necessary. 4 The postpartum examination should not be done quickly. The nurse can take this time to teach the client about the changes in her body after birth.

A 26-year-old new mother says to her nurse, "I am so disappointed. I gained 25 pounds with my baby. Just what the doctor said I should gain. But after I had my baby I only lost 12 pounds." What is the best response by the nurse? 1 "I see that you are bottle-feeding your baby. You would lose your weight faster if you were breastfeeding." 2 "It is normal to lose between 12 and 14 pounds after the baby delivers. You should be back to your pre-pregnancy weight by the time your baby is about 6 months old." 3 "I know you are anxious to lose all your 'baby fat.' Get yourself on a good diet and you will be down to your original weight in no time." 4 "Remember, it took 9 months for you to gain all this weight. It won't disappear in just a couple of days."

2 Immediately after delivery approximately 12 to 14 pounds are lost with expulsion of the fetus, placenta, and amniotic fluid.

The postpartum client and her husband are excited about their new baby. However, they are also concerned about getting pregnant again too soon and ask about using birth control. Which instruction should the nurse include in their discharge education to address this issue? 1 "You may have intercourse until next month with no fear of pregnancy." 2 "Ovulation may return as soon as 3 weeks after birth." 3 "You will not ovulate until your menstrual cycle returns." 4 "Ovulation does not return for 6 months after birth."

2 Ovulation may start at soon as 3 weeks after birth. The client needs to be aware and use a form of birth control. NOT 1 She needs to be cleared by her health care provider prior to intercourse if she has a vaginal birth, but in the event that she has intercourse, needs to be prepared for the possibility of pregnancy. 3 Ovulation can occur without the return of the menstrual cycle 4 Ovulation does return sooner than 6 months after birth.

The primigravida client is surprised by the continued uterine contractions while holding her newborn. Which explanation by the nurse explains the primary reason the contractions occur? 1 Returns the uterus to normal size 2 Seals off the blood vessels at the site of the placenta 3 Stops the flow of blood 4 Closes the cervix

2 The contractions of the uterus help to constrict the vessels where the placenta was located. NOT 3 This does decrease the flow of blood but is secondary in occurrence to the constriction of the blood vessels. 1 Uterine contraction also leads to uterine involution, which normally occurs at a predictable rate. 4 Uterine involution assists in closing the cervix. Again, the other options are secondary to the constriction of blood vessels at the placental site.

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which finding? 1 nonpalpable fundus 2 moderate lochia serosa 3 bruising on arms and legs 4 fever

2 The lochia fails to change colors from red to serosa to alba within a few weeks. Subinvolution is usually identified at the woman's postpartum examination 4 to 6 weeks after birth. The clinical picture includes a postpartum fundal height that is higher than expected, with a boggy uterus (uterus is more flaccid/soft/loose than would be expected) NOT 1 Normally, at 4 to 6 weeks, lochia alba or no lochia would be present and the fundus would not be palpable. Thus evidence of lochia serosa suggests subinvolution. 3 Bruising would suggest a coagulopathy (condition in which the blood's ability to clot is impaired) 4 Fever would suggest an infection.

During the assessment, the nurse observes a separation of the rectus muscle that is more than two fingerbreadths wide. Which instruction should the nurse offer the client? 1 Perform regular exercises. 2 Avoid lifting heavy objects. 3 Sleep on a firm mattress. 4 Avoid sleeping on back.

2 The nurse should teach the client to not lift heavy objects because it could put stress on the abdominal muscles. NOT 1 The client should not be advised to perform regular exercises until the muscles are firmer. 3.4. Sleeping on a firm mattress or avoiding sleep on the back does not help the abdominal muscles in any way.

A client who gave birth to a baby 36 hours ago informs the nurse that she has been passing unusually large volumes of urine very often. How should the nurse explain this to the client? 1 "Bruising and swelling of the perineum often causes excessive urination." 2 "Larger than normal amounts of urine frequently occur due to swelling of tissues surrounding the urinary meatus." 3 "Your body usually retains extra fluids during pregnancy, so this is one way it rids itself of the excess fluid." 4 "Anesthesia causes decreased bladder tone, which causes you to urinate more frequently."

3 Postpartum diuresis is due to the buildup and retention of extra fluids during pregnancy. NOT 1.2.4. Bruising and swelling of the perineum, swelling of tissues surrounding the urinary meatus, and decreased bladder tone due to anesthesia cause urinary retention.

A multigravida client is still focusing on her difficult labor and discusses it with the nurse at each opportunity, several hours after the birth. Which action should the nurse prioritize after noting the client's partner is spending more time with the infant than the client? 1 Redirect her attention to the baby by reminding her of the details of newborn care. 2 Ask her to describe how she plans to integrate the newcomer into her existing family, including any actions she has taken to prepare the siblings. 3 Encourage her to discuss her experience of the birth and answer any questions or concerns she may have. 4 Point out positive features of her baby, and encourage her to hold and cuddle the baby.

3 The client needs to explore her birth experience and clarify her questions. The nurse should allow her to ask questions, be supportive, and encourage her to express her feelings. NOT 1.2.4. Redirecting her attention to the baby, asking her to describe how she plans to integrate the new baby into the family, or pointing out positive features of the new baby do not meet the needs of the client at this time.

A nurse is assessing a postpartum woman's adjustment to her maternal role. Which event would the nurse expect to occur first? 1 reestablishing relationships with others 2 demonstrating increasing confidence in care of the newborn 3 assuming a passive role in meeting her own needs 4 becoming preoccupied with the present

3 The first task of adjusting to the maternal role is the taking-in phase in which the mother demonstrates dependent behaviors and assumes a passive role in meeting own basic needs. In this phase, the mother often processes the birth experience by talking it through with one or more people. NOT 4 During the taking-hold phase, the mother becomes preoccupied with the present. 1.2. During the letting-go phase, the mother reestablishes relationships with others and demonstrates increased responsibility and confidence in caring for the newborn.

The nurse is conducting a postpartum examination on a client who reports pain and is unable to sit comfortably. The perineal exam reveals an episiotomy without signs of a hematoma. Which action should the nurse prioritize? 1 Notify a health care provider. 2 Apply a warm washcloth. 3 Place an ice pack. 4 Put on a witch hazel pad.

3 The labia and perineum may be bruised and edematous after birth; the use of ice would assist in decreasing the pain and swelling. NOT 2 Applying a warm washcloth would bring more blood as well as fluid to the sore area, thereby increasing the edema and the soreness. 4 Applying a witch hazel pad needs the order of the health care provider. 1 Notifying a HCP is not necessary at this time as this is considered a normal finding.

Which nursing intervention is appropriate for prevention of a urinary tract infection (UTI) in the postpartum woman? 1 increasing oral fluid intake 2 increasing intravenous fluids 3 screening for bacteriuria in the urine 4 encouraging the woman to empty her bladder completely every 2 to 4 hours

4 The nurse should advise the woman to urinate every 2 to 4 hours while awake to prevent overdistention and trauma to the bladder. NOT 1.2. Maintaining a good fluid intake is also important, but it is not necessary to increase fluids if the woman is consuming enough. 3 Screening for bacteria in the urine would require a primary care provider's order and is not necessary as a prevention measure.

What temperature reading is concerning?

A temperature above 100.4º F (38º C) at any time or an abnormal temperature after the first 24 hours may indicate infection and must be reported. Typically, the new mother's temperature during the first 24 hours postpartum is within the normal range. Some women experience a slight fever, up to 100.4º F (38º C), during the first 24 hours.