Term
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Definition
| First 6 weeks of post partum period. Lasts until 6-week check-up. This period is also known as "puerperium." |
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Term
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Definition
| Process of rapid reduction of size of the uterus. Important to avoid hemorrhage. |
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Term
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Definition
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Term
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Definition
Term
Preterm
Abortions
Living children |
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Term
| When is the Hgb and Hct done, after delivery |
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Definition
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Term
| How often does the nurse do the physical assessment, after delivery |
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Definition
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Term
| What should the mother do prior to physical assessment after delivery? Why? |
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Definition
| Void. Nurse should tell her to do this, as she may not have the sensation to void. A full bladder will cause the fundus to shift. |
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Term
| What is the difference between baby blues and post partum depression? |
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Definition
| It is normal for the mother to have some sad days after delivery. (Hormones are like--WHOA) When this sadness lasts over 6 months, that might be post partum depression. The nurse will not see this after delivery, as it occurs much later. |
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Term
| 8 parts of physical assessment (BUBBLE-HE) |
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Definition
Breasts
Uterus
Bowels
Bladder
Lochia
Epiostomy (includes hematoma, hemorrhoids)
Homan's sign (don't actually do this, ask about calf pain.)
Emotional status |
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Term
| How often should the nurse check vital signs after a vaginal delivery? |
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Definition
| Q4H for the first 24 hours |
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Term
How often should we check vital signs after a C-section?
Which parts of the assessment are priority? |
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Definition
Q4H the first 48 hours.
Priority assessments are GI, lungs, bowel sounds, abdomen. Remember, this is an abdominal surgery. |
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Term
| During what type of labor might we see Pitosin in the IV bag? |
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Definition
| If the baby was large, or if it was a difficult labor where there is concern about the uterus contracting. |
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Term
| A patient has had an epidural: what does the nurse need to check about the epidural catheter? How long is the catheter in place? What teaching should the nurse do? |
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Definition
Check that the catheter is taped along the back and that there is no movement.
It will be in place for 24 hours after delivery.
Educate mother that pain will increase after catheter is removed, and that she should request pain medication if the pain level reaches a 3. |
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Term
| Why is involution so important? |
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Definition
| If it doesn't take place, the mother will hemorrhage. |
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Term
| What is subinvolution? What causes subinvolution? |
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Definition
Subinvolution is when the uterus contracts to it's pre pregnant state at a slower rate than expected.
It may be caused by retained placental fragments or pelvic infection. |
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Term
| Where is the fundus IMMEDIATELY after delivery of the placenta? |
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Definition
| Halfway between the umbilicus and the symphysis pubis |
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Term
| Where should the fundus be at 2-12 hours after delivery? |
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Definition
| Around the umbilicus, up to 2 finger breadths above it. |
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Term
| Where should the fundus be at 12-24 hours after delivery? |
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Definition
| At the umbilicus. From here, it will descend at the rate of one fingerbreadth daily. |
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Term
| where should the fundus be 10-14 days after delivery? |
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Definition
| It should have contracted beneath the pelvic bone and should not be able to be palpated. |
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Term
| What should the fundus feel like? |
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Definition
| Hard like a small grapefruit. |
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Term
| What if the fundus is soft? |
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Definition
| This is a "boggy uterus" and it is a risk for hemorrhage. |
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Term
| What are some nursing measures that can encourage the uterus to contract? |
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Definition
| Sometimes just touching the fundus will cause its contraction. The nurse could also have the mother breastfeed, which can encourage uterine contractions. |
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Term
| What might the midwife/dr do if the uterus is boggy? |
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Definition
| They may first massage the uterus. If that doesn't work, they will order hormone therapy. |
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Term
| A mother who is breastfeeding complains of cramping that occurs after feed. What can the nurse do? |
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Definition
Offer pain medication just prior to nursing. Only a small amount of pain medication will make its way into the breastmilk, but if it concerns the mother then she should know that taking pain medication just prior to breastfeeding will allow the baby to be fed before the medication metabolizes.
Also, let the mother know that this pain and cramping will only last a few days. |
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Term
| What is the most dangerous time of the PP period? |
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Definition
The first few hours. This is especially true if the labor was long and difficult. The uterus might just "give up" and be atonic.
