Postpartum Care
What are signs of a distended bladder
Location of fundus is above baseline level Common sign is pushes uterus up and to the right Voiding less than 150 mL
What are you assessing for with an episiotomy/perineum/or incision
R= redness E= edema E= ecchymosis D= discharge, drainage A= approximation
What happens to the GI system postpartum
Relief of pressure on organs Decreased bowel tone for several days Decreased peristalsis Constipation Hunger and thirst due to NPO prior to delivery
When assessing traction what are you looking for
What is causing the uterine inversion
What is lochia alba
Whitish yellow Last 10-20 days For about another 1-2 weeks whitish turbid fluid drains from the vagina which consists of decidual cells, mucus and WBC
How many days will it be , before you no longer can feel the uterus
14 days
When will engorgement typically subside
2-3 days
How often should a postpartum pt void
2-4 hours
If you are bottlefeeding a baby how often do you feed the baby
3-4 hours
What is the normal WBC count after birth
30,000 after delivery up to 4 days postpartum
A patients temperature after birth should not exceed what
38.0 Celsius first 24 hours
How much blood loss would you expect with a cesarean birth
>1000 mL
how much blood loss would you expect with a vaginal birth
>500 mL
A client who's beasts are engorged asks the nurse why this occurs what is the nurses best explanation for the physiologic cause of engorgement? A an increase in blood an lymph supply to the breasts B an incarnate in estrogen and progesterone levels C colostrum production increases dramatically D fluid retention in the breasts due to the intravenous fluids given during labor
A
A postpartum woman is experiencing subinvolution. When reviewing the clients history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply A uterine infection B prolonged labor C hydramnios D breastfeeding E early ambulation F empty bladder
A B C
When assessing the episiotomy sites f a postpartum client that delivered 3 hours ago, the nurse would document which findings as expected? Select all that apply A edema B redness C slight bruising D discharge E bleeding
A B C
A client who gave birth 18 hours ago is experience a change in lochia flow from scant to moderate. Prioritized the actions the nurse would take to assess the client's fundus. All options must be used A assist the client to empty her bladder in the bathroom B palpate the fundus C massage the fundus if body D increase IV oxytocin or Brest feed the newborn E assess blood pressure F notify the primary care provider
A B C D E F
Which interventions would the nurse take to reduce the incidence of infection in a postpartum woman? Select all that apply A tech proper positioning of the infant for breast feeding (latching) B recommend that the mother change her peripad every 12 hours C encourage intake of fluids following delivery and after discharge D wash her hands before and after caring for the client E have the mother maintain a low activity level to allow the perineum to heal
A C D
The nurse finds this clients uterus to be body up 2 fingers breaths above the umbilicus, and to the right. A large amount of bright red vaginally bleeding and clots are noted on the choux below the client. In what order would the nurse implement the following interventions A remove the infant front the mothers arms B call for assistance, including the provider and delegate tasks appropriately C perform continous fundal massage D administer oxygen at 10 L /min via face mask E place a Foley catheter to empty the bladder
A C D B E
During the early postpartum period, a new mother is displaying dependent behaviors. What behaviors would the nurse recognize as normal for this period? Select all that apply A needing assistance with changing her peripad B desiring toy hold her infant C telling the nurse about her deliver experience D asking the nurse to take the newborn away so she can rest E changing her newborn's diaper with guidance from the nurse
A C D E
A primigravid client has just completed a difficult, forceps-assisted birth of a 9lb neonate. Her labor was unusually long and required oxytocin (pitocin) augmentation. The nurse who's caring for her should stay alert for: A uterine inversion B uterine stony C uterine involuted D uterine discomfort
B
After childbirth how must will the fundus descend dailty
About 1 cm per day
How long will pt hav renal glycosuria
About 1 week postpartum
How often should a baby breastfeed for
About 30 mins 10-15 mins per side
As the nurse what would you promote to the patient for musculoskelal concerns
Activity Rest Exercise Keel exercises Nutritional education
What can cause postpartum diuresis
Large amounts of intravenous fluids given during labor Decreasing antidiuretic effect of oxytocin as its level declines Buildup and retention of extra fluids during pregnancy Decreasing production of aldosterone
Is this taking in, taking hold, letting go The client gives up the fantasized image of her child and accepts the real one
Letting go
What is baby blues
It is normal Mild depressive stymptoms (anxiety, irritability, mood swings, tearfulness, difficulty sleeping
What is the lochia
It is vaginal discharge after giving birth, containing blood ,mucus, and uterine tissue, lasting 4-6 weeks
What are the 4 stages of role attainment
Anticipatory Formal Informal Personal
