learning guide postpartum

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					                                        Learning Guide
                             Module 6 - Normal Postpartum
                                      Chapter 21

1. Define Puerperium and Involution.

Body System Adaptations:

Reproductive Organs:
Uterus:
2. What are the main mechanisms of uterine involution? Discuss each:
   a. Contraction of the muscle fibers-
   b. Protein material catabolism
   c. Exfoliation/ Regeneration of the endometrium-

3. What is the normal tone and placement of the fundus immediately after delivery, 6-12
   hours after delivery, and then daily?

4. What measure should the nurse encourage prior to assessing the abdomen and fundus?

5. What is the technique used to assess the uterus, lochia and perineum? What nursing
   intervention does the nurse employ to prevent uterine prolapse? How would the nurse
   record findings?

6. What is the most common cause of a deviated uterus? What interventions must the
   nurse include if the uterus is found deviated from midline?

7. What specific interventions must the nurse initiate if the uterus is boggy?

8. What are the three types of lochia, and how long does each one last? What are normal
   characteristics of lochia?

9. Who is more likely to experience afterpains? How are they treated?

Cervix:
10. How does the postpartal cervix differ from a pre-pregnant cervix?

Perineum:
11. What are the changes related to the perineum and how does the nurse assess the
    perineum, what is the REEDA scale?

12. What are common nursing interventions to relieve discomfort related to edema and
    trauma to the perineum. What instruction will the nurse include with each treatment?
          a. Ice pack
          b. Tucks
          c. Topical agents
          d. Sitz bath
          e. Peri-bottle

Cardiovascular:
13. What changes occur with cardiac output and plasma volume? What are two main ways
    that the body rids itself of the excess extracellular fluid from pregnancy?
14. What are normal laboratory findings for the postpartum woman     (**Be able to explain
    changes and rationale for altered results) .
    a. HgB-
    b. Hct-
    c. CBC
    d. WBC
    e. PT / PTT

15. What common changes in vital signs occur in the postpartum period?
    a. Pulse-
    b. Blood pressure-
    c. Respirations-
    d. Temperature

16. What changes in coagulation make the woman at risk for clot formation?

Gastrointestinal:
17. The most common elimination problem is constipation. Describe how each of the
    following contributes to this problem and what is an appropriate nursing intervention to
    address each issue:
    a. Decreased muscle tone and decreased peristalsis-
    b. Dehydration-
    c. Perineal tenderness (lacerations, episiotomy, hemorrhoids)-

Urinary:
18. Why is a woman at risk for urinary retention following birth?

19. What is the problem associated with a full-bladder?

Musculoskeletal:
20. What changes occur in abdomen and what teaching is included?

Endocrine:
21. When does resumption of ovulation and menstruation occur? Why is return prolonged
    in the breastfeeding mother?

22. Why is breastfeeding not a reliable means of contraception

23. What is expected weight loss after delivery?

Postpartum Assessment:

24. What is the nursing assessments and nursing care related to postpartum physiological
    Adaptations including:
    Vital signs
    Perineum
    Bladder
    Breasts
    Lower extremities, Homan’s sign, reflexes

Nursing Care:
25. What immunizations are given in the postpartum period?
26. Explain the use of the following comfort measures:
      Sitz baths
      Peri bottle
      Tucks and Sprays
      Heating pad
      Analgesics

27. What measures are utilized in promoting bladder and bowel elimination?

28. How is care different for the woman who had a cesarean birth?

29. What are the “Taking-in”, “Taking-hold”, and “Letting-go” Postpartum Phases by Rubin?
    What are normal characteristics in each phase?

Process of Becoming Acquainted:
30. What are the four stages in maternal role attainment and characteristics of each?

31. What is postpartum blues?

32. What are the maternal behaviors in the attachment process?


                              Chapter 24 Newborn Feeding

33. What are the physiological changes of the breasts in preparation for lactation?

34. What information is important to include in patient teaching regarding care of breasts
    and how to breast feed?

35. What information is important to include in patient teaching regarding care of breasts
    and how to suppress lactation for the bottle feeding mother?

35. What is the difference in the nutritional needs of a lactating mother and a non-
    breastfeeding mother?

				
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