Rasmussen - MCN - Exam 2
Lochia Rubra (red) - ANSWERLochia _______ is mostly blood, fragments of decidua, and mucus and
starts in postpartum days 1-3
Lochia serosa (pink/brown) - ANSWERLochia _____ is blood, mucus, and invading leukocytes and starts
in postpartum days 3-10.
Lochia Alba (white to yellow-white) - ANSWERLochia ______ is non-odorous, mucus-like, with high
leukocyte counts and starts in postpartum days 10-14 days (can last 6 weeks.)
•The greatest risk in postpartum stage is *hemorrhage, shock, and infection* - ANSWERThe greatest
risks to a postpartum mom
Oxytoxics - ANSWER___________ medications can be given to help promote contraction of the uterus
thus decreasing bleeding and chances of hemorrhage
*afterpains*
▪ breastfeeding increases the afterpains as oxytocin is released with nipple stimulation. -
ANSWER________are the contractions pains that help with involution of the uterus (similar to
menstrual cramps.)
▪ they can be much more painful for multiparas women and those with an over distended uterus
(polyhydramnios, multiple gestations, macrosomic infant, etc.).
▪ they are usually not as bad after the first few days.
▪ Lochia amount varies greatly from woman to woman.
,▪ Mothers who breastfeed tend to have less lochial discharge than those who do not because the natural
release of the hormone oxytocin during breastfeeding strengthens uterine contractions.
▪ Lochial flow increases on exertion, especially the first few times a woman is out of bed but decreases
again with rest.
▪ Saturating a perineal pad in less than 1 hour is considered an abnormally heavy flow and should be
reported.
▪ Don't use tampons to halt the flow or this could lead to infection. - ANSWERLochia Evaluation -
*Amount*
▪ Lochia should contain no exceedingly large clots as these may indicate a portion of the placenta has
been retained and is preventing closure of the maternal uterine blood sinuses.
▪ In any event, large clots denote poor uterine contraction, which needs to be corrected. -
ANSWERLochia Evaluation - *Consistency*
▪ Lochia is red for the first 1 to 3 days (lochia rubra), pinkish-brown from days 4 to 10 (lochia serosa), and
then white (lochia alba) for as long as 6 weeks after birth.
▪ The pattern of lochia (rubra to serosa to alba) should not reverse as this suggests a placental fragment
has been retained or uterine contraction is decreasing and new bleeding is beginning. - ANSWERLochia
Evaluation - *Pattern*
▪ Lochia should not have an offensive odor as this suggests the uterus has become infected.
▪ Immediate intervention is needed to halt postpartal infection. - ANSWERLochia Evaluation - *Odor*
▪ Lochia should never be absent during the first 1 to 3 weeks as absence of lochia, like presence of an
offensive odor, may indicate postpartal infection.
▪ Lochia may be scant in amount after cesarean delivery, but it is never altogether absent. -
ANSWERLochia Evaluation - *Absence*
•Scant - less than 2.5cm
,•Light - less than 10cm
•Moderate - more than 10cm
•Heavy - one pad saturated within 2 hours
•Excessive - one pad saturated in 15mins or less - ANSWERName the 5 types of lochia amounts and their
measurements
*It decreases by one fingerbreadth, or 1 cm, per day*
▪ Right after birth it's at the umbilicus
▪ For example, on the first postpartal day, it will be palpable 1 cm below the umbilicus.
▪ In the average woman, by the ninth or tenth day, the uterus will have contracted so much that it is
withdrawn into the pelvis and can no longer be detected by abdominal palpation - ANSWERPostpartum:
*Fundal Height Changes*
▪ Palpate the fundus of the uterus by placing one hand on the base of the uterus, just above the
symphysis pubis, and the other at the umbilicus.
▪ Press in and downward with the hand at the umbilicus until you "bump" against a firm globular mass in
the abdomen: the uterine fundus - ANSWERHow do you palpate the fundus?
episiotomy - ANSWERincision made into the perineum to enlarge the vaginal opening to help with
delivery
laceration - ANSWERa tear during labor
•Promote measures for the client to help soften her stool (stool softeners or high fiber foods like fruit,
fluids)
•Sitz baths
, •NO Enemas or Suppositories
•Analgesics
•Ice packs for comfort
•Educate on proper cleaning to prevent infection
- wash hands before and after
- use squeeze bottle filled with warm water after each void to cleanse perineal area
- clean from front to back
- blot dry not wipe - ANSWERNursing Care: *Laceration/Episiotomy*
•If fundus is displaced, then the bladder needs to be emptied.
•Pressure from the trauma of delivery cause urinary retention so it is important to monitor I&O and to
promote getting up and using the restroom every 2-3 hours - ANSWERPostpartum: *Bladder
Assessment*
epidurals
spinal tap
urinary catheters
vaginal swelling/trauma from birth - ANSWERCauses of *Urinary Retention*
mastitis - ANSWERIs an infection of the breast involving the interlobular connective tissue and is usually
unilateral
•Localized heat and swelling
•Pain; tender axillary lymph nodes
•Elevated temperature
•Complaints of flulike symptoms
Lochia Rubra (red) - ANSWERLochia _______ is mostly blood, fragments of decidua, and mucus and
starts in postpartum days 1-3
Lochia serosa (pink/brown) - ANSWERLochia _____ is blood, mucus, and invading leukocytes and starts
in postpartum days 3-10.
