Postpartum Assessment and Nursing Care
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Postpartum Assessment and Nursing Care

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What is the weight of the uterus immediately after birth?

  • 500 g
  • 1,000 g (correct)
  • 50 g
  • 1,500 g

    • What stimulates uterine contractions during breastfeeding?

  • Progesterone
  • Prolactin
  • Oxytocin (correct)
  • Estrogen

    • How much does the uterus decrease in size per day during involution after childbirth?

  • 1 fingerbreadth, or 1 cm per day (correct)
  • 2 cm per day
  • 3 cm per day
  • Half a fingerbreadth, or 0.5 cm per day

    • Which condition may delay the involution of the uterus?

    <p>Grand multiparity</p> Signup and view all the answers

    When is the fundus of the uterus typically palpated after birth?

    <p>At the level of the umbilicus</p> Signup and view all the answers

    What might occur if the bladder is full shortly after birth?

    <p>Prevents uterine contraction, raising risk of hemorrhage</p> Signup and view all the answers

    By how much does the uterus weigh at the end of the involution process?

    <p>50 g</p> Signup and view all the answers

    What may happen if there are retained placenta or membranes?

    <p>Leads to ineffective uterine contraction</p> Signup and view all the answers

    What is a primary reason for the chills a woman may experience after childbirth?

    <p>Response to excess epinephrine production during labor</p> Signup and view all the answers

    During which phase of the puerperium is a woman likely to be more passive and prefer others to make decisions for her?

    <p>Taking-in phase</p> Signup and view all the answers

    What behavior is characteristic of the taking-hold phase?

    <p>Increased interest in infant care and decision-making</p> Signup and view all the answers

    What emotional state is common during the taking-in phase of the puerperium?

    <p>Confusion and uncertainty about motherhood</p> Signup and view all the answers

    How can nursing staff assist a woman in the taking-in phase?

    <p>Listening and allowing her to express feelings about her birth experience</p> Signup and view all the answers

    What physiological change may contribute to postpartum chills?

    <p>Sudden release of pelvic nerve pressure</p> Signup and view all the answers

    How long does the taking-in phase typically last after childbirth?

    <p>1 to 3 days</p> Signup and view all the answers

    What might a woman naturally feel during the taking-in phase?

    <p>A sense of wonder about her birth experience</p> Signup and view all the answers

    What happens to the external os after a vaginal birth?

    <p>It remains slightly open and appears slit-like.</p> Signup and view all the answers

    What is a characteristic change in the vagina after vaginal birth?

    <p>The vagina feels soft with few rugae.</p> Signup and view all the answers

    What effect does breastfeeding have on the vaginal walls during the postpartum period?

    <p>It may lead to thin-walled or fragile vaginal cells.</p> Signup and view all the answers

    What primary process occurs in the cervix after birth?

    <p>The cervix undergoes the formation of new muscle cells.</p> Signup and view all the answers

    What can mothers do to improve the strength and tone of the vagina post-birth?

    <p>Practice Kegel exercises.</p> Signup and view all the answers

    What symptom might mothers experience in the perineum immediately after birth?

    <p>Edema and tenderness.</p> Signup and view all the answers

    How do the labia majora and minora change after birth?

    <p>They remain atrophic and softened.</p> Signup and view all the answers

    What nonpharmacologic measures may be suggested for perineal comfort post-birth?

    <p>Applying ice or warm packs.</p> Signup and view all the answers

    What pharmacologic pain relievers should nurses discuss with the mother’s provider after birth?

    <p>Acetaminophen and ibuprofen</p> Signup and view all the answers

    What happens to levels of hCG and hPL within 24 hours after the placenta is no longer present?

    <p>They both decrease to negligible levels</p> Signup and view all the answers

    What is the normal daily urine output for a woman during the second to fifth day after birth?

    <p>2,000 ml to 3,000 ml</p> Signup and view all the answers

    How does the urinary system function in postpartum women shortly after childbirth?

    <p>It assists in ridding the body of excess accumulated fluid</p> Signup and view all the answers

    How long does follicle-stimulating hormone (FSH) remain low after childbirth?

    <p>12 days</p> Signup and view all the answers

    What is the typical blood loss range for a vaginal delivery?

    <p>300 to 500 ml</p> Signup and view all the answers

    What change is observed in the white blood cell count after childbirth?

    <p>It may escalate to 30,000 cells/mm3</p> Signup and view all the answers

    What is an essential consideration for the bladder during the immediate postpartal period?

    <p>Frequent assessment is needed to prevent damage</p> Signup and view all the answers

    What happens to varicosities after pregnancy?

    <p>They recede but rarely return to their pre-pregnancy appearance.</p> Signup and view all the answers

    Which hormone primarily drives milk production during lactation?

    <p>Prolactin</p> Signup and view all the answers

    What effect does relaxin have on bowel function after childbirth?

