NUR 504 Exam 2 Study Questions and
Correct Answers
Puerperium ✅Post partum, after the birth of the baby until the reproductive organs
return to their normal nonpregnant state
Uterine involution ✅going from larger size (melon size back down to pear size and
back down into pelvic cavity)...process of uterus contracting and shrinking back down in
size, going to take days to weeks.
Factors that retard uterine involution ✅- Precipitous (really quick)or prolonged
(because uterus is tired, working very hard and it is hard for muscle to keep working )
labor
- Anesthesia (a lot of these work as muscle relaxants, goes against contraction of
uterus)
- Difficult birth (anything that overly manipulates the uterus)
- Grandmultiparity (more than 3 or greater)
- Full bladder (because of proximity to eachother, bladder is directly below the uterus, if
baldder full it gets pushed up and uterus gets pushed off to the side, can't contract as
effectively)
- Incomplete expulsion of the placenta (this has to do with inflammatory response of
uterine lining, if part of placenta is retained)
- Infection (if infected leads to inflammatory response)
- Overdistention of the uterus (so anything that makes muscle stretch more it makes it
harder for it to shrink back down to size. An example of things that could overexpand is
multiples (twins), LGA baby, too much amniotic fluid)
Lochia ✅medical term for vaginal discharge after childbirth. All women have but c-
section sometimes have less. Goes through certain characteristics through postpardum
period. First is lochia rubra (this is primarily red, looks like blood, can have clots in it up
to golf ball sized, but if excessive we might notify provider, red because lot of RBCs in
discharge. Lasts about 3-4 days). Lochia serosa (pinkish, brownish color because
mixing with more mucus, WBCs and getting diluted in color...lasts an average about 10
days). Lochia Alba (white, pale discharge, has a lot more WBCs in it, and it lasts usually
about until 6 weeks postpardum, some women have it finish much earlier though,
different for every woman).
Cervical changes postpartum ✅Before labor the cervix (opening of uterus) is
closed...has tiny little pinhole. During pregnancy the cervix has to open so baby can
come out. We don't want it staying wide open after birth. Starts closing again. We don't
assess for specifically we assume it is happening...usually checked at 6 weeks visit with
OBGYN...some things never go back completely. Will not go back to pinhole size, but
looks more like a slit.
,Vaginal changes postpartum ✅may be edematous, little red because lots of pressure
baby is exerting on the area, all normal...another difference in this area related to not
having as much estrogen. In postpardum period estrogen levels are low and will
continue to stay low if breastfeeding. Woman complains of vaginal dryness, thinner
tissue, problem with tearing, so if presumes intercourse can be painful and feel dry, feel
like it is tearing...not supposed to be having sexual intercourse for 6 weeks but some
woman do.
Perineal changes pastpartum ✅is possible that no changes happen, but in some
instances there will be tears, lacerations, or we cut to enlarge opening. Episiotomy -
when we cut into perineal tissue to make an opening. If we do epesiotomy or laceration
it will be starting healing process throughout postpartum period. We have degrees of
how severe tear/cut is. First degree is least severe and 4th degree is most severe.
Episiotomies/lacerations:
• First degree- least severe, just involves vaginal mucosa, no underlying tissues
involved, very minimal.
• Second degree- Incorporates everything as first degree plus involving vaginal
submucosal layer (muscle layers), not getting into rectum yet.
• Third degree- starting to involve the rectum, anal sphincter partially and completely.
• Fourth degree- Involving rectal lining.
• First and second degrees are very common, 3rd and 4th are less common. 3rd and
4th degree we can have incontinence problems of urine or stool. Can lead to sexual
dysfunction.
• One way to do episiotomy is midline or medialateral. Pro of midline is that it tends to
heal better and cause less pain. Medialateral (cutting off to the side) tends to be more
painful and not heal as well. Midline very close to rectum and more risk of infection, can
sometimes tear into 3rd or 4th degree).
Breasts postpartum ✅somewhere at around 3 days the milk will come in whether
breast or bottlefeeding, does work on supply demand situation though and will decrease
supply if not used. Breastfeeding it will keep producing. Will feel like breasts getting
larger, heavier, fuller...it is possible for breasts to feel lumpy bc ducts are enlarged and
this is expected and is normal finding provided it is not red, tender, painful, etc.
Adbomen postpartum ✅abdominus recti, when we get pregnant there is thin
membrane in between muscles, uterus enlarges and muscles have to stretch/move/be
separated (diastasis). Diastasis recti is more separation during pregnancy- during
postpartum period this comes back together but this can take awhile. For some women
it never resolves and have to decide if they want surgery. 1-2 fingers are normal, 3
fingers abnormal space between...if hasn't resolved within 6 weeks or so it is abnormal.
Will still look pregnant after they deliver because things don't snap back into place.
Don't be alarmed, very normal.
GI postpartum ✅pregnancy causes GI system to slow down, wants her to be able to
get all water/nutrients possible for fetus and her...not going to automatically pick back
, up in postpartum period, will still be relatively slow, risk for constipation. Might be taking
medicines such as narcotics to relieve pain and this adds to constipation. Common for
women to not experience bowel movement for a while after delivery. Try to minimize
this, lots of women take stool softeners...promote fluids, promote moving as much as
possible. They have been NPO for whole labor which can last 2-3 days even
sometimes, body goes through a lot of work. They will be hungry. Let them eat! Tell
them concerns about nausea/vomiting but not huge issue unless aspirate so not end of
world. If have C-section this is abdominal surgery and is treated differently, started off
slower, some physicians want them to have bowel sounds/flatulence first...major
abdominal surgeries- C-sections.
GU postpartum ✅a medication during delivery is oxytocin. This is given always during
labor, has antidiuretic effect however once oxytocin has stopped then there is a natural
diuresis that happens once it is worn off...we have diuretic effect in immediate
postpartum period. Her bladder is also has an increased filling capacity. We find in
immediate postpartum period they sometimes experience a decreased sensation to
void, even if bladder is full. This sets her up for incontinence, urine retention (risk for
infection), also bladder will be full so is concern for uterus and risk for bleeding. We
need to pay attention to bladder and make sure it is being emptied very frequently. If not
on her own we need to do it for her. Typically can start going soon on own in
postpardum period...but sometimes need to help her.
Postpartum chill ✅a lot of women shake after delivery or during. Not abnormal, we are
not sure exactly why...Probably has to do with quickly changing status of body, a lot
happening very quickly. Not having a seizure or anything wrong, tell her it is normal.
The more they try to stop shaking they more they will shake. Tell them to relax and this
will go away a couple hours after delivery.
Postpartum VS ✅- Temp: Will go up in patients who are exerted or have dehydration.
It is possible that she is exerted for sure, and potentially dehydrated bc losing lots of
fluid bc not drinking, this all means temp can go a little higher than normal...normal to
see it elevate...not abnormal until 100.4, febrile...before that it is not abnormal.
- HR: postpartum bradycardia is very common. This likely has to do with heart doing a
lot of work when pregnant, pumping lots of blood to feed/nourish other human, so heart
kind of takes a vacation after birth...reacting to decreased workload, very common.
- BP: typically stays around the same, might see transient slight rise, not anything
excessive in first day couple days. Shouldn't be getting to 140/90. Shouldn't be all that
abnormal...
- Resp: not much is changing in postpartum period, should still be close to baseline. 12-
20.
Postpartum blood values ✅- Coags: pregnancy is hypercoagulable state, so coags
increase, some activated in pregnancy that aren't usually as well. This is because body
