Maternal Child Health Nursing (Rasmussen
University) MCH Exam 2 with answers review 1
,1
Maternal Exam 2
NUR2513F
Exam 2: Concept Review
Postpartum
▪ Lochia assessment: is the discharge that is made up of the superficial layer of the uterine lining
• Rubra: Red – blood, fragments of decidua, & mucous. Last the first few days after
delivery (1-3)
• Serosa: Pink/brown – blood, mucous and invading leukocytes ( 3- 10 days)
• Alba: White – largely mucous, leukocyte count high (10-14 days)
• Expected amounts…how much is too much? Flow T on exertion, especially the 1st few
days out of bed, w/ rest. Saturating a perineal pad in < 1h is abnormal
▪ How do we assess fundal height in the postpartum period? Assess shortly after the
mom emptied her bladder.
» Place one hand on the base of the uterus, above the symphysis pubis, and the other hand at
the umbilicus.
» Press in and downward w/ the hand on the base of the uterus until you “bump” against a firm
globular mass
» A well-contracted fundus feels firm, like a grapefruit in both size/tenseness
▪ Know the process of involution of the uterus: Involves 2 processes: the area where the
placenta was implanted is sealed off to prevent bleeding. 2 nd the organ is reduced to its
approximate pregestational size.
» Risk of hemorrhage from the denuded surface of the uterus until involution is complete
» Takes about 6wks, will remain slightly larger than pre-pregnant size
• Where do we expect the fundus to be after delivery? Halfway between the umbilicus
and the symphysis pubis. 1h after delivery it will rise to the level of the umbilicus, and
remain there for the next 24h.
• …Day 1? 1cm below the umbilicus
• …Day 2? 2cm below the umbilicus
» Decreases 1cm per day
▪ Be able to provide appropriate postpartum care to the woman after vaginal delivery:
• Episiotomy/laceration: clean perineum w/ warm water every bathroom, ice for the 1st
24h Sitz bath after 24h, tucks (witch hazel patches)
» Redness Edema Ecchymosis Discharge Approximation of skin REEDA
» The proximity of the perineum to the anus T the risk of laceration or surgical incision
, 2
Maternal Exam 2
becoming contaminated w/ fecal matter.
• Bladder assessment- what are the concerns?
» Bladder distention will not allow the uterus to contract. Fundus will be higher than
expected and shifted to the side
» Full bladder sounds resonant, non-fluid filled: dull, thudding
» Hydronephrosis remains for 4wks, in conjunction w/ reduced bladder sensitivity, T the
possibility of urinary stasis and UTI ???
• Medications used during the postpartum period: Acetaminophen, Ibuprofen, Docusate
• Oxytocin, hemabate, methylergonovine, carbaprost can be administered to
promote uterine contractions
▪ What infection risks present for the mom in the postpartum period?
• Episiotomy: can get exposed to fecal matter leading to UTI. REEDA: Redness,
Edema, Ecchymosis, Discharge, Approximation of skin.
• Mastitis
• C-Section incision
▪ What is mastitis? Infection of the breast during lactation
• Symptoms? Pain, redness, high temperature, malaise, fatigue
• Management? ABT, continue breastfeeding, if the baby refuses, pump to maintain flow
and avoid clogged ducts
▪ Differentiate between mastitis and blocked milk duct.
» Mastitis is the glands or milk ducts.
»Blocked: firm nodule detected on palpation, temporary, prevents milk from flowing forward to
the nipple
▪ Rooming in: is it recommended? Yes, the sooner the mom becomes acquainted w/ the
baby, the more confident she will feel.
» Rooming in occurs when the baby remains w/ mom in the room for 23-24h/day. Father and
siblings can visit. In many settings the father can stay overnight
▪ Postpartum Preeclampsia: may occur up to 10-14 days after birth, usually occurs 48h after birth
• Symptoms: proteinuria, edema, T BP
• Nursing care/management: bed rest, quit atmosphere, frequent checks of VS and
urine output. Administer mag sulfate and aspirin/atenolol (???)