A nurse finds there 8 hr postpartum (vaginal) client in bed, pale, shaking, and c/o palpitations. She is experienced a 48 hr induction of labor with oxytocin and delivered a macroscopic newborn. The client currently has a hemlock in place. She has a history of 2 previous term vaginal deliveries, and chronic hypertension. The client is holding the infant. What would the nurses priority assessment be A blood pressure B Fundal tone and position C check the history of bleeding D check hematocrit and hemoglobin
B
A nurse has been assigned to the care of a client who has just given birth. How frequently should the nurse perform the assessments during the first hour after birth A q 30 mins B q 15 mins C after 60 mins D after 45 mins
B
A nurse is caring for a client administered general anesthesia for an emergency cesarean birth. The nurse notes the client's uterus is relaxed upon massage. What would the nurse do next? A continue to monitor the client B continue to massage the client's fundus C administered oxygen to the client D assess the client's vaginal bleeding
B
A nurse assessing a woman during the fist 24 hours after birth. Which assessment finding would the nurse determines as acceptable during this time? Select all that apply A inverted nipples following breastfeeding B fundus one fingerbreadth below the umblicus C hypotonic bowel sounds D urination of 100 mL every 4 hours E moderate saturation of peripad every 3 hours
B C E
While assessing a postpartum client who gave birth about 12 hours ago, the nurse evaluates the client's bladder and voiding. The nurse determines that the client may be experiencing bladder distention based on which finding? Select all that apply A moderate lochia rebrand B rounded mass over symphysis pubis C dullness on percussion over symphysis pubis D fundus boggy to the right of the umbilicus E elevated oral temperature
B C D
What does BUBBLE HE stand for
B-Breast U-Uterus, B-Bowel, B-Bladder, L-Lochia, E-Episiotomy, H-Homan's Sign & hemorrhoids, E-Education
What type of cardiovascular changes happen in postpartum care
Blood volume increased and cardiac output decreases Hematocrit level Pulse rate and blood pressure decreases (40-80 pulse) (not a lot of changes in BP) Coagulation factor (hypercoagulation 2-3 weeks) Red blood cell production (decrease)
What are some subjective assessments for the breasts
Breast of bottle feeding Any problems Wearing a bra Do you feel the milk coming in Sore nipples
Fort eh woman who is not breast feeding her new born, which measure would be most appropriate to relieve engorgement A warm showers B nipple stimulation C ice to the breasts D manually expressing milk
C
The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected A cream colored lochia with clots; uterus above the umbilicus B bright red lochia with clots; uterus 2 fingers breadths below the umbilicus C light pink or brown lochia; uterus 4-5 finger breadths below the umbilicus D yellow, mucous you lochia; uterus at the level of the umbilicus
C
What changes occur postpartum in the musculoskeletal system
Joints stabilize 6-8 weeks after Fatigue and active intolerance for weeks after birth Muscle tone is diminished (diastatis recti abdoinis)
What is the latch score
L = latch A= audible swallowing T = type of nipple C = comfort breast nipple H = Hold (positioning)
After birth what steps in safety must you provide for ambulation
Check BP first Elevate HOB before ambulating Help ambulate and stand with her Frequently as how she is feeling
What are some interventions to protect the nipple skin integrity
Check the LATCH Position baby with head and back lineament close to mom's body Break the suction of infant's mouth before attempting to remove the baby from breast Rotate positions in the beginning
What is involved in bonding
Close emotional attraction to a newborn by the parents that develops the first 30 to 60 mins after birth Indirection from parent to infant
When assessing thrombin for hemorrhage what are you looking for
Coagulopathy (pre existing or acquired)
What are the 3 process with the involution of the uterus
Contraction fo the muscle fibers Catabolic processes Regeneration of uterine epithelium
A client who has just given birth to a baby girl demonstrate behavior not indicative of bonding when she performs which actions A holds and smiles at the infant B kisses the infant on her cheek C strokes the infants head D talks to company and ignores the baby lying next to her
D
A postpartum nurse has been assigned 4 clients which client would the nurse anticipate having the worst complaints of after pains A G2P2 who is bottle feeding her infant B G1 P1 breastfeeding client C G4P3 who is bottle feeding her infant D G4P4 who is pumping q 2 hours for her infant in the nicu
D
Methergine has been ordered for a postpartum woman because of excessive bleeding. The nurse should question this order if which of the following is present A mild abdominal cramping B tender inflamed breasts C pulse rate of 68 beats/ min D blood pressure of 158/96 mm Hg
D
Homan's sign is looking for what
DVT
Lochia rubra is described as
Dark red Lasts 3-4 days Occurring a few days after delivery
What is involved with attachment postpartum
Development of a strong affection between an infant and a significant other
What are some objective assessements for the breasts
Ducts filling Engorgement Blocked ducts Mastitis Breasts firm, tender, or shines Nipple assessment (everted, inverted, flat)
What should you teach a pt to prevent or treat stress incontinence
Educate on level exercises Pelvic PT ( work on muscle tone)
Breast falls under the what
Endocrine system
What changes in the endocrine system postpartum
Estrogen and progesterone drop w/placental delivery Prolactin levels decline within 2 weeks if not breast feeding
