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For development and ancillary work, I would be happy to create custom samples based on materials you provide. For a list of selected projects I've worked on, click on the resumé tab and scroll down.
Learning Objectives
After reading this chapter, students will be able to:
1. Describe key physical changes that occur in the reproductive system during the postpartum period and nursing interventions to address them.
2. List and explain physical changes that occur in other body systems during the postpartum period and nursing interventions to address them.
2. Explain psychological adaptations that occur in the postpartum period and how to help patients cope with them.
3. Discuss how attachment develops between mothers and newborns and how culture affects this process.
4. Identify factors that increase risk for developing complications during the postpartum period.
5. Perform a physical assessment of a patient in the postpartum period.
6. Conduct a psychological assessment of a patient in the postpartum period.
7. Assess attachment between a mother and newborn during the postpartum period.
8. Discuss the components and purpose of a discharge assessment and follow-up.
1. Describe key physical changes that occur in the reproductive system during the postpartum period and nursing interventions to address them.
2. List and explain physical changes that occur in other body systems during the postpartum period and nursing interventions to address them.
2. Explain psychological adaptations that occur in the postpartum period and how to help patients cope with them.
3. Discuss how attachment develops between mothers and newborns and how culture affects this process.
4. Identify factors that increase risk for developing complications during the postpartum period.
5. Perform a physical assessment of a patient in the postpartum period.
6. Conduct a psychological assessment of a patient in the postpartum period.
7. Assess attachment between a mother and newborn during the postpartum period.
8. Discuss the components and purpose of a discharge assessment and follow-up.
Key Terms
Afterpains: episodes of painful contraction and relaxation of the uterus that occur for several days following birth; more common in multiparas
Attachment: a process of emotional bonding between newborn and parent facilitated by physical contact that begins soon after birth and that influences the development of the child
Engorgement: a postpartum process in which the blood and lymph vessels of the breasts increase in size and number and the mammary glands are filled with milk in preparation for breastfeeding, resulting in swollen, warm, and tender breasts
Involution: the shrinking of the uterus during the postpartum period as it returns to its pre-pregnancy state through a series of adaptations including contractions, muscular atrophy, and cellular changes
Lochia: a mixture of blood, shed epithelial cells, and other debris that is discharged from the uterus during the postpartum period, the color and amount of which can be used to assess the progress of healing and the presence of complications
Mastitis: a condition of inflammation and infection of the breast that commonly occurs in lactation
Orthostatic hypotension: a temporary drop in blood pressure that occurs as a result of sitting up or standing too quickly and that can cause dizziness and fainting
Attachment: a process of emotional bonding between newborn and parent facilitated by physical contact that begins soon after birth and that influences the development of the child
Engorgement: a postpartum process in which the blood and lymph vessels of the breasts increase in size and number and the mammary glands are filled with milk in preparation for breastfeeding, resulting in swollen, warm, and tender breasts
Involution: the shrinking of the uterus during the postpartum period as it returns to its pre-pregnancy state through a series of adaptations including contractions, muscular atrophy, and cellular changes
Lochia: a mixture of blood, shed epithelial cells, and other debris that is discharged from the uterus during the postpartum period, the color and amount of which can be used to assess the progress of healing and the presence of complications
Mastitis: a condition of inflammation and infection of the breast that commonly occurs in lactation
Orthostatic hypotension: a temporary drop in blood pressure that occurs as a result of sitting up or standing too quickly and that can cause dizziness and fainting
Chapter Introduction
Following the drama of birth—with all of its moments of fear and excitement, of anxiety and joy—and the intense focus on the newborn, the postpartum period might seem anticlimactic. However, the new mother experiences significant physical and psychological changes during this 6-week period. The nurse must be prepared to recognize them, perform a variety of assessments, and conduct appropriate interventions to aid healing and prevent complications.
This chapter presents these maternal changes and nursing assessments, with the goal of preparing you to provide your clients with the best postpartum care possible.
This chapter presents these maternal changes and nursing assessments, with the goal of preparing you to provide your clients with the best postpartum care possible.
Chapter Summary
- The reproductive system undergoes critical changes in the postpartum period, including the involution of the uterus, production of lochia, constriction of the cervix and vagina, healing of the perineum, and recommencement of ovulation and menstruation.
- The breasts become engorged in preparation for breastfeeding.
- The abdominal muscles gradually recover tone, striae (stretch marks) appear, and weight is lost.
- Increased hunger, thirst, and constipation are common, along with increased urinary output and occurrence of urinary tract infections.
- Cardiac output rapidly decreases to its normal, pre-pregnancy level.
- Headaches and increased sweating may occur.
- The mother moves from a period of taking-in, or passive contemplation, to a period of taking-hold, or actively engaging in care of the infant and self.
- An experience of temporary depression, known as the postpartum blues, may occur, typically lasting about 2 weeks.
- The mother and family begin to form an emotional connection with the infant, a process known as attachment, which is affected by both personal and cultural factors.
- Physical assessments include vital signs, breasts, abdomen and fundus, lochia, perineum, lower extremities, elimination, and rest and sleep.
- Psychological assessment includes screening for depression and evaluation of attachment.
NCLEX-Style Review Questions
1. A nurse is evaluating the lochia of a woman who is in her second day postpartum. Assuming that no complications are present, which of the following should the nurse expect to find on the patient’s peripad? Select all that apply.
A. Dark red stain
B. Stain length of 5 inches
C. Large clots
D. Foul odor
E. Greater flow after standing
Answer: A, B, E
Rationale: On days 1 to 3 postpartum, the lochia is normally rubra, or dark red, and bloody, with small clots. The amount should be moderate (less than a 6-inch stain) or less, and the odor should be fleshy. A greater flow of lochia after standing or while breastfeeding is normal. A foul odor, which likely indicates infection, and the presence of large clots are abnormal and a cause for concern.
