Summary NSG 432 Exam 2 Study Notes | Postpartum Complications, High-Risk Newborn Care, Neonatal Adaptations & Breastfeeding Review | Comprehensive Nursing Notes | Latest 2026–2027 Update

NSG 432 Exam 2 Study Notes | Postpartum
Complications, High-Risk Newborn Care, Neonatal
Adaptations & Breastfeeding Review | Comprehensive
Nursing Notes | Latest 2026–2027 Update


DISCLAIMER: FOCUS ON THE PURPLE NOTES! These are the
things that Professor Webster said/highlighted in class. IT IS MOST
LIKELY going to be on the exam. The BLACK is the powerpoints, the
PINK is the speaker notes. The ORANGE (bottom of the document) is
exam questions.
NSG432 Exam 2 Material

TOPIC 3 MATERIAL

Topic 3: Care of postpartum family part 1 MATERNAL PHYSIOLOGIC CHANGES

Postpartum begins after the placenta is delivered
Vaginal recovery: 1-2 days > check-up 6 weeks after
C/S recovery: 3-4 days > 2 weeks check-up
Newborn is assessed 1-2 days after their birth

INVOLUTION > return to the normal state (the end of the third stage of labor- placenta delivery)
◦ Return of the uterus to a non-pregnant state after brith
◦ End of the third stage, funduc is midline, and descends 2 weight approximately 1000 gm
◦ Within 12 hours fundus is above 1 cm
◦ In 24 hours uterus is size of 20 week gestatino (umbilical leve)

◦ After birth fundus moves 2 cm below the umbilicus
◦ 12 hours after delivery, the fundus (top of the uterus) is 1 cm above the umbilicus
◦ 24 hours after delivery, the fundus (top of uterus) is at the umbilicus
◦ **Very important to remember is the time**

Subinvolution > failure of the uterus to return to a non-pregnant state
◦ Main causes:
o retained placental fragments
o Infection (because with infection there is swelling, and this inhibits the uterus
from returning to its normal state)

,Contractions, After pains, Placental Site
◦ Postpartum hemostasis
◦ After pains- more noticeable in multigravida (because the uterus has lost some of its
elasticity, so it has to work harder to stay contracted)
◦ Placental site > There is a wound at the placental site. And this wound has to heal. With
healing, there is drainage (Lochia). Looks like blood. The main difference between lochia
and blood is that lochia does not clot like blood does.
o Lochia SHOULD NOT HAVE AN ODOR. If there’s an odor it’s a s/s of infection o
Educate them to call the OB doctor if they notice an odor
 They will start the patient on broad spectrum antibiotics, and then once
the swab culture comes back, determine if further action is needed
*** Pitocin is given to keep the uterus contracting and control the bleeding (for vaginal and c/s)
◦ Compression of intra-myometrial blood vessels from uterine muscle contractions
◦ Resolve in 3-7 days
◦ Healed 6 weeks after birth with no scarring
◦ Afterpains more noticeable in births where the uterus was overdistended – macrosomic
infant, multifetal gestation, polyhydramnios

Lochia drainage from the placental site (because its healing and with healing theres going to be
drainage) (heaviest during the first 24 hours)
◦ Lochia rubra – Red last 1-3 days after delivery (heavier flow)
◦ Lochia serosa – after 3-4 days, turns pinkish color; containing old blood and serum tissue
debris. Lasts from day 4- 2 weeks
◦ Lochia alba – about 10-14 days (week 2) after birth discharge becomes yellow to white
containing leukocytes, mucus, serum, and bacteria; lasting up to 4-8 weeks ◦ After 8
weeks, the placenta site wound should be healed.
◦ If you get a question about lochia, pay attention to when the patient delivered, that will
tell you what stage they should be in
*note the amount*
◦ Scant
◦ Light
◦ Moderate
◦ Heavy

, ◦


Fundal checks
◦ Follow your hospitals protocol/policy
◦ After delivery, you are required to do 4 checks every 15 minutes x4, then 30 minutes x2
◦ You can educate your patient to do their own fundal checks
◦ When doing fundal checks, set your hand at the synthesis pubis- to stabilize and
prevent uterine prolapse (be firm but careful with the checks)

Cervix
◦ The cervix is soft immediately after birth
◦ Within 12-18 hours postpartum, it shortens and firms
◦ 2 fingers may still be inserted into the cervix for 4-6 days
After 4-6 days (day 6), the cervix is closed

Vagina and Perineum
◦ Estrogen deprivation = thinness of the vaginal mucosa and absence of rugae
◦ Initially the introitus is edematous and erythematous
◦ Episiotomy and Lacerations
◦ Good hygiene is important to prevent complications from episiotomies and lacerations
◦ Remember that estrogen and progesterone are the two main hormones that cause body
changes during pregnancy. These levels drop after placenta delivery, so everything is
trying to go back to normal
◦ Make sure you are checking the episiotomy and lacerations in your 15-minute check

Lacerations
◦ First degree: laceration that extends through skin and structure superficial to muscles
◦ Second degree: laceration that extends through muscles to the perineal body
◦ Third degree: laceration that extends through the anal sphincter muscle
◦ Fourth degree: laceration that involves the anterior rectal wall VERY BAD

Pelvic Muscular Support
◦ Encourage Kegel exercises to prevent stress incontinence because the pelvic floor
muscle is relaxed after delivery
◦ Uterine supporting structure
◦ Supportive pelvic floor tissues
◦ Kegal exercises
◦ Pelvic relaxation
◦ Muscles and ligaments that support the uterus, can be injured contributing to later gyn
problems.
◦ Pelvic relaxation is a direct but delayed complication of birth
◦ Tone can take up to 6 months to return
◦ Kegels encourage healing

, Abdomen
 Still protrudes after delivery- can stay that way for 2 weeks, but after 6 weeks it should
return to the non-pregnant state
 Protrudes
 2 weeks relaxed
 6 weeks returns to non-pregnancy
 Abdominal muscles separate causing diastasis recti abdominis p. 466

Pituitary Hormones and Ovarian Function
◦ Prolactin is responsible for the milk production
◦ Oxytocin
◦ Prolactin and oxytocin increase after delivery
◦ Estrogen and progesterone decrease after delivery