Postpartum

What is subinvolution?

A uterus that doesn't return to normal

The nurse, while shopping in a local department store, hears a multiparous woman say loudly, "I think the baby is coming." After asking someone to call 911, the nurse assists the client to give birth to a term neonate. While waiting for the ambulance, the nurse suggests that the mother initiate breastfeeding, primarily for what reason?

After an emergency birth, the nurse suggests that the mother begin breastfeeding to contract the uterus.

What causes DVT in postpartum moms?

Cause: venous stasis (bed rest) & hypercoagulation state (mom's more likely to clot after birth)

What discharge teaching should a nurse recommend to a mom after a cesarean birth to prevent infection because she cannot get up and walk around right away?

Cough & deep breath

What should you NEVER do if you suspect a patient has a DVT and why?

DO NOT MASSAGE THE LEG because this could cause a pulmonary embolism (clot traveling to the lungs)

The nurse has provided health teaching about physiologic changes that can be expected during the postpartum period to a postpartum client who is bottle-feeding her neonate. Which client statement indicates that this teaching has been effective? "I will have heart palpitations for several weeks." "My menstrual flow will resume in 6 to 10 weeks." "I will have reddish lochia for 6 weeks." "My varicose veins will disappear completely after childbirth."

For clients who are bottle-feeding, menstrual flow usually returns in 6 to 10 weeks.

How does kangaroo care improve any baby's chance of success?

Helps temp regulation Better O2 levels Less crying/apnea Increases HR Better development

What is the most common cause of uterine atony?

High parity or over distention of the uterus because multiple kids/twins make the uterus tired like an old balloon

What is Thromboembolic Disease, or deep vein thrombosis?

Increased thrombosis (blood clots in blood vessels) in 1 in 2000 women

What is the proper way to assess the fundus?

One hand on the symphysis pubis and one at the umbilicus

A client gave birth vaginally 2 hours ago and has a third-degree laceration. There is ice in place on her perineum. However, her perineum is slightly edematous, and the client is reporting pain rated 6 on a scale of 1 to 10. Which nursing intervention would be the most appropriate at this time?

Pain medication is the first strategy to initiate at this pain level.

What does Thromboembolic Disease put a woman at increased risk for?

Postpartum hemorrhage

What causes subinvolution?

Retained placental fragments, or infection

What is a 1st Degree laceration?

Skin is torn

What is kangaroo care?

Skin to skin contact with mom Golden hour - get baby on mom within 1st hour of life

A nurse is caring for a 1-day postpartum client. The mother feels overwhelmed by the responsibilities of newborn care and is still fatigued from birth. The client is in which phase of the postpartum period?

The taking-in phase is normally the first postpartum phase. During this phase, the mother feels overwhelmed by the responsibilities of newborn care and is still fatigued from birth.

What are the S&S of DVT?

Unilateral (on just the effected side: • Pain/tenderness in legs • Homan's sign + • Warm/red leg • Swollen

What increases the risk of infection for a mom?

Wounds/surgery: Cesarean Section, Episiotomy/Lacerations, or Retained Placenta Long labor: Prolonged Rupture of Membranes & Labor Internal maternal & fetal monitoring Bladder: Bladder catheterization

What is a 2nd Degree laceration?

muscle is torn

While assessing the episiotomy site of a primiparous client on the first postpartum day, the nurse observes a fairly large hemorrhoid at the client's rectum. After instructing the client about measures to relieve hemorrhoid discomfort, how should the patient be taught to lay to reduce discomfort?

the client should lie in the Sims position as much as possible to aid venous return to the rectal area and to reduce discomfort

Following postpartum discharge teaching by the nurse, which statement by the client indicates an understanding of how to provide self-care?

• "I should contract my buttocks before sitting or rising."

A nurse is providing discharge teaching to a postpartum client. Which instruction is the priority to include in the teaching concerning vaginal bleeding?

• "If you have excessive vaginal bleeding, massage your fundus and call the physician."

At what point in the fourth stage of labor is the patient at the highest risk for hemorrhage?

• 1st hour of fourth stage

When does the period usually come back for someone who is bottle feeding?

• 6 weeks to 10 weeks (3 months)

How often should a mother breastfed?

• Every 2-3 hrs

What should you be concerned about if a patient has bad smelling lochia?

• Infection • Contact physical • Many need antibiotics

When caring for a post partum client, the student nurse correctly recalls which expected progression of lochia?

• Rubra, then serosa, then alba Explanation: As the uterus involutes and the placental attachment area heals, lochia changes from bright red (rubra), to pinkish (serosa), to clear white (alba).

What does involution mean?

• The reduction in size of the uterus from oxytocin (what causes after pains)

When can a pt resume intercourse?

