Postpartum Physiological Assessments
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Questions and Answers

Which condition is associated with significant morbidity and mortality in postpartum health?

  • Diet deficiencies
  • Vaccination status
  • Breastfeeding complications
  • Infection (correct)

What is the appropriate first step prior to teaching a new parent?

  • Present multiple teaching methods
  • Ensure individual needs are met (correct)
  • Assess previous knowledge
  • Simplify complex concepts

Which of the following is an essential aspect of the normal assessment of a neonate?

  • Limbs: no symmetrical movement
  • Abdomen: hard and distended
  • Chest: labored breathing
  • Head: fontanels flat and symmetrical (correct)

Which reflex assessment is important for the evaluation of a neonate?

<p>Observing for missing or asymmetrical findings (B)</p> Signup and view all the answers

What critical finding would indicate jaundice in a neonate?

<p>Emergence within the first 24 hours (A)</p> Signup and view all the answers

What should be observed during a normal assessment of a neonate's genitalia?

<p>Female spotting vaginal discharge (B)</p> Signup and view all the answers

What is NOT a normal finding during a neonate's assessment of the limbs?

<p>Clicks during hip movement (A)</p> Signup and view all the answers

What condition signifies a serious abnormality if observed in a neonate's skin?

<p>Skin pallor or cyanosis (C)</p> Signup and view all the answers

What symptom is commonly associated with metritis due to retained placental tissue?

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

Which treatment is indicated for a plugged duct?

<p>Warm showers and compresses (C)</p> Signup and view all the answers

How does postpartum depression generally differ from baby blues?

<p>It can interfere with activities of daily living (ADLs). (C)</p> Signup and view all the answers

Which of the following is a risk factor for urinary tract infection (UTI) post-delivery?

<p>Use of Foley catheter (C)</p> Signup and view all the answers

What is a key difference in the onset of postpartum psychosis compared to postpartum depression?

<p>It occurs within the first three days. (C)</p> Signup and view all the answers

Which of these symptoms is NOT typically associated with mastitis?

<p>Shortness of breath (C)</p> Signup and view all the answers

Which situation is most likely to contribute to the development of deep vein thrombosis (DVT) after childbirth?

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

What is an appropriate action to take if breast milk appears to have pus?

<p>Dump the breast milk. (D)</p> Signup and view all the answers

Which of the following signs indicates a critical condition requiring immediate attention in newborns?

<p>SpO2 levels under 94% (C), Tachycardia with HR over 180 (D)</p> Signup and view all the answers

What condition is associated with retinal detachment and is related to oxygen levels in newborns?

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

Which of the following treatments is used to manage Bronchopulmonary Dysplasia (BPD)?

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

What is a key indicator of Necrotizing Enterocolitis (NEC) that necessitates surgical intervention?

<p>Necrotic bowel (D)</p> Signup and view all the answers

Which finding may indicate the presence of Group B Strep (GBS) infection in a newborn?

<p>Maternal fever during labor (A)</p> Signup and view all the answers

Which neurological condition may result from untreated Phenylketonuria (PKU) in a newborn?

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

What vital sign abnormality indicates immediate compressions in a newborn?

<p>HR under 100 (D)</p> Signup and view all the answers

In the management of patent ductus arteriosus (PDA), which of the following interventions is appropriate?

<p>Implement NPO and fluid restrictions (D)</p> Signup and view all the answers

What is the correct frequency for postpartum physiological assessments within the first 22 hours after birth?

<p>15 minutes x 1 hour, 30 minutes x 1 hour, 4 hours x 22 hours then q shift (C)</p> Signup and view all the answers

Which of the following signs would indicate a critical finding of hemorrhage in a postpartum patient?

<p>Bleeding greater than 500 ml after vaginal birth (D)</p> Signup and view all the answers

What action should be taken if the fundus is found to be boggy and deviated during assessment?

