Postpartum Adaptations & Newborn Care

What is the appearance of meconium stained amniotic fluid?

Green

Which preparations are appropriate when meconium stained fluid is present?

• Notify neonatal resuscitation team

• Prepare suction equipment

• Continuously monitor FHR

• Document meconium characteristics

What is the natural process of the uterus returning to its prepregnancy size?

Involution

What process helps shrink the postpartum uterus through cellular self-destruction?

Autolysis

What is failure of the uterus to return to its nonpregnant state called?

Subinvolution

Which findings commonly contribute to subinvolution?

• Retained placental fragments

• Infecton

• Uterine overdisention

Match each lochia stage with its expected timing

• Rubra (red) - 1-3 days

• Seros (pink/brown) - 3-10 days

• Alba (yellow/white) - 10-14 days and lasts 3-6 weeks

T or F: Lochia rubra that continues beyond the first 3 postpartum days is abnormal.

True

What is the primary hemostatic purpose of afterpains

Compress uterine blood vessels

Which postpartum pts are more likely to experience significant afterpains?

Women who gave birth multiple times (Multiparas)

What coompensatory fluid mechanisms commonly occurs postpartum?

Postpartum diuresis

By how much can cardiac output increase immediately after birth?

60-80%

When does cardiac output generally return to prelabor values?

Within 1 hour

Match each type of postpartum hemorrhage with its timing:

Primary hemorrhage = withing 24 hours

Secondary hemorrhage = 24 hours to 12 weeks

Match the birth route with its average blood loss:

Vaginal birth = 300-500 mL

Cesarean birth = 500-1000mL

What urinary finding should disappear by approximately 1 weak postpartum?

Renal glycosuria

T or F: A distended bladder can contribute to excessive postpartum bleeding.

True

Which findings are postpartum bleeding warning signs?

• Saturating a pad under 1 hour

• Passing large clots

• A boggy uterus

• Dizziness/weakness

What uterine finding suggests uterine atony and hemorrhage risk?

Boggy fundus

Tachycardia and hypotension usually appear after approximatey what blood loss?

30-40%

Which findings suggest postpartum endometritis?

• Foul smelling lochia

• Uterine tenderness

• Pelvic pain

• Chills

A temperature of at least 38 C persisting beyond 24 hours may indicate what?

Postpartum infection

Which findings suggest a postpartum sound infection?

• Erythema

• Warmth

• Seropurulent discharge

• Would separation

Match the complications with its characteristic findings

Mastitis = Unilateral breast warmth and redness

DVT = Unilateral leg edema and warmth

Pulmonary embolism = sudden dyspnea and chest pain

When does postpartum mastitis most commonly occur?

2-4 weeks

Which findings are concerning for pulmonary embolism?

• Sudden dyspnea

• Chest pain

• Tachypnea

• Syncope

What does the first B in the BUBBLEEE assessment represent?

Breasts

Order BUBBLEEE:

1. Breasts

2. Uterus

3. Bowel

4. Bladder

5. Lochia

6. Episiotomy

7. Extremities

8. Emotion

How far should teh postpartum fundus descend each day?

1 inch

T or F: A postpartum fundus should normally be firm and midline.

True

What does a laterally displaced fundus commonly indicate?

Full bladder

Which interventions are appropriate for a boggy postpartum fundus?

• Assess bladder

• Assist voiding

• Massage fundus

• Notify healthcare provider

By days 10-14 postpartum, the fundus should be ___

no longer palpable

What is a common bowel complication related to postpartum anesthesia?

Constipation

What temperature pattern is commonly normal during the first 24 postpartum hours?

Low-grade fever

What postpartum heart rate finding may be normal on days 6-10 if asymptomatic?

Puerperol bradycardia (HR drops to 60bpm)

What BP requires evaluation for possible postpartum preeclapsia when sustained?

140/90 mmHg

Which teaching is appropriate for postpartum orthostatic hypotension?

• Chage positions slowly

• Report sustained hypertension

• Assess for dizzines

When does postpartum breast engorgement commonly occur?

Days 3-5

Which inerventions help relieve breast engourgement?

• Frequent feeding or pumping

• Cold compresses between feeds

• Supportive bra

What breast finding is a characteristic of mastitis?

Unilateral wedge-shaped redness

What nipple problem may result from an imporper latch?

Cracked bleeding nipples

Which interventions are appropriate for postpartum perineal edema or bruising?

• Ice packs for 24 hours

• Sitz baths

• Topical anesthetics

Which factors can contribute to postpartum urinary retention?

• Anesthesia effects

• Perineal trauma

• Fear of pain

Within what time should a postpartum patient generally be assisted to the bathroom?

Within 4-6 hours

By when do afterpains usually resolve?

day 3-7

When should postpartum Rh immune gloubline be administered?

72 hours

Which condition indicate postpartum Rh immune globulin is needed?

• Mother is Rh-negative and baby is Rh-positive

• Mother is unsensitized

What future complication does Rh immune globulin help prevent?

