Postpartum Nursing Care and Assessments
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Questions and Answers

Which of the following symptoms is commonly associated with postpartum depression (MDD)?

  • Mood swings
  • Irritability
  • Persistent sadness (correct)
  • Swelling in one leg

What is the primary recommended action for a patient exhibiting symptoms of postpartum psychosis?

  • Suggest therapy sessions
  • Monitor her alone with the baby
  • Admit to psychiatric care (correct)
  • Provide emotional support at home

How long does the baby blues typically last after childbirth?

  • 1-2 weeks (correct)
  • 3-4 weeks
  • Up to a year
  • 1-2 days

Which sign indicates a potentially abnormal postpartum finding?

<p>Foul odor from lochia (D)</p> Signup and view all the answers

What is a key management strategy for paternal postnatal depression?

<p>Participation in support groups (C)</p> Signup and view all the answers

During the transition to parenthood, what should be prioritized before teaching new parents about their infant's care?

<p>Meeting physical needs (C)</p> Signup and view all the answers

What observation is NOT considered a normal assessment finding in a neonate?

<p>Foul odor from umbilical cord (B)</p> Signup and view all the answers

When does ovulation typically occur in relation to menstrual cycles postpartum?

<p>Before the first menstrual cycle (A)</p> Signup and view all the answers

What is a potential cause of pathologic jaundice that occurs within the first 24 hours?

<p>Hemolytic disease (C)</p> Signup and view all the answers

Bulging fontanel may indicate which condition?

<p>Increased intracranial pressure (ICP) (A)</p> Signup and view all the answers

Tachycardia greater than 180 bpm may indicate which of these conditions?

<p>Respiratory distress syndrome (RDS) (C)</p> Signup and view all the answers

What should be suspected if no meconium is passed within 48 hours?

<p>Hirschsprung's disease (C)</p> Signup and view all the answers

What immediate action should be taken if a patient shows signs of respiratory distress?

<p>Assess oxygen levels (D)</p> Signup and view all the answers

What is the most immediate action to take when there is a sudden drop in O2 saturation?

<p>Assess and provide oxygen (A)</p> Signup and view all the answers

An infant displaying see-saw breathing patterns is likely experiencing what?

<p>Severe respiratory distress (C)</p> Signup and view all the answers

What action is most important if an infant has a heart rate below 60 breaths per minute?

<p>Administer O2 if needed (D)</p> Signup and view all the answers

Which of the following symptoms is associated with severe preeclampsia or eclampsia?

<p>Blurred vision (C)</p> Signup and view all the answers

A temperature greater than 100.4°F in an infant can indicate which of the following?

<p>Infection (C)</p> Signup and view all the answers

What intervention should be performed if the fundus is found to be boggy and elevated?

<p>Massage the fundus until firm (D)</p> Signup and view all the answers

What is a sign of secondary (late) postpartum hemorrhage?

<p>Change in lochia color (A)</p> Signup and view all the answers

Which management approach is appropriate for metritis?

<p>Antibiotics, often broad-spectrum (D)</p> Signup and view all the answers

Which condition presents with painful swelling and a normal fundus?

<p>Hematoma (B)</p> Signup and view all the answers

What should NOT be done if there is pus present in breast milk due to mastitis?

<p>Pump the breast (D)</p> Signup and view all the answers

What are risk factors for urinary tract infections (UTI) in postpartum patients?

<p>Dehydration and Cesarean section (A)</p> Signup and view all the answers

What is the correct frequency for assessing a postpartum patient during the first hour after delivery?

<p>Every 15 minutes (D)</p> Signup and view all the answers

What type of lochia is expected immediately after delivery?

<p>Rubra (C)</p> Signup and view all the answers

Which of the following vital sign changes could indicate a hemorrhage in a postpartum patient?

<p>Tachycardia and hypotension (A)</p> Signup and view all the answers

Which assessment finding is concerning for hemorrhage in fundal evaluation?

<p>Boggy fundus (A)</p> Signup and view all the answers

What findings may indicate a potential infection postpartum?

<p>Foul odor, tachycardia, and fever (A)</p> Signup and view all the answers

What does the acronym 'BUBBLE-HE' stand for in postpartum assessments?

<p>Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy, Homan's sign, Emotions (D)</p> Signup and view all the answers

What constitutes excessive bleeding in a vaginal delivery?