Even though the first few hours are the most dangerous, the nurse needs to remain very watchful throughout duration of PP stay. |
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Term
| In what position should the woman be while the nurse is assessing the fundus? |
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Definition
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Term
| Where should the nurse place her hands while assessing the fundus? |
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Definition
| One hand should be at the symphysis pubis and the other should be at the level of the uterus. |
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Term
| If a woman has had a C-section, what is the best time to assess the fundus? |
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Definition
| 20-30 minutes after giving pain medication |
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Term
| What does the nurse chart about the fundus? |
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Definition
| Quality of the fundus ("firm," "firm with palpation/light massage," "soft/boggy," "difficult to find." |
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Term
The fundus is located slightly to the right. What should the nurse do?
a) have the mother breastfeed
b) have mother sift onto left side
c) ask the mother to use the restroom
d) massage the uterus |
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Definition
| c) Ask the mother to use the restroom. A full bladder can cause the fundus to shift. |
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Term
The nurse knows that which medication is ordered to stimulate contractions in the mother?
a) Methergine
b) Cytotect (misoprostol)
c) Darvan (propoxphene)
d) A and B
e) B and C |
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Definition
| D. Both Methergine and Cytotect help with contractions. Darvon helps with pain. |
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Term
| Methergine (methylergonovine) |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| ordered for pain, often as an adjuvent to Percocet. If mother is in pain between PRN hours, give ibprofen. |
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Term
| On the first day PP, a mother has dark red blood from the vagina. In it, there are several nickle-sized clots. What is this and what should the nurse do? |
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Definition
| This is lochia rubra. This is normal in the first few days PP. Nickle-sized clots are normal, as well. |
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Term
| A woman is 1 day PP and is having dark red blood with clots the size of a quarter. What should the nurse do? |
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Definition
| Lay the woman flat and assess fundus to make sure it's not boggy. |
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Term
| What is lochia serosa (what does it look like) and when do we see it PP? |
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Definition
| Pink and brownish in color, thinner than lochia rubra. Seen 3-10 days PP. |
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Term
On day 3, the nurse charts that the client has moderate lochia serosa. On day 4, the nurse notes that the mother's pad has about 4 inches of dark red blood with one small, nickle-sized blood clot. What is the priority nursing action?
A) Nothing, lochia rubra with small clots is normal.
B) Notify the MD
C) Chart this as "light lochia rubra with nickle-sized clots."
D) Assess the mother's fundus |
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Definition
B. Notify the MD. Lochia flow should never reverse itself.
(Though, if the question states that she is on IV Pitocin, it will decrease the lochia flow until the Pitocin is stopped. When it wears off, teh flow will begin)
It should be charted, and maybe charted first, it is not the priority. |
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Term
A mother tells the nurse that she has been saturating about 1 pad per hour. What should the nurse do?
a) chart this
b) notify the MD
c) put a bag in the bathroom for a pad count
d)nothing. A saturated pad is normal. |
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Definition
| C) Do a pad count. While 1 pad per hour is normal, the mother might feel awkward that she is saturating more than one pad and hour and the nurse needs to be careful about this because excessive saturation, which is 4 pads/hour, is an emergent situation! |
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Term
| What should nurse teach the mother about lochia? |
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Definition
| Change pads frequently, do not use tampons, do not use a washcloth to the vaginal area. Provide a peri bottle with warm water. |
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Term
| How should a C-section mother to her peri care? |
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Definition
| The nurse should do this for the mother. |
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Term
| What physiological changes take place in the vagina during the PP period? |
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Definition
Vagina wall is edematous andmay be bruised
Rugae folds are minimal
Hymen is torn and jagged
Labia majora and manora remain looser |
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Term
| At what point of the PP period should the vagina have returned to *nearly* its pre pregnant state |
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Definition
| 6 weeks pp, involution is complete and vagina is almost pre-pregnant state |
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Term
| How long after childbirth should a woman wait before having sex? |
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Definition
| 6 weeks check up. At this time, she may be given something to help with vaginal dryness. |
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Term
| What position should the woman be in for assessment of the perineum? |
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Definition
| Side lying with leg over other. |
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Term
| What is the nurse looking for when assessing the perineum? |
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Definition
| Intactness, episiotomy (approximate edges. Only a 50-50 chance you will be able to see this due to edema), lacerations, hemorrhoids. |
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Term
| What position should the mother be in for perineum care? |
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Definition
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Term
| How often should we do peri care for the C-section mom? |
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Definition
| Q3H. She can usually shower by day 2. |
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Term
A patient's chart reads that a woman has a 3rd degree perineal laceration. The nurse expects to see a laceration that
a) includes the superficial structures above the muscle
b) goes through the sphincter muscle
c) extends through the perineal muscle
d) extends through the anterior rectal wall |
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Definition
b) a third degree laceration extends through the anal sphincter muscle.
(1st degree involves only skin and superficial structures about the muscle, 2nd degree extends through the perineal muscles, 3rd extends through anal sphincter muscle and 4th continues through the anterior rectal wall.) |
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Term
| Which ovarian hormone is associated with lactation? |
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Definition
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Term
| For the non-lactating mother, when should she resume menstruation? Ovulation? |
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Definition
Menstruation: about 70-75 days
Ovulation: 50% will ovulate with the first menstrual cycle. |
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Term
For the lactating mother, when is she expected to begin menstruating?
