Uterine Involution When checking uterus, always place hand above symphysis pubis to stabilize the uterus - Return of uterus to non-pregnant state following birth. - Progresses rapidly - Fundus descends 1 to 2 cm every 24 hours - 2 weeks after childbirth uterus lies in true pelvis
Subinvolution - F...
NUR 230 Exam 2 Questions and
Solutions
Uterine Involution ✅When checking uterus, always place hand above symphysis pubis
to stabilize the uterus
- Return of uterus to non-pregnant state following birth.
- Progresses rapidly
- Fundus descends 1 to 2 cm every 24 hours
- 2 weeks after childbirth uterus lies in true pelvis
Subinvolution ✅- Failure of uterus to return to non-pregnant state
- Common causes are retained placental fragments and infection
Uterine Contractions ✅- Hemostasis achieved by compression of intramyometrial
blood vessels as uterine muscle contracts
- Hormone oxytocin, released from pituitary gland, strengthens and coordinates
__________________
- Afterpains
Postpartum hemorrhage ✅- Traditionally defined as loss of more than: 500 ml of blood
after vaginal birth or 1000 ml after cesarean birth
- Always check bladder. If cannot void, may need catherization
- Causes may be subinvolution of uterus, pelvic infections, retained placental fragments,
or hematomas
- Uterus is about the size of a grapefruit and at the level of umbilicus immediately
following birth
- Massage fundus- **Priority**
- Watch for saturating pad every hour or constant trickling of blood
- Always turn & check for blood under buttocks
Medication used for postpartum hemorrhage ✅- Oxytocin
- Misoprostol
- Methergine (do not give if BP >140/90)
- 15 Methylprostaglandin (contraindicated if pt has asthma)
Atony ✅- Lack of uterine muscle tone
- If contraction is not present, there can be significant blood loss
- Uterus will feel boggy
- May give Oxytocin or Methargine to cause uterine contraction
- About 75% of postpartum hemorrhage is caused by __________
Lacerations ✅- If you have a steady flow of bright red, unclotted blood (trickling) but
the fundus of the uterus remains firm, a _______________ is a pretty good bet.
, - About 20% of early hemorrhage is d/t _________________
Perineal self care ✅- Ice for 1st 24 hours
- Sitz bath & peri-bottle
Afterpains ✅- After 2nd delivery
- Why? Tightness abdominal muscles
Breastfeeding ✅- Try different positions, find position that is most comfortable
- Side lying may be best for C-section
- Start as quickly as possible
- Snug fitting bra helps pain
- Rotating the infant each feeding will help with milk let down and decrease
engorgement
- Provides adequate iron for infant's first 4-6 months of life
Breast engorgement (non nursing mother) ✅- Snug bra or breast binder
- No stimulation of breasts
- Turn back in showers
- Cold packs
Diabetic Mothers ✅If type 1 diabetes, will need less insulin after pregnancy
Superficial Thrombophelbits ✅- Most common in the postpartum period
- Symptoms appear on postpartum day 3 or 4 and consist of local heat and redness,
tenderness, swelling and possibly low grade fever.
- Pulmonary embolism is rare
DVT ✅- Seen most often in cases where there is a history of thrombosis or in women
with OB complications such as PIH and operative birth
- It is characterized by edema of the ankle and legs, chills and fever, pain with calf
pressure, possibly decreased peripheral pulse
- Pulmonary embolism may be a complication
Thromboembolitic Tx ✅- Follows the same course as in a non pregnant patient and is
treated in the same manner
- Anticoagulant therapy
- Warm, moist soaks to the extremity
- bedrest
- elevate the affected extremity
- Monitor for signs and symptoms of pulmonary embolus (chest pain and dypsnea)
Mastitis ✅- 2-3 post delivery
- Caused by staph
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