Postpartal Period: Maternal Needs

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Questions and Answers

What does a fundus that is boggy on examination indicate?

Normal uterine contraction

Successful uterine involution

Excessive bleeding (correct)

A distended bladder

During which stage of lochia is the discharge primarily yellowish and contains mainly white blood cells?

Lochia Granulosa

Lochia Serosa

Lochia Rubra

Lochia Alba (correct)

What should be done if the fundus remains boggy after massage?

Administer a pain reliever

Increase fluid intake

Continue to observe without intervention

Notify the physician (correct)

What characterizes the lochia during the Rubra stage?

Dark red with possible nickel-sized clots Signup and view all the answers

What is the primary function of colostrum produced in the early postpartum period?

To provide nutrients and immunity Signup and view all the answers

How does the fundus change post-delivery in the first 24 hours?

It rises to the umbilicus and stays there for about 12 hours Signup and view all the answers

What is a common physiological change that mothers experience after giving birth regarding their need for fluids?

Increased thirst due to fluid loss during delivery Signup and view all the answers

Which comfort measure is recommended for alleviating chills in a postpartum mother?

Covering with a warmed blanket Signup and view all the answers

What could potentially increase afterpains in a postpartum mother?

Nursing which stimulates the release of oxytocin Signup and view all the answers

What typical behavior indicates a mother is establishing an emotional connection with her infant?

Increasing face-to-face eye contact with the infant Signup and view all the answers

Which of the following is NOT a recommended comfort measure for managing flatulence in postpartum mothers?

Consuming high-fiber foods immediately after delivery Signup and view all the answers

What emotional response is common for mothers who do not form an immediate bond with their child post-delivery?

Feelings of separation and distance from the child Signup and view all the answers

Which of the following options best describes a recommended action for postpartum mothers experiencing diaphoresis?

Providing dry gowns and linens Signup and view all the answers

What is the primary focus of the acquaintance phase in maternal attachment?

The mother's recognition of the infant's needs and her responses to them Signup and view all the answers

Which of the following best describes the phase of mutual regulation in maternal attachment?

The mother balancing her own needs with those of the infant, recognizing cues from each other Signup and view all the answers

What aspect should be evaluated to assess the progression of maternal attachment?

Face-to-face eye contact and extended interactions with the infant Signup and view all the answers

What does the term 'engrossment' refer to in the context of paternal attachment?

The father's deep emotional involvement and pride concerning the infant Signup and view all the answers

Which factor is NOT considered a barrier to parental attachment?

Siblings feeling included and loved by parents Signup and view all the answers

How can siblings feel after the arrival of a new infant if not handled properly?

Overlooked and possibly left out or overshadowed Signup and view all the answers

Which of the following behaviors would indicate poor attachment from a mother?

Exhibiting apathy or displeasure in interactions with the infant Signup and view all the answers

What is a common outcome of a mother’s negative feelings during mutual regulation?

Fear of judgment regarding her parenting abilities Signup and view all the answers

Which of the following factors could inhibit proper parent-infant attachment in a neonatal intensive care setting?

Physical separation of the infant from the parent Signup and view all the answers

What misconception might parents have regarding their infant's lack of response?

The infant is rejecting them. Signup and view all the answers

What is a significant environmental factor that may affect parents in a neonatal unit?

Presence of medical devices creating auditory and visual stimuli Signup and view all the answers

Which practice should NOT be followed during bottle feeding to prevent choking in infants?

Propping the bottle in the infant's mouth Signup and view all the answers

What is the recommended duration for umbilical cord drying before it typically falls off?

10-14 days Signup and view all the answers

What is a critical action to take if the umbilical cord stump becomes soiled?

Wash with mild soap and water, then dry Signup and view all the answers

Which of the following signs should be reported immediately as a potential infection of the umbilical cord?

Erythema and purulent discharge from the area Signup and view all the answers

How should parents position the infant during feedings to minimize choking risks?

Seated upright in a parent’s lap with head elevated Signup and view all the answers

What role does the medical staff play in the context of parent-infant interactions?

Encouraging parents to bond and actively participate in care Signup and view all the answers

Which of the following is NOT a recommended practice for caring for an infant's umbilical cord stump?

Covering it with clothing to keep it warm Signup and view all the answers

What is the primary reason for positioning infants on their backs during sleep?