<blockquote> <p>500 mL (C)</p> </blockquote> Signup and view all the answers

What does a decrease in SpO2 indicate in a postpartum patient?

<p>Potential pulmonary embolism or hemorrhage (C)</p> Signup and view all the answers

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Flashcards

Postpartum Assessment Frequency

The frequency of postpartum assessments varies depending on the time after delivery. In the first hour, assessments are performed every 15 minutes, followed by every 30 minutes for the next hour, every 4 hours for the next 22 hours, and then every shift after 24 hours.

Hemorrhage Signs

Signs of postpartum hemorrhage include tachycardia, hypotension, cool and clammy skin, dizziness, and pallor.

Lochia Rubra

Lochia rubra is the bright red vaginal discharge present immediately after delivery, lasting from days 1-3.

Fundal Assessment Position

The best position for a fundal assessment is with the patient lying supine, after she has voided.

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Boggy Fundus

A boggy fundus is a soft, spongy uterus, a concerning finding that may indicate postpartum hemorrhage.

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BUBBLE-HE

BUBBLE-HE is a postpartum assessment mnemonic that represents Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy (or Laceration), Homan's sign (for DVT), and Emotions

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REEDA

REEDA is a mnemonic used for assessing the posterior perineum, standing for Redness, Edema, Ecchymosis, Drainage, and Approximation

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Signs of Postpartum Infection

Signs of postpartum infection include purulent discharge with a foul odor, fever, tachycardia, tachypnea, and pain.

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What is Uterine Atony?

A condition where the uterus doesn't contract properly after childbirth, leading to excessive bleeding.

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How do you manage Uterine Atony?

Massage the fundus, encourage voiding or catheterize for retained urine, and administer Oxytocin.

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What is a Laceration?

A tear in the vaginal wall or cervix during labor.

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What is a Hematoma?

A collection of blood in the tissues near the vagina or perineum after delivery.

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What causes Secondary PPH?

Retained placental fragments or subinvolution of the uterus (failure of the uterus to shrink back to normal size).

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What are the signs of Secondary PPH?

Abnormal lochia: foul odor, change in color, and fever.

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What are the signs of Mastitis?

Redness, warmth, fever, and pain in the breast.

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What is Metritis?

Infection of the uterus after childbirth.

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Pathologic Jaundice

Jaundice appearing within the first 24 hours of life, potentially leading to neurological damage.

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Phototherapy

Treatment for pathologic jaundice using bili lights to break down bilirubin in the blood.

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Bulging Fontanel

A bulging soft spot on the baby's head, indicating increased intracranial pressure (ICP).

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Sunken Fontanel

A sunken soft spot on the baby's head, suggesting dehydration.

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See-Saw Breathing

An abnormal breathing pattern where the chest and abdomen move in opposite directions, indicating respiratory distress.

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Tachycardia

A heart rate greater than 180 beats per minute, potentially due to fever, infection, or other factors.

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Respiratory Distress Syndrome (RDS)

A serious lung condition in newborns, often causing tachypnea (rapid breathing) and cyanosis (bluish skin).

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Necrotizing Enterocolitis (NEC)

A serious intestinal condition affecting newborns, often causing abdominal distension and decreased bowel sounds.

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DVT Symptoms

Swelling, redness, and pain in one leg. Can also include sudden shortness of breath and chest pain.

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DVT Management

Treatment focuses on preventing the clot from growing and breaking off. This includes anticoagulation therapy (thinning the blood), supportive care, and monitoring.

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Baby Blues

A common experience after childbirth, characterized by mood swings, irritability, anxiety, and fatigue. It usually lasts for 1-2 weeks.

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Postpartum Depression

Persistent sadness, fatigue, and difficulty bonding with the baby. It can last up to a year after childbirth.

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Postpartum Psychosis

A serious condition characterized by delusions, hallucinations, and suicidal thoughts. Requires immediate psychiatric care.

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Paternal Postnatal Depression

New dads can also experience depression, characterized by irritability, fatigue, and low mood.

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Normal Lochia

The vaginal discharge after birth, which changes color over time: Rubra (red), Serosa (pinkish), and Alba (white).

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Transition to Parenthood Teaching

Providing education and support to new parents about caring for their newborn. This should be done after addressing any immediate needs of the parents and baby.

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Study Notes

Postpartum Physiological Assessments, Nursing Care, and High-Risk Postpartum Care

  • 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

  • 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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Related Documents

Postpartum Physiological Assessments Study Guide PDF

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.

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