| Question | Answer |
| Normal Vaginal Birth.Ms. Jenkins is concerned because she experiences a rush of blood when she first gets out of bed to walk to the bathroom. Is this a serious problem? How would you explain it to the client? | The gush of blood is normal and occurs because blood pools in the vagina when the client is lying down. When she stands, gravity causes the blood to flow. |
| Rubella for non-immunized women are given during the discharge assessment where | SubQ - tell them not to get pregnant for at least 3 months |
| Hemorrhoids are very painful, give ____ soak or ___ cream | magnesium sulfate soak - cortisone cream |
| CS moms must have ____ B4 liquids may be given | bowel sounds. Should be passing flatus B4 solid foods given. |
| Assessing the fundus; empty bladder, ____ position, support lower uterine segment to prevent ____, find fundus around umbilicus by palpating with fingers and make sure it is midline | supine position, prevent displacement |
| What kind of pain is more common in multiparas | afterpains - lasts 2-3 days |
| When to call primary care provider for temperature | sudden, persistent or spiking fever over 100.4F or 38C |
| Acquaintance phase, phase of mutual regulation and reciprocity are the three phases of ____ | Maternal attachment behavior |
| tearfulness, anorexia, difficulty sleeping, and feeling of letdown are all clinical manifestations of | Postpartum blues |
| While the nurse is palpating the fundus of a 12-hour postpartum client, she complains of severe pain. What diagnosis should the nurse suspect? | uterine infection |
| ___ are outpouching of veins seen around the anus after birth. If large need refrral to proctologist | hemorrhoids |
| What is the #1 reason for readmission postpartum | infection |
| advantage of mother-baby or couplet care | allows time to bond with baby and learn to practise care of infant |
| If a woman can not get up to pee after giving birth, palpate the bladder, if full ____ | straight cath to prevent relaxation of the uterus = hemorrhage |
| Urine elimination - Catherize if not voided within ____ hours after delivery or after urinary catherter removal | 8 |
| ____ of the uterus - measurement of descent of fundus for the woman with a vaginal birth, rapidly reduces in size to near pre-pregnant state | Involution of uterus |
| What may be given 30 minutes before doing assessment | pain medication - perform procedure as gently as possible to avoid unnecessary discomfort |
| Assessment of the postpartal woman includes an evaluation of the lochia. Evaluation of the lochia includes character, amount, odor, and the presence of clots. What nursing action is indicated if the client says she has heavy vaginal bleeding? | Assess the perineum and lochia. If heavy bleeding is not seen, ask the client to put on a clean perineal pad and then reassess the client's pad in 1 hour. |
| return demonstration, question and answer session, formal eveluation tool and follow-up call or homehealth visit are all examples of ____ methods | evaluation methods - done with nurse |
| Which of Mercer's stages is the mother comfortable with the role of mother | Personal stage - 3-10 months after delivery |
| By day ____ should no longer feel the fundus, if it can be flet the uterus has not gone through involution and there is a risk for ____ | 10 - hemorrhage |
| unwraping the babies, fingertip exploration and enface position (direct gazing) are all which phase of maternal attachment behavior | acquaintance phase |
| factors that inhibit sexual experience | crying baby, unattractive to mother body, sleep deprivation, hormonal changes, decreased libido |
| When to contact primary care provider with changes in breasts | evidence of mastitis, such as breast tenderness, reddened areas and malaise |
| What needs to be assessed in an adolescent mother | maternal-infant interaction, roles of support people, plans for discharge, knowledge of childrearing, plans for foll-up care |
| How often are uterine status and vital signs taken after delivery | every 15 min for first hour, then every 30 minutes for second hour, then hourly for 2 more hours, then every 4 hours for first 24 hours (follow institution protocols or physician orders) |
| Why do women with CS have less lochia | uterus cleaned out when open |
| Which of Mercer's stage looks to role models for mothering | Anticipatory - during pregnancy |
| BUBBLEHE stand for what | Beast, Uterus, Bladder, Bowel, Lochia, Episiotomy, Hemorrhoid or Homan's, Emotional |
| When giving RhoGAM during the discharge assessment, must get into the muscle not sub Q b/c | if in subQ could cause iso-immunization of mom which is a major prob for future babies |
