NURS 2866 - Week 1 Seminar Packet

What is the postpartum period, how long does it last, and what changes occur?

The postpartum period is the time after delivery when the mother’s body returns to its pre-pregnancy state; it typically lasts 6 weeks (4th trimester) and includes both physiologic and emotional adjustments.

How is postpartum hemostasis achieved and what is the MOST important mechanism?

Postpartum hemostasis is achieved primarily by uterine contraction (MOST IMPORTANT) which compresses blood vessels, along with constriction of spiral arteries and clot formation; this is referred to as “living ligatures” where the contracting uterus clamps vessels.

Are findings of a fundus above the umbilicus, deviated to the right, with a saturated pad expected 3 hours after birth?

❌ NO — this is NOT expected; these findings indicate bladder distention and uterine atony, placing the patient at risk for postpartum hemorrhage.

What specific assessment findings suggest bladder distention in a postpartum patient?

A fundus that is elevated above the umbilicus and displaced (commonly to the right) indicates a full bladder pushing the uterus up and to the side, preventing effective contraction.

Why does a full bladder increase the risk of postpartum hemorrhage?

A full bladder displaces the uterus upward and laterally, preventing it from contracting effectively, which can lead to uterine atony and increased bleeding.

Is a gush of blood when a postpartum patient first stands up a sign of hemorrhage?

❌ NO (not automatically); this is usually pooled blood in the vagina being released when standing.

When is a gush of blood after standing considered expected vs concerning?

It is expected if the fundus becomes firm afterward and bleeding decreases; it is concerning if there is continuous heavy bleeding or a boggy uterus.

What nursing interventions help promote uterine contraction postpartum?

Continue fundal massage, ensure the bladder is empty (assist with voiding), maintain oxytocin infusion, and encourage breastfeeding to stimulate natural oxytocin release.

What risk factors does Janelle have for postpartum hemorrhage and why do they matter?

Grand multiparity (G6P5) causing an overstretched uterus, macrosomia (9 lb baby), prolonged rupture of membranes (24 hours), and obesity (BMI 36); all increase the risk of uterine atony.

What is the PRIORITY nursing action in postpartum hemorrhage?

🚨 Perform fundal massage IMMEDIATELY to stimulate uterine contraction and stop the bleeding.

What additional actions should follow fundal massage in postpartum hemorrhage?

Call for help, assess bleeding amount, ensure IV access, and administer uterotonic medications; overall priority is to STOP THE BLEED.

What are the “4 Ts” causes of postpartum hemorrhage and what does each represent?

Tone (uterine atony), Trauma (lacerations or hematoma), Tissue (retained placenta), Thrombin (coagulopathy).

What is carboprost tromethamine (Hemabate) and how does it work?

Hemabate is a prostaglandin (PGF2α) that causes strong uterine contractions, which helps reduce postpartum bleeding.

What are the most common side effects of Hemabate and what is a major contraindication?

Diarrhea (VERY common), nausea/vomiting, fever/chills, and bronchospasm; it should be avoided in patients with asthma.

What ongoing nursing assessments are required for a patient with postpartum hemorrhage?

Monitor fundal tone, bleeding amount, and vital signs (tachycardia may indicate early shock), maintain strict intake and output, and assess for medication side effects.

What patient education is important after treatment for postpartum hemorrhage?

Educate the patient to report heavy bleeding or clots and explain medication side effects (such as diarrhea being expected with Hemabate).

What risk factors does Jennifer have for postpartum mood disorders?

History of depression, sleep deprivation, poor appetite, stress with breastfeeding, lack of coping, and recent cesarean birth.

What are the key features and treatment of Baby Blues?

Symptoms include crying, mood swings, feeling overwhelmed, and mild anxiety within the first 2 weeks postpartum; treatment is reassurance and emotional support.

What are the key features and treatment of Postpartum Depression?

Symptoms include persistent sadness, fatigue, poor bonding, sleep disturbances, and appetite changes; treatment includes therapy and antidepressants.

What are the key features and urgency of Postpartum Psychosis?

Symptoms include hallucinations, delusions, paranoia, and thoughts of harming self or baby; this is an EMERGENCY requiring hospitalization and medication.

What is the nursing PRIORITY when assessing postpartum mood disorders?

🚨 Assess for safety, specifically risk of self-harm or harm to the baby.

What direct question should always be asked when assessing postpartum mental health?

“Are you having thoughts of hurting yourself or your baby?”

What interprofessional team members are involved in managing postpartum mood disorders and their roles?

Nurse (assessment, education, safety monitoring), OB provider (diagnosis and medications), psychiatrist (mental health management), lactation consultant (breastfeeding support), social worker (resources and support systems), and family (emotional support).

What does a boggy uterus indicate?

Boggy uterus = hemorrhage until proven otherwise.

What does a deviated fundus indicate?

Deviated fundus = full bladder.

What does a firm uterus with continued bleeding suggest?

Firm uterus + bleeding = trauma (such as lacerations or hematoma).

What are the 4 Ts used for?

The 4 Ts identify causes of postpartum hemorrhage: Tone, Trauma, Tissue, Thrombin.

What is the correct priority order for managing postpartum hemorrhage?

Massage FIRST, medications SECOND.