Family Exam 4 (Chapter 19)

How should the postpartum unit be viewed in terms of patient care?

As a couplet (care for mom and baby).

What should nurses do if one nurse is caring for mom and another is caring for baby?

Coordinate assessments.

Why should assessments be coordinated between nurses?

To minimize time spent in the room and enhance couplet bonding.

What care strategy helps minimize disruptions for mom and baby?

Cluster care.

What are the 5 immediate nursing assessments for the postpartum mother?

1.Fundal height
2. Uterine tone
3. Lochia
4. Vital signs
5. Pain

Where should the fundal height be postpartum?

At or below the umbilicus.

What should uterine tone feel like postpartum?

Firm.

What does a boggy uterus mean?

The uterus isn’t contracting.

What is the nursing action for a boggy uterus?

Massage the fundus.

How much pressure should be used for fundal massages?

Not too much.

What should you do with your second hand during fundal massage?

Guard the uterus to prevent uterine inversion.

How often are vital signs taken initially postpartum?

Every 15 minutes.

How often is the initial temperature taken postpartum?

Every 2 to 4 hours unless fever.

Why might a mother not feel pain right after delivery?

it takes a few hours for epidural pain to wear off.

When should breastfeeding be encouraged postpartum?

Within the first 30 minutes of life.

What should you suspect if the uterus is shifted from midline postpartum?

A full bladder (bladder distention).

What are the nursing actions for a full bladder postpartum?

Encourage the patient to void or straight cath.

What can cause urinary retention after delivery?

Delivery trauma.

What are 2 examples of delivery trauma?

1.Laceration
2. Hematoma

What medications may be given to help the uterus contract postpartum?

Oxytocin (IV or IM).

What are the two main sections of the hand-off report?

1.Records of admission & birth
2. Recovery

What obstetric history is included in the hand-off report?

Gravida/parity

What fluid information is given in the recovery report?

Amount of IV fluids.

Which mothers receive RhoGAM during pregnancy?

Rh-negative mothers with Rh-positve babies.

When is RhoGAM given during pregnancy?

26-28 weeks gestation.

Why is RhoGAM given during pregnancy?

So the mother can make antibodies against the babies blood.

Why is RhoGAM given prophylactically during pregnancy?

85% of people are Rh-positive.

Why is RhoGAM given postpartum?

The placental blood can mix with mom’s blood once the placenta is detached; it protects future pregnancies.

When is RhoGAM given postpartum?

Within 72 hours.

Can RhoGAM be given after 72 hours?

Yes but it is less effective.

When is RhoGAM given postpartum?

ONLY if the baby is Rh-positive.

Does an A-negative mom with a B-negative baby need postpartum RhoGAM?

No because the baby is Rh- negative.

Which population may have reservations or restrictions about receiving RhoGAM?

Jehovah’s Witnesses.

Why is the MMR vaccine important to know about for a postpartum patient?

If the mother is not immune, the vaccine is given postpartum.

Why is the MMR vaccine not given during pregnancy?

It’s a live virus and can harm the baby.

Why is the MMR vaccine given to a mom who is not rubella immune?

To protect future pregnancies.

When is the MMR vaccine most commonly given postpartum?

Before leaving the hospital for convience.

What special instruction should the patient receive after the MMR vaccine?

Don’t get pregnant for 4 weeks.

What does TORCH syndrome stand for? Who does it effect?

1.Toxoplasmosis
2. Other agents
3. Rubella
4. Cytomegalovirus
5. Herpes simplex
6. It effects the developing fetus/newborn.

How long should you expect a mother with a vaginal delivery to stay in the hospital?

Around 48 hours.

How long should you expect a mother with a cesarean delivery to stay in the hospital?

Around 3 to 4 days.

When does discharge planning start in pregnancy?

Immediately postpartum.

How many extra calories per day does a breastfeeding mom need?

About 300.

Why does a breastfeeding mom need to stay hydrated?

So milk production doesn’t fall.

What activity is appropriate at the end of the first week postpartum?

Light walks and strolls.

What activity is appropriate in the second week if doing well postpartum?

A leisurely stroll around the block (no power walking).

What should happen to activity after 2 weeks postpartum?

It should slowly increase.

When can a mom return to normal activity postpartum?

By 6 weeks.

How does the activity timeline change after a C-section?

Push it forward by a week or two.

What family planning questions should be discussed at postpartum discharge?

Whether she wants another baby and options like tubal ligation.

When is it okay to resume sexual activity postpartum?

It varies by couple but until bleeding completely stops.

What restriction applies after an episiotomy or laceration postpartum?

Nothing in the vagina (or intercourse) until healed.

When can a cesarean mom resume sex?

Earlier than after a vaginal birth, but still after blood subsides.

How does breastfeeding affect vaginal lubrication?

It decreases it.

What community resources can be offered at discharge?

Lactation consults, home health, support groups.

Is 6 weeks still the standard postpartum follow-up in the OB office?

No.

Is postpartum follow-up now a one-time encounter?

No. It’s based on the woman’s individual needs.

When should the first postpartum encounter occur with an OBGYN?

Within 3 weeks.

What surgical concern is checked at the first postpartum encounter with the OBGYN?

The incision.

What blood pressure concern is followed up postpartum?

Hypertension during the intrapartum period.

What mood concerns are assessed at the first postpartum visit?

Mood disorders and postpartum depression.

What feeding concern is addressed at the first postpartum visit?

Breastfeeding problems.

What symptom is assessed at the first postpartum visit?

Excess fatigue.

What test is needed postpartum for a mom who had GDM?

A 2 hour glucose tolerance test (GTT).

When is the first newborn visit after hospital discharge?

2-5 days after discharge.

What are the routine newborn visit ages after the first visit?

1 month, 2 months, 6 months, 9 months, 12 months.