NSG-432 OB Exam 2 Study Guide
Topic 3: Chapters 18-21
Topic 4: Chapters 22-25
Post-Partum
Kegel Exercises: Pelvic floor muscle training; helps to strengthen muscle tone especially after
vaginal birth. Kegel exercises help women regain the muscle tone that is often lost as pelvic
tissues are stretched and torn during pregnancy and birth.
Postpartum Discomforts
Afterbirth Occur as result of the uterus
Pains More common in multiparas, BF mothers, patients treated
w/oxytocin, and patients who had an overdistended uterus during
pregnancy (twins)
Perineal Apply ice packs to the perineum during the first 24 hours to reduce
Discomfort swelling
After first 24 hours, apply warmth by sitz bath
Episiotomy Instruct patient to administer perineal care after each voiding
Encourage use of analgesic spray as prescribed
Perineal Care for the same way as episiotomy
Lacerations Rectal suppositories and enemas are contraindicated to avoid
injury to sutures
Breast Encourage patient to wear a support bra at all times even when
Discomfort she is sleeping
from Encourage the use of ice packs between feedings if the client is not
Engorgement BF. Use of ice packs could diminish milk supply in the BF mother
Administer analgesics as prescribed if comfort measures are
unsuccessful
Constipation Encourage adequate fluids (2000mL/day)
Encourage a diet high in fiber
Encourage ambulation
Administer stool softener, laxative, enema, or suppository if
needed
Complications:
- PP hemorrhage:
o PPH is defined as a loss of 500mL for vaginal birth and over 1000mL or more after
cesarean birth
o RF and common causes: uterine atony, anesthesia and analgesia, previous hx of
uterine atony, high parity, obesity, prolonged labor (oxytocin-induced labor)
, o Dark blood: Venous origin; lacerations of the birth canal
o Bright blood: Arterial and can indicate deep lacerations of the cervix
o Spurts of blood: Partial placental separation
Maternal Medications for PPH:
Medication Action Nursing Contraindications
Considerations
Oxytocin (Pitocin) Contraction of the Continue to monitor None indicated
uterus to decrease vaginal bleeding and
bleeding uterine tone
Misoprostol (Cytotec) Contraction of the Continue to monitor None indicated
uterus vaginal bleeding and
uterine tone
Usually given
rectally
Methylergonovine Contraction of the Check BP before Hypertension
(Methergine) uterus giving
Preeclampsia
Continue monitoring
vaginal bleeding and Cardiac Disease
uterine tone
Methylprostaglandin Contraction of the Continue to monitor Asthma
(Hemabate/Carboprost) uterus vaginal bleeding and
uterine tone Hypertension
Postpartum Blues Postpartum Depression Postpartum Psychosis
(PDD)
- 50-80% of women go - S/S: Mild to severe with - Most commonly
through PP blues women having good associated with
- Women are days and bad days BPD
emotionally labile and - Can go undetected b/s - S/S: grandiosity,
often cry easily new parents generally decreased need
- Peaks at 5th day and do not voluntarily for sleep, flight of
resolves by 10th day admit this kind of ideas,
- S/S: Let-down feeling, emotional distress distractibility,
restlessness, fatigue, - 2 weeks - 1 year hallucinations and
insomnia, headache, delusions
anxiety, sadness, and
anger
- “Blues” are normal and - Antidepressant - Antidepressants
mother/father may medications - Antipsychotics
, experience them - Sleep deprivation and - Mood stabilizers
- Get plenty of rest; nap plenty of rest - Benzodiazepines
when baby does if - ECT
possible
- Use relaxation
techniques
Assessment: BUBBLEHE
Normal Abnormal Causes Nursing
Findings Findings Interventions for
Abnormal Findings
Breasts Feelings of Cracking or May indicate Assist/educate mother
heavy, full, bleeding on the that infant does in
normal. breasts or around not have a good latching/breastfeeding
areola. May latch techniques
One breast or indicate that
nipple may be infant does not
different/larger have a good
than the other. latch.
Uterus Involution: Subinvolution: Magnesium Treat the cause
Return of the Failure of the since it can put Remove retained
uterus to a uterus to return you at risk for fragments
nonpregnant to a nonpregnant PP hemorrhage
state after birth state. Could Treat the infection
result from Placental w/appropriate
Fundus should infection or fragments medication
be felt around retained
midline at the placental Full bladder Get the uterus to
level of fragments. which can shift contract (fundal
umbilicus and uterus to the massage or
should be firm Fundus not felt right (lateral medication such as
the first 24 hrs. at umbilicus deviation) Pitocin)
Involutes and/or is boggy.
