Postpartum Assessment Quiz

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Questions and Answers

What is the normal temperature range for a postpartum assessment?

36-37°C

36.2-38°C (correct)

37.5-39°C

35.5-37.5°C

Which symptom could indicate a complication during the postpartum assessment regarding pulse?

Regular rhythm

Consistent rate

Bradycardia

Tachycardia (correct)

What is a normal finding for the firmness of the breasts on postpartum day 3?

Firm with tenderness

Engorged

Full and softening (correct)

Very soft

What level of blood pressure is consistent with normal findings in postpartum women?

120/80 mm Hg Signup and view all the answers

Which of the following could indicate potential mastitis in a postpartum patient?

Firmness, heat, and pain in breasts Signup and view all the answers

What is an abnormal respiratory finding in a postpartum assessment?

Bradypnea Signup and view all the answers

What indicates that the fundus in a postpartum assessment is abnormal?

Fundus is higher than expected Signup and view all the answers

What is a normal finding regarding the rectal area during a postpartum assessment?

There should be no abnormalities reported Signup and view all the answers

What does a boggy fundus indicate?

Potential uterine atony Signup and view all the answers

How should a nurse assess the position of the uterus postpartum?

Check if it is shifted to the left or right Signup and view all the answers

What is a normal finding for bladder emptying postpartum?

Complete emptying without difficulty Signup and view all the answers

Which of the following colours of lochia indicates the earliest postpartum days?

Rubra (dark red) Signup and view all the answers

What intervention should a nurse first perform to prevent bladder distension?

Establish a voiding schedule Signup and view all the answers

What factor may suggest a potential infection at the C-section incision site?

Presence of warmth and drainage Signup and view all the answers

Which of the following conditions is characterized by rapid mood swings and confusion?

Postpartum Psychosis Signup and view all the answers

What is the expected timing for the onset of bowel movement postpartum after a normal vaginal birth?

By day 2 or 3 Signup and view all the answers

What is one of the first assessments for perineal trauma after episiotomy or laceration?

Check for hematoma formation Signup and view all the answers

Which symptom is NOT associated with postpartum depression?

Crying spells Signup and view all the answers

What is the recommended action for a patient experiencing difficulty voiding 6-8 hours postpartum?

Perform a bladder scan to assess distention Signup and view all the answers

Which technique is recommended for postpartum perineal cleansing?

Employing front-to-back motions with the peri-bottle Signup and view all the answers

Which strategy can support emotional health in new mothers experiencing postpartum blues?

Encouraging time for self-care activities Signup and view all the answers

What constitutes primary postpartum hemorrhage (PPH)?

Occurs within 24 hours of birth Signup and view all the answers

Which factor is NOT a risk factor associated with hypovolemic shock post-birth?

Excessive weight gain during pregnancy Signup and view all the answers

Which breastfeeding promotion strategy has demonstrated health benefits related to postpartum hemorrhage (PPH)?

Skin-to-skin contact and early initiation of breastfeeding Signup and view all the answers

What is the recommended action if a mother experiences heavy bleeding postpartum?

Notify a healthcare provider immediately Signup and view all the answers

When should Rh immune globulin (Rhig) be administered to Rh-negative women postpartum?

Within 72 hours postpartum if the baby is Rh-positive Signup and view all the answers

Which of the following is a key component of postpartum self-care nutrition?

Balanced diet and hydration for energy and lactation Signup and view all the answers

Which psychological warning sign following childbirth indicates the need for immediate professional help?

Persistent feeling of sadness or hopelessness Signup and view all the answers

What immediate measures should be taken for a mother experiencing hypovolemic shock?

Administer oxygen and maintain IV fluids Signup and view all the answers

What is a common symptom of secondary postpartum hemorrhage?

Occurs between 24 hours to 12 weeks after birth Signup and view all the answers

Which guideline is important for preventing breast engorgement when suppressing lactation?

Wearing a supportive bra for 72 hours Signup and view all the answers

What is an appropriate follow-up timeframe for a mother postpartum without complications?

6 weeks after discharge Signup and view all the answers

What can be done to support breastfeeding immediately after birth?

Assist with breastfeeding within 1-2 hours after birth Signup and view all the answers

Which condition does NOT require immediate medical intervention is a postpartum warning sign?

Light menstrual-like cramping Signup and view all the answers

Which of the following is NOT a method to help prevent Rh isoimmunization?

Providing rubella vaccination during pregnancy Signup and view all the answers

What is the normal respiratory rate range for a postpartum woman?

