Nursing 121: Unit 1, Normal Postpartum Nursing || with
Faultless Solutions.
Maternal Physiologic Changes correct answers - 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 correct answers - reduction in size and return to non-pregnant state
- 1 cm every 24 hours
Subinvolution of the Uterus correct answers - when the uterus remains large, not normal and
requires further assessment
- may be caused by retained products or infection
Fundus correct answers - 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 correct answers - abnormal
- refers to decreased uterine muscle tone and higher bleeding
Lochia correct answers - postpartum discharge that contains the remaining debris after birth
- classified according to its appearance and contents
- if mom is filling 1 full pad in an hour or less, further assessment is needed immediately
Lochia Rubra correct answers - 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 correct answers - 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 correct answers - 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 correct answers - 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 correct answers - external os permanently changed
- vagina returns to normal size within 3-4 weeks
- breast-feeding mom may take longer to return to normal due to hypo-estrogenic state
- educate risks of dyspareunia and comfort measure
- episiotomy heals within 3 weeks but complete healing may take 6 months
- consider pelvic floor weakness and nursing interventions
Urinary Changes correct answers - bruising and trauma may result in decreased sensation and
increased capacity after delivery
- kidneys excrete 2000-3000 mL in 12-24 hours after delivery
Abdominal Changes correct answers - diastasis recti improved with exercise
- stretch marks face but may still be visible
GI Changes correct answers - initial weight loss of 10-12 lbs after delivery
- hunger after birth common
- bowels may be sluggish due to progesterone causing constipation and pain
- consider nursing interventions for women with lacerations or episiotomy
Breast and Nipple Changes correct answers - breasts and nipples may be tender
- encourage breast feeding of colostrum which helps establish gut flora for baby
- transitional milk come in by day 3
- mature milk comes in within 2 weeks
Maternal Changes to Vital Signs correct answers - elevated temperature may occur in the first 24
hours due to dehydration, milk let down
- immediate rise in BP after delivery; significant decrease may indicate hemorrhage
- excessively high BP warrants evaluation to prevent complication
- return to pre-pregnancy BP range should occur within days after delivery
- pulse >100 bpm needs further assessment
- 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 correct answers - non-pathologic leukocytosis occurs with WBC 25,000-
30,000
Faultless Solutions.
Maternal Physiologic Changes correct answers - 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 correct answers - reduction in size and return to non-pregnant state
- 1 cm every 24 hours
Subinvolution of the Uterus correct answers - when the uterus remains large, not normal and
requires further assessment
- may be caused by retained products or infection
Fundus correct answers - 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 correct answers - abnormal
- refers to decreased uterine muscle tone and higher bleeding
Lochia correct answers - postpartum discharge that contains the remaining debris after birth
- classified according to its appearance and contents
- if mom is filling 1 full pad in an hour or less, further assessment is needed immediately
Lochia Rubra correct answers - 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 correct answers - 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 correct answers - 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 correct answers - 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 correct answers - external os permanently changed
- vagina returns to normal size within 3-4 weeks
- breast-feeding mom may take longer to return to normal due to hypo-estrogenic state
- educate risks of dyspareunia and comfort measure
- episiotomy heals within 3 weeks but complete healing may take 6 months
- consider pelvic floor weakness and nursing interventions
Urinary Changes correct answers - bruising and trauma may result in decreased sensation and
increased capacity after delivery
- kidneys excrete 2000-3000 mL in 12-24 hours after delivery
Abdominal Changes correct answers - diastasis recti improved with exercise
- stretch marks face but may still be visible
GI Changes correct answers - initial weight loss of 10-12 lbs after delivery
- hunger after birth common
- bowels may be sluggish due to progesterone causing constipation and pain
- consider nursing interventions for women with lacerations or episiotomy
Breast and Nipple Changes correct answers - breasts and nipples may be tender
- encourage breast feeding of colostrum which helps establish gut flora for baby
- transitional milk come in by day 3
- mature milk comes in within 2 weeks
Maternal Changes to Vital Signs correct answers - elevated temperature may occur in the first 24
hours due to dehydration, milk let down
- immediate rise in BP after delivery; significant decrease may indicate hemorrhage
- excessively high BP warrants evaluation to prevent complication
- return to pre-pregnancy BP range should occur within days after delivery
- pulse >100 bpm needs further assessment
- 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 correct answers - non-pathologic leukocytosis occurs with WBC 25,000-
30,000
