NUR 254 FINAL EXAM QUESTIONS AND ANSWERS
Postpartum
Key
Questions or key points
Nursing Interventions or Nursing Interventions
Complications
Signs and Symptoms
• Postpartum is define as after delivery up until 6 weeks
What are normal postpartum vital signs?
• HR: 60-100
• PP
• TEMP: Should not be higher than 100.4 after 24 hours
• RR:12-20
• BP: Monitor for pre-eclampsia, and hypotension
What does postpartum Lochia look like?
1. rubra
− (red -3/4 days)
2. serosa
− (pinkish -22/27)
3. alba
− (white/yellowish -2/6 weeks)
• **Always look at color, amount, odor
What is uterine involution?
• Uterus going back into its natural state
• When checking uterus, always place hand above symphysis pubis to
stabilize the uterus.
What to do if a mother has postpartum hemorrhaging, and what are some drugs that
can stop it?
,NUR 254 FINAL EXAM QUESTIONS AND ANSWERS
1. Always check bladder. If fundus if boggy. If cannot void, may need
cauterization.
2. Causes may be subinvolution of the uterus, pelvic infection, or
retained placental fragments
3. Uterus is about size of grapefruit and at level of umbilicus
immediately following birth
4. Massage fundus- Priority
5. Watch for saturating pad every hour or constant trickling of blood
6. Always turn & check for blood under buttocks.
7. May use drugs to manage postpartum hemorrhage (table page
533). When can you use these? These drug cause the uterus to
firm up – that is the goal
− Oxytocin
− Misoprostol
− Methergine (do not give if BP > 140/90) –but cannot give to
someone with hypertension/pre-eclampsia
− 15 Methylprostaglandin (contraindicated if pt has asthma)
What is Atony?
• Atony is simply a lack of uterine muscle tone. When the placenta peels off the wall
of the uterus, the only thing that staunches the flow of blood is the clamping down
of the uterine muscle on the open vessels. If that contraction is not present, there
can be significant blood loss. About 75% of all postpartum hemorrhage is caused
by atony. Uterus will feel boggy. May give oxytocin or Methergine to cause uterine
contraction.
How you would know if a postpartum mother has a laceration?
• If you have a steady flow of bright red, unclotted blood (trickling) but the fundus of
the uterus remains firm, a laceration is a pretty good bet. About 20% of early
hemorrhage is d/t lacerations
What is late postpartum hemorrhaging?
• Late postpartum hemorrhage occurs most often 1-2 weeks after childbirth due to
retained placental tissue. There are clues along the way - lochia often fails to
make the normal progression from rubra to serosa to alba. If lochia is rubra for
longer than 2 weeks, that is highly suspect. The other clue is subinvolution, which
is a uterus that fails to return to normal size after the pregnancy.
, NUR 254 FINAL EXAM QUESTIONS AND ANSWERS
• Make sure to turn the client to her side frequently so that you can check the pad
underneath. Often blood can accumulate underneath the client. Weigh peripads to
estimate blood loss if a careful measurement is necessary.
• Assess for signs of shock. Remain with the client. If the uterus is boggy,
massage it gently but firmly.
Are diuresis and dehydration common after delivery?
• Diuresis & dehydration are common after delivery. May have profuse sweating.
(Might have a fever but should not be greater than 100.4 F.) Increase fluids.
What is some perineal client self-care?
1. Ice for 1st 24 hours, after that we can use heat
2. Sitz bath(hot water up over your perineum) & peri-bottle(squeeze
bottle with hot water then let the water run across the perineum) –
helps with infection
What are some after pains, and when do they occur?
• After pains – occur in women that have already had 1 children, happens with
second child. Uterus is contracting more and more.
1. After 2nd delivery
2. Why? Tightness of abdominal muscles
How should you tell a mother to breastfeed?
• Breastfeeding
1. Try different positions, find position that is most comfortable.
2. Side-lying may be best for C-section
3. Start as quickly as possible
4. Snug fitting bra helps pain
5. Rotating the infant each feeding will help with milk let down &
decrease engorgement.
6. Provides adequate iron for infant’s first 4-6 months of life.
• Breast engorgement for non-nursing mother
1. Snug bra or breast binder
2. No stimulation of breasts
3. Turn back in showers
4. Cold packs
What is some insulin information for Diabetic Mothers?
