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Nursing 121 Unit 1: Normal Postpartum Nursing Exam with Correct Answers, Exams of Nursing

Brown UniversityNursing

A comprehensive overview of normal postpartum physiological changes, focusing on the involution of the uterus, lochia, cervical, vaginal, and perineal changes, urinary and abdominal changes, breast and nipple changes, maternal vital signs, blood values, and hormonal changes. It also includes nursing considerations for maternal assessment, physiological assessment using bubblhe and reeda, perineal well-being and comfort measures, becoming a mother and maternal role attainment, attachment behaviors, and rest and activity.

Typology: Exams

2024/2025

Available from 11/04/2024

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Nursing 121 Unit 1, Normal Postpartum
Nursing Exam with correct answers
Maternal Physiologic Changes - ANSWER -- the process of readjusting physically and
mentally from pregnancy and birth begins immediately after birth and continues for
about 6 weeks
- many factors contribute to mother's response to her infant during this time:
mother's energy level and degree of comfort
health of newborn
care and encouragement given by health professionals
Involution of the Uterus - ANSWER -- reduction in size and return to non-pregnant
state
- 1 cm every 24 hours
Subinvolution of the Uterus - ANSWER -- when the uterus remains large, not normal
and requires further assessment
- may be caused by retained products or infection
Fundus - ANSWER -- after delivery of placenta, the uterine blood vessels become
compressed with a firm contracted uterus
- should be high and midline
- if fundus is deviated from midline, have mom enter her bladder and recheck
Boggy Uterus - ANSWER -- abnormal
- refers to decreased uterine muscle tone and higher bleeding
Lochia - ANSWER -- postpartum discharge that contains the remaining debris after
birth
- classified according to its appearance and contents
Nursing 121 Unit 1, Normal Postpartum
Nursing Exam with correct answers
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Nursing 121 Unit 1, Normal Postpartum

Nursing Exam with correct answers

Maternal Physiologic Changes - ANSWER -- the process of readjusting physically and mentally from pregnancy and birth begins immediately after birth and continues for about 6 weeks

  • many factors contribute to mother's response to her infant during this time: mother's energy level and degree of comfort health of newborn care and encouragement given by health professionals Involution of the Uterus - ANSWER -- reduction in size and return to non-pregnant state
  • 1 cm every 24 hours Subinvolution of the Uterus - ANSWER -- when the uterus remains large, not normal and requires further assessment
  • may be caused by retained products or infection Fundus - ANSWER -- after delivery of placenta, the uterine blood vessels become compressed with a firm contracted uterus
  • should be high and midline
  • if fundus is deviated from midline, have mom enter her bladder and recheck Boggy Uterus - ANSWER -- abnormal
  • refers to decreased uterine muscle tone and higher bleeding Lochia - ANSWER -- postpartum discharge that contains the remaining debris after birth
  • classified according to its appearance and contents

Nursing 121 Unit 1, Normal Postpartum

  • if mom is filling 1 full pad in an hour or less, further assessment is needed immediately Lochia Rubra - ANSWER -- dark red
  • occurs for the first 2-3 days
  • contains epithelial cells, erythrocytes, leukocytes, shreds of decidua, and occasionally fetal meconium, langugo, and vernix
  • some small clots (no larger than a nickel) are common, especially in the first few days after birth Lochia Serosa - ANSWER -- a pinkish color
  • from 3-10 days after birth
  • composed of serous exudate, shreds of degenerating decidua, erythrocytes, leukocytes, cervical mucus, and numerous microorganisms
  • RBC component decreases gradually Lochia Alba - ANSWER -- a creamy or yellowish discharge
  • final postpartum discharge, persists for an additional week or two
  • composed primarily of leukocytes, decidual cells, epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria Suggested Guidelines for Assessing Lochia Volume - ANSWER -- scant amount: blood only on tissue when wiped or less than 1-inch stain on peripad
  • light amount: less than 4-inch stain on peripad
  • moderate amount: less than 6-inch stain on peripad
  • heavy amount: saturated peripad within 1 hour
  • lochia should never exceed a moderate amount
  • if peripad is heavily saturated in 1 hour or less, further assessment is needed immediately Cervix, Vaginal, and Perineal Changes - ANSWER -- external os permanently changed