• When lochia & episiotomy pain have stopped • This can be as early as 3 weeks

The nurse is caring for a client on her second postpartum day. The nurse should expect the client's lochia to be

• red and moderate. Explanation: During the first 3 days, the lochia will be red (lochia rubra) with moderate flow. Note, however, that the client shouldn't be soaking more than one pad every hour.

Which practice should a nurse recommend to a client who has had a cesarean birth?

As for any postoperative client this client needs to be taught coughing and deep-breathing exercises to keep the alveoli open and prevent infection.

What should you do first if you suspect hemorrhage?

FUNDAL MASSAGE Check if the fundus is deviated to the RIGHT. Have her pee if it is, then do a fundal massage.

A woman mentions she isn't worried about getting pregnant while breastfeeding. Why does she believe this?

Prolactin increases which suppresses ovulation

After the first breastfeeding, the client asks the nurse, "How often should I try to breastfeed?" What frequency should the nurse recommend?

Soon after giving birth, the client should breastfeed every 2 to 3 hours until her milk supply is established in about 48 hours.

A nurse observes several interactions between a client and her neonate son. Which behaviors by the mother would the nurse identify as evidence of mother-infant attachment? Select all that apply. • Cuddles her son close to her. • Talks and coos to her son. • Takes a nap when the neonate is sleeping. • Encourages the father to hold the neonate.

Talking to, cooing at, and cuddling with her son are positive signs that the client is adapting to her new role as a mother. Feeding a neonate is an important role of a new mother and facilitates attachment. Encouraging the father to hold the neonate will facilitate attachment between the neonate and his father.

A nurse is palpating the uterine fundus of a client who gave birth to a neonate 8 hours ago. Identify the area where the nurse should expect to feel the fundus.

The uterus would be palpable at the level of the umbilicus between 4 and 24 hours after birth. The fundus of the uterus should be palpated for position and firmness.

The nurse is caring for a primigravida who gave birth to a viable neonate 2 hours ago under epidural anesthesia. The new mother has a midline episiotomy. What amount of bleeding would warrant further assessment?

Two perineal pads soaked within 30 minutes may be indicative of early postpartum hemorrhage and warrants further investigation.

On the second postpartum day after a cesarean birth, the client reports having gas pains. What should the nurse should instruct the client to do?

• Ambulate more often.

What should your episiotomy assessment include & when will it heal?

• Episiotomy (cutting of little vag flap) • Edges should be approximated (together) • heal by 2-3weeks • Have mom use ice

How big is the uterus immediately after birth?

• The size of a grapefruit

Why is this the most dangerous time for hemorrhage?

• Thrombi (blood clot) hasn't formed over the blood vessels in the uterus yet

What is atony, and what should you do if Pt has it?

• Uterine atony = uterus isn't firm bc it's not contracting 1. Gently massage the fundus

What is a 4th Degree laceration?

Goes all the way through bun hole, super dangerous

What is a 3rd Degree laceration?

Goes all the way to the bun hole, maybe dangerous

What is the most common cause of postpartum hemorrhage?

Uterine atony Explanation: Uterine atony means that the uterus is not firm because it is not contracting.

What should you inform a woman about birthcontrol while breast feeding?

• Breastfeeding is NOT birthcontrol • Use alternative birthcontrol or abstenance until mense returns

How long does it take for the fundus to be at it's pre-pregnancy size?

• By 4 to 6 weeks it should be deep in the pelvis/back to original size

What are the two main goals for the uterus after birth?

• Clamp down/seal off placental site (bc bleeding happens at placental site until thrombi/clamped down) • Reduce size (involution)

While caring for a multiparous client 4 hours after vaginal birth of a term neonate, the nurse notes that the mother's temperature is 99.8°F (37.2°C), the pulse is 66 bpm, and the respirations are 18 breaths/min. Her fundus is firm, midline, and at the level of the umbilicus. What should the nurse do?

• Continue to monitor the client's vital signs.

A client is a gravida 1, para 0. During the first 24 hours after birth, she doesn't show consistent interest in her neonate. What should the nurse do next?

• Document these expected behaviors of the taking-in period.

A client who's breast-feeding has a temperature of 102° F (38.9° C) and complains that her breasts are engorged. Her breasts are swollen, hard, and red. Which action by the client requires intervention?

• Facing the shower head or Applying a breast binder to support the breasts

Why is pooping difficult & what is the usual treatment?

• GI moves slow, episiotomy, swelling, hemorrhoids • Stool softeners

During the fourth stage of labor, the client should be assessed carefully for

• uterine atony.

A multigravida 30-year-old woman has given cesarean birth to a healthy term neonate due to an abnormal fetal heart rate tracing. At 2 hours postpartum, the nurse assesses the client's urinary catheter and observes that the client's urine is slightly red-tinged. What should the nurse do next?

