Postpartum Nursing Care Assessments

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Questions and Answers

What is a key symptom of yeast candidiasis?

Severe abdominal pain

Cottage cheese discharge (correct)

Nausea

Heavy bleeding

What is an important instruction for a patient preparing for a PAP test?

Refrain from eating 24 hours prior

Stop all medications before the test

No intercourse for 48 hours (correct)

Drink an increased amount of fluids

Which of the following statements about hysterectomy is true?

Patient should remain NPO after surgery (correct)

It eliminates the risk of all infections

It is recommended for all patients with fibroids

It is considered a minor procedure

Which of the following complications is associated with PCOS?

Hypertension Signup and view all the answers

What is a potential risk associated with menopause?

Higher risk of heart attack Signup and view all the answers

What signs indicate a potential infection in a postpartum patient?

Purulent discharge with fever and tachycardia Signup and view all the answers

Which finding is consistent with primary postpartum hemorrhage?

Boggy and elevated fundus Signup and view all the answers

What is a common critical finding in a patient with preeclampsia?

Severe headaches and blurred vision Signup and view all the answers

What assessment should be performed if a patient has a deviated fundus?

Encourage the patient to void Signup and view all the answers

Which of the following is a sign of a hematoma in the postpartum period?

Normal fundus with redness and swelling Signup and view all the answers

What is an appropriate nursing action for a patient exhibiting signs of uterine atony?

Massage the fundus until it is firm and midline Signup and view all the answers

What finding suggests secondary postpartum hemorrhage?

Bright red discharge with changes in color Signup and view all the answers

Which symptom is least likely to be associated with a urinary tract infection in the postpartum period?

Low blood pressure Signup and view all the answers

What is a key indicator of postpartum depression that differentiates it from baby blues?

Inability to perform activities of daily living (ADLs). Signup and view all the answers

What condition can cause pathologic jaundice in a neonate within the first 24 hours?

Pathological jaundice. Signup and view all the answers

Which of the following is a major risk factor for necrotizing enterocolitis (NEC) in neonates?

Prematurity. Signup and view all the answers

What is a critical assessment finding for a neonate indicating potential sepsis?

Pallor or dusky skin. Signup and view all the answers

How can health providers support bonding in new parents during the transition to parenthood?

Observe and promote bonding. Signup and view all the answers

What is a common sign that a male neonate may have an issue requiring further examination?

Swollen scrotum. Signup and view all the answers

What condition can result from insufficient lung maturity in a preterm infant?

RDS (Respiratory Distress Syndrome). Signup and view all the answers

What symptom is indicative of postpartum psychosis?

Inability to perform ADLs. Signup and view all the answers

What treatment is typically employed for a neonate presenting with signs of respiratory distress syndrome (RDS)?

Oxygen therapy. Signup and view all the answers

What is one of the critical early recovery assessments for a female neonate?

Documenting any swelling of labia. Signup and view all the answers

Which statement about circumcision care is correct?

Infection is a potential risk if proper cleaning is not performed. Signup and view all the answers

What behavioral indicator may suggest a need for further support in a new parent experiencing postpartum depression?

Self-harm or baby-harm thoughts. Signup and view all the answers

What is an important consideration when teaching parents about SIDS prevention?

Promote safe sleeping positions by placing the baby on their back. Signup and view all the answers

Study Notes

Postpartum Physiological Assessments and Nursing Care

Assessment Frequency: Initial assessments are 15 minutes for the first hour, then 30 minutes for the next hour and 4 hours for the next 22 hours. Thereafter, assessments occur every shift.
Hemorrhage Assessment: Regularly assess for hemorrhage, including potential complications like DIC, AFE, PE. Monitor vital signs (temperature, blood pressure, heart rate, respiratory rate, SpO2, pain). Evaluate lochia (color, amount, odor). Assess the fundus (position, height, tone - firm or boggy - and location). Perform a head-to-toe assessment (BUBBLE-HE, REEDA).
Critical Findings (Hemorrhage): Purulent discharge (infection), bleeding >500 mL after vaginal birth (>1000 mL after C-section), boggy or deviated fundus, hypotension, tachycardia, tachypnea, dizziness, pale, cool, clammy skin.
Critical Findings (Preeclampsia/Eclampsia, HELLP): Hypertension (above 160/100), headache, nausea, altered mental status/seizures, blurred vision, RUQ pain, edema, bleeding (internal and external petechiae, purpura). Observe for a sudden drop in oxygen saturation.
Fundal Assessments and Management: A firm, midline fundus indicates proper involution. A boggy or deviated fundus indicates uterine atony (often requiring voiding, massage, oxytocin administration, and ongoing reassessment every 30 minutes).
Primary vs. Secondary Postpartum Hemorrhage (PPH): Primary PPH occurs within the first 24 hours, usually due to uterine atony (a boggy, elevated, or displaced fundus). Secondary PPH happens after 24 hours, often resulting from retained placental fragments/tissue or subinvolution.

