Postpartum Pretest Name: Use the Ricci Maternity textbook (chapters 15, 16 & 22) to complete this pretest.

Students may work in groups but each student must hand-in the assignment. Type answers on this form after each question & cite page numbers for each answer. Pretest is due in clinical conference the week prior to beginning the Maternity rotation.

1. Describe the pathophysiology of the process of involution. Involution is the retrogressive changes that return the uterus to its original size and condition. The contraction of muscle fibers reduce the stretched parts of the uterus. Catabolism reduces enlarged myometrial cells. The regeneration of uterine epithelium from the lower layers of the decidua after the upper layers has been sloughed off and shed during lochial discharge. Pg 406
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Identify postpartum focus assessment criteria for the vaginal delivery patient using BUBBLE EE. List the additional assessments that will be performed on a cesarean section patient versus a vaginal delivery? Define postpartum hemorrhage (pg 648). What is the single most common cause during the 1st 24 hours after delivery? What are other possible causes of early postpartum hemorrhage?

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7. What factors place a woman at risk for postpartum hemorrhage? Multiple gestation, large baby, polyhydramnios, multipartity, prolonged labor, labor augmentation, general anesthesia, and placenta previa places the woman at risk for postpartum hemorrhage.
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What is the initial S/S of postpartum hemorrhage? ANSWER a boggy uterus with a peripad saturated in < 30-60 minutes. (requires no answer by student) Why does postpartum hemorrhage not initially exhibit the most common S/S of other types of hemorrhage (i.e. falling BP, increased pulse, etc)?

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10. Describe the nursing management of early postpartum hemorrhage (including medications).

Close observation and documentation of maternal vital signs and condition. Also observe blood loss, uterine tone and size. The uterus should be periodically massaged to minimize clots accumulated in the uterus. The use of medication to control PPH is uterotonic drugs which stimulate contraction of the uterine muscle.

11. Discuss the normal lochia cycle for a vaginally delivered mother. There are three stages of lochia. The first stage is lochia rubra which occurs during the first three to five days. It is bright red and contains a large amount of red blood cells. The second stage is lochia serosa which occurs until the tenth day and it is thinner than lochia rubra and is brownish or pink. The last stage is lochia alba which occurs next and lasts for up to six weeks. It is white or yellowish-white. All stages have a similar odor of a normal menstrual flow. 12. When assessing lochia amount, how would you define the following: scant, light, moderate, heavy. Scant amounts is coin-sized stain. A small or light amount is less than a 4-inch stain on the peripad. A moderate amount is less than a 6-inch stain. Heavy is a saturated peripad within one hour. 13. Why is it important to closely monitor the bladder and voiding amounts for 24-48 hours after delivery? Some woman experience bladder control issues during pregnancy or after childbirth because the pelvic floor muscles are weaker.
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Name 2 major complications may result from retention of urine?

15. State the precautions you will use when getting the PP patient out of bed for the 1st time? Why?

When getting the patient out of bed for the first time, provide assistance because of the shift in blood volume and total body fluid will take the cardiovascular system some time to adapt to the changes. 16. Describe the steps that you will teach the mother regarding putting the infant to breast correctly and use of effective breast feeding techniques. Have the mother relax and have her hold the baby in her arms, cradling him/her so that her stomach is touching the babys. Prop up baby with a soft pillow and have the mother sit back so she is not leaning forward. Have her grasp the areola on the breast firmly and raise baby to it slightly. Tilt the babys head forward to ensure that the entire nipple is scooped into the mouth. What will you teach the breastfeeding mother about caring for her breasts and preventing sore/cracked nipples? Avoid pressure on breasts by not sleeping in a face down position, wearing underwire bras, tight bras and clothes that are tight on the breasts. Wear a supportive bra and a cotton bra is the best since they wont trap moisture that can irritate nipples. Washing breasts with warm water once a day and not with soap or other cleansing agents because they can cause irritation. After washing, dry completely and let breasts airdry after breastfeeding. Use breast milk or pure lanolin ointment on nipples to keep them from getting chapped and dried out. Proper positioning of baby during breastfeeding can prevent cracked or bleeding nipples.
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18. What complication can result from cracked nipples?

19. Identify what you will teach the bottle-feeding mother about preventing engorgement.

Pumping or manually pushing breast milk out can help reduce engorgement. Taking a warm shower can also help with the discomfort. To reduce pain and swelling, take Motrin or apply cold compresses. Putting raw cabbage leaves inside breasts help reduce milk production.
20. How would you teach post voiding/BM perineal care to a newly delivered mother?

Use squirt bottle to pour warm water on perineum after going to bathroom. Pat dry from front to back to avoid introducing germs from rectum to vagina. 21. What interventions can the nurse implement to relieve perineal pain/discomfort & promote healing? Ice packs on perineum to relieve pain/discomfort. Also have the patient take Motrin or acetaminophen. Avoid sitting for long periods of time.
22. What is the pathophysiology of preeclampsia?

Preclampsia is an endothelial cell disorder resulting in mild to severe microangiopathy of target organs such as the brain, liver, kidney, and placenta. It may be a result from fetal antigens of the fetus that trigger an immune response in the mother.
23. Identify the specific criteria for preeclampsia.

Symptoms of preeclampsia are headaches, blurred vision, intolerance for bright light, nausea and vomiting, salt and water retention.
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Identify the specific criteria for eclampsia.

25. Describe the medical management of postpartum patients with severe preeclampsia.

IV administration of magnesium sulfate and delivery as soon as the fetus is mature.

26. Describe the nursing assessment/interventions used to manage the postpartum patient hospitalized with

severe preeclampsia (be specific).