| stool softners, ambulation increase fluid intake (200ml/day or more) add fruits and roughage to prevent ___- | constipation |
| How high does the temperature elevate due to normal process of birth and how long does it last | no more than 38C (100.4F) for 24 hours - due to dehydration, if still high after hydrated may be an infection |
| Which vital sign slows then retgurns to pre-pregnancy level after birth | Pulse |
| When lochia stops, cervix is considered to be ____ | closed |
| Tx for positive Homan's sign | Heparin |
| Teach client to increase ambulation over 6 weeks, avoid ____, ____, ____ activity, and return to work after final postpartal examination | heavy lifting (more than baby), excessive stair climbing, and strenuous activity |
| When to contact primary care provider with change in lochia | foul smelling, return to bright red bleeding, excessive amount, or passage of large clot |
| Taking in stage lasts ___ days which includes sorting reality from fantasy in birth experience, passive focused on her own needs, and relieving experience, taking hold stage lasts ____ days and includes readiness to resume control over her life | taking in 1-2 days, taking hold 2-3 days |
| If the bladder is empty and the uterus is still boggy then ____ uterus | massage |
| Estimated weight loss for the first 6 to 8 weeks after delivery | 25-30 lbs |
| When to contact the primary care provider with UTI | urgency, frequency and burning on urination |
| Teaching needs for adolescent mothers | self-care, infant care and behaviors, contraception, responsibilities of motherhood, goal setting, peer relationships, and resources |
| A nurse is assessing the lochia of a 24-hour postpartum client and notes the presence of blood clots. What would be the appropriate nursing action? | Assess voiding pattern. |
| handouts and discharge instuctional manuals, formal classes, videotapes, individual intraction and demonstrations and closed circuit educational TV shows for new mothers are all examples of ____ methods | instructional methods - nurses provide |
| If a woman has a hx or family hx of DVT then she takes ___ during the postpartal period | Lovonox |
| After birth, the fundus will rise to the level of the ____ and then descend ____cm every 24 hours | umbilicus then descend 1 cm every 24 hrs |
| A nurse is teaching a postpartum client about the medication methylergonovine maleate (Methergine) that is ordered for postpartum bleeding. What must the nurse caution the client to avoid? | asprin |
| The abdomen appears loose and flabby because the diastasis recti abdominis ____ | seperates (muscle straight down the middle) responds to exercise |
| What are breastfeeding concerns | Nipple soreness(peak 3-6 day), cracked niples, breast engorgement, plugged ducts, alcohol and medications, return to work, weaning |
| Why should a mother breastfeed prior to sex | to reduce milk flow with orgasm |
| The nurse assesses an 8-hour-postpartum client. Findings include a constant trickle of lochia rubra, with a firm fundus at the level of the umbilicus. What might the nurse suspect? | a cervical laceration |
| ____ is the period during which a woman adjusts physicaly and psychologically to the process of childbirth and begins immediately after birth and continues for approx 6 weeks or until the body has returned to near prepregnant state | Postpartal period or Puerperium period |
| Dilated uteters increases the risk for ___. | UTI. dilated ureters and renal pelvis return to prepregnant state by 6 weeks |
| call primary care provider if experiencing ____ postpartal depression | incapacitating |
| What is assessed for preparation of discharge | mother's physical and psychologic condition, newborn adjustment, family adjustment, need for outside resources |
| The risk for thromboembolism lasts for ____ weeks due to progesterone/estrogen flucations | 6 weeks |
| Ways to prevent respiratory infection | cough and deep breath every 2-4 hours and CS moms use incentive spirometer |
| what are the health benefits of postpartial exercises | maintain insulin and high-density cholesterol levels, positive self-estem, less fatigue, improves fitness, decreases urinary leakage (kegel exercises) |
| Ms. Jenkins tells you, "I don't feel as excited about the baby as I expected. Mostly, I'm just tired. Is there something wrong with me?" How would you best respond to her concerns? | Assure Ms. Jenkins that a "let down" feeling after childbirth is common. Allow her to express her negative feelings & provide emotional support. |
| A nurse is assessing a 12-hour postpartum client. Where should the nurse expect to palpate the fundus? | midway and at the level of the umbilicus |
