NUR 3 test 1

“What would any other reasonable prudent nurse do?

• -Postpartum, may be referred to as 4th trimester
• -6 week period following childbirth and expulsion of placenta
• -All organs go back to where they normally are- Period comes back, breast feeding begins

• -Involution begins directly after delivery of the placenta
• -Contraction controls bleeding from area where placenta separates from uterus
• -Uterus becomes smaller as muscles contract & gradually return to original size

• -Midline or Medial lateral
• - Reduces pressure on fetal head and shortens second stage of labor
• - Tear may heal more quickly and may have less scarring

• -Minimal blood loss, neat, little scaring, less post-partum pain, shortens 2nd stage of labor
• -Higher risk to extend into rectal sphincter & urethra

• -More opening, if tearing occurs it’s away from rectum
• -More blood loss, increased post-partum pain, goes through muscle, have to sit on one side, longer healing, prolonged painful intercourse

• 1) Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm.
• 2) After the cervix is dilated to 10 cm until the delivery of the baby.
• 3) Delivery of placenta

• -Ambulation ASAP post-delivery
• -Massage fundus
• -Breast feeding (releases oxytocin)
• -3 drugs,
• Oxytocin,
• Methergine- potent vasoconstrictor, contraindicated if mother has chronic HTN or PIH
• Hemobate- cost > oxytocin & Methergine

• -Bradycardin d/t large amounts of blood returning to central circulation. Increases stroke volume decreasing HR.
• -Tachycardina- excitement, fear, fatigue, pain, dehydration, hypovolemia, anemia, infection. Rule out excessive bleeding/intervene STAT if hemorrhage is suspected.

• -Rubra (1-3 days) mod-heavy, red, some clots
• -Serosa (4-10 days) mod-scant, pink
• -Alba (11-21 days) scant, white-tan,

• - Delayed bowel evacuation
• -Hemorrhoids- tucks pads, epifoam, sitz-bath, dermafoam
• -Constipation- increase fiber & fluids, diet, ambulate asap

• -Taking in- mother focus on self (sleep, her needs, food), content 4 others to make decisions, mom tries to integrate birth experience into reality.
• -Taking hold- High-fatigue, mother more independent, verbalize anxiety of competence as mom, “teachable reachable referable”, let mom do as much care as possible.
• -Letting go- relinquish old life, see themselves as a parent, disappointment/grief, fantasize baby’s future, let go of expectations.

• -insomnia, irritability, fatigue, tearful, mood instability
• -Symptoms usually unrelated to events -begins first week and no longer then 2 weeks
• -Common and effects 70% of women
• -Do not confuse with postpartum depression/psychosis

• -Holds baby close. “en face” position, kiss/touch cheek to hers
• -Speaks to baby in soft voice
• -Notes desirable traits
• -Attentive to baby’s reflex actions

• - Eye contact with mom
• - Roots, sucks, licks
• - Vocalizes/stretches to mom’s voice
• - Mimics mom’s facial expressions

• -Early, prolonged contact during the 1st few hours
• - Rooming in allows for better contact, helps mom feel more confident in her role and ability to care for baby

• - Holds baby at far distance
• - calls baby “it”
• - Quickly hands baby off
• - Doesn’t talk to baby, ignores baby’s communication
• - May express demand for attention in competition w/ infant
• - These behaviors more common in drug addicts, rape victims

• -Engrossment- intense fascination & close face-to-face observation
• - En Face position
• - Desires to hold, touch, & chuck in the air

• Post partum assessment
• B- breast
• U- Uterus
• B- Bladder
• B- Bowel function
• L- Lochia
• E- Episiotomy
• H- Homan’s sign
• E- Emotional Status
• R- Relationship

- First pap should be within 3 years of beginning sexual activity and yearly after that