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

Which of the following is NOT a risk factor for meconium aspiration?

<p>Preterm birth (D)</p> Signup and view all the answers

Which conditions are associated with a sudden drop in oxygen saturation in postpartum patients?

<p>Anaphylaxis and pulmonary embolism (B)</p> Signup and view all the answers

What is a typical presentation indicating meconium aspiration?

<p>Amniotic fluid has a green hue at time of rupture (C)</p> Signup and view all the answers

When assessing lochia during postpartum care, which characteristic is NOT monitored?

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

What is the first step in treating meconium aspiration syndrome?

<p>Suction the airway (D)</p> Signup and view all the answers

Which of the following statements regarding SIDS prevention is accurate?

<p>Back to sleep is a recommended practice (A)</p> Signup and view all the answers

Which of the following observations could indicate infection in a postpartum patient?

<p>Foul-smelling discharge and fever (A)</p> Signup and view all the answers

Which of the following describes a common symptom of bacterial vaginitis?

<p>Fishy odor with grey discharge (A)</p> Signup and view all the answers

In cases of uterine atony, which finding is expected in the assessment of the fundus?

<p>Boggy and elevated, deviated (B)</p> Signup and view all the answers

What is the purpose of avoiding deodorants, powders, or lotions before a mammogram?

<p>To prevent interference with imaging (D)</p> Signup and view all the answers

What is the expected response to fundal massage for a boggy uterus?

<p>Becomes firm and midline (A)</p> Signup and view all the answers

Which of the following factors does NOT contribute to the risk of acquiring STIs?

<p>Using barrier devices (B)</p> Signup and view all the answers

What should be done to care for the umbilical cord after birth?

<p>Clean it regularly and avoid direct pressure (B)</p> Signup and view all the answers

Flashcards

Postpartum Assessment Frequency

Postpartum assessments are done every 15 minutes for the first hour, every 30 minutes for the second hour, every 4 hours for the next 22 hours, and then every shift after.

Postpartum Hemorrhage Assessment

Assess for postpartum hemorrhage by checking vital signs (temperature, blood pressure, heart rate, respiratory rate, oxygen saturation, and pain), lochia (color, amount, odor), and fundus (height, tone, and location).

What is a critical finding in postpartum assessment?

Purulent discharge is a critical finding, indicating infection. It may be accompanied by fever, tachycardia, tachypnea, and pain.

Postpartum hemorrhage volume

Postpartum hemorrhage is defined as bleeding greater than 500 ml after a vaginal birth or greater than 1000 ml after a cesarean section.

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Signs of Postpartum Hemorrhage

Signs of postpartum hemorrhage include hypotension, tachycardia, tachypnea, dizziness, and pale, cool, clammy skin. It may also be accompanied by a boggy and deviated fundus.

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What to do for a boggy fundus?

If the fundus is boggy and deviated, the first step is to have the patient void. Then, massage the fundus until it is firm. If this doesn't resolve the issue, administer oxytocin (IV or IM) and reassess every 30 minutes.

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Preeclampsia/Eclampsia and HELLP in postpartum

Preeclampsia/eclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count) can occur in the postpartum period. Signs include hypertension (above 160/100), headaches, nausea, altered mental status/seizures, blurred vision, right upper quadrant pain, and edema.

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Primary Postpartum Hemorrhage

Primary postpartum hemorrhage occurs within the first 24 hours after delivery. Two common causes are uterine atony and lacerations.

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Retained Placental Fragments

Pieces of the placenta that remain in the uterus after delivery. This can lead to complications.

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Subinvolution

The uterus does not return to its normal size after childbirth. This can be a result of retained placental fragments.

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Metritis

Infection of the uterus that can occur after childbirth. Common causes include retained placental tissue, stillbirth, and infections.

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Mastitis

Infection of the breast tissue that commonly occurs 3-4 weeks postpartum. Symptoms include redness, pain, warmth, fever, and flu-like symptoms.