12–24 breaths/min Signup and view all the answers

Which finding is considered a sign of potential complications regarding the condition of the breasts postpartum?

Softness with redness and heat Signup and view all the answers

What is the indication of a boggy fundus during a postpartum examination?

Abnormal uterine tone requiring intervention Signup and view all the answers

Which of the following conditions is indicated by tachycardia in a postpartum assessment?

Hemorrhage Signup and view all the answers

Which clinical sign suggests the need for further evaluation regarding the temperature postpartum?

Temperature remains at 38°C after 24 hours Signup and view all the answers

What could indicate a potential infection during a postpartum assessment of the nipples?

Presence of redness, heat, and pain Signup and view all the answers

What blood pressure reading is considered a sign of hypertension in a postpartum woman?

140/90 mm Hg Signup and view all the answers

Which statement is true regarding postpartum discharge criteria?

Patient must demonstrate stable vital signs. Signup and view all the answers

What does a fundal height above the umbilicus indicate?

Bladder distention Signup and view all the answers

Which nursing action is appropriate for a boggy fundus?

Performing uterine massage Signup and view all the answers

What indicates a normal bladder function postpartum?

Absence of bladder distention Signup and view all the answers

What is a common characteristic of lochia rubra?

Dark red color for the first few days Signup and view all the answers

What is a significant sign of postpartum psychosis that requires immediate attention?

Hallucinations Signup and view all the answers

What nursing intervention can help reduce the risk of urinary stasis?

Establishing a regular voiding schedule Signup and view all the answers

Which nursing assessment would indicate a potential infection at a C-section incision site?

Pronounced edema and warmth Signup and view all the answers

What should nursing interventions after an episiotomy include?

Encouraging sitz baths twice a day Signup and view all the answers

What is a normal finding when assessing bowel function postpartum?

Active bowel sounds in all quadrants Signup and view all the answers

What typical emotional sign indicates postpartum blues?

Crying spells without a clear cause Signup and view all the answers

Which nursing intervention is recommended to promote pelvic floor strength postpartum?

Encouraging Kegel exercises Signup and view all the answers

What is a typical duration for observing postpartum depression symptoms before seeking help?

Symptoms that persist beyond 2 weeks Signup and view all the answers

What should a nurse monitor for when assessing the legs postpartum?

Presence of varicosities and pain Signup and view all the answers

Which of the following lochia types indicates a longer postpartum duration?

Lochia alba Signup and view all the answers

What is the maximum amount of blood loss classified as postpartum hemorrhage after a C-section?

1,000 mL Signup and view all the answers

Which type of postpartum hemorrhage occurs more than 24 hours after birth?

Secondary PPH Signup and view all the answers

Which of the following is a common risk factor for uterine atony?

High parity Signup and view all the answers

What should be the first action taken when a patient exhibits signs of hypovolemic shock?

Notify the provider Signup and view all the answers

Which of the following is NOT a sign of hypovolemic shock?

Warm, dry skin Signup and view all the answers

What is the recommended action to manage breast engorgement in a mother who is suppressing lactation?

Supportive bra for 72 hours Signup and view all the answers

What dosage of Rh immune globulin is recommended for Rh-negative women postpartum?

300 mcg Signup and view all the answers

Which of the following describes a psychological warning sign that requires immediate attention postpartum?

Persistent sadness Signup and view all the answers

In what time frame should a mother have her routine checkup after a C-section?

6 weeks Signup and view all the answers

Which practice is recommended to promote early breastfeeding after birth?

Skin-to-skin contact Signup and view all the answers

Which intervention should be performed to manage heavy postpartum bleeding?

Massaging the fundus Signup and view all the answers

What type of follow-up care involves assessing the mother and baby at home?

Community health nurse visits Signup and view all the answers

Which dietary recommendation is essential for postpartum self-care?

Balanced diet and hydration Signup and view all the answers

Study Notes

Course is about nursing care of the family during postpartum.
Instructor is Krissy Jordan, RN, MSCN, PhD Candidate.
Course is part of York University.

Learning Objectives

Understand components of a systematic postpartum assessment and post-partum nursing care.
Learn criteria and teaching plan for postpartum discharge.

Postpartum Physical Assessments

Vital signs, including temperature, pulse, respirations, blood pressure.
Breath sounds.
Rectal area assessment.

