Podcast
Questions and Answers
Which of the following symptoms is commonly associated with postpartum depression (MDD)?
Which of the following symptoms is commonly associated with postpartum depression (MDD)?
What is the primary recommended action for a patient exhibiting symptoms of postpartum psychosis?
What is the primary recommended action for a patient exhibiting symptoms of postpartum psychosis?
How long does the baby blues typically last after childbirth?
How long does the baby blues typically last after childbirth?
Which sign indicates a potentially abnormal postpartum finding?
Which sign indicates a potentially abnormal postpartum finding?
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What is a key management strategy for paternal postnatal depression?
What is a key management strategy for paternal postnatal depression?
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During the transition to parenthood, what should be prioritized before teaching new parents about their infant's care?
During the transition to parenthood, what should be prioritized before teaching new parents about their infant's care?
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What observation is NOT considered a normal assessment finding in a neonate?
What observation is NOT considered a normal assessment finding in a neonate?
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When does ovulation typically occur in relation to menstrual cycles postpartum?
When does ovulation typically occur in relation to menstrual cycles postpartum?
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What is a potential cause of pathologic jaundice that occurs within the first 24 hours?
What is a potential cause of pathologic jaundice that occurs within the first 24 hours?
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Bulging fontanel may indicate which condition?
Bulging fontanel may indicate which condition?
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Tachycardia greater than 180 bpm may indicate which of these conditions?
Tachycardia greater than 180 bpm may indicate which of these conditions?
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What should be suspected if no meconium is passed within 48 hours?
What should be suspected if no meconium is passed within 48 hours?
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What immediate action should be taken if a patient shows signs of respiratory distress?
What immediate action should be taken if a patient shows signs of respiratory distress?
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What is the most immediate action to take when there is a sudden drop in O2 saturation?
What is the most immediate action to take when there is a sudden drop in O2 saturation?
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An infant displaying see-saw breathing patterns is likely experiencing what?
An infant displaying see-saw breathing patterns is likely experiencing what?
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What action is most important if an infant has a heart rate below 60 breaths per minute?
What action is most important if an infant has a heart rate below 60 breaths per minute?
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Which of the following symptoms is associated with severe preeclampsia or eclampsia?
Which of the following symptoms is associated with severe preeclampsia or eclampsia?
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A temperature greater than 100.4°F in an infant can indicate which of the following?
A temperature greater than 100.4°F in an infant can indicate which of the following?
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What intervention should be performed if the fundus is found to be boggy and elevated?
What intervention should be performed if the fundus is found to be boggy and elevated?
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What is a sign of secondary (late) postpartum hemorrhage?
What is a sign of secondary (late) postpartum hemorrhage?
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Which management approach is appropriate for metritis?
Which management approach is appropriate for metritis?
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Which condition presents with painful swelling and a normal fundus?
Which condition presents with painful swelling and a normal fundus?
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What should NOT be done if there is pus present in breast milk due to mastitis?
What should NOT be done if there is pus present in breast milk due to mastitis?
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What are risk factors for urinary tract infections (UTI) in postpartum patients?
What are risk factors for urinary tract infections (UTI) in postpartum patients?
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What is the correct frequency for assessing a postpartum patient during the first hour after delivery?
What is the correct frequency for assessing a postpartum patient during the first hour after delivery?
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What type of lochia is expected immediately after delivery?
What type of lochia is expected immediately after delivery?
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Which of the following vital sign changes could indicate a hemorrhage in a postpartum patient?
Which of the following vital sign changes could indicate a hemorrhage in a postpartum patient?
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Which assessment finding is concerning for hemorrhage in fundal evaluation?
Which assessment finding is concerning for hemorrhage in fundal evaluation?
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What findings may indicate a potential infection postpartum?
What findings may indicate a potential infection postpartum?
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What does the acronym 'BUBBLE-HE' stand for in postpartum assessments?
What does the acronym 'BUBBLE-HE' stand for in postpartum assessments?
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What constitutes excessive bleeding in a vaginal delivery?
What constitutes excessive bleeding in a vaginal delivery?
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What does a decrease in SpO2 indicate in a postpartum patient?
What does a decrease in SpO2 indicate in a postpartum patient?
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Study Notes
Postpartum Physiological Assessments, Nursing Care, and High-Risk Postpartum Care
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Postpartum Assessments and Frequency:
- First Hour: Assess every 15 minutes for 1 hour.
- Next Hour: Assess every 30 minutes for 1 hour.
- Next 22 Hours: Assess every 4 hours.
- After 24 Hours: Assess every shift.