1cm/day. Multiparous
moms
Bladder Normal for Distended or full Full bladder Encourage voiding
postpartum bladder which Q2-3 hours b/c it will
women to not can shift fundus Infection decrease pain and
feel the urge to help mother heal
void (will Dysuria, faster
decrease pain, frequency,
heal faster) burning
(infection)
Topic 3: Chapters 18-21
Topic 4: Chapters 22-25
Post-Partum
Kegel Exercises: Pelvic floor muscle training; helps to strengthen muscle tone especially after
vaginal birth. Kegel exercises help women regain the muscle tone that is often lost as pelvic
tissues are stretched and torn during pregnancy and birth.
Postpartum Discomforts
Afterbirth Occur as result of the uterus
Pains More common in multiparas, BF mothers, patients treated
w/oxytocin, and patients who had an overdistended uterus during
pregnancy (twins)
Perineal Apply ice packs to the perineum during the first 24 hours to reduce
Discomfort swelling
After first 24 hours, apply warmth by sitz bath
Episiotomy Instruct patient to administer perineal care after each voiding
Encourage use of analgesic spray as prescribed
Perineal Care for the same way as episiotomy
Lacerations Rectal suppositories and enemas are contraindicated to avoid
injury to sutures
Breast Encourage patient to wear a support bra at all times even when
Discomfort she is sleeping
from Encourage the use of ice packs between feedings if the client is not
Engorgement BF. Use of ice packs could diminish milk supply in the BF mother
Administer analgesics as prescribed if comfort measures are
unsuccessful
Constipation Encourage adequate fluids (2000mL/day)
Encourage a diet high in fiber
Encourage ambulation
Administer stool softener, laxative, enema, or suppository if
needed
Complications:
- PP hemorrhage:
o PPH is defined as a loss of 500mL for vaginal birth and over 1000mL or more after
cesarean birth
o RF and common causes: uterine atony, anesthesia and analgesia, previous hx of
uterine atony, high parity, obesity, prolonged labor (oxytocin-induced labor)
, o Dark blood: Venous origin; lacerations of the birth canal
o Bright blood: Arterial and can indicate deep lacerations of the cervix
o Spurts of blood: Partial placental separation
Maternal Medications for PPH:
Medication Action Nursing Contraindications
Considerations
Oxytocin (Pitocin) Contraction of the Continue to monitor None indicated
uterus to decrease vaginal bleeding and
bleeding uterine tone
Misoprostol (Cytotec) Contraction of the Continue to monitor None indicated
uterus vaginal bleeding and
uterine tone
Usually given
rectally
Methylergonovine Contraction of the Check BP before Hypertension
(Methergine) uterus giving
Preeclampsia
Continue monitoring
vaginal bleeding and Cardiac Disease
uterine tone
Methylprostaglandin Contraction of the Continue to monitor Asthma
(Hemabate/Carboprost) uterus vaginal bleeding and
uterine tone Hypertension
Postpartum Blues Postpartum Depression Postpartum Psychosis
(PDD)
- 50-80% of women go - S/S: Mild to severe with - Most commonly
through PP blues women having good associated with
- Women are days and bad days BPD
emotionally labile and - Can go undetected b/s - S/S: grandiosity,
often cry easily new parents generally decreased need
- Peaks at 5th day and do not voluntarily for sleep, flight of
resolves by 10th day admit this kind of ideas,
- S/S: Let-down feeling, emotional distress distractibility,
restlessness, fatigue, - 2 weeks - 1 year hallucinations and
insomnia, headache, delusions
anxiety, sadness, and
anger
- “Blues” are normal and - Antidepressant - Antidepressants
mother/father may medications - Antipsychotics
, experience them - Sleep deprivation and - Mood stabilizers
- Get plenty of rest; nap plenty of rest - Benzodiazepines
when baby does if - ECT
possible
- Use relaxation
techniques
Assessment: BUBBLEHE
Normal Abnormal Causes Nursing
Findings Findings Interventions for
Abnormal Findings
Breasts Feelings of Cracking or May indicate Assist/educate mother
heavy, full, bleeding on the that infant does in
normal. breasts or around not have a good latching/breastfeeding
areola. May latch techniques
One breast or indicate that
nipple may be infant does not
different/larger have a good
than the other. latch.
Uterus Involution: Subinvolution: Magnesium Treat the cause
Return of the Failure of the since it can put Remove retained
uterus to a uterus to return you at risk for fragments
nonpregnant to a nonpregnant PP hemorrhage
state after birth state. Could Treat the infection
result from Placental w/appropriate
Fundus should infection or fragments medication
be felt around retained
midline at the placental Full bladder Get the uterus to
level of fragments. which can shift contract (fundal
umbilicus and uterus to the massage or
should be firm Fundus not felt right (lateral medication such as
the first 24 hrs. at umbilicus deviation) Pitocin)
Involutes and/or is boggy.
1cm/day. Multiparous
moms
Bladder Normal for Distended or full Full bladder Encourage voiding
postpartum bladder which Q2-3 hours b/c it will
women to not can shift fundus Infection decrease pain and
feel the urge to help mother heal
void (will Dysuria, faster
decrease pain, frequency,
heal faster) burning
(infection)