Nursing 121 Unit 1, Normal Postpartum

  • postpartum chill may be related to release of pressure on pelvic nurses, epidural, adrenaline
  • chill is not concerning unless accompanied by a fever Maternal Blood Values - ANSWER -- non-pathologic leukocytosis occurs with WBC 25,000-30,
  • blood loss averaged 200-500 mL for vaginal birth, 1000 mL for c-section
  • hemoglobin and hematocrit may be hard to interpret in the first 48 hours due to changing blood volume due to fluid volume shifts
  • hemostasis returns 3-4 weeks postpartum but diameters of deep veins can take up to 6 weeks Maternal Changes to Hormones: Placental Hormones - ANSWER -- expulsion of placenta results in dramatic decreases of placental-produced hormones
  • decreases in chorionic somatomammotropin (hCS), estrogens, cortisol, and placental enzyme insulinase reverse effects of pregnancy
  • estrogen and progestrone levels drop markedly Maternal Changes to Hormones: Pituitary Hormones and Ovarian Function - ANSWER -lactacting and nonlactating women differ in timing of first ovulation and menstruation Breastfeeding Mothers - ANSWER -- before lactation, a yellowish fluid, colostrum, can be expressed from nipples
  • tenderness may persist for 48 hours after start of lactation Non-Breastfeeding Mothers - ANSWER -- engorgement resolves spontaneously
  • discomfort decreases within 24 to 36 hours
  • if mom is not planning on breastfeeding or is unable to, milk supply can be reduced when avoiding stimulation, with breast binder or tight bra
  • ice packs, cabbage leaves, or mild analgesics may be used to relieve discomfort

Nursing 121 Unit 1, Normal Postpartum

Cardiovascular System - ANSWER -- cardiac output remains increased for 48 hours after birth

  • decreases by 30% by 2 weeks postpartum
  • stroke volume, cardiac output, end-diastolic volume, and systemic vascular resistance remain elevated for 12 weeks postpartum
  • left ventricular volume and cardiac output remain elevated for 1 year postpartum Neurologic System - ANSWER -- pregnancy-induced neurologic discomforts reduce after birth
  • headache requires careful assessment
  • postpartum headaches may be caused by gestational hypertension, stress, and leakage of cerebrospinal fluid into the extradural space during placement of needle for epidural or spinal anesthesia Integumentary System - ANSWER -- vascular abnormalities, spider angiomas, palmar erythema regress with rapid decline in estrogens
  • spider nevi persis indefinitely for some
  • hair growth slows during postpartum period
  • abundance of fine hair during pregnancy usually disappears after birth
  • coarse or bristly hair that appears during pregnancy usually remains
  • chloasma of pregnancy usually disappears at end of pregnancy
  • hyperpigmentation of areolae and linea nigra may not regress completely after childbirth
  • some women will have permanent darker pigmentation of those areas
  • stretch marks on breasts, abdomen, and thighs may fade but not disappear
  • profuse diaphoresis in immediate postpartum period is most noticeable change in integumentary system Rest and Activity - ANSWER -- reversal of pregnancy adaptations
  • joints are completely stabilized by 6-8 weeks after birth
  • provide opportunities for rest
  • encourage frequent rest periods

Nursing 121 Unit 1, Normal Postpartum

Redness Edema Ecchymosis Drainage Approximation of wound edges Perineal Well-Being and Comfort Measures - ANSWER -- assess perineum

  • perineal care
  • surgigator, sitz bath or peri bottle
  • analgesics
  • ice packs to reduce swelling
  • if hemorrhoids, encourage stool softeners and Tuck's pads Becoming a Mother and Maternal Role Attainment - ANSWER -- the process of learning mothering behaviors and the process of change and transition into the maternal-child relationship
  • mother may be passive and somewhat dependent after delivery; "taking in" period
  • encourage her to talk, process, clarify her reality, encourage eating and rest
  • by day 2-3 after delivery, mother may be more independent and have a greater sense of control; "taking hold" period
  • postpartum blues are transient periods of mood/behavioral changes that occur and resolve within 2 weeks
  • worsening symptoms or prolonged beyond 2 weeks should be evaluated by provider
  • consider social support and the function of the family process Attachment Behaviors - ANSWER -- En Face Position: face to face position with eye contact promotes attachment
  • skin to skin for both mother and partner encourages bonding, especially after delivery; can also stimulate hormonal release and instinctual behavior for infant to nurse

Nursing 121 Unit 1, Normal Postpartum

Acquaintance Phase - ANSWER -getting to know the infant Mutual Regulation - ANSWER -relationship between needs of the mother and needs of the infant Reciprocity - ANSWER -when the mother and infant enjoy each other's company Engrossment - ANSWER -process of absorption, preoccupation and interest in the infant demonstrated by fathers Factors that Hinder Parent-Infant Attachment - ANSWER -- physical condition of the mother and the newborn

  • maternal reactions to stress
  • anesthesia
  • medications Nursing Care Management: Psychosocial Needs of the Family - ANSWER -- impact of birth experience
  • maternal self-image and restoring physical health
  • adaptation to parenthood
  • competence in parent-infant interactions
  • look for problems with attachment Family Wellness - ANSWER -- family structure and functioning: are there struggles?
  • altering liffestyles to accommadte parenting
  • impact of cultural diversity
  • encourage bonding with the infant
  • provide family centered care, including siblings
  • information should be easily accessible, easy to read, and available in various formats (demonstration, hand out, teach back) and languages
  • encourage new learning in a supportive environment