Ovulating? |
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Definition
Menstruation: about 6 months
Ovulation: about 190 days. Most will have one or more anovulatory cycle prior to first ovulatory cycle. However, breastfeeding is not a reliable method of birth control! |
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Term
| A mother is concerned that she lost hair during her pregnancy. What can the nurse tell her? |
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Definition
| Hair usually grows back at about 3 months post partum. |
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Term
| What can a mother do to hasten the "let down" period where breasts fill with milk? |
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Definition
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Term
| What can a woman do to ease engorgement? |
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Definition
| Frozen cabbage leaves in the bra (apply cold). |
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Term
What is the expected blood loss for a vaginal delivery?
C-section? |
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Definition
Vaginal: 300-500mL
C-section: 500-1000mL |
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Term
| Why do women have a lower plasma volume? |
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Definition
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Term
| PP, what should the H&H be like? |
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Definition
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Term
| For how long should a mother take prenatal vitamins? |
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Definition
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Term
| How many mLs should a lactating mother increase her fluids? |
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Definition
| 500mLs (at least 3L daily) |
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Term
| What is the average leukocytes for the PP woman? How high is still considered "normal." |
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Definition
| 12,000, and 25,000 is still considered normal. |
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Term
| What is a normal temperature for a woman who is 24 hours PP? After 24 hours? |
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Definition
| Afebrile for first 24 hours, then 100.4 is normal inflammatory response. If her temp is above 100.4, consider infection. |
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Term
How should a woman's BP be, PP?
Why might it be low? High? |
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Definition
Stable and normal, as it was pre labor.
If there was extensive blood loss or fluid shift, she may have a decreased BP .
PIH will cause BP to be high. |
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Term
| What is a normal pulse range for the PP woman? |
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Definition
| 50-70. A low pulse is normal. Over 100 needs to be investigates. |
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Term
| Expected Respiration in the PP woman? |
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Definition
| No change from pre-labor state and back to pre-pregnancy state by 6 wk checkup |
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Term
| How much weight should the mother lose in the initial PP period? How much weight due to sweating/peeing? |
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Definition
10-12lbs from infant, placenta, and fluid
5 lbs from diaphoresis and diuresis |
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Term
| How many calories should the non lactating woman consume PP? The lactating woman? |
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Definition
Non lactating: 2200-2300
lactating: 2700-2800 |
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Term
| About how long after delivery should the mother have a BM? |
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Definition
| Several days. May not have BM until at home. |
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Term
| How long does it take for the muscle tone in the abdominal wall to improve? |
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Definition
| 2-3 months, with exercise. |
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Term
| How long after delivery should the mother be ambulate? |
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Definition
| Several hours. She may feel weak and wobbly and the nurse should be with her. |
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Term
| The mother tells the nurse she is having some pain in her lower legs. What should the nurse do? |
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Definition
| REPORT that. The mother is at risk for DVT. |
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Term
| A woman has spinal anesthesia. How long should she lay flat to avoid spinal headache? |
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Definition
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Term
| A woman has an uncontrollable shaking and chill in the PP period. What does this suggest and what can hte nurse do? |
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Definition
| This is a post-partum chill. The nurse should reassure the woman that this is not a sign of infection and provide warm blankets. |
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Term
| What are the three psychosocial stages of the PP period? |
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Definition
1) Taking in (dependent phase)
2) Taking hold (dependent-independent)
3) letting go |
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Term
| How should the nurse approach teaching during the taking-in phase? How long does this phase last? |
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Definition
The nurse should teach one thing at a time and use imagery.
Know that she is not going to remember a lot of what she is taught during this phase.
This phase lasts about 24-48 hours. |
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Term
| During which psychosocial phase should the nurse expect the mother to begin asking a lot of questions? Which days PP does this phase take place? |
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Definition
| The second phase, taking hold. PP days 2-10. |
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Term
| when does the mother complete the letting go phase? |
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Definition
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Term
| A nurse notes that the new mother is interested in watching television during her discharge teaching. It is day 3 PP and so far, she has not been involved in the newborn's care. What should the nurse do? |
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Definition
| Notify the social worker. These are red flags. |
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Term
| What are the 3 stages of transitioning into fatherhood? |
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Definition
1) Expectations
2) Reality
3) Transition into mastery |
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Term
| How long after delivery should the mother be using the peri bottle for peri care? |
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Definition
| Peri care should be continued until the bleeding stops. |
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Term
| What is the average healing time for an episiotomy? |
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Definition
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Term
| In what situation involving lochia flow should the mother contact her provider |
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Definition
Saturating more than 1 pad/hour
Foul smelling lochia
Large clots
Abdominal tenderness |
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Term
| How long after deliver will a woman's urine flow remain increased |
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Definition
First 24 hours.
Need to increase liquids. |
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Term
| Where should Tuck's be stored for hemorrhoid care |
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Definition
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Term
| How should the mother increase her rest periods at home? |
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Definition
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Term
| How long after a C-section may the mother drive again? |
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Definition
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Term
| How long after a C-section should a woman have her follow-up? |
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Definition
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