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NURS6700 EXAM 4 QUESTIONS AND VERIFIED DETAILED ANSWERS
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NURS6700 EXAM 4 QUESTIONS AND VERIFIEDDETAILED ANSWERS 2024-2025
postpartum physiologic changes - Answer Involution
•Uterus returns to pre-pregnant state
•Helps to prevent hemorrhage
•6-8 weeks
Psychosocial
•Everything has changed
•Support ?
•Identity crisis?
•Mood changes
Cardiovascular
•500-1000 cc blood loss during birth
• Diuresis and diaphoresis return blood volume to nearly normal
•Takes 2 weeks: cardiac output remains high and syst resistance returns to normal:
watch for HTN
Respiratory
•Diaphragm returns to pre-pregnant position
•Rib expansion reverses over 2 weeks
•O2 consumption returns to normal
Hematological
•Hgb/Hct decreased
•Dilution vs. actual anemia
•10/30 anemia
•Transfusion for symptomology + anemia
,•Normal elevated WBC's (neutrophils)
•Hypercoagulability remains high for 7 days PP
•
immediate pp nursing assessments - Answer §
§Maternal VS + Fundal and Lochia assessment:
oQ15min x 1 hr
oQ 30min 1-2 hours
oQ1-2 h x2 (or up to 4-8 hrs)
oQ 4 h (up to 24 hrs)
othen Q 8h
o
§Full/focused OB assessment q shift (8 hr):
oCV, resp, GI
oPerineum
oBreast assessment: fullness, nipple integrity
oPain level
oAssess for DVT
os/s pre-eclampsia
os/s infection
oEducation /skill needs
§NOTE: Exams should not interrupt breastfeeding & family bonding
§
uterine involution - Answer Immediately post delivery -
,fundus @ U (umbilicus)
•By 12 hr ~1 cm below U
•Day 1-8 - decreases ~ 1 cm/day
•Day 9 - not palpable
•By 5- 6 wks - near non-pregnant size
lochia rubra -Answer Reddish or red-brown vaginal discharge that occurs immediately
after childbirth to first 3-4 days PP; composed mostly of blood, may have small clots, if
the pad is filled w blood after 1 hr that is a hemorrhage
lochia serosa -Answer Pink, serous, and blood-tinged vaginal discharge that follows
lochia rubra and lasts until the 4-12th day after birth.
lochia alba - Answer Whitish/yellowish discharge - lasts 12 days - 3 weeks, may last 3-6
weeks and remain normal. gradually disappearing
assessing the postpartum fundus - Answer height- according to time, abnormal if higher
than expected
position/displacement- midline is normal, abnormal is displaced to left or right
firmness- immediately firm is normal, firms w massage and boggy is abnormal
lochia- normal according to time, abnormal if gushes w large clots passed w massage
nursing interventions to promote uterine involution - Answer breastfeeding- exogenous
oxytocin release
empty bladder- offloading extra blood volume, effect of labor IVF and pitocin, straight
cath if necessary, empty bladder if fundus is not midline first
massage- support uterus just above the symphysis pubis, massage fundus w dominant
hand
call provider if not resolved- meds, assess for retained placenta
, perineal tears grading:
1st:
2nd:
3rd:
4th: - Answer involving vaginal epithelium and vulva skin only
injury to perianal muscles, but NOT anal sphincter
injury to perineum involving anal sphincter complex
injury to perineum involving anal sphincter AND RECTAL MUSCOSA
perineum assessment - Answer Better visualization from side-lying position
Generally heals in ~ 2 - 3 weeks
§Stitches are dissolvable
REEDA Scale: Rates 0-3 (best to worst) on each parameter [range of 0-15]
oRedness
oEdema
oEcchymosis
oDischarge
oApproximation
perineal care - Answer •Cold/Warm
•Cold 1st 24 hours and prn
•Warm after (sitz bath?)
•Pericare
•Hygiene is extremely important—infection prevention
•Lukewarm water—peri bottle or bidet
•Front to back
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