Interpartum/Postpartum Care
how long does it take for cervix to heal and close?
1 week, 3-4 months
light bleeding
10 cm, 4 inch
Vital signs are check how often in the first hour of post partum?
15min
Scant bleeding
2.5 cm < 1 inch
Hemoglobin and Hematocrit falls by 1 to 2 points due to how much fluid loss?
250ml
Vital signs are check how often in the second hour of post partum?
30 min
How much fluid does a woman lose during vaginal delivery?
300-500ml
How much fluid does a woman lose during cesarean delivery?
500 - 1000ml
How long does it take for cardiovascular system to return to normal after birth?
6-12 weeks
When does the menstrual cycle begin after pregnancy?
6-8 weeks if not nursing, ovulation 3 wks
moderate bleeding
< 15cm, 6 inch
postpartum blues
A down feeling caused by hormone changes some women experience within a few days after delivery to tw0 weeks
When does milk come in?
About 1 to 3 days after baby is born.
Couvelaire uterus
Associated with placental abruption; occurs when blood accumulates between the separated placenta and the uterine wall. The uterus appears purple or blue rather than its usual "bubblegum pink" color, and contractility is lost.
A client is resting comfortably 4 hours after delivering her first child. When measuring her heart rate, the nurse expects which normal finding?
Bradycardia
During labor, a client's cervix fails to dilate progressively, despite her uncomfortable uterine contractions. To augment labor, the physician orders oxytocin. When preparing the client for oxytocin administration, the nurse describes the contractions the client is likely to feel when she starts to receive the drug. Which description is accurate?
Contractions will be stronger and more uncomfortable and will peak more abruptly.
A client in the early stage of labor states that she has a thick, yellow discharge from both of her breasts. Which action by the nurse is most appropriate?
Informing the client that the discharge is colostrum, which is a normal finding
A nurse is caring for a client during the fourth stage of labor. Which intervention by the nurse can prevent uterine atony?
Massage the fundus.
engrossment
Paternal analogue of maternal emotional bonding; term used to describe fathers' fascination with their neonates, including their desire to touch, hold, caress, and talk to the newborn baby.
Lochia serosa
Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum, containd rbc, wbc, discharge from cervix
Episiotomy and Lacerations assessment
REEDA
Lochia rubra
Red, distinctly blood-tinged vaginal flow that follows birth and lasts 3 to 4 days, made up of blood, fetal membranes, decidua, meconium
excessive bleeding
Saturated pad in 15 minutes
diastasis recti
Separation of the longitudinal muscles of the abdomen (rectus abdominis) during pregnancy.
Fundal massage
The application of external pressure to the uterus to stop postpartum bleeding
RhoGAM
Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type. if woman is Rh- negative and baby is Rh positive
Lochia alba
Whitish/yellowish discharge - lasts 10-28 days, may last 1- 2 weeks and remain normal. mainly consists of decidual cells, mucus, wbc, epithelial cells
attachment
an emotional tie with another person; shown in young children by their seeking closeness to the caregiver and showing distress on separation
What happens if there is too much sugar in the mom's blood?
big baby
What are the causes of uterine atony?
boggy uterus, fundus above umbilicus, lochia with clots
BUBBLE -EER
breast, uterus, bladder, bowels, lochia, episiotomy, perineum, extremities/homans sign, emotions/bonding, rhogam/rubella
A client in labor is receiving magnesium sulfate as an intravenous infusion. Which medication should the nurse ensure is at the bedside while the magnesium sulfate is being infused?
calcium gluconate
puerperal sepsis
childbirth fever
symptoms of postpartum depression
crying, loss of appetite, difficulty sleeping, anxiety
A postpartum client tells the nurse that she feels like crying for no apparent reason and is unable to sleep well. What should the nurse point out to the client that this may be related to?
decreased progesterone levels
What is late hemorrhage?
defined as occurring between 24 hours and 6 weeks after delivery
sometimes called nesting?
energy burst
Vital signs are check how often in the first 24 hours of post partum?
every 4 hours
Subinvolution
failure of uterus to return to non-pregnant state
What warrants an episiotomy?
fetal shoulder dystocia, assisted birth, occiput (sunny side up)
Taking hold phase
focuses on maternal role and care of the newborn; eager to learn; may develop blues
How is the uterus displaced that can lead to postpartum hemorrhage?
full bladder
What can lead to postpartum hemorrhage?
full bladder
The nurse is assessing the fundus of a client on postpartum day 1. What should the nurse expect when palpating the fundus?
fundus one fingerbreadth below umbilicus and firm
A nurse is observing the interaction between a new father and his newborn. The nurse determines that engrossment has yet to occur based on which behavior?
identifies imperfections in the newborn's appearance
uterine atony
inability of the uterus to contract effectively
What should lochia never contain?
large clots
pelvimetry
measurement of the dimensions of the maternal pelvis
What should lochia smell like?
normal menstrual flow
How does hematomas cause postpartum hemorrhage?
pain in vulva, pressure complaints, unusual amount lochia
dyspareunia
painful intercourse (coitus)
What is known as the fourth trimester?
puerperium
REEDA
redness, edema, ecchymosis, discharge, approximation
Nulliparous cervical os
round
heavy bleeding
saturated pad in 1 hour
A nurse is caring for a client on her third postpartum day. The nurse identifies a foul-smelling lochia suggesting endometritis. The nurse would also expect to assess an elevation in which of the following?
temperature
uterine involution
the process of the uterus returning to normal size
puerperium
the time from the delivery of the placenta through approximately the first 6 weeks after the delivery
Colostrum
thin, milky fluid secreted by the breast during pregnancy and during the first days after birth before lactation begins
What is the most common cause of post-partum hemorrhage?
uterine atony
What is early hemorrage?
within 24 hours of postpartum