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Plugged Duct

A blockage in a milk duct in the breast, which can cause pain and swelling.

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Postpartum Blues (Baby Blues)

Mild mood swings, anxiety, and crying that occur within the first two weeks after childbirth.

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Postpartum Depression (MDD)

A more severe form of depression that occurs after childbirth. It's characterized by persistent low mood, fatigue, loss of interest in activities, and difficulty performing daily tasks.

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Postpartum Psychosis

Serious mental health condition occurring within the first few days or weeks postpartum. Symptoms include hallucinations, delusions, rapid mood changes, and difficulty caring for the baby.

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Hypotonia

Decreased muscle tone, making the baby feel floppy and loose.

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Seizure

Sudden, uncontrolled electrical activity in the brain causing involuntary muscle movements, changes in behavior, or loss of consciousness.

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Fontanel Bulging

Swelling or protrusion of the soft spots on a baby's head, indicating increased pressure inside the skull.

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Sunken Fontanel

A sunken or depressed soft spot on a baby's head, suggesting dehydration.

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Paradoxical Breathing

Abnormal breathing pattern where the chest and abdomen move in opposite directions during inhalation and exhalation.

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Distension

Swelling or enlargement of the abdomen, often associated with gas or fluid buildup.

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RDS (Respiratory Distress Syndrome)

A breathing problem in babies where the lungs don't have enough surfactant, a substance that keeps the air sacs open.

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PDA (Patent Ductus Arteriosus)

A condition where a blood vessel connecting the aorta and pulmonary artery remains open after birth, causing increased blood flow to the lungs.

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Normal Neonatal Tone

A healthy newborn infant will exhibit a flexed posture where their arms and legs are bent towards their body.

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Caput Succedaneum

A soft, edematous area on the scalp that crosses suture lines. It is caused by pressure during delivery.

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Cephalohematoma

A collection of blood under the periosteum of the skull. It is a localized swelling that does not cross suture lines.

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Neonatal Respiratory Rate

A healthy newborn infant will have a respiratory rate of 30-60 breaths per minute, with a regular pattern. Count for a full minute.

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Neonatal Heart Rate

A healthy newborn infant will have a heart rate of 110-160 beats per minute. The heart rate may be slightly irregular due to breathing.

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Normal Neonatal Abdomen

A healthy newborn infant will have a soft, round abdomen with belly breathing. The umbilical cord should have three blood vessels (AVA).

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Acrocyanosis

A normal finding in newborns where the hands and feet appear bluish or mottled due to poor circulation.

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Jaundice (Pathologic)

Yellow skin discoloration that appears within the first 24 hours of life. It is a sign of a serious medical condition.

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Meconium Aspiration Risk

Stress (hypoxic events) or the baby being postdates can lead to meconium aspiration.

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Meconium Aspiration Presentation

Green amniotic fluid indicates the presence of meconium in the fluid.

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Meconium Aspiration Syndrome

Low APGAR scores, floppy muscle tone, and poor air entry are signs of meconium aspiration syndrome.

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Circumcision Care

Circumcision care focuses on preventing infection, cleaning the wound, and managing pain, bleeding, and swelling.

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Cord Care

Cord Care involves avoiding direct pressure on the cord and keeping it clean.

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SIDS Prevention

Safe sleep practices include placing the baby on their back, in a crib without loose bedding, and not swaddling during sleep.

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Baby Bathing

Babies should be bathed with warm, gentle water, never left unattended near water, and dried thoroughly after bathing.

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LGBTQIA Care

Provide care for LGBTQIA patients that is respectful, affirming, and avoids re-traumatization.

