NU 356 - Exam 3
Practice Questions &
Answers
Comprehensive Explanations
& Rationales
Key Concepts • Review
Questions • Exam Preparation
,Involution of the Uterus -Contraction of the muscle fibers
-Catabolic process
-Regeneration of uterine epithelium
-Site of placental attachment heals by process of exfoliation
Involution can be evaluated by measuring the __________ Descent
of the fundus
Lochia The postpartum vaginal discharge that typically continues for 4-6 weeks after
childbirth
Descent of Uterine Fundus -About 1cm per day
-14 days after childbirth, fundus should not be palpable
-Afterpains/intermittent contractions may cause discomfort
Types of Lochia Rubra (red) - lasts 3 to 5 days
Serosa (pink) - lasts 22 to 27 days
Alba (white) - continues for 10 to 14 days
Assessment of Lochia -Amount
-Type
-Color
-Odor
Vagina It takes 6-10 weeks for the vagina to regain its nonpregnant size and contour
Perineum Trauma and hemorrhoids cause discomfort and can interfere with activity and bowel
elimination
Lacerations of the birth canal First Degree
-Superficial vaginal mucosa or perineal skin
Second Degree
-Fascia and muscles of the perineum
Third Degree
-Involves anal sphincter
Fourth Degree
-Extends through anal sphincter into the rectal mucosa
Postpartum Cardiovascular changes Cardiac Output
-Blood from the uterus and placenta returns to central circulation
-Extracellular fluid moves into the vascular compartment
-CO increases and excess fluid is excreted by diuresis and diaphoresis
Coagulation
-Increased clotting factors predispose the woman to clot formation
,Postpartum GI changes -Constipation WILL occur
•Decreased food and fluid intake during labor
•Reduced muscle and bowel tone
•Fear of pain during defecation
-First stool 2-3 days post birth
Postpartum Urinary system changes -Increased bladder capacity & decreased sense to fluid pressure
•Urinary retention
-Stasis of urine allows bacterial growth
•UTI
-Distended bladder displaces the uterus and interfered with uterine contraction
•Excessive bleeding
Signs of a Distended Bladder -Location of fundus above baseline level
•Determine with empty bladder
-Fundus displaced from midline
-Excessive lochia
-Bladder discomfort
-Bulge of bladder above symphysis
-Frequent voiding of less than 150mL
Postpartum Musculoskeletal changes Muscles & Joints
-First 1-2 days after birth, muscle fatigue & aches
Abdominal Wall
-Diastasis recti
Reduction in discomfort
-Exercises to strengthen the abdominal muscles
-Good posture
-Body mechanics
Diastasis Recti Abdominis Separation of the longitudinal muscles of the abdomen (rectus abdominis) during
pregnancy.
Postpartum Endocrine system changes Integumentary
-Hormone levels decline, skin gradually returns to normal
Resumption of ovulation/menstruation
-Breastfeeding may delay return of ovulation
-Ovulation may occur before first menses
Breastfeeding
-More likely to experience vaginal dryness that results from inadequate estrogen
Resumption of Ovulation and Menstruation -Ovulation may occur before 1st menses
-May resume as early as 3 weeks postpartum
-Frequent breastfeeding may delay resumption of menses
Lactation -Prolactin levels remain high, initiating milk production 2-3 days post birth
•Anterior Pituitary
-Oxytocin is necessary for milk "letdown"
•Posterior Pituitary
, Focused Assessment following vaginal birth -Vital Signs
•Blood pressure
•Orthostatic Hypotension
•Pulse
•Respirations
•Temp
•Pain
-Fundus
-Lochia
-Perineum (REEDA)
-Bladder exam
-Breasts
-Lower extremities
-Homans sign
-Edema & DTR
REEDA -Redness
-Edema
-Ecchymosis
-Discharge
-Approximation
Homans sign -Pain in calf upon dorsiflexion of foot
-May indicated thrombophlebitis
Risk factors for Postpartum Hemorrhage -Grand multiparity
-Overdistention of uterus
-Rapid, precipitous, prolonged labor
-Retained placenta
-Placenta previa
-Abruptio placenta
-Medications (tocolytics, oxytocin)
-Operative procedures
-Coagulation defects
Risk factors for Postpartum Infection -Operative procedures
-Multiple cervical exams
-Prolonged labor
-Prolonged rupture of membranes
-Manual extraction of placenta
-Diabetes
-Catheterization
Comfort measures after birth -Ice packs
-Sitz baths
-Perineal care
-Topicals
-Analgesics
Becoming Acquainted: Bonding -Initial attraction felt by parents for their infants
-Unidirectional from parent to child
-Skin-to-skin
Becoming Acquainted: Attachment -Process by which an enduring bond between a parent and child is developed
-Begins in pregnancy and extends for many months after birth
Reciprocal attachment behaviors -Eye contact with prolonged, intense mutual gazing
-Eye movements with attempts to "track" parent's face
-Grasping and holding of parent's finger
-Synchronous movements in response to rhythms and patterns of parent's voice
-Rooting, suckling, and latching on to breast
-Being comforted by parent's voice or touch