| ____ may cause an overdistended uterus, contributing to afterpains. | Hydramnios may cause an overdistended uterus, contributing to afterpains. |
| ____ is the vaginal drainage after delivery - can indicate how well the rupture from the placenta from the uterus is healing | Lochia |
| mother's general attitude, feelings of competence, available support systems, caregiving skills, fatigue level, sence of satisfaction, and ability to accomplish developmental tasks are what type of adjustment assessment | psychologic |
| 4 physical and developmental tasks to accomplish in the postpartal period | restoring physical condition, develope competence in caring for and meeting needs of infant, establish relationship with infant, adapt to altered lifestyle and family structure |
| What can make the psychologic adjustment difficult | fatigue, depression, preoccupation with physical status or discomfort, low self-esteem, lack of support, material probs, inablity to care for newborn, current family crisis (illness or unemployment) |
| The uterus relaxes when the ____ is full | bladder - causes the uterus to hemorrhage |
| how soon does menstration return for nonlactating women | 6-10 weeeks usually |
| A full bladder can make the uterus deviate to the ____ side, make sure it is empty before doing assessment | right |
| In lactating women, menstration returns at various times because | increased levels of prolactin - therefore breastfeeding is not a reliable means of contraception |
| nursing interventions for the woman who relinquishes her newborn | emotional support, explain grief process, respect special requests regarding care of infant (whether to see and hold infant, early discharge, transfer to medical unit) |
| Check perineal and incisional areas for REEDA what does REEDA stand for | Redness - Echymosis (bruising) - Edema - Drainage - Approximation |
| Iron supplements, if prescribed must be taken for ____ - ____ weeks after delivery to prevent anemia | 4-6 weeks |
| what is engrossment? | The characteristic sense of absorption, preoccupation, and interest in the newborn demonstrated by fathers during early contact is termed engrossment. |
| What are the risk factors for suboptimal breastfeeding | maternal obesity, primiparity, formula supplementation, pacifiers, CS, 2nd stage more than 1 hr, LBW, flat or inverted nipples |
| Which of Mercer's stages does the woman act as she believes others expect her to act | Formal state - when baby is born |
| Which phase of maternal attachment behavior includes the mom adjusting her needs to the infant (any negative feelings may come out here) | Phase of mutual regulation - mom adjusts her needs to the infant |
| Which phase of maternal attachment behavior is mutually gratifying interaction amount mother infant and father | reciprocity |
| If the uterus relaxes after birth it can cause | hemorrhage |
| Which vital sign should remain stable right after birth | blood pressure - if not stable may be due to pregnancy induced HTN |
| maternal and infant care, role changes, psychological adjustment, special education needs (CS, Multiple, congenital anomaly) and anticipatory guidance are all apart of ____ content | teaching content - nurses provide |
| How much blood loss is normal | 200-300cc |
| What is done to relieve after pains | prone with small pillow uner lower abdomen, warm sitz bath, warm K-Pad, ambulation, analgesic like Ibuprofen or Naproxen Sodium |
| Check perineum for lacerations, hemorrhoids, and episiotomy, takes ____ - ____ weeks to heal. | 4-6 weeks |
| A new non-breastfeeding mother asks the nurse, "When should I expect my next period?" The most correct statement by the nurse would be\: | "6-9 weeks." |
| How long does the vagina take to decrease in size for nonlactating women and why longer in lactating women | 3 weeks - lactating women have hypoestrogenic state |
| ____ is released during breastfeeding which enhanses ____ | Oxytocin - involution |
| Assessment of the postpartal woman includes an evaluation of the lochia. Evaluation of the lochia includes character, amount, odor, and the presence of clots. Describe the normal progression of lochia after birth. | First 1-3 days\: rubra; following rubra, days 3-10\: serosa |
| ____ is a transient period of depression occuring during the first few days after delivery until 10-14 days | Postpartum blues |
| The nurse is caring for a postpartum client 10 hours after a normal vaginal birth. Where should the nurse expect to palpate the fundus? | level with the umbilicus |
| When is it safe to resume sex | episiotomy healed copletely, no lochia and check with physician (about 4-6 weeks) |
