Study Guide Ch 22

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Chapter 22 Study Questions
All page numbers reference 9th edition unless otherwise noted
Question Answer
1. What is involution and when does it begin?Involution – The return of the uterus to its non-pregnant state. This process begins immediately after the placenta is expelled. Page 576
2. Where is the fundus (the top part of the uterus) after the third stage of labor?The fundus is resting in the sacral proximity. Page 576
3. 12 hours after birth, where is the fundus in relation to the abdominal wall?It is located about 1 cm above the umbilicus within 12 hours after birth. Page 576
4. What size is the uterus 24 hours postpartum?It is about has reduced to the size it was at 20 weeks gestation 24 hours postpartum. Page 576
5. How much does the fundus descend each postpartum day?It descends about 1-2 cm every 24 hours. Page 576
6. By what time should the uterus be unpalpable through the abdominal wall (because it has descended below the symphysis pubis)?By 2 weeks post partum the uterus should not be palpable abdominally. Page 576
7. How does the size of the uterus change with each pregnancy?It weighs slightly more with each pregnancy because there will be some residual tissues and cells. Page 576
8. What is subinvolution of the uterus?Subinvolution is the failure of the uterus to return to its non-pregnant state. Page 577
9. What are the most common causes of subinvolution?Most common causes are retained placental fragments and infection. Page 577
10.How is postpartum hemostasis achieved?Compression of the intramyometrial blood vessels as the uterine muscle contracts. Page 577
11.After expulsion of the placenta, which hormone is usually administered to enhance uterine contractility?Oxytocin (Pitocin) is usually administered to IV or IM page 577
12.What are afterpains?Uncomfortable cramping that occurs due to periodic relaxation and then vigorous contractions of the uterus. More common in subsequent pregnancies or pregnancies that caused the uterus to be over-distended page 577
13.What are the 3 varieties of lochia?Lochia is post childbirth uterine discharge. Lochia rubra is mostly blood and decidual and trophoblastic debris. Turns from pink to brown over 3-4 days until it turns into Lochia Serosa which consists of is old blood, serum, leukocytes, and tissue debris. Average time of discharge of lochia serosa is 22-27 days. Lochia alba consists of leukocytes, decidua, epithelial cells, mucus, serum, and bacteria. Average of 10-14 days but longer can still be considered normal. Pages 577 and 578


Chapter 22 # 14-26


Question Answer
14.How long should each stage of the lochias last?Lochia rubra—3-4 days. Lochia serosa—22-27 days. Lochia alba—10-14 days but may last longer and still be normal
15.Is there more lochia after C/S or SVD? (Cesarean or spontaneous vaginal delivery)More lochia after SVD. The amount of lochia typically is less after cesarean births because the surgeon suctions the blood and fluids from the uterus or wipes the uterine lining before closing the incision.
16.If lochia rubra recurs at 7 – 14 days postpartum, what is the likely site from which the bleeding is issuing?From the healing placental site
17.What are signs of postpartum endometritis?Continued flow of lochia serosa or lochia alba by 3-4 weeks after birth, fever, pain or abdominal tenderness associated with discharge
18.What should be the odor of normal lochia?Normal lochia should smell like normal menstrual flow
19.How long should it take for an episiotomy to heal?Healing of an episiotomy or laceration is the same as any surgical incision. Initial healing occurs within 2-3 weeks but 4-6 months can be required for the repair to heal completely.
20.What exercises are recommended after childbirth to help strengthen the perineal muscles?Kegel exercises which involve tightening and relaxing of the muscles that support the bladder and urethra
21.Which hormone in the puerperium seems to inhibit ovulation? Prolactin
22.When does ovulation occur (use the mean/average times) in non-lactating vs. in lactating women?Lactating women mean length of time is approximately 6 months. Non-lactating women mean time is approximately 70-75 days
23.When do many or most women ovulate in relation to their first postpartum menses?Menstruation usually resumes by 4-6 weeks postpartum after birth
24.Is the first menses postpartum heavier or lighter than the woman’s usual period?First postpartum menses is heavier
25.How long does it take for the distended abdominal muscles to return to the pre-pregnancy state? Approximately 6 weeks
26.In some cases the abdominal muscles actually separate due to uterine distension. What is this called?Diastasis recti adominis