Practice Questions &
Answers
Comprehensive Explanations
& Rationales
Key Concepts • Review
Questions • Exam Preparation
,Involution of the Uterus -Contraction of the muscle fibers
-Catabolic process
-Regeneration of uterine epithelium
-Site of placental attachment heals by process of exfoliation
Involution can be evaluated by measuring the __________ Descent
of the fundus
Lochia The postpartum vaginal discharge that typically continues for 4-6 weeks after
childbirth
Descent of Uterine Fundus -About 1cm per day
-14 days after childbirth, fundus should not be palpable
-Afterpains/intermittent contractions may cause discomfort
Types of Lochia Rubra (red) - lasts 3 to 5 days
Serosa (pink) - lasts 22 to 27 days
Alba (white) - continues for 10 to 14 days
Assessment of Lochia -Amount
-Type
-Color
-Odor
Vagina It takes 6-10 weeks for the vagina to regain its nonpregnant size and contour
Perineum Trauma and hemorrhoids cause discomfort and can interfere with activity and bowel
elimination
Lacerations of the birth canal First Degree
-Superficial vaginal mucosa or perineal skin
Second Degree
-Fascia and muscles of the perineum
Third Degree
-Involves anal sphincter
Fourth Degree
-Extends through anal sphincter into the rectal mucosa
Postpartum Cardiovascular changes Cardiac Output
-Blood from the uterus and placenta returns to central circulation
-Extracellular fluid moves into the vascular compartment
-CO increases and excess fluid is excreted by diuresis and diaphoresis
Coagulation
-Increased clotting factors predispose the woman to clot formation
,Postpartum GI changes -Constipation WILL occur
•Decreased food and fluid intake during labor
•Reduced muscle and bowel tone
•Fear of pain during defecation
-First stool 2-3 days post birth
Postpartum Urinary system changes -Increased bladder capacity & decreased sense to fluid pressure
•Urinary retention
-Stasis of urine allows bacterial growth
•UTI
-Distended bladder displaces the uterus and interfered with uterine contraction
•Excessive bleeding
Signs of a Distended Bladder -Location of fundus above baseline level
•Determine with empty bladder
-Fundus displaced from midline
-Excessive lochia
-Bladder discomfort
-Bulge of bladder above symphysis
-Frequent voiding of less than 150mL
Postpartum Musculoskeletal changes Muscles & Joints
-First 1-2 days after birth, muscle fatigue & aches
Abdominal Wall
-Diastasis recti
Reduction in discomfort
-Exercises to strengthen the abdominal muscles
-Good posture
-Body mechanics
Diastasis Recti Abdominis Separation of the longitudinal muscles of the abdomen (rectus abdominis) during
pregnancy.
Postpartum Endocrine system changes Integumentary
-Hormone levels decline, skin gradually returns to normal
Resumption of ovulation/menstruation
-Breastfeeding may delay return of ovulation
-Ovulation may occur before first menses
Breastfeeding
-More likely to experience vaginal dryness that results from inadequate estrogen
Resumption of Ovulation and Menstruation -Ovulation may occur before 1st menses
-May resume as early as 3 weeks postpartum
-Frequent breastfeeding may delay resumption of menses
Lactation -Prolactin levels remain high, initiating milk production 2-3 days post birth
•Anterior Pituitary
-Oxytocin is necessary for milk "letdown"
•Posterior Pituitary
, Focused Assessment following vaginal birth -Vital Signs
•Blood pressure
•Orthostatic Hypotension
•Pulse
•Respirations
•Temp
•Pain
-Fundus
-Lochia
-Perineum (REEDA)
-Bladder exam
-Breasts
-Lower extremities
-Homans sign
-Edema & DTR
REEDA -Redness
-Edema
-Ecchymosis
-Discharge
-Approximation
Homans sign -Pain in calf upon dorsiflexion of foot
-May indicated thrombophlebitis
Risk factors for Postpartum Hemorrhage -Grand multiparity
-Overdistention of uterus
-Rapid, precipitous, prolonged labor
-Retained placenta
-Placenta previa
-Abruptio placenta
-Medications (tocolytics, oxytocin)
-Operative procedures
-Coagulation defects
Risk factors for Postpartum Infection -Operative procedures
-Multiple cervical exams
-Prolonged labor
-Prolonged rupture of membranes
-Manual extraction of placenta
-Diabetes
-Catheterization
Comfort measures after birth -Ice packs
-Sitz baths
-Perineal care
-Topicals
-Analgesics
Becoming Acquainted: Bonding -Initial attraction felt by parents for their infants
-Unidirectional from parent to child
-Skin-to-skin
Becoming Acquainted: Attachment -Process by which an enduring bond between a parent and child is developed
-Begins in pregnancy and extends for many months after birth
Reciprocal attachment behaviors -Eye contact with prolonged, intense mutual gazing
-Eye movements with attempts to "track" parent's face
-Grasping and holding of parent's finger
-Synchronous movements in response to rhythms and patterns of parent's voice
-Rooting, suckling, and latching on to breast
-Being comforted by parent's voice or touch
