OB Postpartum Care
Postpartum Blues
-First day or two heightened joy and well-being -"blue" period -50-90% of women experience -Crying easily and for no reason -Peak on 5th day, resolves by 10th day -then return to normal
Risk factors for PP hemorrhage
-High parity, hydramnios, macrosomic fetus, multifetal gestation -"Overstretched uterus" -Traumatic birth -Mag. Sulfate, rapid/prolonged labor -Use of oxytocin for induction/augmentation
Guideline for care of vagina/perineum area
-Peribottle - front to back, every void -Ice first 24 hours -Heat after first 24 hours until healed
Lochia rubra
-deep red to brown -last 3-4 days
Subinvolution
-failure of the uterus to return to pre-pregnant state -reasons (placental fragment, infection)
Lochia alba
-final stage -white to clear -last up to 6 weeks
Inversion of uterus: risk factors
-fundal implantation of placenta -manual extraction of placenta -short umbilical cord -uterine atony -leiomyomas -abnormally adherent placental tissue
Primary signs of inversion of uterus
-hemorrhage -shock -pain -absence of a palpable fundus abdominally
Involution
-return of uterus to non-pregnant state, immediately after placenta expulsion -Descends 1-2 cm (fingerbreadths) every 24 hours -6 wks returned to non-pregnant size (50-60 gm)
Lochia serosa
-second stage -pink to pale brown -last 3-10 days
Normal Blood Loss for PP patient
-vaginal=500cc -c-section birth=1000cc -hematocrit stays same
What is the leading cause of late PP hemorrhage?
placental fragments in uterus
What is the leading cause of early PP hemorrhage?
uterine atony
How long does an Episiotomy take to heal?
2-3 weeks
How long does it take the vagina to return to pre pregnancy size?
6-8 weeks
The nurse is providing instructions to a pregnant client with human immunodeficiency virus (HIV) infection regarding care to the newborn after delivery. The client asks the nurse about the feeding options that are available. Which response should the nurse make to the client? A. "You will need to bottle-feed your newborn." B. "You will need to feed your newborn by nasogastric tube feeding." C. "You will be able to breast-feed for 6 months and then will need to switch to bottle-feeding." D. "You will be able to breast-feed for 9 months and then will need to switch to bottle-feeding."
A. "You will need to bottle-feed your newborn."
The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss? A. A temperature of 100.4° F B. An increase in the pulse rate from 88 to 102 beats/minute C. A blood pressure change from 130/88 to 124/80 mm Hg D. An increase in the respiratory rate from 18 to 22 breaths/minute
B. An increase in the pulse rate from 88 to 102 beats/minute Rationale: During the fourth stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. An increasing pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. A slight increase in temperature is normal. The blood pressure decreases as the blood volume diminishes, but a decreased blood pressure would not be the earliest sign of hemorrhage. The respiratory rate is slightly increased from normal
A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? Select all that apply. A. Breast-feeding needs to be stopped for 3 months. B. Pregnancy needs to be avoided for 1 to 3 months. C. The vaccine is administered by the subcutaneous route. D. Exposure to immunosuppressed individuals needs to be avoided. E. A hypersensitivity reaction can occur if the client has an allergy to eggs. F. The area of the injection needs to be covered with a sterile gauze for 1 week.
B. Pregnancy needs to be avoided for 1 to 3 months. C. The vaccine is administered by the subcutaneous route. D. Exposure to immunosuppressed individuals needs to be avoided. E. A hypersensitivity reaction can occur if the client has an allergy to eggs.
After a precipitous delivery, the nurse notes that the new mother is passive and only touches her newborn infant briefly with her fingertips. What should the nurse do to help the woman process the delivery? A. Encourage the mother to breast-feed soon after birth. B. Support the mother in her reaction to the newborn infant. C. Tell the mother that it is important to hold the newborn infant. D. Document a complete account of the mother's reaction on the birth record.
B. Support the mother in her reaction to the newborn infant. Rationale: Precipitous labor is labor that lasts 3 hours or less. Women who have experienced precipitous labor often describe feelings of disbelief that their labor progressed so rapidly. To assist the client to process what has happened, the best option is to support the client in her reaction to the newborn infant. Options 1, 3, and 4 do not acknowledge the client's feelings
The nurse is assessing a client who is 6 hours postpartum after delivering a full-term healthy newborn. The client complains to the nurse of feelings of faintness and dizziness. Which nursing action would be most appropriate? A. Raise the head of the client's bed. B. Obtain hemoglobin and hematocrit levels. C. Instruct the client to request help when getting out of bed. D. Inform the nursery room nurse to avoid bringing the newborn to the client until the mother's symptoms have subsided.
C. Instruct the client to request help when getting out of bed. Rationale: Orthostatic hypotension may be evident during the first 8 hours after birth. Feelings of faintness or dizziness are signs that caution the nurse to focus interventions on the client's safety. The nurse should advise the client to get help the first few times she gets out of bed. Option 1 is not a helpful action in this situation and would not relieve the symptoms. Option 2 requires a health care provider's prescription. Option 4 is unnecessary.
The nurse is preparing to care for four assigned clients. Which client is at highest risk for hemorrhage? A. A primiparous client who delivered 4 hours ago B. A multiparous client who delivered 6 hours ago C. A primiparous client who delivered 6 hours ago and had epidural anesthesia D. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction
D. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction
The postpartum nurse is taking the vital signs of a client who delivered a healthy newborn 4 hours ago. The nurse notes that the client's temperature is 100.2° F. What is the priority nursing action? A. Document the findings. B. Retake the temperature in 15 minutes. C. Notify the health care provider (HCP). D. Increase hydration by encouraging oral fluids.
D. Increase hydration by encouraging oral fluids. Rationale: The client's temperature should be taken every 4 hours while she is awake. Temperatures up to 100.4° F (38° C) in the first 24 hours after birth often are related to the dehydrating effects of labor. The appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading. Although the nurse also would document the findings, the appropriate action would be to increase hydration. Taking the temperature in another 15 minutes is an unnecessary action. Contacting the HCP is not necessary.
The nurse is caring for four 1-day postpartum clients. Which client would require further nursing action? A. The client with mild afterpains B. The client with a pulse rate of 60 beats/minute C. The client with colostrum discharge from both breasts D. The client with lochia that is red and has a foul-smelling odor
D. The client with lochia that is red and has a foul-smelling odor Rationale: Lochia, the discharge present after birth, is red for the first 1 to 3 days and gradually decreases in amount. Normal lochia has a fleshy odor or an odor similar to menstrual flow. Foul-smelling or purulent lochia usually indicates infection, and these findings are not normal. The other options are normal findings for a 1-day postpartum client.