Assessing for Hemorrhage and Other Complications
- Hemorrhage: Check for signs of DIC (Disseminated Intravascular Coagulation), AFE (Amniotic Fluid Embolism), PE (Pulmonary Embolism), HELLP, or Eclampsia.
Vital Signs
- Temperature: Low-grade fever is normal; higher suggests infection.
- Blood Pressure (BP): Hypotension may indicate hemorrhage; hypertension suggests preeclampsia/eclampsia.
- Heart Rate (HR): Tachycardia may indicate hemorrhage, infection, or PE.
- Respiratory Rate (RR): Elevated RR may indicate infection, PE, or hemorrhage.
- SpO2: A drop in O2 saturation could signal PE, hemorrhage, or anaphylaxis.
- Pain: Document and treat appropriately.
Lochia
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Color, Amount, and Odor:
- Rubra: Bright red, immediately post-delivery (days 1-3).
- Serosa: Pink to brown, after 3-7 days.
- Alba: White/yellowish, from 10 days to 6 weeks. Check for foul odor (indicates potential infection).
Fundus
- Assessment Position: Have the patient void before assessment, then assess while lying supine.
- Fundal Height (U): Should be at or below the umbilicus after delivery.
- Tone: Should be firm; a boggy fundus is concerning for hemorrhage.
- Location: Should be midline; deviation may indicate a full bladder.
- Shift Head-to-Toe Add-Ons: BUBBLE-HE (Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy (or Laceration), Homan's sign (for DVT), Emotions). REEDA (Redness, Edema, Ecchymosis, Drainage, Approximation).
Critical Findings
- Infection: Purulent discharge (foul odor), fever, tachycardia, tachypnea, pain. Potential complications include mastitis, metritis, or wound infection.
- Bleeding: Excessive bleeding (>500 mL for vaginal delivery or >1000 mL for cesarean delivery). Signs include tachycardia, hypotension, cool/clammy skin, dizziness, pallor.
- Boggy and Deviated Fundus (Hemorrhage Signs): Have the patient void, massage the fundus until firm, and administer Oxytocin (IV or IM)
Preeclampsia/Eclampsia, HELLP (DIC)
- Symptoms: Hypertension (>160/100), headache, nausea, blurred vision, RUQ pain, edema, bleeding, petechiae, purpura.
Sudden Drop in O2 Saturation
- Causes: Anaphylaxis, PE, or hemorrhage. Immediate action: Assess, provide O2, and call for assistance.
Hemorrhage Management
- Fundus: Firm and midline for proper involution..
- Primary (Early) PPH (First 24 Hours): Uterine atony (boggy, elevated, deviated fundus). Intervention: Massage fundus, encourage voiding or catheterize. Other issues: Lacerations, hematomas.
- Secondary (Late) PPH (After 24 Hours): Identify possible causes, which may include retained placental fragments, subinvolution.
Infection (Mastitis, Metritis, Wound Infection)
- Risk Factors: DM, obesity, immunocompromised, poor hygiene.
- Symptoms: Redness, swelling, pain. Need for antibiotics, wound care, ongoing monitoring.
Other Complications
- Disseminated Intravascular Coagulation (DIC): Excessive bleeding, bruising, petechiae, purpura.
- Anaphylaxis: Swelling, rash, difficulty breathing. Treat with epinephrine and emergency support.
- VTE/DVT/PE: Symptoms of swelling, redness, pain in one leg, and sudden shortness of breath or chest pain. Management: Anticoagulation therapy, supportive care, and monitoring.
Psychological Disorders
- Baby Blues: Timeframe: 1-2 weeks postpartum. Symptoms: Mood swings, irritability, anxiety, fatigue. Treatment: Reassurance, emotional support.
- Postpartum Depression (MDD): Timeframe: Persistent sadness, fatigue, difficulty bonding with baby.
Discharge Teaching
- Normal vs. Abnormal Postpartum Findings: Lochia (normal (rubra, serosa, alba); foul odor or heavy bleeding=abnormal), Involution, and afterpains. Other areas needing teaching: Postpartum Depression, Hemorrhage risk, Contraception.
- Transition to parenthood: Ensure the parent's needs are met before beginning education. Evaluate understanding. Provide support, avoid retraumatization, and promote successful grieving (DABDA)
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Description
This quiz covers postpartum physiological assessments and nursing care, including vital signs monitoring and risk factors for complications such as hemorrhage and infection. Test your knowledge on assessment frequencies and the signs of serious postpartum conditions to ensure comprehensive patient care.