To reduce the risk of sudden infant death syndrome (SIDS) Signup and view all the answers

What is the safest practice for placing an infant in an infant car seat?

In the back seat, away from side airbags Signup and view all the answers

What method should be avoided when preparing an infant for their bath?

Using an adult tub for bathing Signup and view all the answers

What is the best approach to prevent diaper rash in infants?

Changing the infant's diaper promptly when soiled or wet Signup and view all the answers

How should an infant be supported during a bath to ensure safety?

With one arm under their upper back and neck Signup and view all the answers

What is the appropriate action if the umbilical cord becomes soiled?

Wash with mild soap and water, then rinse and dry Signup and view all the answers

Which statement is correct regarding the care of a non-circumcised penis?

Only water should be used during routine cleaning Signup and view all the answers

How should you position an infant while bathing?

Always support the baby's head and neck Signup and view all the answers

What is the recommended method for burping an infant?

Change positions if they do not burp after 2-3 ounces Signup and view all the answers

When should you report concerning signs in an infant's fontanels?

If the fontanel feels soft and sinks below the skull Signup and view all the answers

What should be avoided to prevent irritation of the umbilical cord stump?

Covering the stump with clothing Signup and view all the answers

Which observation may indicate an infection in an infant's circumcision site?

Erythema and purulent discharge Signup and view all the answers

Which positioning is recommended to prevent sudden infant death syndrome (SIDS)?

Positioning the baby on their back Signup and view all the answers

What is a safe practice when using an infant seat in a car?

Always face the infant seat backwards Signup and view all the answers

Which cleaning product should be avoided on a circumcision site until it heals?

Baby wipes or commercial soaps Signup and view all the answers

Study Notes

Maternal Physical Needs

The Fundus

After placenta expulsion, the uterus contracts to about grapefruit size, with the fundus located between the symphysis pubis and umbilicus.
Fundal height rises to the umbilicus within 6-12 hours after delivery, with excessive bleeding indicated by a boggy fundus.
On the first postpartum day, the fundus is about 1 cm below the umbilicus and descends 1 cm daily until no longer palpable (within 2 weeks).
A boggy uterus requires massage; failure to firm may need physician notification.

Lochia

Lochia is vaginal discharge post-delivery, averaging 240-480 ml, helping clear the uterus of debris.
Discharge stages include:
- Rubra (Days 1-3): Dark red, containing cells and clots up to nickel size.
- Serosa (Days 4-10): Pink/brown, lightening as red blood cells decrease.
- Alba (up to 85 days, average 24): Yellowish, mostly white blood cells and decidual cells.

Assessment of Breasts

Hormonal changes lead to increased milk production; fullness is normal but should not feel hard.
Breastfeeding should start immediately post-birth to support bonding and uterine contraction.
Colostrum is produced in small amounts initially, providing antibodies and nutrients.

Comfort Measures

Postpartum mothers may experience hunger, thirst, chills, diaphoresis, afterpains, and flatulence.
Adequate hydration and warm blankets help manage thirst and chills.
Afterpains may require analgesics, especially during breastfeeding.
Early ambulation and dietary adjustments can alleviate flatulence.

Attachment/Bonding

Maternal Attachment Processes

Touching involves slowly exploring the infant's body, with skin-to-skin contact enhancing attachment.
En face positioning allows increased eye contact and verbal responses, fostering connection.
Initial feelings of separation are normal but should gradually shift towards bonding.

Maternal Attachment Phases

Acquaintance: First few days focusing on responding to infant needs strengthens the bond.
Mutual regulation: Balancing infant and maternal needs, with negative feelings being a common experience.

Assessing Maternal Attachment

Evaluate progression in touching and eye contact to identify attachment issues.
Look for consistency in care and sensitivity to the infant's needs.
Assess the mother’s expression of happiness and engagement with the infant.

Paternal, Sibling, and Family Attachment

Fathers experience attachment, called engrossment, through early contact with the infant.
Siblings should be included in the process to foster their attachment and address feelings of being overshadowed.
Grandparents and family members also develop bonds with the infant.

Barriers to Parental Attachment

Physical separation from the infant impede bonding.
Lack of understanding concerning infant health issues may lead to misinterpreted rejection.
Negative staff attitudes can inhibit parental attachment.

