OB Exam 2 Study Guide 12/03/2016
Fundal Assessment
•
Actions/Interventions
o
Determine tone
▪
Firm=contracted
▪
Soft=boggy
Indicates uterus is not contracting and places the woman at
an increased risk for excessive blood loss
Massage fundus w/palm of hand in a circular motion until firm
to stimulate contraction
•
Reevaluate w/in 30 mins
Give oxytocin to stimulate smooth muscle of uterus to
contract
Physiological changes in PP
•
Assessment & Care
o
Reproductive
▪
Assess uterus for location, position,
and tone of fundus
Potential complications that
may lead to postpartum
hemorrhage are greatest within
the first hour following delivery
▪
Measure the distance between the
fundus and umbilicus
Each finger breadth=1cm
▪
Determine position of uterus
Shifted to side may indicate distended bladder
If deviated, soft, or elevated above the umbilicus, have pt void
o
Endometrium
, ▪
Assess lochia to monitor blood loss
Scant (<1in), light (<4in), moderate (<6in), heavy (pad
saturated)
Measure clots—10g=10mL of blood loss
(Table 12-2 pg. 313)
o
Vaginal/perineum
▪
Assess perineum using
REEDA
Redness,
edema, ecchymosis,
discharge,
approximation of edges of episiotomy or laceration
▪
Position in side lying position for better visualization
▪
Apply ice or cold sitz baths for first 24 hours; warm sitz baths after
24 hours twice a day for 20 mins
▪
Give peri-bottle w/warm water to rinse area after elimination
▪
Tighten gluteal muscle as she sits down and to relax muscles
after she is seated
o
Cardiovascular
▪
Assess pulse & BP—every 15 mins for the first hour
▪
Assess for orthostatic hypotension
▪
Assess for venous thrombosis
Homan’s sign
Calf tenderness, edema, and sensation of warmth
Encourage early ambulation
▪
Assess for postpartum chills and give warm blanket
o
Breast
Fundal Assessment
•
Actions/Interventions
o
Determine tone
▪
Firm=contracted
▪
Soft=boggy
Indicates uterus is not contracting and places the woman at
an increased risk for excessive blood loss
Massage fundus w/palm of hand in a circular motion until firm
to stimulate contraction
•
Reevaluate w/in 30 mins
Give oxytocin to stimulate smooth muscle of uterus to
contract
Physiological changes in PP
•
Assessment & Care
o
Reproductive
▪
Assess uterus for location, position,
and tone of fundus
Potential complications that
may lead to postpartum
hemorrhage are greatest within
the first hour following delivery
▪
Measure the distance between the
fundus and umbilicus
Each finger breadth=1cm
▪
Determine position of uterus
Shifted to side may indicate distended bladder
If deviated, soft, or elevated above the umbilicus, have pt void
o
Endometrium
, ▪
Assess lochia to monitor blood loss
Scant (<1in), light (<4in), moderate (<6in), heavy (pad
saturated)
Measure clots—10g=10mL of blood loss
(Table 12-2 pg. 313)
o
Vaginal/perineum
▪
Assess perineum using
REEDA
Redness,
edema, ecchymosis,
discharge,
approximation of edges of episiotomy or laceration
▪
Position in side lying position for better visualization
▪
Apply ice or cold sitz baths for first 24 hours; warm sitz baths after
24 hours twice a day for 20 mins
▪
Give peri-bottle w/warm water to rinse area after elimination
▪
Tighten gluteal muscle as she sits down and to relax muscles
after she is seated
o
Cardiovascular
▪
Assess pulse & BP—every 15 mins for the first hour
▪
Assess for orthostatic hypotension
▪
Assess for venous thrombosis
Homan’s sign
Calf tenderness, edema, and sensation of warmth
Encourage early ambulation
▪
Assess for postpartum chills and give warm blanket
o
Breast
