Postpartum Study guide PDF

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OB Study Guide: Postpartum Unit Describe the stages and characteristics of lochia- (off of handouts) o Lochia- postbirth uterine discharge o Rubra- first 3-4 days, small-mod amount, mostly bloody and dark red with fleshy odor, (blood and decidual and trophoblastic debris) o Serosa- days 4-10, decreases to small amount, brownish/pink color (old blood, serum, leukocytes, and debris) o Alba- after day 10, white-pale yellow, mostly WBC’s (leukocytes, decidua, epithelial cells, mucus, serum, and bacteria *A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman? d. Lochia serosa *Post birth uterine/vaginal discharge, called lochia: d. Should smell like normal menstrual flow unless an infection is present. *Which maternal event is abnormal in the early postpartum period? d. Lochial color changes from rubra to alba  Identify risk factors for uterine atony o Big baby, multiple fetuses, polyhydramnios, multiple births, placenta is inside more than 30 mins, placenta fragments retained *. A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of postpartum hemorrhage in this woman is: c. Uterine atony. *. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: a. Uterine atony. . 

Discuss signs and symptoms of postpartum hemorrhage o Excessive blood loss Saturated pad in less than 15 min. o Check for pooling under their bottom o Increase HR o Increase Pulse o Increase respiration o Pale color skin o Loss of 500 mL or more vaginal o Loss of 1000 mL or more c-section *A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 mL. When assessing the woman’s vital signs, the nurse would be concerned to see: a. Temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50. 

*On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse’s first action is to: d. Massage the woman’s fundus. *Excessive blood loss after childbirth can have several causes; the most common is: c. Failure of the uterine muscle to contract firmly. *A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15minute assessment, she tells you that she “feels all wet underneath.” You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? b. Assess the fundus for firmness.

Describe the management of postpartum bleeding o Firmly massage fundus o Elimination of bladder o Continuous IV infusion of 10-14 units of oxytocin added to 1000 mL of LR or NS o Oxygen can be given by nonrebreather face mask o Insertion of indwelling urinary catheter o CBC, PLT, PT/aPTT, blood type & antibody screen, H&H *Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus? d. Assist the patient in emptying her bladder. *A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: b. Perform fundal massage *Medications used to manage postpartum hemorrhage (PPH) include (Select all that apply): a. Pitocin. d. Hemabate. b. Methergine.  Discuss signs and symptoms of wound infection o Fever o Pain o Erythema o Edema o Warmth o Tenderness o Seropurulent drainage & wound separation *One of the first symptoms of puerperal infection to assess for in the postpartum woman is: d. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth. *A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that: c. The organisms that cause mastitis are not passed to the milk.  Recognize signs of hypovolemic shock 

o (impending shock) pale to gray color, mucous membranes pale, increased resp, skin cool/clammy, dizzy/head spinning, seeing spots *What PPH conditions are considered medical emergencies that require immediate treatment? a. Inversion of the uterus and hypovolemic shock Describe medical management of hypovolemic shock o Massage uterus gently & expel clots to cause to contract o Add oxytocin agent to IV drip o Give oxygen by non rebreather facemask @ 10 L/min. o Tilt onto side or elevate right hip; elevate her legs to at least a 30 degree angle to promote venous return  Provide patient education regarding peri care o Give often, Q4h, after each bowel movement, warm water with peri bottle - squeezed front to back w/ water  Recognize lab values related serologic immunity to Rubella o Titer 1-8 or greater, MMR, *The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data? a. Rubella vaccine should be given.  Provide education to the postpartum mother regarding the Rubella and Varicella Vaccine o Education: can not have while pregnant due to them being live viruses o Rubella: can not become pregnant for at least a month after vaccine *As relates to rubella and Rh issues, nurses should be aware that: b. Women should be warned that the rubella vaccination is teratogenic, and that they must avoid pregnancy for 1 month after vaccination.  Discuss the “taking in”, “taking hold”, and “letting go” stages of maternal role attainment o Dependent behavior- (Taking in phase) first 24 hrs, mom is okay w/ others taking care of the baby, excited @ baby o Dependant- independent- (taking hold phase) 2nd or 3rd day, last @ least 10 days to several weeks, changing focus (she wants to do everything herself), best time to teach (pt discharge education) o Independent behavior- (letting go phase) focus is shifting back to the whole family *. Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically this expression refers to: d. Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood. *. During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby? a. Letting go 

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Identify signs and symptoms of perineal hematomas o Report of persistent perineal or rectal pain o Feeling of pressure in the vagina o However retroperitoneal hematoma can cause minimal pain & the initial symptoms can be signs of shock *. A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: b. Lacerations of the genital tract. 

