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Questions and Answers
What is the term for vaginal discharge that occurs 3-4 days postpartum?
Which of the following describes the typical color of lochia rubra?
When should parent teaching for postpartum care be most effective based on stages influenced by Rubin’s theory of psychological changes during the puerperium?
What term is used to describe the thickening and hardening of the vaginal walls postpartum?
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A mother who is exclusively breastfeeding her newborn can expect the return of menstruation around ________.
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Which characteristic best describes lochia rubra?
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What is a common change in the cervix and vagina postpartum?
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What should be assessed for in the perineum using the REEDA scale?
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When does menstruation typically return postpartum?
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What care measure is helpful in relieving engorgement during breastfeeding?
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What finding is indicative of moderate lochia rubra?
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Where should the fundus be expected to be located 24 hours after birth?
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Which breast change indicates a potential issue postpartum?
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What is a characteristic of lochia alba?
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When can ovulation typically resume after childbirth?
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What is the term for vaginal discharge that lasts about 3 days after giving birth?
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In Rubin's theory of psychological changes during the puerperium, when does the puerperium period refer to?
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What is the recommended time frame for becoming pregnant after receiving a rubella vaccine?
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Which type of vaginal discharge is known as lochia Rubra?
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When can ovulation typically resume after childbirth?
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Study Notes
Puerperium
- Also known as the postpartum period
- Lasts for six weeks after childbirth
- Sometimes referred to as the fourth trimester of pregnancy
Emotional Care of the Family
- The birth of an infant brings about physical changes in the mother and emotional and relationship changes in all family members
- The family care plan integrates knowledge of family structure, culture, and community-based care into the care of the patient
- "Patient" encompasses the entire family
Rubin's Psychological Adaptation of the Puerperium
- Phase 1: Taking In
- Mother is passive and willing to let others do things for her
- Conversation centers on her birth experience
- Has interest in newborn but prefers that others care for newborn
- Has little interest in learning
- Focus is on need for food, fluids, and restorative sleep
- Nursing response: provide opportunity for rest and appropriate nutrition; provide opportunity to discuss birth experience and vent disappointments or share joys
- Phase 2: Taking Hold
- Mother begins to initiate action and becomes interested in caring for newborn
- May be critical about her abilities
- Has increased concern about her body functions and assumes self-care needs
- Nursing response: provide guidance and support for self-care and newborn care
Postpartum Assessment
- Use the acronym BUBBLE-HE to remember key components of the postpartum assessment:
- Breast
- Uterus
- Bladder
- Bowel
- Lochia
- Episiotomy
- Homans' sign
- Emotions
Reproductive System
- Uterus:
- Fundal assessment: involution, decrease in size, and descent of uterus into pelvic cavity
- Uterine complications: boggy uterus, massage until firm, observe perineum during massage to determine amount of clots and bleeding, may need medication to maintain contraction
- Cervix and vagina:
- Cervix regains muscle tone
- Vaginal rugae disappears during childbirth due to stretching, reappearing around 3 weeks postpartum
- Perineum:
- Encompasses lacerations and episiotomies
- Assessed for REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation)
- Lochia:
- Uterine discharge
- Assessed in conjunction with uterus
- Characteristics:
- Rubra: bright or dark red, red-brown discharge (first 1-3 days postpartum)
- Serosa: pink to brown discharge (postpartum days 3-10)
- Alba: yellow to white discharge (may last up to 21 days postpartum)
- Abnormal lochia: foul-smelling or green-tinged discharge, bright red discharge, regression in color of discharge lochia rubra after 3rd day postpartum, pad saturated in less than an hour, frequent or large clots are passed
Cardiovascular System
- Cardiac output and blood volume:
- Increased blood volume during pregnancy allows for blood loss during delivery
- Postpartum redirection of blood from reproductive tissues into main circulation temporarily increases volume
- Any excess fluid may present with edema
- Orthostatic hypotension:
- May be due to decreased resistance in pelvic vessels or hypovolemia
- Dizziness, lightheadedness, and fainting
- Patient requires assistance with early ambulation
Urinary System
- Anesthesia during labor and decreased bladder tone during pregnancy affect ability to void
- Assess for distention
- Measure first voids after delivery
- Monitor for and educate regarding UTI signs and symptoms
Gastrointestinal System
- Assess bowel activity and sounds
- Prevent distention and constipation
- Hemorrhoids, perineal lacerations or episiotomy, cesarean incision, distended abdominal muscles, dehydration
- Anesthesia and opioids
Integumentary System
- Reversal of pregnancy-induced skin changes
- Chloasma, linea nigra, striae gravidarum
- Will not disappear but will fade over time
- Hyperpigmentation of areola
Musculoskeletal System
- Hypermobility of joints returns to normal
- Abdominal tone and stabilization by 6 weeks
- Common postpartum exercises
- Consult provider prior to starting exercise routine
- Utilize proper body mechanics
Immune System
- Determine need for immunizations prior to discharge
- RhoGAM: within 72 hours postpartum if infant is Rh+
- MMR (Rubella): if non-immune
- Should not get pregnant for 28 days after administration
- Need consent and education
- May also get flu shot if didn’t already receive during pregnancy### Caring for New Mothers and Babies
- Create a supportive atmosphere to help new mothers and families adapt to the new baby.
- Identify the mother's support system and use teaching moments to reinforce self-care and newborn caretaking abilities.
Letting-Go Phase
- Mothers and partners work through giving up their previous lifestyle to incorporate the newborn.
- They must reconcile their ideal birth experience with what really occurred and accept their real child.
Parenthood and Relationships
- New parents must learn new roles and expectations, which can affect communication between partners.
- Common feelings among new parents include ineptitude, fatigue, irritability, and loneliness.
- Parents should identify their own needs, set priorities, and maintain a sense of humor.
Fathers and Other Family Members
- Fathers go through four phases of adjustment: engrossment, having expectations and personal intentions, confronting reality, and reaping rewards.
- Siblings' reactions to the new baby depend on their age; preparation is essential.
- Grandparents' involvement is often dependent on physical proximity to the new family and may be dictated by cultural expectations.
The Grieving Family
- Therapeutic communication and nursing care are crucial in helping families deal with grief.
- The stages of grief include shock and disbelief, anger, guilt, sadness and depression, and gradual resolution of sadness.
The Family Care Plan
- The plan is individualized by family and considers cultural differences.
- It involves community resources and follow-up appointments.
- Selected Nursing Diagnosis: Compromised family coping resulting from a new family member (newborn).
- Goals: Family members will express satisfaction with adaptation to the newborn and confidence in their roles.
Rubin's Theory and the Puerperium Period
- The puerperium period refers to the 6 weeks following birth.
- According to Rubin's theory, new mothers go through psychological changes during the puerperium, influencing when parent teaching would be most effective.
Additional Notes
- Vaginal discharge that lasts about 3 days after giving birth is called lochia rubra.
- The recommended time frame for becoming pregnant after receiving rubella vaccine is 1 month.
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Description
Test your knowledge on providing nursing care during the postpartum period for families after birth. This quiz covers topics related to postpartum nursing care for both vaginal and cesarean deliveries.
