NR 327 maternal OB
EXAM 2 STUDY GUIDE
Chapter 17: Postpartum Adaptations and nursing Care
Chapter 22: Infant Feeding
Chapter 25: Family planning
Quiz #3
Chapter 19: Normal Newborn-Processes of
adaptation Chapter 20: Assessment of the normal
newborn Chapter 21: Care of the normal newborn
Quiz #4
Chapter 10: Complications of
Pregnancy Chapter 16: Intrapartum
Complications
Chapter 18: Postpartum Maternal
Complications Quiz #5
Exam 2 Thursday December 6th
FOCUS ON
1. Newborn assessment
2. Postpartum assessment
3. Postpartum hemorrhage
4. Preeclampsia
5. Placental previa
6. Placental abruptio
7. Preterm labor
8. Hydatidiform mole
8. Medications on your clinical list
,NR 327 maternal OB
Chapter 17: Postpartum Adaptations and nursing
Care Chapter 22: Infant Feeding
Chapter 25: Family
planning Quiz #3
• 4th stage of labor/Postpartum period/Puerperium
• First 6 weeks after birth of infant
o -Return of reproductive organs to normal nonpregnant state
• Physiological maternal changes
o Uterine involution
▪ Starts right after delivery of placenta
▪ Changes of reproductive organs, particularly the uterus that returns
to non-pregnant size and condition
• Involves three processes
o 1. Contraction of muscle fibers
o 2. Catabolism: the process of converting cells into
simpler compounds
o 3. Regeneration of the uterine
epithelium Sub-involution: when uterus does not return to non-
pregnant state,
o lochia flow, cervical involution,
o Decrease in vaginal distention
o alteration in ovarian function and menstruation
o Cardiovascular, urinary tract, breast and GI tract changes
Afterpains: intermittent uterine contractions, source of discomfort for many women, the
discomfort is more acute for multiparas because repeated stretching of muscle fibers
leads to muscle tone loss that causes repeated contraction and relaxation of the uterus.
• Greatest risks during postpartum period: hemorrhage, shock, and infection.
• Oxytocin
,NR 327 maternal OB
o Administer postpartum to improve the quality of uterine contractions. A firm and
contracted uterus prevents excessive bleeding and hemorrhage
• After delivery of the placenta, hormones decrease resulting in decreased blood
glucose, estrogen and progesterone
o Decreased estrogen causes breast engorgement, diaphoresis, and diuresis
o Decreased vaginal lubrication
Assessment
• Monitor vital signs, uterine firmness and its location in relation to the umbilicus,
uterine position in relation to the midline of the abdomen, and amount of vaginal
bleeding
• BP and pulse assessed every 15 mins for the first 2 hours after birth
• Temperature every 4 hours for first 8 hours after birth and then at least every 8 hours
Postpartum Assessment
• Breasts
• Uterus (fundal height, uterine placement, and consistency
• Bowel and GI function
• Bladder function
• Lochia (color, odor, consistency, and amount (COCA))
• Episiotomy (edema, ecchymosis, approximation)
Vital signs to include pain assessment and teaching needs
RH Negative mothers
• Rho(D) immune globulin is administered within 72 hours to women who are Rh-
negative and gave birth to infants who are Rh-positive to prevent sensitization
in future pregnancies.
Kleihauer-betke test
• Determines amount of fetal blood in maternal circulation if large
fetomaternal transfusion suspected. If 15 ml or more of fetal blood detected,
mom can get increased Rho(D) immune dose
Thermoregulation
• Postpartum chill occurs in first 2 hours puerperium
o Uncontrollable shaking chill following birth
o Nervous system response, vasomotor changes, a shift in fluids,
and/or work of labor
o Normal unless along with elevated
temperature Interventions:
Provide warm blankets and fluids
Assure client that chills are self-limiting
Fundus
, NR 327 maternal OB
Physical changes include involution of the uterus
Uterus decreases in size from 1 kg to 60 to 80 g at 6 weeks with fundal height into
pelvis at one fingerbreadth per day
• At end of 3rd stage of labor, uterus palpable at midline and 2 cm below to
halfway between umbilicus and symphysis pubis.
