postpartum NURS509 Exam Questions and Answers

Taking-in phase - THE CORRECT ANSWER IS dependent period 24-48 hours in the immediate postpartum period. Focus is on one's own needs and need to be cared for. Need to understand this time as the nurse and not misinterpre ...

Taking-in phase - THE CORRECT ANSWER IS dependent period 24-48 hours in the immediate postpartum period. Focus is on one's own needs and need to be cared for. Need to understand this time as the nurse and not misinterpret it. Taking hold phase - THE CORRECT ANSWER IS transition between dependence and independence: can occur in the weeks following birth; no set time. Giving up the pregnancy role and taking on the maternal role Letting-go phase - THE CORRECT ANSWER IS : Moving form independence into the full role of motherhood. Occurs throughout the first year post-birth and beyond. Accepting of new role and infant, letting go of old roles and expectations, reestablishing relationship with partner and within the family. Female reproductive system - THE CORRECT ANSWER IS Uterus Cervix Vagina Perineum Uterine involution - THE CORRECT ANSWER IS the return of the uterus to its normal size and former condition after delivery Factors that can prolong or interfere with involution - THE CORRECT ANSWER IS Prolonged labor Rapid delivery Anesthesia Excessive analgesia Instrument-assisted birth Grand multiparity (gravida 5 or greater) Full bladder Incomplete expulsion of the placenta or membranes Use of magnesium sulfate during or after birth Postpartum hemorrhage - THE CORRECT ANSWER IS Postpartum hemorrhage is the leading cause of maternal morbidity and mortality. Critical to assess in the immediate postpartum period and until uterine involution is completed. Nurses must assess and be aware of uterine and lochia changes that could indicate the potential for a postpartum hemorrhage Uterine changes - THE CORRECT ANSWER IS Fundus of the uterus may be palpated at the level of the umbilicus after birth The fundus should feel: Firm Grapefruit sized Midline 12 hours after birth, fundus should be 1 cm above the umbilicus 24 hours after birth, fundus should be 1 cm below the umbilicus The uterus usually can be felt 1 finger breath lower each day after birth By approximately day 10, the uterus has descended below the symphysis pubis and is not palpable What helps prevent uterine distention and promote involution? - THE CORRECT ANSWER IS Promote good hydration as well as frequent urination to help prevent uterine distention and promote involution endometrium - THE CORRECT ANSWER IS is the mucus membrane that lines the uterus Endometrial changes - THE CORRECT ANSWER IS The endometrium undergoes a period of necrosis of the superficial layer and regeneration of the decidua basalis following the birth of the placenta Lochia - THE CORRECT ANSWER IS is the discharge that occurs in the 4-6 week period after birth that reflects the healing process of the endometrium Lochia Rubra - THE CORRECT ANSWER IS dark red discharge that occurs for the first 1 to 3 days postpartum Scant: less than 2.5 cm (1 in.) on menstrual pad in 1 hour Light: less than 10 cm (4 in.) on menstrual pad in 1 hour Moderate: less than 15 cm (6 in.) on menstrual pad in 1 hour Heavy: saturated menstrual pad in 1 hour Excessive: menstrual pad saturated in 15 minutes Lochia Serosa - THE CORRECT ANSWER IS pinkish, serosanguinous discharge that occurs from about the 3 to 10 days post partum. Lochia Alba - THE CORRECT ANSWER IS creamy, yellowish discharge that follows serosa at about 10 days to 6 weeks post partum. Cervical changes - THE CORRECT ANSWER IS Appears spongy, bruised and formless Closes slowly By the end of the 1st week, only a fingertip-size opening remains Internal os returns to normal by 2 weeks External os widens and appears as a slit Vaginal changes - THE CORRECT ANSWER IS Edematous following birth, depending on the length and difficulty of the birthing process, the type of birth, and the size of the infant. Can appear discolored or bruised Small superficial lacerations may be noted. Larger lacerations are repaired at the time of birth, and need to be assessed. Rugae reappear in 3 weeks. Vagina returns to near pre-pregnant size at 6 - 8 weeks postpartum, but will remain slightly larger. Assess for increasing pain and discomfort, and do a visual inspection if noted: may be a hematoma forming perinium - THE CORRECT ANSWER IS Not uncommon to remain intact—remember there is not always perineal injury with the birthing process Age, parity, nutritional status, obesity, and disease processes can affect the perinium during the birthing process Postpartum assessment of the perinium includes assessment of any lacerations or episiotomy Evidence-based that episiotomies can lead to more intensive lacerations of the perinium Assessing a perinium laceration - THE CORRECT ANSWER IS 1st degree: through the superficial skin layer 2nd degree: through the skin and muscle layers 3rd degree: through skin and muscle, and extending to—but not through—the external anal sphincter 4th degree: extends through the anal sphincter Postpartum bowel function - THE CORRECT ANSWER IS Decreased muscle tone in the intestinal tract Decreased hormonal levels Decreased intra-abdominal pressure: intestines returning to pre-pregnant position Pre-labor diarrhea Lack of food and fluids during labor C/S Bladder function - THE CORRECT ANSWER IS voiding reflex may be diminished due to: Perineal edema Perurethral lacerations Hyperemia of the bladder Decreased sensitivity to fluid pressure ( often residual effects of epidural anesthesia) Swelling and/or bruising around the urethra Average blood loss during birth - THE CORRECT ANSWER IS Average blood loss is 200-500 ml during the birthing process, and 600-800 ml with a c/s birth Temperature changes - THE CORRECT ANSWER IS Transient temperature changes in the first 24 hours: report temperature of 100.4 or greater, or as directed by provider. Women who are rubella non-immune should receive vaccination before discharge Rh factor diastasis recti adominis - THE CORRECT ANSWER IS separation of the rectus muscle. Can cause muscle soreness and abdominal weakness. Do breast feeding woman need extra calories? - THE CORRECT ANSWER IS Breastfeeding women often have an increased appetite and need 300-500 extra calories a day: be proactive and offer nourishing foods and snacks. Also encourage hydration, especially in breastfeeding moms who need 1-2 liters of fluid a day. Bowel sounds - THE CORRECT ANSWER IS Decreased B.S. are common Absence of B.S. is not normal To assess the uterus - THE CORRECT ANSWER IS Bladder should be empty Place one hand below the patient's lower uterine segment for support Place the other hand on the top of the patient's fundus With firm, even pressure evaluate the fundus Fundal height in relation to the umbilicus Position of the uterus (midline, to the right or left) How should the uterus feel - THE CORRECT ANSWER IS The uterus should feel firm to the touch If it feels "BOGGY": Massage the fundus Observe the amount of lochia Observe the character of the lochia Assess for clots Assess for return to contracted state Assess for full bladder What to asses for in the breasts? - THE CORRECT ANSWER IS Gentle palpation of each breast to assess for: Heat Edema Engorgement Nipple tenderness or cracked nipples Pain discharge Baby blues - THE CORRECT ANSWER IS Considered part of the postpartum transition period Most common the first two weeks postpartum, usually day 3-8 after birth (discharge) 60-80% of women will experience postpartum "baby blues" Partners and family members can experience as well Baby blues signs and symptoms - THE CORRECT ANSWER IS Mood swings Weepiness Anorexia Difficulty sleeping Fatigue Discomfort Over stimulation Postpartum depression (ppd) - THE CORRECT ANSWER IS 10-20% of postpartum women experience PPD Highest risk time is 4-6 weeks postpartum Can occur up to one year postpartum 60-70% of women experience PPD within the first three weeks to six months