Diusscs management of perineal hematomas o Careful attention to pain relief o Monitor amount of bleeding o Replacing fluids o Reviewing lab results (H&H) *. If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition? d. D&C 

Provide examples of the following maternal attachment behaviors: o 1. Reciprocity- a process of communication between a baby and a parent. The baby sends out signals about his or her needs, using facial and vocal expressions, and waits for a response. The parent reads and responds to the baby's signal's, which serves as a return signal for the baby to read. o 2. Synchrony- embedded within dynamic biological and neural functions that develop as experiences occur—constantly shaping and being shaped by behavioral synchrony. These biological processes provide an additional level of representation and understanding to interpersonal coordination. o 3. Biorhythmicity- Babies hear mom’s heartbeat. Don’t use placenta bears for preterm babies b/c they may forget to breathe d/t being relaxed. o 4. Entrainment- Babies respond by moving according to mom’s voice o Example of reciprocity and synchrony: sucking on hand/ mom knows to feed the baby. *After they are born, a crying infant may be soothed by being held in a position in which the newborn can hear the mother’s heartbeat. This phenomenon is known as: . d. Biorhythmicity. *The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to: a. The positive feedback an infant exhibits toward parents during the attachment process. *When the infant’s behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called: a. Mutuality.

*In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which one is a facilitating behavior? b. The parents hover around the infant, directing attention to and pointing at the infant. *. Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say: b. Infants can learn to distinguish their mother’s voice from others soon after birth. *Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is management of the environment. While providing routine mother-baby care, the nurse should ensure that: d. An environment that fosters as much privacy as possible should be created. 

Calculate fluid replacement needs of the patient in hypovolemic shock o The formula for that is 3mL of a crystalloid solution (Lactated Ringers) for every 1 mL of blood loss. For example, if a patient loses 1500ml of blood, he/she would receive 4500mL of IV fluids.  Describe the uterine involution process after delivery and through the postpartum period o Is the return of the uterus to a nonpregnant state following birth o Progresses rapidly o Fundus descends 1 to 2 cm every 24 hrs o 2 weeks after childbirth the uterus is no longer palpable o Returns to a nonpregnant state state by 6 weeks * With regard to the postpartum uterus, nurses should be aware that: b. After 2 weeks postpartum it should not be palpable abdominally. *A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman’s fundus? a. One centimeter above the umbilicus *Which finding 12 hours after birth requires further assessment? a. The fundus is palpable two fingerbreadths above the umbilicus. *. Which documentation on a woman’s chart on postpartum day 14 indicates a normal involution process? c. Fundus below the symphysis and not palpable  Discuss afterpains o Helps bring uterus back to previous state o Most likely to notice pains when breastfeeding *Which woman is most likely to experience strong afterpains? b. A woman who is a gravida 4, para 4-0-0-4 *With regard to afterbirth pains, nurses should be aware that these pains are: c. More noticeable in births in which the uterus was overdistended. *Which breastfeeding patient is most likely to have severe afterbirth pains and request a narcotic analgesic? a. Gravida 5, para 5

