Postpartum Nursing Care Quiz

Postpartum Nursing Care

• Family dynamics become more complex with each child born
• Support family dynamics and include family in teaching and care
• Observe sibling interactions to identify potential problems and make referrals

Puerperium

• Period after childbirth, from placenta delivery until reproductive organs return to non-pregnant state
• Usually about 6 weeks, potentially longer with multiple pregnancies

Postpartum Physical Adaptations

• Body changes immediately after delivery
• Postpartum shivering has an unknown cause, possibly due to fetal/maternal blood mixing or amniotic fluid in the bloodstream
• Provide patients with warmth to alleviate shivering
• Reproductive system experiences substantial changes, primarily focused on uterus involution
  • Oxytocin release causes uterine contractions to shrink the uterus
  • Uterus size and weight decreases
  • Fundus is firm at the umbilicus 1 hour after delivery and descends 1 cm daily
  • 10 days post-delivery, the uterus may not be palpable.
• Afterpains (intermittent uterine contractions) may occur, often more noticeable in women who have had multiple children
• Lochia (vaginal discharge) may last up to 6 weeks, gradually decreasing in amount and color over time
• Cervix slowly closes, becoming barely dilated by 14 days post-delivery
• Vagina experiences diminished tone and swelling, but normal vaginal rugae (folds) should return in 4 weeks.
• Perineum may be bruised and edematous after delivery, Muscle tone should restore over 4-6 weeks

Ovaries and Ovulation

• Normal function after delivery is variable, potentially influenced by breastfeeding
• Menstruation may be delayed

Breasts

• Breasts secrete colostrum at first, then transition to mature milk
• Nipple stimulation triggers prolactin release to initiate milk production
• Engorgement (swelling) commonly occurs between the second and fourth day of postpartum
• Pain and tenderness may be present, but pain is not normal
• Interventions may be needed to suppress milk production if breastfeeding is not desired

Integumentary System

• Stretch marks may persist after delivery
• Linea nigra (line along the abdomen) may fade but may not fully disappear

Gastrointestinal System

• Increased hunger and thirst are common post-delivery
• Sluggish bowel movements and constipation may occur due to decreased movement and progesterone and anesthesia, stool softener or other treatments might be necessary.

Cardiovascular System

• Blood loss varies (250-500 mL vaginal birth, 800-1000 mL C-section)
• Cardiac output increases after delivery

Removal of excess fluid

• Diuresis: increased urine output (up to 3000 mL/day)
• Diaphoresis (sweating) is a means to remove excess fluid

Respiratory System

• Diaphragm returns to its normal position
• Respiration rate returns to pre-pregnancy levels
• Nasal congestion decreases

Urinary System

• Bladder tone decreases
• Bladder distension can obstruct uterine involution/lead to hemorrhage
  • Urinary problem is often reported and monitored
• Encourage fluids to support excretion of excess fluid
• Monitor output

Musculoskeletal System

• Relaxin levels decrease
• Hip pain may persist
• Diastasis recti (separation of abdominal muscles) can occur and may involve surgery.
  • Should be assessed and treated by healthcare provider as needed

Nursing Care During Early Postpartum Period

• Immediate postpartum care: typically in the hospital for 1-2 days (vaginal birth) or 3-4 days (C-section)
• Nurses provide physical care, monitor for complications and teach self-care

Uterine Assessment

• Palpate fundus to assess location and consistency
• Assess for tone
• Never palpate without supporting the lower uterine segment

Lochia Assessment

• Inspect amount and character to observe for complications
• Assess amount and color of lochia postpartum

Nursing Care During First Hour Post Delivery

• Vital signs monitored at regular intervals (every 15 minutes)
• Palpating the uterus is performed every 15 minutes
• Assess uterine tone, amount of vaginal bleeding, and condition of lochia
• Most crucial hour to identify and address potential postpartum complications
• Check for vital changes and other conditions like hemorrhage

Breast Assessment

• Assess for breast engorgement and nipple and breast pain
• Icepacks or supportive bras can help lessen the pain, discomfort and help with engorgement if not breastfeeding
• Teach mothers about supportive bra, ice-packs and analgesics.

Nursing Care for Women Who Relinquish Infants for Adoption

• Assessing emotional and psychological considerations
• Supporting patient decisions
• Including the mother's partner in the process

Development of Family Attachment

• Partner involvement is encouraged from prenatal and throughout the labor and delivery process
• Fostering sibling bonding, possibly requires strategies to establish and maintain a positive and healthy relationship among siblings.

Preparation for Discharge

• Self-care instructions, including perineal care, analgesics (pain relief medication), and dietary recommendations are vital to enable a stable transition home
• Follow-up appointments are essential
• Symptoms requiring medical attention are documented and reported

Postpartum Depression

• Risk assessment to help prevent or identify and treat the condition

C-section

• Uterine assessment, incisions, medications
• Support for Post-Surgical Adjustments
• Post-op care to prevent complications and monitor the patients
• Monitor for complications, including: atelectasis, thrombosis, infections, and deep vein thrombosis.

This quiz covers essential aspects of postpartum nursing care, including family dynamics, physical adaptations after childbirth, and the puerperium period. Test your knowledge on how to support patients and their families during this critical time, as well as identify important changes in the reproductive system postpartum.