Nursing 121 Unit 1, Normal Postpartum

  • nonjudgmental emotional support
  • education regarding newborn care and illness (feeding, weight, illness, airway)
  • education regarding self-care
  • VNA services Care of the Postpartum Mother with Obesity - ANSWER -- at higher risk for: injury respiratory complications DVT infection
  • assess for airway obstruction and hypoxia if narcotics were given
  • ambulation to prevent PNA and DVT especially if c-section
  • mother should demonstrate effective self-care, cleaning, drying, and protecting Care of the Lesbian Mother/Couples - ANSWER -- patient centered and family centered focus, build a rapport
  • these couples may have unique bonds when compared to heterosexual families
  • the non-pregnancy parent may easily assume a co-parenting role
  • same education and assessment apply, but contraception may not be appropriate unless used to treat menstrual suppression
  • nurses need to examine their own feelings about how they perceive alternative families and be mindful of nonverbal expressions when interacting with families Care of the Mother with Developmental Challenges - ANSWER -- provide education appropriate for their level of comprehension
  • use easy to ready formats, pictures, hands on demonstration
  • include family or peer mentor in education
  • nurses should be patient and consider re-education to enhance understanding (if appropriate)
  • perform a needs assessment for the patient and family

Nursing 121 Unit 1, Normal Postpartum

  • offer community resources (public and private) to make transition home easier and help arrange services if necessary Care of the Mother Who Relinquishes Her Infant - ANSWER -- may be elective due to maternal circumstances
  • may be legally due to drug use or incarceration
  • consider ambivalence and processes of grieving
  • encourage expressing of emotions
  • allow her to decide if she wishes to see infant
  • she should have access to the newborn and can assist in grieving
  • it is normal to feel strong attachment and love for the infant
  • the nurse needs to assure mother that these feelings do not mean her decisions are wrong as this is a painful act of love
  • consider special requests including relocation or early discharge if appropriate Infant Safe Haven Act of 1997 - ANSWER -- protects newborns from deaths cause by abandonment
  • provides a mother with a place to offer baby for adoption anonymously, and to ensure babies are left with safe providers who can care for them and provide medical services
  • the mother is protected from prosecution for neglect or abandonment
  • havens include hospitals, police departments, and manned fire stations
  • DCF is then notified and assumes legal custody and plans for adoption Care of the Mother with a History of Abuse - ANSWER -- may have more anxiety and stress related to being in a hospital or being physically examined
  • establishing a trusting relationship may be difficult or take more time
  • offer draping and privacy whenever possible
  • privacy helps promote trust and protect emotions from others
  • discuss contraception options she prefers, may be at risk for contraception sabotage if partner is abusive
  • offer support groups and community resources in private

Nursing 121 Unit 1, Normal Postpartum

  • readiness for enhanced family coping
  • readiness for enhanced self-health management Nursing Interventions: Infant Feeding and Comfort Needs - ANSWER -- encourage listening to baby, cue into types of cries
  • consider skin care, warmth, safety education Nursing Interventions: Episiotomy Care - ANSWER -- describe the healing process
  • discuss risks for contamination
  • describe methods of effective cleaning which promotes healing
  • signs and symptoms of infection Nursing Interventions: Sexual Activity - ANSWER -- resume after lochia stops
  • may be uncomfortable
  • encourage water soluble lubricants
  • if breastfeeding, forewarn mom that milk may release due to oxytocin
  • contraception
  • potential limiting factors: fatigue; demands of the infant Nursing Interventions: Sibling Attachment - ANSWER -- point out when the baby is looking at the sibling
  • acknowledge the role of the "big brother" or "big sister"
  • remind parents to reassure the child that they are still loved
  • encourage siblings help the mother (under supervision according to age and experience) to promote their sense of value Newborns' and Mothers' Health Promotion Act of 1996 - ANSWER -requires plans that offer maternity coverage to pay for at least a 48-hour hospital stay following childbirth (96-hour stay in the case of a cesarean section)

Nursing 121 Unit 1, Normal Postpartum

Criteria for Early Discharge - ANSWER -- woman recovered and able to care for self and baby

  • additional documentation may be required (AMA form)
  • provider and nurse are still responsible if the woman is planning to be discharged before her condition is stable Early Discharge - RN's Role - ANSWER -- RN's responsibility is a thorough head to toe assessment and discharge teaching
  • monitor for signs of possible complications
  • encourage rest and activity
  • educate when it is safe for resuming sexual activity
  • provide referral numbers for questions
  • offer contact information about local agencies or support groups
  • bottle or breastfeeding information, lactation services
  • ensure VNA services, if necessary, 3-4 after discharge
  • a scheduled postpartum exam 4-8 weeks after delivery unless maternal complication that needs sooner follow up (HTN, GDM)
  • a scheduled newborn well-baby visit
  • procedure for obtaining the birth certificates
  • review of newborn care, bathing, feeding, and stool changes
  • signs and symptoms of infant complications Discharge Teaching - ANSWER -- self-management and signs of complications (UTI, DVT, headache, fevers, severe pain, abnormal bleeding)
  • sexual activity/contraception
  • prescribed medications
  • providing basic infant care including car seat safety and nutrition
  • routine mother and baby checkups
  • dealing with activities of daily living at home and visitors
  • community support groups, parent hot line resources

Nursing 121 Unit 1, Normal Postpartum