• 1 hr after, fundus rise to level of umbilicus
• Every 24 hour, fundus should descend 1-2 cm. halfway between the
symphysis pubis and umbilicus by 6th postpartum day
• After 2 weeks, uterus should lie within true pelvis and should not be palpable
Assessment
Assess fundal height, uterine placement, and uterine consistency at least every
8 Hr after recovery period ended
Cup one hand just above symphysis pubis to support lower segment of
uterus and palpate abdomen to locate fundus with other hand
Document fundal height
Midline or displaced
If displaced, due to full bladder
Firm or boggy (not firm)
If boggy, lightly massage the fundus in a circular motion
Patient-Centered Care
• Administer oxytocics (oxytocin, methylergonovine and carboprost) IM or IV
after placenta to promote uterine contractions and to prevent hemorrhage
• Encourage emptying of bladder every 2 to 3 hours to prevent possible uterine
displacement and atony
Lochia
Post-birth uterine discharge that contains blood, mucus, and uterine tissue
Rubra: bright red color, dark red or brown color, blood consistency, fleshy odor, can
contain small clots, transient
flow increases during breastfeeding and upon rising, lasts 1-3 days after delivery
Serosa: pinkish brown color and serosanguinous consistency. Lasts from day 4 to day 10
after delivery
Alba: yellowish white creamy color, fleshy odor, lasts from day 11 up to 4 to 8 weeks
Postpartum
Rub for 3 days, sir has six alibis and
on Rubra (3 days), serosa (6 days),
alba
EXAM 2 STUDY GUIDE
Chapter 17: Postpartum Adaptations and nursing Care
Chapter 22: Infant Feeding
Chapter 25: Family planning
Quiz #3
Chapter 19: Normal Newborn-Processes of
adaptation Chapter 20: Assessment of the normal
newborn Chapter 21: Care of the normal newborn
Quiz #4
Chapter 10: Complications of
Pregnancy Chapter 16: Intrapartum
Complications
Chapter 18: Postpartum Maternal
Complications Quiz #5
Exam 2 Thursday December 6th
FOCUS ON
1. Newborn assessment
2. Postpartum assessment
3. Postpartum hemorrhage
4. Preeclampsia
5. Placental previa
6. Placental abruptio
7. Preterm labor
8. Hydatidiform mole
8. Medications on your clinical list
,NR 327 maternal OB
Chapter 17: Postpartum Adaptations and nursing
Care Chapter 22: Infant Feeding
Chapter 25: Family
planning Quiz #3
• 4th stage of labor/Postpartum period/Puerperium
• First 6 weeks after birth of infant
o -Return of reproductive organs to normal nonpregnant state
• Physiological maternal changes
o Uterine involution
▪ Starts right after delivery of placenta
▪ Changes of reproductive organs, particularly the uterus that returns
to non-pregnant size and condition
• Involves three processes
o 1. Contraction of muscle fibers
o 2. Catabolism: the process of converting cells into
simpler compounds
o 3. Regeneration of the uterine
epithelium Sub-involution: when uterus does not return to non-
pregnant state,
o lochia flow, cervical involution,
o Decrease in vaginal distention
o alteration in ovarian function and menstruation
o Cardiovascular, urinary tract, breast and GI tract changes
Afterpains: intermittent uterine contractions, source of discomfort for many women, the
discomfort is more acute for multiparas because repeated stretching of muscle fibers
leads to muscle tone loss that causes repeated contraction and relaxation of the uterus.
• Greatest risks during postpartum period: hemorrhage, shock, and infection.
• Oxytocin
,NR 327 maternal OB
o Administer postpartum to improve the quality of uterine contractions. A firm and
contracted uterus prevents excessive bleeding and hemorrhage
• After delivery of the placenta, hormones decrease resulting in decreased blood
glucose, estrogen and progesterone
o Decreased estrogen causes breast engorgement, diaphoresis, and diuresis
o Decreased vaginal lubrication
Assessment
• Monitor vital signs, uterine firmness and its location in relation to the umbilicus,
uterine position in relation to the midline of the abdomen, and amount of vaginal
bleeding
• BP and pulse assessed every 15 mins for the first 2 hours after birth
• Temperature every 4 hours for first 8 hours after birth and then at least every 8 hours
Postpartum Assessment
• Breasts
• Uterus (fundal height, uterine placement, and consistency
• Bowel and GI function
• Bladder function
• Lochia (color, odor, consistency, and amount (COCA))
• Episiotomy (edema, ecchymosis, approximation)
Vital signs to include pain assessment and teaching needs
RH Negative mothers
• Rho(D) immune globulin is administered within 72 hours to women who are Rh-
negative and gave birth to infants who are Rh-positive to prevent sensitization
in future pregnancies.
Kleihauer-betke test
• Determines amount of fetal blood in maternal circulation if large
fetomaternal transfusion suspected. If 15 ml or more of fetal blood detected,
mom can get increased Rho(D) immune dose
Thermoregulation
• Postpartum chill occurs in first 2 hours puerperium
o Uncontrollable shaking chill following birth
o Nervous system response, vasomotor changes, a shift in fluids,
and/or work of labor
o Normal unless along with elevated
temperature Interventions:
Provide warm blankets and fluids
Assure client that chills are self-limiting
Fundus
, NR 327 maternal OB
Physical changes include involution of the uterus
Uterus decreases in size from 1 kg to 60 to 80 g at 6 weeks with fundal height into
pelvis at one fingerbreadth per day
• At end of 3rd stage of labor, uterus palpable at midline and 2 cm below to
halfway between umbilicus and symphysis pubis.
• 1 hr after, fundus rise to level of umbilicus
• Every 24 hour, fundus should descend 1-2 cm. halfway between the
symphysis pubis and umbilicus by 6th postpartum day
• After 2 weeks, uterus should lie within true pelvis and should not be palpable
Assessment
Assess fundal height, uterine placement, and uterine consistency at least every
8 Hr after recovery period ended
Cup one hand just above symphysis pubis to support lower segment of
uterus and palpate abdomen to locate fundus with other hand
Document fundal height
Midline or displaced
If displaced, due to full bladder
Firm or boggy (not firm)
If boggy, lightly massage the fundus in a circular motion
Patient-Centered Care
• Administer oxytocics (oxytocin, methylergonovine and carboprost) IM or IV
after placenta to promote uterine contractions and to prevent hemorrhage
• Encourage emptying of bladder every 2 to 3 hours to prevent possible uterine
displacement and atony
Lochia
Post-birth uterine discharge that contains blood, mucus, and uterine tissue
Rubra: bright red color, dark red or brown color, blood consistency, fleshy odor, can
contain small clots, transient
flow increases during breastfeeding and upon rising, lasts 1-3 days after delivery
Serosa: pinkish brown color and serosanguinous consistency. Lasts from day 4 to day 10
after delivery
Alba: yellowish white creamy color, fleshy odor, lasts from day 11 up to 4 to 8 weeks
Postpartum
Rub for 3 days, sir has six alibis and
on Rubra (3 days), serosa (6 days),
alba