Slightly red-tinged urine may indicate that the bladder was accidentally cut during the cesarean birth. The nurse should notify the HCP as soon as possible about the urine color.

The nurse is caring for a client 24 hours postpartum from a normal, vaginal delivery. What assessment finding might the nurse identify indicating a DVT?

• Patient reports pain and warmth behild the knee

One day after a client gives birth, the nurse performs a postpartum assessment. Which finding indicates a need for further evaluation?

• The patietn reporting uterine tenderness

When should an Rh negative pregnant mom receive RhoGAM?

• w/i 72 hrs after delivery if baby is RH+ • Given IM (deltoid or gluteal) • Even if preg ends in miscarriage/ectopic/etc (mini dose for these)

When should an Rh negative NOT-pregnant mom the rubella vaccine?

She should receive it 4 weeks to 3 months before getting pregnant

What should you teach A woman who mentions she isn't worried about getting pregnant while breastfeeding.?

• Ovulation occurs before menses, so you can still become prego while breastfeeding

What should you expect if a patient's fundus is at the symphysis (the part right between vag&belly button) 6 weeks after delivery?

• This is subinvolution • Cause: infection or retained placental fragments

What form of feeding causes contractions? Why?

• Breastfeeding causes contractions bc oxytocin is released which makes involution faster

How are Rubin's three phases used to help new parents transition to parenthood?

• Comparing these phases to how the parents are feeling can show how well they're adapting/what they need • Can help parents and nurses understand how bonding occurs and if there truly is a problem

During the immediate postpartum period after giving birth to twins, the client experiences uterine atony. What should the nurse do first?

• Gently massage the fundus. Explanation: Uterine atony means that the uterus is not firm because it is not contracting. First, the nurse should gently massage the uterus in an effort to help contract the uterus and make it firm.

What are the 3 types? How long should each last.

• rubra, serosa, and alba 1. Rubra is red/first color lasting 3-4 days (C/S = less, longterm dime sized clots = hemorrhage risk) 2. Serosa is pink/lasts a 10-14 days 3. Alba is white/lasts 2-6 weeks after birth

In preparation for discharge, the nurse discusses sexual issues with a primiparous client who had a routine vaginal birth with a midline episiotomy. The client asks, "I've heard recommendations about when to resume intercourse have changed since my last baby. What are they saying now?" When should the nurse instruct the client that she can resume sexual intercourse?

• when lochia flow and episiotomy pain have stopped.

A primiparous client planning to breastfeed her term neonate born vaginally asks, "When will my 'real' milk come in?" The nurse explains to the client that after birth, breasts begin to produce milk within what time period?

• 2 to 4 days Explanation: If the client begins breastfeeding early and often after birth, the breasts begin to fill with milk within 48 to 96 hours, or 2 to 4 days. The breasts secrete colostrum for the first 24 to 48 hours, which is beneficial to the neonate because of the immunoglobulins contained in colostrum.

A client has just given birth to her first child, a healthy, full-term girl. The client is Rho(D)-negative and her neonate is Rh-positive. What intervention will be performed to reduce the risk of Rh incompatibility?

• Administration of Rho(D) immune globulin I.M. to the mother within 72 hours

Sealing the placenta causes the uterus to contract. What is this called?

• After-pains

What women should receive RhoD immune globulin (RhoGAM), and why?

• All RH neg moms • Provides passive antibodies, so that mom's immune system doesn't attack baby • will protect "future" pregnancies

A nurse coming onto the night shift assesses a client who gave birth vaginally that morning. The nurse finds that the client's vaginal bleeding has saturated two perineal pads within 30 minutes. What is the first action the nurse should take?

• Assess the fundus and massage it if it's boggy.

What is the most common cause of SUBINVOLUTION?

• Body tries to "wash out" Non-adherent retained placenta with lots of blood • NOT uterine atony (bc uterus IS clammed down/fundus IS firm)

What increases the instance of after-pain after the first 24-48 hours?

• Breastfeeding causes more oxytocin secretion/clamps uterus down harder

1. What occurs during the first phase: Dependent or taking-in phase of Rubin's phases?

• Family & nurses need to care for mom (and maybe dad) • Mom may not have consistent interest in the baby (expected behavior) • Mom should go through this phase in 1st day • NOT a good time for teaching (but do tell her about self care)

The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?

• G3, P3 client who is breastfeeding her infant Explanation: The major reasons for afterbirth pains are breastfeeding, high parity, overdistended uterus during pregnancy, and a uterus filled with blood clots.

A nurse is assessing the parent-neonate attachment of postpartum clients. Which finding most indicates a need for further evaluation?

