NURSING 306 OB Exam 2 Study Guide OB Hartman Gold, A+ Solutions & Guide!

NURSING 306 OB Exam 2 Study Guide OB Hartman, A+ Solutions & Guide!-Immediately after delivery the fundus is right at the umbilicus, feels like fist Every PP day fundus drops 1cm Day 9-10: cannot feel fundus at all - Should be firm - If it’s boggy - at risk for PP hemorrhage Massage the fundus immediately & reassess in 30 min If massage is not helping, give oxytocin Should be midline If boggy & deviated it means the bladder is full- always massage, if not resolved ask pt to void & reevaluate Assess for clots The uterus on the average descends 1 centimeter per day. ○ ○ The first nursing action for a boggy uterus is to massage the fundus. ○ Oxytocin is commonly used to control postpartum bleeding related to Postpartum period: 6 week period after childbirth The Reproductive System Uterus: The uterus needs to be contracted to prevent hemorrhaging Women who are in a healthy state and had a low risk pregnancy have a lower risk for complications Women are at risk for infection and hemorrhage Involution: uterus returns to pre-pregnant size, shape and location Afterpains: moderate to severe cramp-like pains RT/ uterus contracting &/or the release of oxytocin from the infant suckling Nursing Actions: Assess the uterus for location, position and tone of the fundus (inform, explain, and instruct pt to void) An over distended bladder may cause uterine atony (decreased uterine muscle tone that may lead to postpartum hemorrhage)/displacement, therefore voiding gives you an accurate assessment Rationale: An over distended bladder can result in uterine displacement and atony. Encouraging the woman to void prior to uterine assessment will allow for an accurate assessment of uterine placement and tone. Hemorrhage: Primary (early) first 24 hours after birth & Secondary (late) 6-14 days following birth. Place pt in supine position Locate the fundus with the other hand using gentle downward pressure Determine the tone of the fundus: Firm = contracted Soft = boggy: indicates that the uterus is not contracting and places the woman at risk for excessive blood loss. INTERVENTION: massage the uterus to stimulate contraction/ give Oxytocin to stimulate contraction Measure the distance between the fundus and umbilicus with your fingers (each finger breadth is 1 cm) Determine the position of the uterus Rationale: A uterus that is shifted to the side may indicate a distended bladder. A distended bladder interferes with uterine contractibility, which places the woman at risk for uterine atony and increases her risk of hemorrhage. Expected assessment finding after birth of the placenta: After birth: uterine fundus is midline between the umbilicus and symphysis pubis and is firm at midline Within 12 hours: level of the umbilicus or 1cm above the umbilicus/ midline 24hrs after: 1cm below the umbilicus / firm and midline Note: the uterus descends 1cm per day/ by day10 it descends into the pelvis and is not palpable Boggy Uterus: a sign that the uterus is not contracting At risk of excessive blood loss/hemorrhage is ^ Immediate action is to massage the fundus with the palm of your hand in a circular motion until firm and reevaluate within 30 min If the uterus does not respond to massage, follow the standing order for oxytocin and notify the HCP