University) MCH Exam 2 with answers review 1
,1
Maternal Exam 2
NUR2513F
Exam 2: Concept Review
Postpartum
▪ Lochia assessment: is the discharge that is made up of the superficial layer of the uterine lining
• Rubra: Red – blood, fragments of decidua, & mucous. Last the first few days after
delivery (1-3)
• Serosa: Pink/brown – blood, mucous and invading leukocytes ( 3- 10 days)
• Alba: White – largely mucous, leukocyte count high (10-14 days)
• Expected amounts…how much is too much? Flow T on exertion, especially the 1st few
days out of bed, w/ rest. Saturating a perineal pad in < 1h is abnormal
▪ How do we assess fundal height in the postpartum period? Assess shortly after the
mom emptied her bladder.
» Place one hand on the base of the uterus, above the symphysis pubis, and the other hand at
the umbilicus.
» Press in and downward w/ the hand on the base of the uterus until you “bump” against a firm
globular mass
» A well-contracted fundus feels firm, like a grapefruit in both size/tenseness
▪ Know the process of involution of the uterus: Involves 2 processes: the area where the
placenta was implanted is sealed off to prevent bleeding. 2 nd the organ is reduced to its
approximate pregestational size.
» Risk of hemorrhage from the denuded surface of the uterus until involution is complete
» Takes about 6wks, will remain slightly larger than pre-pregnant size
• Where do we expect the fundus to be after delivery? Halfway between the umbilicus
and the symphysis pubis. 1h after delivery it will rise to the level of the umbilicus, and
remain there for the next 24h.
• …Day 1? 1cm below the umbilicus
• …Day 2? 2cm below the umbilicus
» Decreases 1cm per day
▪ Be able to provide appropriate postpartum care to the woman after vaginal delivery:
• Episiotomy/laceration: clean perineum w/ warm water every bathroom, ice for the 1st
24h Sitz bath after 24h, tucks (witch hazel patches)
» Redness Edema Ecchymosis Discharge Approximation of skin REEDA
» The proximity of the perineum to the anus T the risk of laceration or surgical incision
, 2
Maternal Exam 2
becoming contaminated w/ fecal matter.
• Bladder assessment- what are the concerns?
» Bladder distention will not allow the uterus to contract. Fundus will be higher than
expected and shifted to the side
» Full bladder sounds resonant, non-fluid filled: dull, thudding
» Hydronephrosis remains for 4wks, in conjunction w/ reduced bladder sensitivity, T the
possibility of urinary stasis and UTI ???
• Medications used during the postpartum period: Acetaminophen, Ibuprofen, Docusate
• Oxytocin, hemabate, methylergonovine, carbaprost can be administered to
promote uterine contractions
▪ What infection risks present for the mom in the postpartum period?
• Episiotomy: can get exposed to fecal matter leading to UTI. REEDA: Redness,
Edema, Ecchymosis, Discharge, Approximation of skin.
• Mastitis
• C-Section incision
▪ What is mastitis? Infection of the breast during lactation
• Symptoms? Pain, redness, high temperature, malaise, fatigue
• Management? ABT, continue breastfeeding, if the baby refuses, pump to maintain flow
and avoid clogged ducts
▪ Differentiate between mastitis and blocked milk duct.
» Mastitis is the glands or milk ducts.
»Blocked: firm nodule detected on palpation, temporary, prevents milk from flowing forward to
the nipple
▪ Rooming in: is it recommended? Yes, the sooner the mom becomes acquainted w/ the
baby, the more confident she will feel.
» Rooming in occurs when the baby remains w/ mom in the room for 23-24h/day. Father and
siblings can visit. In many settings the father can stay overnight
▪ Postpartum Preeclampsia: may occur up to 10-14 days after birth, usually occurs 48h after birth
• Symptoms: proteinuria, edema, T BP
• Nursing care/management: bed rest, quit atmosphere, frequent checks of VS and
urine output. Administer mag sulfate and aspirin/atenolol (???)
