NR 327 EXAM 2 OB MATERNAL
Chapter 17: Postpartum Adaptations and nursing Care Chapter 22: Infant Feeding
Chapter 25: Family planning Quiz #3
Chapter 19: Normal Newborn-Processes of adaptation Chapter 20: Assessment of the normal newborn Chapter 21: Care of the normal newborn
Quiz #4
Chap...
FOCUS ON
1. Newborn assessment
2. Postpartum assessment
3. Postpartum hemorrhage
4. Preeclampsia
5. Placental previa
6. Placental abruptio
7. Preterm labor
8. Hydatidiform mole
8. Medications on your clinical list
, Chapter 17: Postpartum Adaptations and nursing Care
Chapter 22: Infant Feeding
Chapter 25: Family planning
Quiz #3
4th stage of labor/Postpartum period/Puerperium
First 6 weeks after birth of infant
o -Return of reproductive organs to normal nonpregnant state
Physiological maternal changes
o Uterine involution
Starts right after delivery of placenta
Changes of reproductive organs, particularly the uterus that returns to
non-pregnant size and condition
Involves three processes
o 1. Contraction of muscle fibers
o 2. Catabolism: the process of converting cells into simpler
compounds
o 3. Regeneration of the uterine epithelium
Sub-involution: when uterus does not return to non-pregnant state,
o lochia flow, cervical involution,
o Decrease in vaginal distention
o alteration in ovarian function and menstruation
o Cardiovascular, urinary tract, breast and GI tract changes
Afterpains: intermittent uterine contractions, source of discomfort for many women,
the discomfort is more acute for multiparas because repeated stretching of muscle
fibers leads to muscle tone loss that causes repeated contraction and relaxation of the
uterus.
Greatest risks during postpartum period: hemorrhage, shock, and infection.
Oxytocin
, o Administer postpartum to improve the quality of uterine contractions. A firm
and contracted uterus prevents excessive bleeding and hemorrhage
After delivery of the placenta, hormones decrease resulting in decreased blood glucose,
estrogen and progesterone
o Decreased estrogen causes breast engorgement, diaphoresis, and diuresis
o Decreased vaginal lubrication
Assessment
Monitor vital signs, uterine firmness and its location in relation to the umbilicus, uterine
position in relation to the midline of the abdomen, and amount of vaginal bleeding
BP and pulse assessed every 15 mins for the first 2 hours after birth
Temperature every 4 hours for first 8 hours after birth and then at least every 8 hours
Postpartum Assessment
Breasts
Uterus (fundal height, uterine placement, and consistency
Bowel and GI function
Bladder function
Lochia (color, odor, consistency, and amount (COCA))
Episiotomy (edema, ecchymosis, approximation)
Vital signs to include pain assessment and teaching needs
RH Negative mothers
Rho(D) immune globulin is administered within 72 hours to women who are Rh-
negative and gave birth to infants who are Rh-positive to prevent sensitization in
future pregnancies.
Kleihauer-betke test
Determines amount of fetal blood in maternal circulation if large fetomaternal
transfusion suspected. If 15 ml or more of fetal blood detected, mom can get
increased Rho(D) immune dose
Thermoregulation
Postpartum chill occurs in first 2 hours puerperium
o Uncontrollable shaking chill following birth
o Nervous system response, vasomotor changes, a shift in fluids, and/or
work of labor
o Normal unless along with elevated temperature
Interventions:
Provide warm blankets and fluids
Assure client that chills are self-limiting
Fundus
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