assessing for early signs of potential complications; health promotion; family education
The focus of the physiological aspect of postpartum nursing care is on these three things.
This is the process by which the uterus returns to a pre-pregnant size, shape and location; and the placental site heals.
This process occurs through UCs and atrophy of the uterine muscle.
multiparous; increases with each birth
This group of women experiences afterpains.
moderate to severe cramp-like pains that are related to the uterus working harder to remain contracted and/or due to the release of oxytocin in response to infant suckling
Decrease the risk of hemorrhage
Why does the uterus need to be in a contracted state postpartum?
Uterine muscle compresses the open veins at the placental site
How does uterine contraction prevent hemorrhage during the pospartum period?
15, 30, 4, shift
Nursing actions: After the third stage of labor, assess the uterus every _________ minutes for the first hour, every _____minutes for the second hour, every ______hours for the next 22 hours, and then every ______ after the first 24 hours.
Should the woman void before you palpate her uterus?
supine and flat
What position should the woman be in during assessment of the uterus by palpation?
just above the symphisis pubis
Where should you place your hand in order to support the lower uterine segment during palpation?
uterus is not contracting, excessive blood loss
What does a boggy uterus indicate, and what does that cause a risk for?
oxytocin as per order; fundal massage
What two nursing actions should the nurse do if the uterus is boggy?
A uterus that is shifted to the right may indicate what?
This condition interferes with uterine contractibility placing the woman at risk for uterine atony and hemorrhage.
at the umbilicus, firm, and midline
Immediately after placenta birth, where is the uterine fundus located?
midway between the symphisis pubis and umbilicus
Where is the uterine fundus located 1-2 hours postpartum?
1 cm above the umbilicus
Where is the uterine fundus located 12 hours postpartum?
1 cm below the umbilicus
Where is the uterine fundus located 24 hours postpartum?
How many centimeters does the uterus descend per day?
At what postpartum day will you no longer be able to palpate the uterus?
circular fundal massage until firm; reassess in 30 minutes
What is the immediate action for a boggy uterus?
IV, IM, 10 units
What are the two routes for oxytocin, and what is the dosage?
This structure undergoes regeneration after placental birth through necrosis of the superficial layer of the decidua and regeneration of the decidua basalis into this structure.
This is a bloody discharge from the uterus that contains sloughed off necrotic tissue.
less than 1 inch on peripad
How much is scant lochia?
less than 4 inches on peripad
How much is light lochia?
less than 6 inches on peripad
How much is moderate lochia?
saturated within 1 hour
How much is heavy lochia?
What is the timeframe for lochia rubra?
What is the timeframe for lochia serosa?
What is the timeframe for lochia alba?
bloody with small clots; scant-moderate; increased flow on standing or breastfeeding; fleshy odor
What are the expected findings for lochia rubra?
What is an indicator of infection with lochia rubra?
What size clots can interfere with uterine contractions and should be reported to the MD or CNM?
What size clots do not need to be reported but should be noted in the patient's chart?
blood pooling in lower uterine segment
When is it common for lochia to contain clots?
saturated pad in 15 minutes
What amount of lochia may indicate a possible hemorrhage?
What should not be found in lochia rubra?
pink or brown
What color is lochia serosa?
scant; physical activity; fleshy
How much lochia serosa is considered normal? When might the flow increase? How should it smell?
yellow to white
What is a normal color for lochia alba?
How much lochia serosa is considered normal? How should it smell?
bright red lochia alba
What may indicate late pospartum hemorrhage?
change pad, reassess in 15 minutes
If there is excessive bleeding and the uterus is firm and midline, then what should the nurse do?
within the first few days; 36 hours
When do afterpains occur? How long do they last?
When might afterpains increase during the first few postpartum days?
What condition may increase afterpains?
empty bladder; warm blanket to abdomen; 600-800 mg Ibuprofen PO q6h prn; relaxation techniques
What are four comfort measures for afterpains?
getting up in morning; after sitting for long periods due to pooling; excessive physical activity
During patient education, when might the flow of lochia increase?
if sudden increase in lochia amount; if bright red blood after rubra stage; if foul odor
When should the mother notify the nurse?