Lochia Alba (white to yellow-white) - ANSWERLochia ______ is non-odorous, mucus-like, with high
leukocyte counts and starts in postpartum days 10-14 days (can last 6 weeks.)
•The greatest risk in postpartum stage is *hemorrhage, shock, and infection* - ANSWERThe greatest
risks to a postpartum mom
Oxytoxics - ANSWER___________ medications can be given to help promote contraction of the uterus
thus decreasing bleeding and chances of hemorrhage
*afterpains*
▪ breastfeeding increases the afterpains as oxytocin is released with nipple stimulation. -
ANSWER________are the contractions pains that help with involution of the uterus (similar to
menstrual cramps.)
▪ they can be much more painful for multiparas women and those with an over distended uterus
(polyhydramnios, multiple gestations, macrosomic infant, etc.).
▪ they are usually not as bad after the first few days.
▪ Lochia amount varies greatly from woman to woman.
,▪ Mothers who breastfeed tend to have less lochial discharge than those who do not because the natural
release of the hormone oxytocin during breastfeeding strengthens uterine contractions.
▪ Lochial flow increases on exertion, especially the first few times a woman is out of bed but decreases
again with rest.
▪ Saturating a perineal pad in less than 1 hour is considered an abnormally heavy flow and should be
reported.
▪ Don't use tampons to halt the flow or this could lead to infection. - ANSWERLochia Evaluation -
*Amount*
▪ Lochia should contain no exceedingly large clots as these may indicate a portion of the placenta has
been retained and is preventing closure of the maternal uterine blood sinuses.
▪ In any event, large clots denote poor uterine contraction, which needs to be corrected. -
ANSWERLochia Evaluation - *Consistency*
▪ Lochia is red for the first 1 to 3 days (lochia rubra), pinkish-brown from days 4 to 10 (lochia serosa), and
then white (lochia alba) for as long as 6 weeks after birth.
▪ The pattern of lochia (rubra to serosa to alba) should not reverse as this suggests a placental fragment
has been retained or uterine contraction is decreasing and new bleeding is beginning. - ANSWERLochia
Evaluation - *Pattern*
▪ Lochia should not have an offensive odor as this suggests the uterus has become infected.
▪ Immediate intervention is needed to halt postpartal infection. - ANSWERLochia Evaluation - *Odor*
▪ Lochia should never be absent during the first 1 to 3 weeks as absence of lochia, like presence of an
offensive odor, may indicate postpartal infection.
▪ Lochia may be scant in amount after cesarean delivery, but it is never altogether absent. -
ANSWERLochia Evaluation - *Absence*
•Scant - less than 2.5cm
,•Light - less than 10cm
•Moderate - more than 10cm
•Heavy - one pad saturated within 2 hours
•Excessive - one pad saturated in 15mins or less - ANSWERName the 5 types of lochia amounts and their
measurements
*It decreases by one fingerbreadth, or 1 cm, per day*
▪ Right after birth it's at the umbilicus
▪ For example, on the first postpartal day, it will be palpable 1 cm below the umbilicus.
▪ In the average woman, by the ninth or tenth day, the uterus will have contracted so much that it is
withdrawn into the pelvis and can no longer be detected by abdominal palpation - ANSWERPostpartum:
*Fundal Height Changes*
▪ Palpate the fundus of the uterus by placing one hand on the base of the uterus, just above the
symphysis pubis, and the other at the umbilicus.
▪ Press in and downward with the hand at the umbilicus until you "bump" against a firm globular mass in
the abdomen: the uterine fundus - ANSWERHow do you palpate the fundus?
episiotomy - ANSWERincision made into the perineum to enlarge the vaginal opening to help with
delivery
laceration - ANSWERa tear during labor
•Promote measures for the client to help soften her stool (stool softeners or high fiber foods like fruit,
fluids)
•Sitz baths
, •NO Enemas or Suppositories
•Analgesics
•Ice packs for comfort
•Educate on proper cleaning to prevent infection
- wash hands before and after
- use squeeze bottle filled with warm water after each void to cleanse perineal area
- clean from front to back
- blot dry not wipe - ANSWERNursing Care: *Laceration/Episiotomy*
•If fundus is displaced, then the bladder needs to be emptied.
•Pressure from the trauma of delivery cause urinary retention so it is important to monitor I&O and to
promote getting up and using the restroom every 2-3 hours - ANSWERPostpartum: *Bladder
Assessment*
epidurals
spinal tap
urinary catheters
vaginal swelling/trauma from birth - ANSWERCauses of *Urinary Retention*
mastitis - ANSWERIs an infection of the breast involving the interlobular connective tissue and is usually
unilateral
•Localized heat and swelling
•Pain; tender axillary lymph nodes
•Elevated temperature
•Complaints of flulike symptoms