Hemolytic disease

T or F: Rh immune globulin is effective if the mother already has Rh antibodies.

False

Which discharge instructions apply to an Rh-negative mother?

• Inform healthcare providers of Rh status

• Repeat prophylaxis after future pregnancy loss

• Ensure administration is documented

What type of contact promotes early breastfeeding and attachment?

Skin-to-skin contact

What care model optimizes family-centered postpartum care through extedned contact?

Couplet care

What is golden hour?

First 60 minutes after birth for uninterrupted skin-to-skin.

During which phase does the parent focus primarily on sleep, food, and personal needs during the first 3 days?

Taking in phase (1-3 days)

When is the optimal time to teach hands on newborn care?

Taking hold phase (4-10 days)

During whcih phase should nurses encourage partner involvment and provide community resources?

Letting go phase

T or F: The taking in phase is usually the optimal time to expect a mother to perform newborn care tasks independently.

False

Which behaviors support maternal attachment to a newborn?

• Eye contact

• Touch

• Voice

• Skin to skin

Which behaviors are newborn attachment behaviors?

• Rooting and grasping

• Sucking and feeding well

• Recognizing parents

• Enjoying being held

What type of contact promotes early breastfeeding and facilitate attachment?

Skin to skin contact

Match each parent to infant interactions concept with its description:

• Biorhythmicity = Newborn synchronizes rhythms with parents

• Reciprocity = Behavior provides cues to the observer

• Synchrony = Infant cues fit the parent’s ersponse

• Extended contact = Roomin in with couplet care

Order Rubin’s stages of maternal adaptation from earliest to latest:

1. Taking in phase (1-3 days)

2. Taking hold phase (4-10 day)

3. Letting go phase

What happens to pulmonary resistance when the newborn takes the first breath?

Decreases

What happens to pulmonary blood flow after the newborn’s lungs expand?

Increases

What substance reduces alveolar surface tension?

Surfactant

What minimum lecithin to sphingomyelin ration indicates adequate fetal lung maturity?

2:1

Which factors help initiate breathing after birth?

• Increased CO2

• Decreased body temperature

• Mechanical lung compression

• Sensory stimulation

Which finding indicate newborn respiratory distress?

• Nasal flaring

• Intercostal/Subcostal retractions

• Grunting

T or F: Acrocyanosis of the extremities can be a normal finding during the first 24 hours after birth

True

T or F: Central cyanosis of the newborn is considered a normal finding after birth.

False

Which circulatory changes occur after umbilical cord clamping?

• Placental circulation stops

• Systemic resistance increases

• Foramen ovale & Ductus arteriosus constricts

Which findings may indicate a newborn cardiopulmonary problem?

• Persistant tachycardia / Bradycardia

• Pallor

• Trunk cyanosis

What mechanism of heart loss occurs when cooler air currents move accross the newborn’s body?

Convection

What mechanism of heat loss occurs when heat moves to a cooler object without physical contact?

Radiation

What mechanism of heat loss occurs when liquid on the ksin becomes gas?

Evaporation

What mechanism of heat loss occurs thorugh direct contact with a cold surface?

Conduction

Which interventions reduce evaporative heat loss?

• Dry the newborn quickly

• Place newborn skin to skin

• Warm blanket

• Hat

Which interventions reduce convective heat loss?

• Crib with solid sides

• Away from air vents and window

What is the expected axillary temperature range for a newborn?

36.5-37.5 C (97.7-99.5F)

What newborn oxygen saturation requires immediate intervention?

90% or less

What respiratory rate is expected for newborn?

30-60 breaths/min

What is the expected newborn birth-weight range?

2700g-4000g

Which findings require further newborn assessment?

• No void by 24 hours

• No stool by 48 hours

• Jaundice

• Airway secretions requiring suctioning

What percentage of weight loss can occur during the first few days before further concern is indicated?

up to 10%

What Apgar is normal.

7-10

What Apgar indicates severe distress?

0-3

When is Apgar scoring routinely performed?

1 and 5 minutes

How often should Apgar scoring be repeated when the 5 minute score is below 7?

Every 5 minutes

What does Apgar stand for?

• Appearance (skin color)

• Pulse (HR)

• Grimace (Reflex irritability)

• Activity (Muscle tone)

• Respiration (Breathing effort)

Which newborn reflex disappears by 4 months?

Moro and tonic neck reflex

What reflex disappears by 1 year?

Babinski reflex

What medication is given intramuscularly within 1-2 hrs after birth to prevent hemorrhagic disease?

Vitamin K

When should newborn eye prophylaxis be administered?

Within the first hour

What is the purpose of the newborn metabolic heel-stick screening?

Detect metabolic disorders

When is the newborn metabolic screen ideally performed?

After 24 hours

When should newborn hearing screening be comopleted?

Before hospital discharge

Which safe-sleep practices should parents follow?

• Place infant supine

• Use firm sleep surface

• Share room, not bed

Why is supine sleep position recommended for newborns?

Prevents SIDS

When should routine swaddling be discontinued?

After 2 months