What is a modifiable risk factor of infection?
redness, edema, ecchymosis, discharge, approximation of edges
When assessing the perineum every shift you should use the acronym REEDA.
on her side
What position should the woman be in for perineal exam?
mild edema; minor ecchymosis; wound edge approximation; mild to moderate pain
What are the 4 expected assessment findings for the perineum?
first 24 hours
During what period should ice be applied to the perineum to decrease edema and provide anesthetic effect?
What position decreases pressure on the perineum?
tighten glues when sit down; relax once seated
How might the woman cushion the perineum and increase comfort when assuming a sitting position?
24 hours after delivery bid for 20 minutes; promotes circulation, healing, and comfort
When and how often should a woman take a Sitz bath after birth? What does this do?
use peribottle with warm water to rinse perineum
What should the woman due after elimination (bowel evacuation) in order to decrease risk of infection?
Around what postpartum day do all women experience some degree of primary engorgement?
This is an increase in the vascular and lymphatic system of the breasts and precedes the initiation of milk production.
larger, firm, warm, tender, throbbing
What are five normal conditions of the breast during primary engorgement?
At what point after starting does primary engorgement subside?
This infection may be due to bacterial entry through cracks in the nipples.
The S&S of this infection are fever, malaise, unilateral breast pain, and area tenderness.
Should a woman with mastitis continue to breastfeed or pump?
tenderness, firmness, warmth, enlargement
What are the four signs of engorgement?
In the first 24 hours postpartum, the breasts should be _______ and ______.
slightly firm; nontender
On the 2nd postpartum day, the breasts should be ______ and _____.
firm, tender, warm
On the 3rd pospartum, the breasts are _____, ____, and ______ to touch.
Assess the nipples for signs of ______ and nipple tissue ______.
cracked, blistered, reddened
Signs of nipple irritation and breakdown include _____, ______, ______ areas.
localized tenderness, warmth, and redness; increased temperature; malaise
What are S&S of mastitis?
heat (unless she isn't breastfeeding; then avoid heat)
Should one use heat or cold to increase comfort to the breasts?
What should be worn by the mother to increase breast comfort?
examine nipples for irritation
What should the woman do to her breasts before breastfeeding?
express milk or breastfeed
What should a woman be encouraged to do if she is experiencing breast engorgement?
24 hours a day until breasts become soft
How long should a woman wear a supportive bra?
heat application, expressing milk
If a woman is not breastfeeding, then what should not be done to the breasts?
Should heat or should ice be applied to the breast of a woman who is not breastfeeding in order to ease engorgement?
For the non--breastfeeding woman, when will breast engorgement subside?
400-500 mL; pregnancy-induced hypervolemia
Women have an average blood loss related to vaginal birthing experience. How much do they lose? Why does this only have a minimal effect on the woman's system?
When does CO decrease after the normal postpartum increase that occurs during the first few hours postpartum?
blood that was shunting through the uteroplacental unit returns to the maternal system
What causes the normal postpartum increase in CO?
25,000; 7 days
How high may the WBC go within a few hours of birth and when will it return to normal?
Women are at risk for _____r/t the increase in circulating clotting factors during pregnancy. However, clotting factors slowly decrease after placental birth and return to normal range within the first ______ postpartum weeks.
decreased vascular resistance in the pelvis
Why is there an increased risk of orthostatic hypotension?
postpartum chills; vascular instability
Most women will experience an episode of feeling cold and shaking during the first few hours postpartum. This is referred to as________and is r/t _______.
15 minutes, 30 minutes, 4 hours, shift
You should assess pulse and BP every _____for the first hour; every ______for the second hour; every _______for the next 22 hours; and every _______after the first 24 hours.
During the first _____hours postpartum, women will need assistance when ambulating due to orthostatic hypoention.
Women are at risk for ______during the first postpartum week. If the woman faints, use an ammonia ampule.
An increase in _____rate may be an indicator of excessive blood loss.
1-1.5 g/dL; 3-4%
How much do hematocrit and hemoglobin decrease for every 500 mL of blood loss?