• Limited parent-neonate contact immediately after birth, like not preforming kangaroo care

What should you do if a fundus feels boggy?

• Massage it to firm the fundus/seal the placenta site • How/why to provide support • to lower segment of uterus to prevent inversion • Nondom hand above symphysis • Dom hand at umbilicus

Which coombs test looks at circulating antibodies in mom's blood sample, & which looks at RBCs coated in antibodies in baby's blood sample?

• Maternal sample: Indirect coombs for rh immune goblin • Newborn sample: Direct coombs for rh immune goblin

What should you teach a patient about menstruation after birth?

• Ovulation comes before menstruation • Woman can get pregnant before return of menstruation • A lack of menstruation does not mean the woman cannot become pregnant

What nursing interventions need to be preformed for the urinary system?

• Palpate for distended bladder • Check fundul position (if it's on the right side = she need to pee) • Check lochia (see if she's bleeding too much) • Ice on vag • Tell mom to pee often

Where should your hands be placed when assessing a patient's fundus?

• Place the nondominant hand above the symphysis pubis and the dominant hand at the umbilicus.

When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse should include which information?

• Pregnancy should be avoided for 4 weeks after the immunization.

What would you do for a patient with hemorrhoids?

• Sitz bath, no showers • Topical anesthetics (tuck pads) • Avoid sitting/laying on back for too long

While assessing a primiparous client 8 hours after birth, the nurse inspects the episiotomy site, finding it edematous and slightly reddened. Which interpretation by the nurse is most appropriate?

• The client needs application of an ice pack.

A primigravid client gave birth vaginally 2 hours ago with no complications. As the nurse plans care for this postpartum client, which postpartum goal related to the mother and infant would have the highest priority?

• The client will demonstrate self-care and infant care by the end of the shift.

A multiparous client whose fundus is firm and midline at the umbilicus 8 hours after a vaginal birth tells the nurse that when she ambulated to the bathroom after sleeping for 4 hours, her dark red lochia seemed heavier. Which information would the nurse include when explaining to the client about the increased lochia on ambulation?

• The increased lochia occurs from lochia pooling in the vaginal vault.

During the postpartum period, a nurse should assess for signs of normal involution. Which statement would indicate that a client is progressing normally?

• The uterus is descending at the rate of one fingerbreadth per day. Explanation: During the normal involutional process, the uterus will descend approximately one fingerbreadth per day.

How is the amount of fetal blood in maternal system determined for RhoGAM administration?

• by either FETAL SCREEN or KLEIHAUER-BETKE (KB) test

A primiparous client who gave birth to a viable term neonate vaginally 48 hours ago has a midline episiotomy and repair of a third-degree laceration. When preparing the client for discharge, which assessment would be most important?

• constipation Explanation: The client with a third-degree laceration should be assessed for constipation because a third-degree laceration extends into a portion of the anal sphincter.

The nurse is assessing a client at her postpartum checkup 6 weeks after a vaginal birth. The mother is bottle-feeding her baby. Which client finding indicates a problem at this time?

• firm fundus at the symphysis Explanation: By 4 to 6 weeks postpartum, the fundus should be deep in the pelvis and the size of a nonpregnant uterus.

A primiparous client, 48 hours after a vaginal birth, is to be discharged with a prescription for vitamins with iron because she is anemic. To maximize absorption of the iron, the nurse instructs the client to take the medication with which liquid?

• orange juice Explanation: Iron is best absorbed in an acid environment or with vitamin C.

A multiparous client, 28 hours after cesarean birth, who is breastfeeding has severe cramps or afterpains. The nurse explains that these are caused by which factor?

• release of oxytocin during the breastfeeding session Explanation: Breastfeeding stimulates oxytocin secretion, which causes the uterine muscles to contract.

Twenty-four hours after giving birth to a term neonate, a primipara receives acetaminophen with codeine for perineal pain. One hour after administering the medication, which finding should alert the nurse to the development of side effects?

• respiratory depression, dizziness, light-headedness, hypotension, and fainting. constipation, nausea and vomiting, and urinary retention

Antenatal laboratory testing revealed a negative rubella antibody for a client admitted to the postpartum unit. Which action takes priority for this client during early puerperium?

• rubella counseling and immunization with live rubella virus vaccine Explanation: Because she is negative and NOT pregnant, she doesn't need RhoGAM, she needs the vaccine. If she was positive it would be different, and if she was pregnant and negative she would get RhoGAM.

During the immediate postpartum period, the nurse is caring for a primipara who gave birth to a postterm neonate after an oxytocin induction. When developing the client's plan of care, which fundal problem should the nurse expect to assess for frequently?

• uterine atony Explanation: Uterine atony is more common in clients who have received oxytocin during labor because the uterine muscle becomes fatigued