| Ways to promote maternal rest | organize nursing care to avoid frequent interruptions, encourage naps (helps decrease probs of establishing breastfeeding pattern) and put sign on mothers door for visitors to check in at nurses station |
| What can help supress lactation in non-breastfeeding mother | suportive bra, ice pack to axillary 20 min 4X/day, avoid stimulation and heat (shower on breast), analgesic (Tylenol or Ibuprofen) |
| Any deviations of VS needs to be recorded b/c can be sign of ____ or ____ | hemorrhaging or shock |
| The nurse is caring for four postpartum clients. Which client is at greatest risk for bladder atony? | 39-week-gestation client with a 36-hour labor |
| ____ is a nervous response to vasomotor change | postartal chill - tx warm blanket |
| When to contact primary care provider with thrombophlebitis | calf pain, tenderness and redness |
| Which of Mercer's stages does the mother develop her own style of mothering | Informal stage up to 3 months after delivery |
| changing hormone levels, psycholigic adjustments, unsupportive environment, insecurity, fatigue, discomfort, overstimulation and lack of sleep are all causes of | Postpartum blues |
| If there is an problem with early attachment, the nurse should find out what the problem is and the ____ of the problem | source - devise an approac for development of mother-infant relationship |
| Lochia should smell like fresh blood, if smells bad, could be | infection |
| When is birth certificate information, info on support groups, follow-up care and plan for follow-up visit done | discharge |
| The nurse is researching the relationship between estrogen and lactation. What condition is the lactating client more susceptible to? | dyspareunia |
| Advantages of sibiling visitation | reassure mother's love and well-being, opportunity to become familiar with infant |
| The nurse is caring for four high-risk postpartum clients. Which predisposing condition places a client at risk for developing pulmonary edema? | pregnancy-induced hypertension |
| Colace which is a ____ may be given to women who fear the first bowel movement (bearing down) - fear of pain and tearing episiotomy delays elimination | stool softener |
| Puerperal diuresis occures because the ____ system that has been going to baby is going into general circulation | cardiovascular system |
| T/F Pt is allergic to aspirin; therefore, she cannot have the Empirin #3. | true |
| With the knee bent, doriflex the foot, if severe pain it is a positive ____ sign | Hogman's sign - notify physician |
| Which hormone makes the bowels sluggish after birth | progestrone influence |
| Cervix changes from dimple-like os of a nullipara to a ____ of multipara | lateral slit |
| What is used to cleanse perineal area | peribottle, moist antiseptic towelettes, clean hands |
| Nursing mothers should increase kcal to what over pregnancy requirments | 200kcal (in addition to the pregnancy 300 kcal increase) |
| When resuming sex, use only ____ lubercant with female superior or side lying position | water-soluble |
| What is used to relieve perineal and hemorrhoidal discomfort | icepack on 20 off 10 for 24 hrs, warm sitz bath 102-105 F for 20 min PRN, cool sitz bath, and anesthetic spray, which hazel compresses and ointment |
| ways to increase circulation after birth | leg exercises Q2H until ambulating, tighten abdominal muscles (CS moms have AV boots or stockings to promote circulation) |
| Best time to give pt referrlas, follow-up info and Rx | Discharge assessment |
| Afterpains are more severe and frequent in lactating women due to what hormone | oxytocin |
| What are the four stages of maternal role attainment (Mercer's research) | Anticipatory stage, Formal stage, Informal stage, and Personal stage |
| signs of too strenous activity | increased locia and pain |
| Lochia starts out bright red after birth then follows a color pattern until clear, what are the colors and about how long for each | Rubra (dark red) first 2-3 days, Serosa (pink) 3-10 days, Alba (creamy white or light yellowish), clear |
| Before performing a physical assessment, be sure to ____ before entering, record findings as clearly as possible,explain purpose of regular assessments and teach client ____ while performing assessment | be sure to knock first. Teach client self-care |
| The nurse is teaching nutrition requirements to a breastfeeding postpartum client. What is the correct amount of caloric intake by the client required for successful breastfeeding? | 500 more than prepregnancy |
| why is WBC count not a good indication of infection in postpartal period | WBC normally elevated after delivery so go by temp over 100.4F |
