NURSING 306 OB Exam 2 Study Guide

OB Exam 2 Study Guide 12/03/2016 Fundal Assessment • Actions/Interventions o Determine tone ▪ Firm=contracted ▪ Soft=boggy  Indicates uterus is not contracting and places the woman at an increased risk for excessive blood loss  Massage fundus w/palm of hand in a circular motion until firm to stimulate contraction • Reevaluate w/in 30 mins  Give oxytocin to stimulate smooth muscle of uterus to contract Physiological changes in PP • Assessment & Care o Reproductive ▪ Assess uterus for location, position, and tone of fundus  Potential complications that may lead to postpartum hemorrhage are greatest within the first hour following delivery ▪ Measure the distance between the fundus and umbilicus  Each finger breadth=1cm ▪ Determine position of uterus  Shifted to side may indicate distended bladder  If deviated, soft, or elevated above the umbilicus, have pt void o Endometrium ▪ Assess lochia to monitor blood loss  Scant (1in), light (4in), moderate (6in), heavy (pad saturated)  Measure clots—10g=10mL of blood loss  (Table 12-2 pg. 313) o Vaginal/perineum ▪ Assess perineum using REEDA  Redness, edema, ecchymosis, discharge, approximation of edges of episiotomy or laceration ▪ Position in side lying position for better visualization ▪ Apply ice or cold sitz baths for first 24 hours; warm sitz baths after 24 hours twice a day for 20 mins ▪ Give peri-bottle w/warm water to rinse area after elimination ▪ Tighten gluteal muscle as she sits down and to relax muscles after she is seated o Cardiovascular ▪ Assess pulse & BP—every 15 mins for the first hour ▪ Assess for orthostatic hypotension ▪ Assess for venous thrombosis  Homan’s sign  Calf tenderness, edema, and sensation of warmth  Encourage early ambulation ▪ Assess for postpartum chills and give warm blanket o Breast ▪ Breastfeeding:  Inspect for signs of engorgement:hard, swollen, red, tender/painful, warm to touch, throbbing sensation, increased temperature  Assess nipples for nipple tissue breakdown: cracked, blistered, or reddened areas  Tx: frequent feedings to empty breasts and prevent milk stasis, warm compresses and massage, supportive bra ▪ Non-breastfeeding:  Supportive bra, avoid stimulating breasts, ice packs to breasts, subsides w/in 24 hours ▪ Assess for plugged milk ducts  Frequent feedings, changing feeding position, warms compresses and massages, wear supportive bra o Immune ▪ Common for mild temperature elevations during first 24 hrs postbirth ▪ Immunize for rubella before discharge ▪ Rh isoimmunization  First injection given at 28 weeks, second given if she is Coombs’ negative o Endocrine ▪ Nonlactating: menses begins 7-9 weeks post-birth  Ovulation usually occurs by the fourth cycle ▪ Lactating: suppresses menses and ovulation and is dependent upon length and amount of breastfeeding ▪ Need to use some form of contraception in both situations Contraception Method