Education for Infant Care

Choking or Gagging Prevention

Keep hazardous items out of infant reach.
Never prop bottles for feeding; burp the infant regularly during feedings.
Choking response involves positioning the infant face down and delivering gentle back thumps.

Umbilical Cord Care

The cord changes color from grayish to black before falling off in 10-14 days.
Protect from moisture; sponge baths recommended until the cord detaches.
Report signs of infection like redness or purulent discharge.

Circumcision Care

Clean the circumcision area gently, applying petrolatum jelly for protection.
Avoid using soaps until healing is complete; report unusual symptoms like increased swelling or discharge.

Non-Circumcised Penis and Fontanels

Infants' foreskin should not be retracted; wash with water only.
Fontanels should feel flat but firm; report any bulging or sinking signs.

Burping

Regular burping is essential to relieve infant discomfort; various positions can facilitate this.

Positioning and Safety

Place infants on their backs to prevent SIDS; alternate head positions to avoid flat spots.
Use proper infant seats in cars, ensuring safety during transit.

Bathing

Sponge baths until umbilical cord falls off (10-14 days) using mild soap or water only.
Always check bath water temperature; support the infant’s head and neck during baths.

Diaper Rash Prevention

Change diapers promptly to avoid irritation; cleanse gently with water.
Use barrier creams to prevent and treat diaper rash; contact a physician if rash worsens.

Fecal Elimination

Normal first stool is black and tarry, transitioning to yellow by day three for breastfeeding infants.
Monitor for abnormalities in stool, reporting any unusual findings.

Urinary Elimination

Wet diaper counts indicate hydration; typically, infants pass 6-8 wet diapers per day by day six.
Frequent checks are necessary, especially during or after feedings.### Diaper Care and Cradle Cap
Change diapers promptly when wet; use mild soap and water, plain water, or unscented baby wipes for cleansing.
Cradle cap presents as scaly or flaky skin on the scalp and face; it is non-contagious and resolves in 1-2 months without indicating poor hygiene.
Cleanse the affected areas thoroughly; gently rub with terry cloth or fingers to loosen crusts or flakes.
For persistent cradle cap, soften crusts with olive oil, wait 15 minutes, then brush or comb to loosen before washing with baby shampoo.

Discharge Education for Special Needs Infants

Family involvement and education are essential for the successful transition home of special needs infants.
Parents/guardians need preparation on appropriate care methods.
Teach parents to recognize and interpret the infant’s cues for needs, ensuring timely responses.

Feeding the Neonate

Feed neonates on demand, typically every 2-3 hours for breastfeeding and every 2-4 hours for bottle-feeding, totaling 8-12 feeds daily that last 20-40 minutes.
Recognize early hunger cues to feed the infant before they become distressed; signals include licking, rooting, sucking, clenched fists, hand-to-mouth motions, and head bobbing.
Stroking the infant’s cheek or lower lip may elicit a turning response, indicating hunger.
Monitor outputs such as diaper and stool counts; a decrease could signal dehydration or feeding issues.
Note infant-rest behaviors; some may rest at the breast before continuing feeding, and a satiated infant typically turns away from feeding.

Breastfeeding Techniques

Positioning

Ensure the baby faces the mother, tilting slightly to make eye contact, with the mouth positioned just below the nipple.
Cradle Hold: Baby is cradled in the arm on the nursing side, supported by a pillow; the opposite hand guides the nipple.
Cross-Cradle Hold: Support the baby's head with one arm while using the opposite hand to guide the breast.
Football Hold: Infant is positioned under the arm on the nursing side; the hand supports the back while the opposite hand cradles the head.
Side-Lying Hold: Similar to cradle hold, but mother reclines on her side to avoid pressure on the abdomen, supporting the infant with the nursing arm.

Latching and Let-Down

Positioning is crucial; grasp the breast using a C-hold or U-hold to firm it before guiding it to the infant.
Brushing the nipple against the infant’s mouth can stimulate them to open wide and latch onto the breast.
Ensure the infant's lower lip is low on the areola for an effective latch; both nipple and areola should be engaged for successful suckling.

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Description

This quiz covers the maternal physical needs during the postpartal period, focusing on the fundus after delivery. Understand the changes in the uterus and its role in preventing bleeding. Enhance your knowledge about maternal care during this critical time.