When breastfeeding a baby how often do should you breastfeed the baby
Every 2-3 hours
In breastfeeding women engorgement is relieved by:
Frequent emptying Warm showers Warm compresses before feeding Cold compresses between feedings
What nursing management will be done with hemorrhage
Fundal massage; pad count (firmly rubbing) Administration of uterotonic Fluid administration Monitoring for signs and symptoms of shock Emergency measures of DIC occurs
What are complications of subinvolution
Hemorrhage Pelvic peritonitis Salpingitis Abscess foramtion
What type of diet should a patient follow after delivery
High protein High calcium High fiber High iron Maintain pregnancy diet
Assessing the lochia you would ask what
How often are you changing your peripad Any clots Look for amount, color, odor Pad count Quantified blood loss x 12 hrs
What are some comfort measures for non breastfeeding mothers
Ice packs Cabbage leaf compress Analgesics
What is subinvolution
Incomplete involution of the uterus after birth
What is a uterotonic agent
Increase the tone of the uterus Methergine (works fast) not a lot of side effects but can cause hypertension Hemabate, has a lot of GI effects, explosive diarrhea
Glomerular filtration rate and renal flow do what after postpartum
Increases
A patient that is postpartum will have strict what when it pertains to the bladder
Input and output
What are you assessing with mother's emotional status postpartum
Interactions with family Energy levels Eye contact with infant Sleep /rest patterns Mood Postpartum blues/ depression
What are some causes of postpartum hemorrhage
MOST COMMON UTERINE ATONY Lacerations of the genial tract Episiotomy Remained placental fragments Uterine inversion Coagulation disorder
Involution can be evaluated by
Measuring the descent of the fundus
What will continue milk production
Newborn sucking stimulates production of both oxytocin and prolactin Continued emptying of the breasts
What nursing care and education would you give to a breastfeeding women
Nipple care ( delatching, milk on nipple prevents breakdown) Positioning Nutrition and fluids Effective breast feeding pattern
After 14 days the fundus will
No longer be palpable
What happens to the pituitary hormones and ovarian function postpartum
Nonlactating women return to menstruation 7-9 weeks after birth Lactating women: return dependent on breast feeding frequency and duration Ovulation may occur w/o menses
What does "Let Down" mean
Oxytocin allows milk to be ejected from alveoli to nipple Foremilk vs hindmilk
What will you do to assess the uterus after birth
Palpate the fundus Note the location and consistency Educate the involution process
What are some nurising management for episiotomy or laceration care
Peri wash after every voiding or by Tucks or witch hazel pads Ice packs in the first 12-24 hours followed by heat Sits baths Tighten cultural muscles with position changes
What is lochia serosa
Pinkish brown Lasts 4-10 days Contains less RBC and has more WBC , wound discharge from the placental and other sites
Postpartum hemorrhage is a:
Potential life threatening complication of both vaginal and cesarean births
What is engorgement
Process of swelling of the breast tissue due to an increase in blood and lymph It is a precursor to lactation
When assessing tissue for hemorrhage what are you looking for
Retained placenta and clots
What are the causes of subinvolution
Retained placental fragments, distended bladder, uterine myoma, infection
What is colostrum
Secreted by the breasts front eh 3rd trimester to the 3rd day postpartum Thin, yellowish fluid, rich in antibodies (IgA)
What is diastatis recti abdominis
Separation of abdominal muscles
What is a boggy uterus
Soft uterus with out tone
What is postpartum depression (PPD)
Symptoms are more intense and last longer than blues, develop day 14 pp and or put o a year pp
When does baby blues first appear
Symptoms usually begin 2-4 days and resolve by day 8-10
Is this taking in , taking hold, letting go The client holds her new child and breastfeeds without prompting
Taking hold
Is this taking in, taking hold, letting go The client expresses a strong interest in taking care of her child
Taking hold
Is this taking in , taking hold, letting go The client relies on the nurse for health maintenance cues
Taking in
Is this taking in, taking hold, letting go The client rests to regain physical strength and calm her swirling thoughts
Taking in
What happens typically 3 to 5 days after child birth to the breasts
The tissue becomes larger, firmer, and more tender just before mild arrives
What does involution mean
The uterus is returning to normal after birth
In non breast feeding women engorgement is relieved by:
Tight or supportive bra Ice Avoidance of breast stimulation
What are the 5 t's
Tone Tissue Trauma Thrombin Tractions
What happens to the urinary system postpartum
Urinary retention Voiding sensations Perineal lacerations Generalized swelling and bruising of the perineum Hematoma Decreased bladder tone
When looking at tone what are you asssessing
Uterine Antony, distended bladder
What is involved in the involution processQ
Uterine size and progressive changes Treatment for body uterus
When assessing for hemorrhage you are looking for what types of trauma
Vaginal Cervical Uterine injury
Education for non breastfeeding mothers would include
Wear a well fitting supportive bra 24 hrs / day Don't remove breast Vick Avoid nipple stimulation Avoid warm water
What medication is used to help treat PPD
Zulresso (brexanolone) injection Don't need to know this for test maybe NCLEX-RN