    <p>It may slow down the passage of stool through the bowel.</p> Signup and view all the answers

    What is the significance of encouraging the consumption of fruits and soluble fiber post-delivery?

    <p>They help keep stools naturally soft and ease bowel movements.</p> Signup and view all the answers

    What might occur if diastasis recti is present after delivery?

    <p>It may require surgical intervention to correct.</p> Signup and view all the answers

    Which condition is described as excessive pigment on the face and neck during pregnancy?

    <p>Chloasma</p> Signup and view all the answers

    What is the role of oxytocin in the lactation process?

    <p>Triggers the let-down reflex.</p> Signup and view all the answers

    What does bilateral ankle edema indicate during the postpartum period?

    <p>It is common but should not progress above the knees.</p> Signup and view all the answers

    Study Notes

    Postpartum Assessment and Nursing Care

    • Postpartum women often experience chills and a shaking sensation 10 to 15 minutes after birth. This is a normal phenomenon, often resulting from the release of pressure on pelvic nerves or increased epinephrine production during labor.
    • Reassure women that these chills are temporary, common, and pass quickly.
    • Behavioral Adjustment: Reva Rubin's three phases of the puerperium: Taking-in, Taking-hold, and Letting-go.
    • Taking-in Phase: (1-3 days)
    • Characterized by a passive and reflective period.
    • The woman prefers assistance with her needs and decision-making.
    • This phase is influenced by physical discomfort, uncertainty about caring for the newborn, and exhaustion.
    • Encourage conversations about the labor and birth to help the woman integrate the experience.
    • Taking-hold Phase:
      • The woman transitions from passive reliance to initiating action.
      • She shows more interest in her infant.
      • She exhibits maternal role behaviors and takes ownership of tasks.
    • Uterine Involution: The process of the uterus returning to its pre-pregnancy size
      • Begins immediately after placental delivery.
      • Fundal Height:
        • The fundus is palpable through the abdominal wall.
        • It descends one fingerbreadth (1 cm) daily.
      • Factors Influencing Involution:
      • Breastfeeding: Oxytocin release stimulates uterine contractions.
      • Bladder: A full bladder can displace the uterus.
      • Nutrition and Ambulation: Proper nutrition and early ambulation are essential.
      • Delayed Involution: Can be caused by multiple births, hydramnios, prolonged labor, multiparity, excessive analgesia, or retained placenta.
    • Cervical Involution: The cervix returns to its pre-pregnancy state.
    • The external os narrows to a pencil opening by day seven.
    • The internal os closes, while the external os remains slightly open, appearing slit-like or star-shaped.
    • Perineum:
    • May exhibit edema and tenderness due to pressure during labor.
    • Ecchymosis patches from ruptured capillaries may be visible.
    • Pain Management:
    • Provide comfort measures such as ice or warm packs, pillows, and donut cushions.
    • Discuss and administer pharmacologic pain relievers as prescribed.

    Systemic Changes

    • Hormonal System:
      • Pregnancy hormones decline rapidly after the placenta is delivered.
      • hCG and hPL levels are nearly negligible by 24 hours.
      • Estrogen, progesterone, and estradiol return to pre-pregnancy levels by week one.
      • FSH remains low for 12 days before rising, indicating the start of a new menstrual cycle.
    • Urinary System:
      • Diaphoresis and diuresis begin almost immediately to eliminate excess fluid.
      • Urine production can increase significantly in the first few days.
      • Reassure the woman that increased urine production is normal.
      • Assess Bladder: Frequently monitor bladder fullness and empty it regularly to prevent overdistention.
    • Circulatory System:
      • Blood volume returns to pre-pregnancy levels by the first or second week post birth due to diuresis and blood loss.
      • Normal blood loss during vaginal birth: 300-500 ml
      • Normal blood loss during cesarean delivery: 500-1000 ml.
      • Leukocytosis:
      • White blood cell count rises (mainly granulocytes) due to the body's defense system against infection and healing.
      • Vascular Blemishes: Spider angiomas may fade but not disappear entirely.
    • Gastrointestinal System:
      • Digestion and absorption resume quickly.
      • Bowel Function:
      • Passage of stool may be delayed due to relaxin effects.
      • Encourage fiber-rich foods and fluids for easy bowel movements.
    • Integumentary System:
      • Stretch marks remain prominent.
      • Chloasma and linea nigra will fade by 6 weeks.
      • Diastasis recti, requires strengthening of abdominal muscles to restore abdominal support.
    • Lactation:
    • Four phases of lactogenesis (milk production).
    • Prolactin is responsible for milk production, and oxytocin is responsible for the let-down reflex.
    • A retained placenta can inhibit this process.

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    Description

    This quiz covers essential postpartum assessment and nursing care strategies for new mothers. It highlights common physical responses after birth, such as chills, and outlines Reva Rubin's three phases of the puerperium. Understanding these concepts is crucial for providing effective care and support during this transitional period.

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