Vital Signs

Normal Findings: Temperature (36.2-38°C), Pulse (60-100 beats/min), Respirations (12-24 breaths/min), Blood pressure consistent with baseline (120/80 mmHg), clear breath sounds.
Signs of Complications: Temperature ≥ 38°C after 24 hours (possible infection), Tachycardia (possible hemorrhage), Bradypnea/Tachypnea (possible complications), Hypertension/Hypotension (possible complications), Crackles (possible fluid overload).

Breasts & Nipples

Breasts: Size, Shape, Firmness, Redness and Heat, Symmetry.
Nipples: Size, Shape, Integrity, Tenderness.
Normal Findings (Breasts): Day 1-2: Soft, Days 2-3: Filling, Days 3-5: Full, softens with breastfeeding. Skin intact, no soreness reported.
Potential Complications (Breasts): Firmness, heat, pain (possible engorgement), Redness, heat, pain, fever, body aches (potential mastitis).

Uterus

Fundus: Firm or soft, boggy; higher than expected level.
Fundal Height: In relation to umbilicus; First 24 hours at level of umbilicus; involutes 1-2cm/day.
Documentation: "1/U = 1 finger above the umbilicus," "@ U" = At umbilicus," U/1 = 1 finger below the umbilicus".
Location: Midline or deviated to the left or right (deviating usually indicates a full bladder).

Nursing Considerations for Maintaining Uterine Tone

Stimulation through gentle fundal massage.
Boggy fundus may indicate uterine atony (increased risk of postpartum hemorrhage (PPH)).
Nursing Actions: Perform uterine massage, encourage patient to void, utilize uterotonic medications (Oxytocin), and contact a medical professional (likely MRP).

Bladder

Establish a voiding schedule to prevent bladder distention and urinary stasis.
Encourage urination prior to breastfeeding.
Normal findings: Able to void spontaneously within 8 hours, no bladder distension, able to empty bladder completely, no dysuria (painful urination), diuresis begins within 12 hours after birth.

Nursing Interventions in Preventing Bladder Distinction

Empty the bladder as soon as possible, assist/ambulate the patient to promote voiding, use pain medications for discomfort during voiding, use a peri-bottle after voiding for hygiene, and comfort, use intermittent urinary catheters if necessary (if patient doesn't void within 6-8 hours of delivery), and encourage Kegel exercises.

Bowels

Passing flatus: Soon after vaginal birth.
Bowel movements: Within 2-3 days.
Active bowel sounds: All four quadrants (especially for C-section).
Nursing care: Measures to avoid constipation, ambulation or rocking to stimulate bowel movement, increase fiber and fluid intake, and use stool softeners as needed.

Lochia

Color: Rubra (dark red; birth to 3-4 days), Serosa (brownish red or pink; day 4 to 2-4 weeks), Alba (yellowish white; after 10-14 days)
Odor: "No odour" or "foul"
Amount: Scant, Moderate, Heavy
Presence of clots: Cherry, peach, or plum or golf size.

Legs

Peripheral edema may be present.
Observe for redness, tenderness, pain, venous thromboembolism (VTE).
Observe for varicosities.

Episiotomy/Laceration or CS Birth Incision

Perineal area assessment: Check for episiotomy or vaginal tearing, hematoma formation, and hemorrhoids.
Use REEDA scale to grade severity of perineal trauma associated with episiotomy or lacerations.
Normal findings: Minimal edema, episiotomy or laceration edges approximated, C-section incision: Dressing clean and dry, suture line intact.
Abnormal findings: Pronounced edema, bruising or hematoma, redness, warmth, and drainage, possible infection.
C-section incision: Redness, edema, warmth, drainage - potential infection.

Nursing Interventions (Episiotomy, Lacerations & Hemorrhoids)

Cleansing (front-to-back, post-void and stool, at least 4 times daily), ice pack (first 24 hours), squeeze bottle (peri-bottle), and Sitz baths (X2/day for 20 minutes), and topical applications.

Emotional Status

Caregiving of self and baby is an indicator of emotional status.
Note patient's response to health teaching, affect, eye contact, and interests in newborn and adjustment to postpartum.
If concerned, discuss with a medical professional (likely MRP) the need for referral to a Social Worker.
Psychological assessment: Use Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder scale (GAD-7).
Emotional conditions: Postpartum blues, Postpartum depression, and Postpartum psychosis.