Postpartum
Key
Questions or key points
Nursing Interventions or Nursing Interventions
Complications
Signs and Symptoms
• Postpartum is define as after delivery up until 6 weeks
What are normal postpartum vital signs?
• HR: 60-100
• PP
• TEMP: Should not be higher than 100.4 after 24 hours
• RR:12-20
• BP: Monitor for pre-eclampsia, and hypotension
What does postpartum Lochia look like?
1. rubra
− (red -3/4 days)
2. serosa
− (pinkish -22/27)
3. alba
− (white/yellowish -2/6 weeks)
• **Always look at color, amount, odor
What is uterine involution?
• Uterus going back into its natural state
• When checking uterus, always place hand above symphysis pubis to
stabilize the uterus.
What to do if a mother has postpartum hemorrhaging, and what are some drugs that
can stop it?
,NUR 254 FINAL EXAM QUESTIONS AND ANSWERS
1. Always check bladder. If fundus if boggy. If cannot void, may need
cauterization.
2. Causes may be subinvolution of the uterus, pelvic infection, or
retained placental fragments
3. Uterus is about size of grapefruit and at level of umbilicus
immediately following birth
4. Massage fundus- Priority
5. Watch for saturating pad every hour or constant trickling of blood
6. Always turn & check for blood under buttocks.
7. May use drugs to manage postpartum hemorrhage (table page
533). When can you use these? These drug cause the uterus to
firm up – that is the goal
− Oxytocin
− Misoprostol
− Methergine (do not give if BP > 140/90) –but cannot give to
someone with hypertension/pre-eclampsia
− 15 Methylprostaglandin (contraindicated if pt has asthma)
What is Atony?
• Atony is simply a lack of uterine muscle tone. When the placenta peels off the wall
of the uterus, the only thing that staunches the flow of blood is the clamping down
of the uterine muscle on the open vessels. If that contraction is not present, there
can be significant blood loss. About 75% of all postpartum hemorrhage is caused
by atony. Uterus will feel boggy. May give oxytocin or Methergine to cause uterine
contraction.
How you would know if a postpartum mother has a laceration?
• If you have a steady flow of bright red, unclotted blood (trickling) but the fundus of
the uterus remains firm, a laceration is a pretty good bet. About 20% of early
hemorrhage is d/t lacerations
What is late postpartum hemorrhaging?
• Late postpartum hemorrhage occurs most often 1-2 weeks after childbirth due to
retained placental tissue. There are clues along the way - lochia often fails to
make the normal progression from rubra to serosa to alba. If lochia is rubra for
longer than 2 weeks, that is highly suspect. The other clue is subinvolution, which
is a uterus that fails to return to normal size after the pregnancy.
, NUR 254 FINAL EXAM QUESTIONS AND ANSWERS
• Make sure to turn the client to her side frequently so that you can check the pad
underneath. Often blood can accumulate underneath the client. Weigh peripads to
estimate blood loss if a careful measurement is necessary.
• Assess for signs of shock. Remain with the client. If the uterus is boggy,
massage it gently but firmly.
Are diuresis and dehydration common after delivery?
• Diuresis & dehydration are common after delivery. May have profuse sweating.
(Might have a fever but should not be greater than 100.4 F.) Increase fluids.
What is some perineal client self-care?
1. Ice for 1st 24 hours, after that we can use heat
2. Sitz bath(hot water up over your perineum) & peri-bottle(squeeze
bottle with hot water then let the water run across the perineum) –
helps with infection
What are some after pains, and when do they occur?
• After pains – occur in women that have already had 1 children, happens with
second child. Uterus is contracting more and more.
1. After 2nd delivery
2. Why? Tightness of abdominal muscles
How should you tell a mother to breastfeed?
• Breastfeeding
1. Try different positions, find position that is most comfortable.
2. Side-lying may be best for C-section
3. Start as quickly as possible
4. Snug fitting bra helps pain
5. Rotating the infant each feeding will help with milk let down &
decrease engorgement.
6. Provides adequate iron for infant’s first 4-6 months of life.
• Breast engorgement for non-nursing mother
1. Snug bra or breast binder
2. No stimulation of breasts
3. Turn back in showers
4. Cold packs
What is some insulin information for Diabetic Mothers?
