Module 1 Lesson 6: Maternity Client Postpartum Care
A nurse taking the vital signs of a client who delivered a healthy newborn infant 4 hours ago notes that the client's oral temperature is 101.2° F (38.4°C). Which action would be appropriate? A. Documenting the findings B. Notifying the health care provider C. Retaking the temperature rectally D. Telling the client that the temperature at this level is expected at this time
B. Notifying the health care provider
By which day after delivery can the fundus no longer be palpated?
Between the 10th and 14th day
How many extra calories should a breastfeeding mother consume?
200 to 500 calories plus increased fluids and continuation of prenatal vitamins and minerals may be recommended
When does menstrual flow resume in breastfeeding mothers?
3 to 4 months
When does engorgement occur?
48 to 72 hours
When does menstrual flow resume in non-breastfeeding mothers?
8 weeks
A nurse monitoring lochial flow in a woman who delivered 2 hours earlier notes that the client's perineal pad shows drainage measuring less than 1 inch in a 1-hour period. How should the nurse report the lochial flow? A. Scant B. Light C. Heavy D. Excessive
A. Scant
How much does the fundus descend each day?
About 1 cm
Interventions for episiotomy
Administer perineal care after each voiding Encourage use of analgesic spray Administer analgesics as prescribed
Interventions for perineal discomfort
Apply ice packs during 24 hours after delivery After first 24 hours, apply warmth through use of sitz baths
What could a drop in BP indicate?
Hypovolemia or bleeding
What is the best way to relieve engorgement?
Breastfeeding
What color should the lochia be days 4 to 10 after delivery?
Brownish-pink (serosa)
A nurse provides instructions to a breastfeeding mother about measures that will provide relief from breast engorgement. Which statement by the mother indicates an understanding of the instructions? A. "I should switch to formula to feed my baby for 1 week." B. "I need to stop breastfeeding until the engorgement resolves." C. "I should apply warm packs to my breasts before each feeding." D. "I need to apply ice packs to my breasts 20 minutes before a feeding."
C. "I should apply warm packs to my breasts before each feeding."
What does involution refer to?
Describes the changes in the uterus as it returns to its nonpregnant size and condition (breastfeeding can cause more rapid involution)
T/F? An increased temperature of 100.4 after delivery is considered abnormal and should be reported immediately to the HCP?
False. Temperatures may be elevated up to 100.4 during 24 hours after delivery related to dehydration. Temperatures over 100.4 should e reported to HCP, as it can indicate infection.
T/F? Breastfeeding can be considered a form of birth control.
False. Women may ovulate without menstruating, so breastfeeding should not be considered a form of birth control.
What does a tender fundus indicate?
Infection
Where can the uterus be palpated immediately after delivery?
Midway between the symphysis pubis and the umbilicus It then rises to just above the umbilicus and then sinks to the level of the umbilicus and remains there for about 24 hors
What does an increase in respirations indicate?
Pulmonary embolism, uterine atony, or bleeding
When does the postpartum period start and usually end?
Starts immediately after delivery Ends by week 6 after delivery
T/F? A pulse rate greater than 100 could indicate blood loss or infection.
True. Bradycardia is common during the first week after delivery
What does a flaccid fundus indicate?
Uterine atony--massage fundus until firm
Interventions for postpartum blues
Verbalization of concerns and fears should be encouraged
Interventions for breast discomfort from engorgement
Wear supportive bra at all times, even while sleeping Use ice packs if client is not breastfeeding Use of warm soaks before feeding for the breastfeeding mother Analgesics as prescribed
What color should the lochia be 10 to 14 days after delivery?
White (alba)
What color should the lochia be from delivery day until day 3 after delivery?
bright red (rubra)
A woman who has just delivered a baby asks the nurse when she may resume sexual intercourse. Which response should the nurse give to the client? A. Intercourse may be resumed at any time after delivery. B. Intercourse may not be resumed until menstruation returns. C. Intercourse may not be resumed until after the 6-week checkup with the obstetrician. D. Intercourse may be resumed 2 to 4 weeks after delivery, once bleeding has stopped and the episiotomy has healed.
D. Intercourse may be resumed 2 to 4 weeks after delivery, once bleeding has stopped and the episiotomy has healed.
Postpartum Client Teaching
Demonstrate newborn-care skills as necessary. Provide the opportunity for the mother to bathe the newborn. Instruct mother in feeding technique. Instruct the mother to avoid heavy lifting for at least 3 weeks. Instruct the mother to plan at least one rest period per day. Instruct the mother in postpartum exercises. Instruct the mother that contraception should begin after delivery or with the initiation of sexual intercourse. (Intercourse should be postponed at least until lochia ceases and the episiotomy has healed.) Instruct the mother to report any chills, fever, increased lochia, or feelings of depression to the health care provider immediately. Instruct the mother in the importance of follow-up.
Postpartum Nursing Interventions
Monitor vital signs. Assess height, consistency, and location of fundus. Monitor color, amount, and odor of lochia. Assess breasts for engorgement. Monitor perineum for swelling or discoloration. Monitor episiotomy site for healing. Assess incisions or dressings of client who has given birth by cesarean. Monitor bowel status. Monitor intake and output. Encourage frequent voiding. Encourage ambulation. Administer Rho(D) immune globulin (RhoGAM) as prescribed within 72 hours of delivery to the Rh factor-negative client who has given birth to an Rh-positive newborn. Assess mother's bonding with the newborn. Assess emotional status of the new mother