Signs of Postpartum Blues, Depression, or Psychosis

Baby blues: Sad, anxious, overwhelmed feelings, crying spells, loss of appetite, difficulty sleeping (lasting more than 2 weeks).
Postpartum depression: Persistent symptoms of baby blues, thoughts of self-harm or harm to baby, loss of interest in baby, hallucinations, confusion, rapid mood swings.
Postpartum psychosis: Any symptoms of psychosis should be reported immediately, including worsening symptoms, inability to function, or thoughts of harming self or baby

Postpartum Blues

Affects 50-80% of new mothers, typically begins within days of birth, and peaks around day 5, resolving by day 10.
Associated symptoms include: Emotional lability, easy crying, sadness, anxiety, fatigue, restlessness, insomnia, anger, mild depression.
Management: Reassurance and support; encourage self-care activities (sleep, relaxation, outings). Social support is beneficial; consider community resources and childcare.

Postpartum Hemorrhage (PPH)

Leading cause of maternal death worldwide.
Risk for all patients post-birth.
Definition: Loss of ≥500 mL blood after vaginal birth, ≥1,000 mL after C-section.
Types: Primary (occurs within 24 hours of birth), Secondary (occurs >24 hours to 12 weeks post-birth).
Risk Factors/Causes: Uterine atony, trauma, retained tissue, thrombocytopenia.
Management: Immediate assessment & intervention for bleeding control (massage fundus), oxytocic medications, surgical intervention if needed.
Prevention: Early recognition and prompt treatment to reduce maternal mortality.

Hypovolemic Shock

Signs and Symptoms: Rapid bleeding, weakness, lightheadedness, nausea/seeing stars, anxiety, reluctance to hold baby, ashen/grey skin, cool/clammy, increased pulse/respirations, decreased urine output, and declining BP.
Immediate Actions: Notify provider, uterine intervention (massage), oxygen (8-10 L/min), position (tilt/elevate legs 30°), IV support, further measures (blood transfusion, urinary catheter, prepare for surgery).

Breastfeeding

Promotion: Early initiation (skin-to-skin contact and breastfeeding within 1-2 hours after birth), health benefits, support (assess latch, education on cue-based feeding), and community resources.
Suppression: Indications (not breastfeeding/infant loss), use of supportive bra, avoidance of stimulation, management of breast engorgement.

Health Promotion for Future Pregnancies

Rubella vaccination (administer MMR vaccine if non-immune, given postpartum, safe for breastfeeding), prevention of Rh isoimmunization (standard dosage, antepartum prevention @26-28 weeks gestation, and within 72 hours if positive).

Postpartum Self-Care: Key Essentials

Nutrition: Balanced diet & hydration, additional iron may be needed for low hemoglobin levels.
Exercise: Gentle walking and stretching, gradually increase activity, kegel exercises for bladder control.
Medications: NSAIDs or stool softeners, clearly defined dosage, timing, and side effects given at discharge.
Family Planning: Contraception options, consider non-hormonal and lactation-safe methods.

Postpartum Warning Signs

Physical signs: Heavy bleeding (soaking more than 1 pad/hour or passing large clots), severe abdominal pain, fever, severe headache, leg swelling/pain, wound infection, painful urination.
Psychological signs: Postpartum depression/anxiety, suicidal thoughts, and breastfeeding concerns/difficulties.

Postpartum Follow-up After Discharge

Routine checkups: Mother (6-week visit, or 2 weeks for C-section/complications), newborn (3-5 days after birth or 48-72 hours).
Home visits: Community health nurses assess mother, baby, and environment and provide education to support breastfeeding.
Telephone follow-up: Postpartum calls for health checks, teaching, and support, Outcomes: Better breastfeeding, reduced depression, higher satisfaction
Warm Lines/Consultation Services: Non-crisis support for feeding, crying, etc.
Support groups: Peer connections.
Community Resources: Referrals to local/national services tailored to family needs.

Summary, Education/Anticipatory Guidance

Specific patient education points (breastfeeding, newborn feeding, normal physiological changes, voiding/bowel patterns, self-care, pain management, recognizing symptoms needing follow-up).
Review of discharge medication and community resources.
Discussion of postpartum blues/perinatal depression.
Information on family planning and sex education/concerns.
Information on who the primary health care provider is and contact information.
Includes information on rubella status, MMR vaccination dates, rh immune globulin, and other relevant tests/procedures.

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Description

Test your knowledge on the normal parameters and potential complications during postpartum assessments. This quiz covers vital signs, breast firmness, and other key indicators relevant to postpartum care. Perfect for nursing students and healthcare professionals.