How often should you assess the woman for Homans' sign and calf tenderness and warmth?
pressure on the diaphragm
There is a return of chest wall compliance after birth due to a reduction of _________.
15, 30, 4 hours, shift
You should assess RR every ______minutes for the first hour, every _____minutes for the second hour, every ______ for the next 22 hours, and every______after the first 24 hours.
It is common for a woman to experience a ________elevation during the first 24 hours post-birth r/t muscular exertion, exhaustion, dehydration, or hormonal changes.
A temperature greater than ______after the first 24 hours on two occasions may be indicative of postpartum infection and requires further evaluation.
Fetal exposure to _____in the first trimester increases risk for birth defects including deafness, blindness, heart defects, and mental retardation.
When should a rubella-nonimmune mother be immunized?
For how long after immunization should a woman avoid pregnancy in order to decrease the risk of birth defects caused by the immunization (rare but still important)?
When should rho immune globulin be given to Rh-negative women prenatally?
A second injection of Rho immune globulin is given to the woman if she is _________.
Women who are sensitized (Rho isoimmunization) produce ______ which crosses the placenta and attacks the fetal RBCs, causing hemolysis.
Rh-negative women with Rh-positive neonates
Who is given Rho GAM after birth?
300 mcg IM within 72 hours
What is the route, dose, and time of Rho GAM administration after birth?
hydrate; promote relaxation and rest; reassess in 1 hour after interventions
What are the interventions for a temperature less than 100.4 during the first 24 hours post-birth?
hydrate; notify MD or CNM for further evaluation
What are the interventions for a temperature elevation of 100.4 or higher after 24 hours post-birth?
frequency, urgency, pain/burning on urination, malaise
What are the S&S of cystitis?
antibiotics, increased hydration, rest
What is the treatment for cystitis?
bladder distention, incomplete emptying, inability to void
These three conditions of the urinary system are common during the first few days post-birth and are related to decreased urge and/or edema around the urethra.
Diuresis, caused by decreased _____ and _____ levels, occurs within 12 hours post-birth and aids in elimination of excess tissue fluids.
You should measure voidings during the first ______hours post-birth. A voiding of less than _______, necessitates palpation for bladder distention which may call for catheterization.
If unable to void within ______ hours post-birth the woman may need to be catheterized. A Foley Catheter is used when inability to void is related to _______.
An alternative method to use when a woman is unable to void is the use of ________ with a saturated cotton ball placed in a "hat". This relaxes the urinary sphincter.
Assist the woman to the bathroom and encourage her to void within ______hours post-birth, because this decreases the risk of ______.
Instruct the woman to increase fluid intake to a minimum of ______glasses per day.
prolactin, 6-10, anovulatory, 4th
In nonlactating women ______ levels decline throughout the first 3 postpartum weeks, menses begin _____ to _____weeks post-birth. The first menses is usually ________, which tends to restart by the ______cycle.
Return of menses in lactating women depends on _____ and _____of breastfeeding.
______occurs during the first few postpartum weeks in response to decreased estrogen levels. It usually occurs at night, and it assists the body in excreting increased fluid accumulated during pregnany.
A comfort measure for diaphoresis is wearing ______nightwear.
Afterbirth the ______muscles have a reduction in tone causing a soft, flabby appearance.
diastasis recti abdominis
Some women experience a separation in the rectus muscle, noted as _________, which becomes less apparent as the body returns to a pre-pregnant state.
There is a decrease in GI muscle tone and motility post-birth with a return to normal by the end of the ______week.
prescribed diet, diabetes
Women are hungry after the birthing experience and can be given a regular diet, unless they are on a _________ such as for ______.
Women are exceptionally _______during the first few postpartum days.
The average American woman at the end of 6mo postpartum is about _____ to _____lbs above her pre-pregnancy weight.
Most women will experience significant weight loss during the first _____to_____weeks postpartum.
This medication is given to prevent constipation in postpartum women by promoting incorporation of water into the stool.
mild abdominal cramps
The most common side effect of colace is ________.
100 mg PO BID
The route and dose for colace is:
Lactating women should increase their caloric intake by _______calories per day and have a fluid intake of about _____liters per day.