• Uterus going back into its natural state
• When checking uterus, always place hand above
symphysis pubis to stabilize the uterus.
What to do if a mother has postpartum hemorrhaging, and what are some
drugs that can stop it?
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, NUR 254 (NUR254 EXAM2 STUDY GUIDE
1. Always check bladder. If fundus if boggy. If cannot void,
may need cauterization.
2. Causes may be subinvolution of the uterus, pelvic
infection, or retained placental fragments
3. Uterus is about size of grapefruit and at
level of umbilicus immediately following
birth
4. Massage fundus- Priority
5. Watch for saturating pad every hour or constant trickling of
blood
6. Always turn & check for blood under buttocks.
7. May use drugs to manage postpartum hemorrhage
(table page 533). When can you use these? These drug
cause the uterus to firm up – that is the goal
- Oxytocin
- Misoprostol
- Methergine (do not give if BP > 140/90) –but
cannot give to someone with hypertension/pre-
What is eclampsia
Atony?
- 15 Methylprostaglandin (contraindicated if pt has
asthma)
• Atony is simply a lack of uterine muscle tone. When the placenta peels
off the wall of the uterus, the only thing that staunches the flow of
blood is the clamping down of the uterine muscle on the open vessels.
If that contraction is not present, there can be significant blood loss.
About 75% of all postpartum hemorrhage is caused by atony. Uterus
will feel boggy. May give oxytocin or Methergine to cause uterine
contraction.
How you would know if a postpartum mother has a laceration?
• If you have a steady flow of bright red, unclotted blood (trickling) but
the fundus of the uterus remains firm, a laceration is a pretty good
bet. About 20% of early hemorrhage is d/t lacerations
What is late postpartum hemorrhaging?
• Late postpartum hemorrhage occurs most often 1-2 weeks after
childbirth due to retained placental tissue. There are clues along the
way - lochia often fails to make the normal progression from rubra to
serosa to alba. If lochia is rubra for longer than 2 weeks, that is highly
suspect. The other clue is subinvolution, which is a uterus that fails to
return to normal size after the pregnancy.
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, NUR 254 (NUR254 EXAM2 STUDY GUIDE
• Make sure to turn the client to her side frequently so that you can
check the pad underneath. Often blood can accumulate underneath
the client. Weigh peripads to estimate blood loss if a careful
measurement is necessary.
• Assess for signs of shock. Remain with the client. If the uterus
is boggy, massage it gently but firmly.
Are diuresis and dehydration common after delivery?
• Diuresis & dehydration are common after delivery. May have profuse
sweating. (Might have a fever but should not be greater than 100.4
F.) Increase fluids.
What is some perineal client self-care?
1. Ice for 1st 24 hours, after that we can use heat
2. Sitz bath(hot water up over your perineum) & peri-
bottle(squeeze bottle with hot water then let the water
run across the perineum)
– helps with infection
What are some after pains, and when do they occur?
• After pains – occur in women that have already had 1 children,
happens with second child. Uterus is contracting more and
more.
1. After 2nd delivery
2. Why? Tightness of abdominal
muscles How should you tell a mother to
breastfeed?
• Breastfeeding
1. Try different positions, find position that is most
comfortable.
2. Side-lying may be best for C-section
3. Start as quickly as possible
4. Snug fitting bra helps pain
5. Rotating the infant each feeding will help with milk
let down & decrease engorgement.
6. Provides adequate iron for infant’s first 4-6 months of life.
• Breast engorgement for non-nursing mother
1. Snug bra or breast binder
2. No stimulation of breasts
3. Turn back in showers
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