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Provide patient education regarding expected characteristics of the menstrual cycle after delivery *Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? b. “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.” *With regard to postpartum ovarian function, nurses should be aware that: d. The first menstrual flow after childbirth usually is heavier than normal.  Discuss strategies to promote mother-infant attachment  Early skin-to-skin contact immediately after birth & during the first hour  Rooming in  Touch, eye contact, voice & odor *In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with: d. The nurse. *The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? b. Seldom makes eye contact with her son *The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to: b. Show the mother how the infant initiates interaction and pays attention to her. *The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad’s chin. This woman’s statement reflects: c. Claiming. *New parents express concern that, because of the mother’s emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. The nurse’s response should convey to the parents that: a. Attachment, or bonding, is a process that occurs over time and does not require early contact. *. The nurse can help a father in his transition to parenthood by: a. Pointing out that the infant turned at the sound of his voice. *On observing a woman on her first postpartum day sitting in bed while her newborn lies awake in the bassinet, the nurse should: c. Hand the baby to the woman. *The best way for the nurse to promote and support the maternal-infant bonding process is to: c. Assist the family with rooming-in. *. To promote bonding and attachment immediately after delivery, the most important nursing intervention is to: b. Assist the mother in assuming an en face position with her newborn.  Distinguish between Postpartum Blues, Postpartum Depression, and Postpartum Pshychosis  Postpartum Blues: pink period first day or 2 after birth characterized by heightened joy & feelings of wellbeing followed by a blue period

emotionally labile & often cry easily for no apparent reason peaks around day 5 & subsides by the 10th day(let down feeling, fatigue, insomnia, HA, anxiety, sadness, & anger)  Postpartum Depression: can range from mild to severe same signs as baby blues lasts more than 2 wks(thoughts of harming self or baby, not having interest in baby)  Postpartum Psychosis: manifests within first 2 weeks postpartum, will see or hear things that are not there, feelings of confusion, rapid mood swings, trying to hurt baby or self *. During a phone follow-up conversation with a woman who is 4 days’ postpartum, the woman tells the nurse, “I don’t know what’s wrong. I love my son, but I feel so let down. I seem to cry for no reason!” The nurse would recognize that the woman is experiencing: c. Postpartum (PP) blues. *The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression (PPD). Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis? c. PPD can easily go undetected. *A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your initial action should be to d. Allow her time to express her feelings. *A man calls the nurse’s station and states that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, “She was never like this before the baby was born.” The nurse’s initial response could be to: b. Reassure him that this behavior is normal. *When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may: c. Harm her infant. *. According to Beck’s studies, what risk factor for postpartum depression is likely to have the greatest effect on the woman’s condition? a. Prenatal depression *To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features: c. Is distinguished by irritability, severe anxiety, and panic attacks. *To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features: d. May include bipolar disorder (formerly called “manic depression”). *With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to:

d. Realize that this is a common occurrence that affects many women. *. Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? d. Postpartum blues Describe the assessment of organ perfusion during fluid resuscitation for the patient in hypovolemic shock  Respirations, pulse, bp, skin, UOP, LOC, mental status, central venous pressure *When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: d. Urinary output of at least 30 mL/hr. 

Describe signs of lacerations to the reproductive tract  Bleeding that continues despite a firm, contracted uterine fundus  Can be a slow trickle, an oozing, or frank hemorrhage  Distinguish between early and late postpartum hemorrhage  Early, acute or primary occurs within 24 hours of birth  Late or secondary occurs more than 24 hours after but less than 6 wks after birth *The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by: a. Subinvolution of the placental site. *Which woman is at greatest risk for early postpartum hemorrhage (PPH)? b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose labor is being induced *Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance: d. Traditionally PPH has been classified as early or late with respect to birth. *. Early postpartum hemorrhage is defined as a blood loss greater than: a. 500 mL in the first 24 hours after vaginal delivery. 

Describe management of postpartum hemorrhage for patients with coagulation disorders  Idiopathic Thrombocytopenic Purpura:Treat with corticosteroids or IV immunoglobulin, Platelet transfusion,Splenectomy may be needed if ITP does not respond to medical management  Von Willebrand disease: administration of desmopressin, can be given nasally, IV or orally, transfusion therapy w/ plasma products  analgesia(NSAIDS), rest w/ elevated leg & compression stockings *The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: c. Palpate the uterus and massage it if it is boggy. 

*A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect __________ and should confirm the diagnosis by ___________. c. Thrombophlebitis; using real-time and color Doppler ultrasound *. Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks after delivery as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences...