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OBDay4Postpartum1.pdf
OB Day #4 Postpartum
You are a L&D nurse. Your patient just delivered vaginally. Right after birth, you feel the woman’s UTERUS.
If it is BOGGY, SOFT, MUSHY, ATONY….what do you do? ____________________________________________
If it is FIRM, WELL-CONTRACTED… but above the umbilicus and/or deviated to the right or left side….what do you do? _____________________________________________
OB Day #4 Postpartum
The nursery nurse asks you to help her calculate the APGAR SCORE.
At 1-minute after delivery, the following is noted: • Body pink in color
with blue extremities • Heart rate of 110 • Minimal grimace in
response to suctioning of the nares
• Some flexion in arms and legs
• Weak cry
Calculate the 1-Minute APGAR score. ___________
At 5-minute after delivery, the following is noted: • Pink body and pink
extremities • Heart rate of 128 • Good grimace, crying • Good flexion of
extremities • Good strong cry
Calculate the 5-Minute APGAR score. ___________
OB Day #4 Postpartum
You assist your patient out of bed to the bathroom to teach her about PERICARE. You have her urinate and/or have a bowel movement. Answer the following based on photos on next slide:
• What do you have her fill up with warm water and rinse herself off with afterwards?? __________________________________________
She then pats herself gently dry with toilet paper.
• You then give her numbing spray for her episiotomy/ laceration/ hemorrhoid discomfort. What is this numbing spray called?________________________________
• She complains of hemorrhoids. You give her medicated witch hazel pads. What are they called?_______________
• You teach her how to use ice packs. She asks how long she should use them. You tell her to use them for _______-______hours.
• Then, you tell her she will switch to warm water by sitting in a plastic container. What is this container called? _______________________________________________
She states that she has no questions. You assist her back to her bed and await transfer to the postpartum unit.
OB Day #4 Postpartum
12-24 hours
OB Day #4 Postpartum
Moments later, she calls out to you that she thinks she is bleeding a lot. You remind her that ice packs are not absorbent. So you replace her ice pack with a regular sanitary pad. You wait 15 minutes. * * * * * * * * * * *
Calculate her blood loss in _____mL if a new sanitary pad weighs 40mg and her bloody sanitary pad weighs 100mg. (show your calculations)
Calculate her blood loss in _____mL if a new sanitary pad weighs 80mg and her bloody sanitary pad weighs 180mg. (show your calculations)
Calculate her blood loss in _____mL if a new sanitary pad weighs 100mg and her bloody sanitary pad weighs 250mg. (show your calculations)
OB Day #4 Postpartum
You explain to her about the bleeding she may have for the next 6 weeks. You tell her that:
“The heavy bright red blood is called Lochia __________.”
“The lighter pink blood is called Lochia ______________.”
“The scant yellow-white discharge is called Lochia _____.”
Mary Hemorrhaged like a Cherry Pit!
M:__________________________
H:__________________________
C:__________________________
P:__________________________
Had your patient really had a postpartum hemorrhage, you would have anticipated the doctor to order one of the following medication. List the common postpartum hemorrhage medications.
OB Day #4 Postpartum
OB Day #4 Postpartum
Your patient says she is worried about having a bowel movement and constipation.
What medication, stool softener, might you give her if ordered? ____________________________________________________
What foods do you encourage her to drink/eat? • • •
What foods do you encourage her to avoid? • • •
OB Day #4 Postpartum
Which of the following medications might you anticipate giving your postpartum patient? (Select all that apply) a) Motrin b) Colace c) Iron d) Prenatal Vitamin e) Aspirin f) Dermoplast g) Tucks
Which of the following medications would you question giving your postpartum patient? a) Motrin b) Aspirin c) Tucks d) Pericolace
Which of the following medications might you expect to give your patient who is experiencing a postpartum hemorrhage? (Select all that apply) a) Methylergonovine b) Pitocin c) Misoprostyl d) Aspirin e) Carboprost Tomethamine f) Heparin g) Coumadin
OB Day #4 Postpartum
Your patient says she feels very emotional after having her baby. She tells you that her sister experienced periods of sadness and crying after her nephew was born. EXPLAIN THE DIFFERENCE BETWEEN Baby Blues, Postpartum Depression, and Postpartum Psychosis to your patient.
Baby Blues:
Postpartum Depression:
Postpartum Psychosis:
OB Day #4 Postpartum
Your patient shares with you that she is still not sure whether she wants to BREASTFEED or FORMULA FEED the baby. Discuss with her the advantages and disadvantages of each:
Breastfeeding Advantages: • • •
Breastfeeding Disadvantages: • • •
Formula Advantages: • • •
Formula Disadvantages: • • •
OB Day #4 Postpartum
After listening to you discuss breast and formula feeding, the patient still has many questions about each method of feeding the newborn. Answer the following for her:
BREAST FEEDING:
• How often does a breast fed baby eat? _________________________________
• Can I put him/her on a feeding schedule? __________________________________
• What does a breast fed baby’s poop look like? __________________________________
• How do I know he/she is hungry? ___________________________________
• What is the last sign of hunger? __________________________________
• How do I know he/she is getting enough? ___________________________________
• How do I know he/she is done eating? ___________________________________
• How do you position a baby when breast feeding? ___________________________________
FORMULA FEEDING:
• How often does a formula fed baby eat? _________________________________
• Can I put him/her on a feeding schedule? __________________________________
• What does a formula fed baby’s poop look like? __________________________________
• Should I ever dilute “ready to feed” formula? __________________________
• Should I ever “prop” a bottle? ________
• Should I hold the bottle horizontally or tilt it so that the nipple is full of formula? ___________________________________
• Should I give my baby, under 1 year of age, cow’s milk if I ever run out of formula?____
OB Day #4 Postpartum
You are teaching your patient about CRIB SAFETY and the newborn. Teach her at least 10 things that can help in preventing SIDS (Sudden Infant Death Syndrome):
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OB Day #4 Postpartum
1. The priority nursing observation during the 4th stage is for: a) Vaginal bleeding b) Perineal bulging c) Uterine infection d) Parent-infant bonding
2. The correct way to suction a baby’s mouth with a bulb syringe is to: a) Compress the bulb, place the tip in the side of the mouth, then
release the bulb. b) Place the tip in the side of the mouth, compress the bulb, then
release the bulb. c) Compress the bulb, place the tip in the center of the mouth, then
release the bulb. d) Place the tip in the center of the mouth, compress the bulb, then
release the bulb.
3. A nurse is educating a mother about the proper use of the bulb syringe. Which of the following responses should the nurse include in the teaching? a) “Suction the baby’s nose before her mouth.” b) “Suction the baby’s mouth before her nose.” c) “Place the bulb syringe to the back of the baby’s throat.” d) “Compress the syringe after it is placed in the baby’s mouth or
nose.”
4. Which statement made by the patient indicates a need for additional teaching regarding proper use of the bulb syringe? a) The mother states that the baby’s mouth should be suctioned
before the nose is suctioned. b) The mother states that the bulb syringe should be compressed
before it is placed in the baby’s mouth or nose. c) The mother states that, when suctioning the mouth, the bulb
syringe should not touch the back of the baby’s throat. d) The mother states that the bulb syringe should remain compressed
until it is removed from the baby’s nose or mouth.
OB Day #4 Postpartum
5. A nurse is caring for a newborn. How many vessels should the nurse expect to observe in the newborn’s umbilical cord? a) One artery and one vein b) Two arteries and two veins c) Two veins and one artery d) Two arteries and one vein
6. When administering Rho(D) immune globulin (RhoGAM) to an Rh-negative mother who has delivered an Rh-positive infant, what is the maximum length of time the nurse has to give the medication? a) 48 hours after delivery b) 72 hours after delivery c) At the 6-week postpartum checkup d) Within the first 24 hours of delivery
7. During the initial assessment, the nurse notes that the patient’s fundus is firm and left of midline. What nursing action is warranted at this time? a) Massage the uterus vigorously. b) Have the patient empty her bladder. c) Reassess the client in 4 hours. d) No action is presently required.
8. The patient asks the nurse how long after discharge should sexual intercourse be delayed. The best nursing response is that sexual intercourse may be resumed at which time? a) As soon as the lochia has ceased and the perineum is healed. b) As soon as an acceptable birth control method is selected. c) After the postpartum checkup in 4-6 weeks. d) After the uterus has returned to its normal position.
OB Day #4 Postpartum
9. The patient states “My breasts are small. Will I be able to breast feed my baby?” Which response by the nurse is most appropriate? a) “The size of your breasts does not affect your ability to breast feed.” b) “You should attempt to breast feed and give supplemental formula.” c) “Bottle feeding is just as nutritious as breast feeding.” d) “You can do exercises to increase the size of your breasts.”
10. The newborn’s father asks about positioning the baby in the crib after being fed. The nurse correctly explains that it is best to place the newborn in which position in the crib after feeding? a) Right side-lying b) Left side-lying c) Prone d) Supine
11. The new mother is HIV+ and is inquiring about breast versus formula feeding her newborn. Which explanation by the nurse is most appropriate regarding breast feeding this newborn? a) “It’s OK to breast feed the baby if the anti-HIV test results are positive.” b) “It’s OK to breast feed the baby as long as he is symptom-free.” c) “You can’t breast feed the baby because you are HIV-positive.” d) “You can’t breast feed the baby if you have developed symptoms of
AIDS.”
12. The father of a toddler brings the child to the hospital to see the newborn sibling. The toddler acts out and throws the newborn’s pacifier onto the floor. The parents are embarrassed about their toddler’s behavior. Which parental advice regarding sibling rivalry is most appropriate at this time? a) After going home, each parent should spend time with the toddler doing
activities the toddler enjoys. b) The toddler should be sent to a grandparent’s home for the first week
until a routine can be established with the newborn. c) Set firm limits on the toddler’s behavior providing appropriate discipline
and punishment. d) Keep the toddler and the newborn separate for the first few days until
the toddler can adjust to the new sibling.
OB Day #4 Postpartum
13. Which finding would the nurse consider abnormal for the postpartum patient who delivered within the past 24 hours? a) The patient has passed a nickel-sized clot. b) The patient has calf pain when her foot is dorsiflexed. c) The patient has abdominal cramping while breastfeeding. d) The patient’s vaginal discharge is dark red.
14. To prevent hemorrhage, when should the nurse massage the fundus during the postpartum period? a) When the fundus is firm and hard. b) When the fundus is at the umbilicus. c) When the amount of lochia decreases. d) When the fundus is soft and boggy.
15. The nurse correctly massages the fundus by placing one hand on the fundus and the other hand where? a) Just above the symphysis pubis b) To the right side of the abdomen c) Just below the xiphoid process d) To the left side of the abdomen
16. The nurse’s one hand massages the uterus. What is the function of the nurse’s other hand during massage? a) To anchor the lower uterine segment b) To palpate the bladder c) To observe sanitary pad for blood loss during massage d) To answer her cell phone
OB Day #4 Postpartum
17. Which reason explains why women should be encouraged to perform Kegel exercises after delivery? a) They assist with lochia removal. b) They promote the return of normal bowel function. c) They promote blood flow, enabling healing and muscle
strengthening. d) They assist the client in burning calories for rapid postpartum
weight loss.
18. The nurse teaching a patient with newly diagnosed mastitis about her condition would inform her that she most likely contracted the disorder from which organism? a) Escherichia coli b) Group beta-hemolytic streptococci (GBS) c) Staphylococcus aureus d) Streptococcus pyogenes
19. The nurse is teaching a patient about mastitis. Which statement should the nurse include in her teaching? a) The most common pathogen is group A beta-hemolytic
streptococci. b) A breast abscess is a common complication of mastitis. c) Mastitis usually develops in both breasts of a breast-feeding
patient. d) Symptoms include fever, chills, malaise, and localized breast
tenderness.
20. Which recommendation should be given to a patient with mastitis who’s concerned about breast-feeding her neonate? a) Stop breast feeding until completing the antibiotic. b) Supplement feeding with formula until the infection resolves. c) Do not breast feed, pump, or express the milk on the affected
breast until the infection resolves. d) Continue to breast feed; mastitis does not affect the neonate.
OB Day #4 Postpartum
21. A 37-year-old patient experienced a perinatal loss 3 days ago. The nurse, who is concerned about the possibility of dysfunctional grieving, should assess the patient for which sign? a) Lack of appetite b) Blaming herself c) Frequent crying spells d) Denial of the death
22. On the first postpartum night, a patient requests that her neonate be sent back to the nursery so she can get some sleep. The patient is most likely in which phase? a) Depression phase b) Letting-go phase c) Taking-hold phase d) Taking-in phase
23. The nurse observes several interactions between a mother and her new son. Which behaviors by the mother would the nurse identify as evidence of mother-infant attachment/bonding? (select all that apply) a) Talks and coos to her son b) Cuddles her son close to her c) Doesn’t make eye contact with her son d) Requests the nurse to take the baby to the nursery for all feedings e) Encourages the father to hold the baby f) Takes a nap when the baby is awake and alert
24. The most appropriate way to identify mother and newborn when reuniting them is to: a) Check the identification band number of each. b) Ask the mother to clearly state her name. c) Examine the mother’s fingerprint and the newborn’s footprints. d) Ask the mother “is this your baby?”.
OB Day #4 Postpartum
25. Which woman is most likely to have after pain cramps? a) Gravida 1, Para 1 b) Gravida 5, Para 3 c) Gravida 2, Para 1 d) Gravida 3, Para 1
26. Colostrum’s greatest benefit to the newborn is prevention of: a) Constipation b) Weight loss c) Hemorrhage d) Infection
27. What should the nursing mother be taught about breast care? a) Clean the breasts with plain water when washing. b) Give one formula feeding daily to limit engorgement. c) Do not wear a bra the first few days after birth. d) Always begin feeding on the same breast.
28. Diuresis in the early postpartum period indicates: a) Urinary tract infection. b) Retention of body fluids. c) Excretion of excess fluids. d) Edema near the urinary meatus.
29. Which is the best nursing measure to increase the woman’s perineal comfort during the first hour after vaginal birth with a midline episiotomy? a) Help her take a warm sitz bath. b) Give her an oral analgesic drug. c) Apply topical anesthetic ointment. d) Place an ice pack on the area.
OB Day #4 Postpartum
30. Which lochia characteristic should the nurse teach the woman to report? a) Change from red to pink to white. b) Cessation of flow by 4 weeks postpartum. c) Return of red heavy flow at 12 days postpartum. d) Presence of a menstrual-like odor.
31. To detect pulmonary embolus in a patient in the immediate postpartum period, a nurse should be alert to which symptoms? a) Sudden dyspnea and chest pain. b) Chills and fever. c) Bradycardia and hypertension. d) Confusion and bradycardia.
32. Which situation should concern the nurse treating a postpartum patient within a few days of delivery? a) The patient is nervous about taking the baby home. b) The patient feels empty since she delivered the baby. c) The patient would like to watch the nurse change the diaper
another time. d) The patient would like the nurse to take her baby to the nursery so
she can nap.
33. Your postpartum patient has continuous seepage, a trickle, of blood from the vagina. Palpation of her uterus reveals a firm uterus, 1 cm below the umbilicus. A nurse would monitor this patient closely for which condition? a) Retained placental fragments b) Urinary tract infection c) Cervical laceration d) Uterine atony