Postpartum Infections

Breast Infection (Mastitis): Assess for redness, pain, warmth, fever, headache, and flu-like symptoms in the breast. Encourage breastfeeding, and apply warm compresses. Seek medical attention if pus is present (discard milk). Use antibiotics (e.g., Keflex) and pain relievers as directed.
Metritis: Occurs more than 24 hours after delivery. Signs include odor, pain, and fever. Potential causes - retained tissue, stillbirth, intercourse/objects, STIs.
Incision/Laceration Infection: Infection risk factors include C-sections, lacerations, poor wound care, underlying conditions like diabetes or immunocompromise, and obesity/hypertension.
Urinary Tract Infections (UTIs): Causes include anesthesia, Foley catheters, vaginal births, urinary retention, and peri/hygiene issues. A complication, pyelonephritis (kidney infection), presents with flank pain.

Postpartum Complications and Psychological Disorders

Disseminated Intravascular Coagulation (DIC): A serious complication linked to preeclampsia and HELLP syndrome.
Anaphylaxis: Could pose a risk with sudden drops in oxygen saturation.
Venous Thromboembolism (VTE) and Deep Vein Thrombosis (DVT): Potential complications related to blood clots.
Postpartum Blues/Baby Blues: Transient emotional distress within the first few days/weeks postpartum, affecting ADLs.
Postpartum Depression (MDD): A more serious and prolonged condition affecting ADLs within the first year postpartum. Symptoms include changes in sleep, appetite, weight, self-care, thoughts of self-harm or harming the baby. Seek immediate medical attention or ED visit.
Postpartum Psychosis: Characterized by severe disruptions in thinking and mood, sometimes manifesting as mania. Requires immediate hospitalization to protect both the mother and infant.
Paternal Postpartum Depression: May be related to low testosterone levels. Referral to a healthcare provider, therapy, or hormone replacement therapy is recommended.

Neonatal Assessment and Care

Normal Neonatal Assessment: Assess tone (flexed), head (fontanels, symmetry, eyes/ears), chest (respirations and heart rate), abdomen, genitalia, back, limbs, and skin. Document color, lanugo, vernix, birthmarks, injuries, and vascular spots. Evaluate all reflexes carefully.
Critical Neonatal Findings: Jaundice (within 24 hours is considered pathologic), pallor, cyanosis, hypotonia, seizures, bulging/sunken fontanels, respiratory distress, decreased bowel sounds, lack of meconium and/or urine production, abnormalities in vital signs, critical glucose levels.
Respiratory Distress Syndrome (RDS), Bronchopulmonary Dysplasia (BPD), Patent Ductus Arteriosus (PDA), Retinopathy of Prematurity (ROP), Infections, Jaundice: Discuss these specific conditions, their causes, and potential treatments.
Meconium Aspiration Syndrome: Recognize signs of stress and post-term births, suctioning, resuscitation, and provider assistance are required.
Necrotizing Enterocolitis (NEC): A serious intestinal condition, especially in premature infants, often requiring surgical intervention and monitoring.

Discharge Teaching, Transition, and Loss

Discharge Teaching: Explain the normal changes and abnormal findings related to postpartum recovery, lochia, involution, afterpains, RhoGAM, postpartum depression, and infection. Offer guidance on diet, exercise, sleep, smoking cessation, sexual activity, and contraception.
Transition to Parenthood: Ensure the parent's needs are met before teaching infant care. Assess understanding and provide support and observation to facilitate bonding.
Loss: Offer support and strategies for parents dealing with grief or loss in a healthy way, avoiding retraumatization.

Women's Health and Other Issues

LGBTQIA+ Care: Assess and support inclusivity for LGBTQIA+ patients, using appropriate language and pronouns. Alter care as needed.
Sexually Transmitted Infections (STIs): Educate regarding potential transmission methods and the importance of testing and reporting.
Vaginitis: Differentiate between bacterial and yeast infections, and outline appropriate treatment using medications like Metronidazole (Flagyl) or Miconazole (Monistat).
Cancer Screening: Guidance on cervical (PAP smear), breast (mammography), and endometrial screening.
Surgical Procedures: Post-operative care for fibroid removal, hysterectomy, and fistula repair, to help with complications.
PCOS, Menopause, and IPV: Discuss potential complications and treatment strategies. Increased awareness and support for patients facing possible IPV.

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Description

This quiz covers the essential physiological assessments and nursing care required during the postpartum period. Focus on the frequency of assessments, critical findings for hemorrhage, and monitoring parameters for conditions like preeclampsia. Evaluate your understanding of the key assessments necessary for ensuring maternal safety and well-being.