Cognitive Level: Application
Client Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process
2. Twelve hours after delivery of the placenta, a nurse assesses a patient’s uterus and finds that it is still boggy. The nurse reports this finding to the physician. What medication should the nurse anticipate the physician ordering to address this concern?
A. Ibuprofen
B. Docusate
C. Oxytocin
D. Rho(D) immune globulin
Answer: C
Rationale: Oxytocin stimulates uterine contractions and may be prescribed by the physician to treat uterine atony. Ibuprofen is an analgesic, ordered to treat pain. Docusate is used to treat constipation. Rho(D) immune globulin is administered to women who are Rh-negative who give birth to infants who are Rh-positive, to prevent production of antibodies.
Cognitive Level: Application
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process
3. A new mother complains that she continually experiences plugged milk ducts. Which of the following should the nurse recommend to this patient? Select all that apply.
A. Apply ice packs to the breasts
B. Feed the infant frequently on demand
C. Feed the infant in the same position each time
D. Massage the breasts before feeding
E. Feed long enough to empty each breast
Answer: B, D, E
Rationale: The patient should massage the breasts and apply warm compresses, not ice packs, to promote increased circulation. The mother should feed the infant frequently on demand and long enough to empty each breast, which should prevent milk stasis and the formation of milk duct plugs. Changing feeding positions, rather than feeding the infant in the same position, can improve the efficiency of breastfeeding and promote emptying of the breasts, thus helping prevent plugged milk ducts.
Cognitive Level: Application
Client Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Teaching and Learning
4. On day 2 postpartum, a new mother demonstrates uterine atony. Which nursing diagnosis related to this condition is most important?
A. Risk for Infection
B. Altered Skin Integrity
C. Risk for Impaired Urinary Elimination
D. Risk of Bleeding
Answer: D
Rationale: Uterine atony, a condition in which the uterus fails to contract properly following labor, places the patient at increased risk for bleeding, as blood vessels remain dilated%2
A. Dark red stain
B. Stain length of 5 inches
C. Large clots
D. Foul odor
E. Greater flow after standing
Answer: A, B, E
Rationale: On days 1 to 3 postpartum, the lochia is normally rubra, or dark red, and bloody, with small clots. The amount should be moderate (less than a 6-inch stain) or less, and the odor should be fleshy. A greater flow of lochia after standing or while breastfeeding is normal. A foul odor, which likely indicates infection, and the presence of large clots are abnormal and a cause for concern.
Cognitive Level: Application
Client Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process
2. Twelve hours after delivery of the placenta, a nurse assesses a patient’s uterus and finds that it is still boggy. The nurse reports this finding to the physician. What medication should the nurse anticipate the physician ordering to address this concern?
A. Ibuprofen
B. Docusate
C. Oxytocin
D. Rho(D) immune globulin
Answer: C
Rationale: Oxytocin stimulates uterine contractions and may be prescribed by the physician to treat uterine atony. Ibuprofen is an analgesic, ordered to treat pain. Docusate is used to treat constipation. Rho(D) immune globulin is administered to women who are Rh-negative who give birth to infants who are Rh-positive, to prevent production of antibodies.
Cognitive Level: Application
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process
3. A new mother complains that she continually experiences plugged milk ducts. Which of the following should the nurse recommend to this patient? Select all that apply.
A. Apply ice packs to the breasts
B. Feed the infant frequently on demand
C. Feed the infant in the same position each time
D. Massage the breasts before feeding
E. Feed long enough to empty each breast
Answer: B, D, E
Rationale: The patient should massage the breasts and apply warm compresses, not ice packs, to promote increased circulation. The mother should feed the infant frequently on demand and long enough to empty each breast, which should prevent milk stasis and the formation of milk duct plugs. Changing feeding positions, rather than feeding the infant in the same position, can improve the efficiency of breastfeeding and promote emptying of the breasts, thus helping prevent plugged milk ducts.
Cognitive Level: Application
Client Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Teaching and Learning
4. On day 2 postpartum, a new mother demonstrates uterine atony. Which nursing diagnosis related to this condition is most important?
A. Risk for Infection
B. Altered Skin Integrity
C. Risk for Impaired Urinary Elimination
D. Risk of Bleeding
Answer: D
Rationale: Uterine atony, a condition in which the uterus fails to contract properly following labor, places the patient at increased risk for bleeding, as blood vessels remain dilated%2
Case Study With Critical Thinking Questions
Rosita Vasquez is a 33-year-old Hispanic woman who vaginally delivered her fifth child, Carlos, 3 hours ago. He weighs 4,400 g, and labor was prolonged. The nurse assesses Rosita’s fundus and finds it to be boggy. On checking her peripad, the nurse finds that it is fully saturated with dark red lochia that includes some large clots.
1. What serious postpartum complication should the nurse be most concerned about in this case?
2. What condition is the most likely cause of this complication, given the nurse's assessment findings?
3. What risk factors are evident in this case for this condition?
4. What immediate action or actions should the nurse take in response to the lochia finding?
5. What interventions should the nurse make to address the boggy uterus?
1. What serious postpartum complication should the nurse be most concerned about in this case?
2. What condition is the most likely cause of this complication, given the nurse's assessment findings?
3. What risk factors are evident in this case for this condition?
4. What immediate action or actions should the nurse take in response to the lochia finding?
5. What interventions should the nurse make to address the boggy uterus?