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Study Notes

Postpartum Physiological Assessments and Nursing Care

  • Postpartum assessments are performed at 15 minutes for 1 hour, 30 minutes for 1 hour, 4 hours for 22 hours, and then every shift.
  • Assess for hemorrhage (DIC, AFE, PE), HELLP/Eclampsia.
  • Vital signs (temperature, blood pressure, heart rate, respiratory rate, SpO2, pain) should be monitored.
  • Lochia (color, amount, odor) should be assessed.
  • Fundal height, tone, and location (midline, displaced) should be evaluated.
  • Monitor for purulent discharge and fever as signs of infection.
  • Assess for bleeding greater than 500 mL (vaginal birth) or 1000 mL (C-section) and for signs such as hypotension, tachycardia, and tachypnea that indicate hemorrhage.
  • Boggy and deviated fundus indicates potential hemorrhage.
  • Massage the fundus to firm it up, administer oxytocin as needed to prevent hemorrhage.

Postpartum Physiological Assessments and Nursing Care High-Risk Cases

  • Assessments and frequency are crucial in high-risk cases.
  • Monitor for preeclampsia/eclampsia (high blood pressure, headaches, nausea, visual disturbances, RUQ pain, edema, bleeding, petechiae).

Postpartum Hemorrhage

  • Fundus firm and midline indicating proper involution.

Primary PPH (Early)

  • Uterine atony: characterized by a boggy, elevated, or displaced fundus and urinary retention.
  • Lacerations: result in red bleeding with a normal fundus.
  • Hematomas: present with a normal fundus and ecchymosis or swelling, and often severe pain.

Secondary PPH (Late)

  • Retained placental fragments: cause subinvolution, changes in color or odor, and sometimes metritis.

Breast Infections

  • Mastitis/abscess (redness, swelling, pain, fever) during post-delivery period.
  • Encourage breastfeeding, warm compresses, massage.
  • Treat with antibiotics.

Infections

  • Assess for metritis, incision/lacerations, or UTIs.
  • Monitor for signs of infection.

Other Issues

  • Monitor for DIC, anaphylaxis, VTE, or DVT.

Psychological Disorders

  • Assess for baby blues, postpartum depression (unable to perform ADLs), or postpartum psychosis (SI/HI, can harm baby or self).
  • Provide appropriate support and care.

Neonate

  • Assess tone, head, chest, abdomen, genitalia, back, limbs, skin.
  • Assess for jaundice, pallor, cyanosis, hypotonia, seizures.
  • Look for see-saw breathing or bradycardia/tachycardia.
  • Hypothermia: low temperature, use warm blankets and skin-to-skin
  • Hypoglycemia: glucose levels below 40mg/dL—monitor, and consider feeding or glucose support.
  • Apnea (breathing cessation) and bradycardia with newborns (especially pre-term).
  • RDS and BPD: respiratory distress syndrome, and bronchopulmonary dysplasia (caused by preterm birth and immature lungs); ventilation and oxygenation.
  • PDA, or patent ductus arteriosus (failure to close the ductus arteriosus after birth)
  • Infections include group B strep (GBS)- maternal cultures and antibiotics are often given before or after delivery.

Other Postpartum Issues

  • Jaundice, PKU, NEC (Necrotizing enterocolitis), and meconium aspiration syndrome.

Discharge Teaching

  • Observe for normal resolution of pregnancy vs. abnormal findings (lochia).
  • Recognize signs of postpartum depression.
  • Postpartum hemorrhage remains a leading cause of post-birth mortality.

Women's Health

  • Assess for vaginal infections.
  • Recommend screening for cervical, breast, and endometrial cancers.
  • Discuss treatment options for fibroids.
  • Review potential complications from PCOS and procedures such as hysterectomy.
  • Discuss risks of IPV (Intimate Partner Violence) which increase with pregnancy.

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Description

This quiz focuses on postpartum physiological assessments and nursing care practices, especially in high-risk cases. It covers vital signs monitoring, lochia evaluation, fundal assessments, and the recognition of complications such as hemorrhage and infection. Test your knowledge on important nursing procedures and interventions required during the postpartum period.

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