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NURSING 306 OB Exam 2 Study Guide

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OB Exam 2 Study Guide 12/03/2016 Fundal Assessment • Actions/Interventions o Determine tone ▪ Firm=contracted ▪ Soft=boggy  Indicates uterus is not contracting and places the woman at an increased risk for excessive blood loss  Massage fundus w/palm of hand in a circular motion u...

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  • October 26, 2022
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  • 2022/2023
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OB Exam 2 Study Guide 12/03/2016
Fundal Assessment

Actions/Interventions
o
Determine tone

Firm=contracted

Soft=boggy
 Indicates uterus is not contracting and places the woman at
an increased risk for excessive blood loss
 Massage fundus w/palm of hand in a circular motion until firm
to stimulate contraction

Reevaluate w/in 30 mins
 Give oxytocin to stimulate smooth muscle of uterus to
contract

Physiological changes in PP

Assessment & Care
o
Reproductive

Assess uterus for location, position,
and tone of fundus
 Potential complications that
may lead to postpartum
hemorrhage are greatest within
the first hour following delivery

Measure the distance between the
fundus and umbilicus
 Each finger breadth=1cm

Determine position of uterus
 Shifted to side may indicate distended bladder
If deviated, soft, or elevated above the umbilicus, have pt void
o
Endometrium

, ▪
Assess lochia to monitor blood loss
 Scant (<1in), light (<4in), moderate (<6in), heavy (pad
saturated)
 Measure clots—10g=10mL of blood loss
 (Table 12-2 pg. 313)
o
Vaginal/perineum

Assess perineum using
REEDA
 Redness,
edema, ecchymosis,
discharge,
approximation of edges of episiotomy or laceration

Position in side lying position for better visualization

Apply ice or cold sitz baths for first 24 hours; warm sitz baths after
24 hours twice a day for 20 mins

Give peri-bottle w/warm water to rinse area after elimination

Tighten gluteal muscle as she sits down and to relax muscles
after she is seated
o
Cardiovascular

Assess pulse & BP—every 15 mins for the first hour

Assess for orthostatic hypotension

Assess for venous thrombosis
 Homan’s sign
 Calf tenderness, edema, and sensation of warmth
 Encourage early ambulation

Assess for postpartum chills and give warm blanket
o
Breast

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