NUR 230 EXAM 2 REVIEW

Exam 2 Review
Thursday, July 30, 2026 10:05 AM



Postpartum and Client's Health Issues
1. What does the term involution mean? Define what occurs with normal involution.
○ Involution is the return of uterus to the pre-pregnant state. Uterus may rise above the umbilicus by 1 cm
within the first 12 hours.
○ Normal occurrence:
 Within in 24 hours should be at umbilicus (the level of 20 weeks gestation).
 Uterine involution should occur at a rate of 1-2 cm per day and at 2 weeks postpartum should not
be felt externally.

2. Define the 3 stages of lochia and the expected length of time they should occur? Would there be a
difference in the amount of lochia seen in a vaginal delivery versus C/S?
○ Rubra: First 3 day, dark red color, menstrual period like
○ Serosa: 4-10 days, pinkish color
○ Alba: 11 days to 6 weeks, yellowish white color
○ Women who undergo c-sections typically have less lochia because the surgeon manually
vacuums/sponges out the uterine cavity prior to closing the incision.

3. Review the anatomic and physiologic patterns during postpartum recovery to pre-pregnancy.
○ Hematological and Metabolic:
 Decreased blood volume
 Estrogen, Progesterone, and prolactin
○ Neurological:
 Fatigue and discomfort
○ Renal, Fluid, and Electrolytes:
 Natriuresis and Diuresis
○ Respiratory:
 Decrease in Intra-abdominal Pressure
○ Integumentary:
 Stretch marks
○ Cardiovascular:
 Cardiac output, Diuresis
○ Immune:
 Elevated WBC, Rhogam, MMR, & Tdap
○ Reproductive:
 Return of Ovulation and Menstruation
○ Musculoskeletal:
 Muscle Fatigue, Diastasis, Recti-abdominis

4. What are the expected vital signs we would see in a postpartum patient? When would you be
concerned that the patient is showing signs of complications?
○ Expected vitals: Temperature: May increase up to 100.4 during the first 24 hours due to dehydrating
effects of labor; should be normal thereafter, Heart rate is transient bradycardia (50-70 bpm) Pulse
returns to baseline within days, Respirations should remain in the normal non pregnant range of 12-20
breath/min, and BP should remain stable or show a slight, transient elevation over baseline
○ When to be concerned: Temp above 100.4 after 24 hours = probable infection, Report pulse if increased
more than 100 bpm, Monitor for preeclampsia and assess for hypotension (sign of severe postpartum
hemorrhage or septic shock), and Hypoventilation/Hypoxia (complication of spinal/epidural anesthesia
or PE)

5. What postpartum patient should receive Rhogam after delivery and when should they receive it?
○ When a baby is Rh positive. They should receive it WITHIN 72 HOURSafter delivery to prevent mother
of baby from developing antibodies.
6. What are expected normal findings in a CBC after delivery?
○ Elevated WBC are normal in the first 10-12 days without indicating infection.
○ Decreased Hgb/Hct: greater than 10%
○ Platelets: Coagulation factors and fibrinogen remain elevated during early postpartum, while platelets

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, ○ Platelets: Coagulation factors and fibrinogen remain elevated during early postpartum, while platelets
drop slightly after placental separation before gradually rising.
7. What are Rubin's 3 maternal stages of adaptation and what occurs during the stages?
○ Phase 1: Taking-in (First 1-2 days)- mother is passive and dependent; focuses on her own basic needs
(sleep, food, comfort). Relies on other to meet her needs; eager to talk about the labor and birth
experience to integrate it emotionally.
○ Phase 2: Taking-hold (Days 2 to 10)- mother shifts focus to newborn and assumes caregiving
responsibilities. Desires independence and direct care tasks; highly receptive to nursing instruction,
though easily frustrated if skills are not mastered immediately.
○ Phase 3: Letting go- Reorganizes family dynamics; let go of former lifestyle and idealized vision of the
birth/baby. Fully accepts the reality of the infant and steps confidently into the maternal role

8. What is the difference between postpartum blues, postpartum depression, and postpartum
psychosis?
○ Postpartum blues:
 Onset & Duration: Begins within the first 2 to 4 days post-birth, peaks around day 5, and resolves
spontaneously within 10 to 14 days.
 Symptoms: Emotional lability, tearfulness, mood swings, mild anxiety, fatigue, and irritability.
 Key Features: It is self-limiting and considered a normal, temporary response after giving birth;
daily maternal functioning remains intact, and medical treatment is not required
○ Postpartum depression:
 Onset & Duration: Develops more gradually, typically within the first 4 weeks after delivery, but can
manifest anytime during the first year.
 Symptoms: Persistent and severe sadness, intense anxiety or panic, extreme fatigue, severe
mood swings, feelings of guilt or worthlessness, difficulty bonding with the baby, and loss of
interest in activities.
 Key Features: Significantly impairs the mother's ability to carry out daily activities and care for
herself or her infant; requires medical intervention, such as psychotherapy and antidepressant
medications.
○ Postpartum psychosis:
 Onset & Duration: A rare psychiatric emergency that develops suddenly, usually within the first 2
to 3 weeks postpartum.
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 Symptoms: Auditory or visual hallucinations, severe delusions (often related to the infant),
disorganized thinking, extreme confusion, paranoia, severe agitation, and rapid mood changes.
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 Key Features: Involves a break from reality with a high risk of infant harm, child abuse, or suicide;
requires immediate emergency medical evaluation and inpatient psychiatric hospitalization

9. What are the manifestations that would suggest the patient is having a postpartum hemorrhage?
Where would the uterus be located? Would there be any changes to the bladder? What are the risk
factors for a postpartum hemorrhage? What medications would be used?
○ Manifestations:
 Excessive bleeding greater than 500 mL for vaginal; greater than 1000mL for c-section or loss with
signs of hypovolemia, saturated pads in less than 15 minutes, passage of large blood clots,
tachycardia, drop in BP, pale/clammy skin, dyspnea
○ Uterine location:
 The uterus is boggy (soft, uncontracted) and displaced above the level of the umbilicus
○ Risk Factors:
 Uterine atony, history of postpartum hemorrhage, overdistended uterus from twins,
polyhydramnios, macrosomia), prolonged or precipitous labor, high parity, use of oxytocin
induction, mag. Sulfate, chorioamnionitis, retained placenta fragments
○ Medications:
 Oxytocin (Pitocin): 1st line uterotonic
 Methylergonovine (Methergine): Contraindicated in patients with hypertension/preeclampsia
 Misoprostol (Cytotec): Administer rectally, orally, or sublingual
 Tranexamic Acid (TXA): Antifibrinolytic agent given IV

10. The nurse is caring for a mom who had gestational diabetes during her pregnancy. What nursing
interventions would the nurse do for the mom and baby after delivery and why?
○ Monitor blood glucose levels: Placental removal triggers a sudden, drastic drop in human placental
lactogen (HPL)
○ Assess for postpartum hemorrhage: Polyhydramnios or fetal macrosomia associated with gestation



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