  Chapter 22 Study Questions
Question Answer
27.Besides losing fluids through the renal system, which other method do postpartum women use to eliminate accumulated fluid?Diaphoresis
28.Women often do not feel the urge to void in the immediate postpartum, even when the bladder is full. How does this affect the uterus?Pushes the uterus up and to the side, prevents the uterus from contracting firmly.
29.What are the causes of postpartal constipation?Decreased muscle tone in the intestines during labor and the immediate puerperium, prelabor diarrhea, lack of food, or dehydration.
30.What are two causes of postpartal anal incontinence? Operative vaginal birth and anal sphincter lacerations.
31.The breasts begin the lactation process by secreting colostrums. When does the real milk come in? 72 – 96 hours after birth.
32.Should the woman who does not plan to lactate pump her breasts or allow the baby to suckle to relieve engorgement on the 3rd or 4th postpartum day? Why?Neither, nipple stimulation is to be avoided. If suckling is never begun, lactation ceases within a few days to a week.
33.How much blood is lost during a SVD?During a C/S? 500ml during vaginal birth of a single fetus and approximately twice this much during cesarean birth.
34.The WBC count in pregnancy is about 12,000 /mm3. What happens to the WBC level during the first 10 – 12 days after birth?Commonly between 20,000 – 25,000/mm3.
35.Clotting factors are elevated during pregnancy. What happens to them in the postpartum?Decrease to nonpregnant levels within a few days.
36.Varicosities can occur in women’s legs and vulva during pregnancy (especially in grand multigravidas). How do these change in the puerperium?Total or nearly total rapid regression is expected immediately after birth.
37.Many women get carpal tunnel syndrome during pregnancy. How does this change in the postpartum time?Disappears after birth.


  Chapter 23 Study Questions
Question Answer
1. How does breastfeeding in the fourth stage of labor prevent maternal hemorrhage?Aids in the contraction of the uterus and the prevention of maternal hemorrhage.
2. Which conditions can predispose a woman to hemorrhage? 4Precipitous labor, a large baby, grand multiparity, induced labor, or a magnesium infusion during labor.
3. For healthy women, which is the most dangerous potential complication on the fourth stage?Hemorrhage
4. Chills are really common in the 4th stage. Women shake and say they are freezing. What should be the nurse’s intervention 3 ?Warm blankets. Assurance that chills are normal and self limiting. Last only a short time.
5. Before transferring a woman from post-anesthesia recovery, she should have recovered completely from the effects. What should she be able to do demonstrate recovery 7 ?Awake Oriented to time, place, and person Normal RR O2 at least 95% Epidural Recovery: Raise legs, Extendes at knee, Off the bed Or flex her knees, feet flat on the bed, Raise her buttocks off bed.
6. The Newborn’s and Mothers’ Health Protection Act of 1996 gives minimum standards for insurance companies on how long women can stay in the hospital after delivery. What is the minimum time for vaginal and surgical deliveries? (Note that under certain conditions they can leave earlier – Box 23-2.)Minimum: 48 hoursMaximum: 96 hours
7. Note the legal tip on pg 590. Nurses are responsible for showing in their assessments that women are stable before they can be discharged. What is the charge that could be leveled at a nurse for allowing a patient to be discharged too early?Abandonment.
8. Educating women in the pp time to prevent infection is important. Wiping from front becomes hugely important in this time period, and what other consideration of this nature is also important? (In regard to the peri pad?)Remove from front to back each time voiding or defecating.
9. What is the most frequent cause of excessive bleeding after birth?Uterine Atony—Failure to contract firmly.
10. What is the time frame—in minutes—that your book gives for an example of excessive bleeding?Perineal pad is soaked within 15 minutes. Change in VS is late signs.
11. Is B/P a good indicator of impending shock in early PPH? 5It is not. Better signs are RR, pulse, skin condition, urinary output, LOC.
12. How can good fundal tone, a firm contracting uterus be maintained—which intervention should the nurse use?Massaging until firm. Also, fluids and oxytocic medications.
13. A woman is hemorrhaging severely. The nurse has several responsibilities. What should the nurse do, according to the legal tip on page 598?Must remain with mother and call for help. Leaving can lead to an abandonment charge.
14. How can a full bladder impede the uterus from contracting?Displaces uterus above the umbilicus and well to one side of midline in the abdomen.
15. What non-pharmacological interventions can a nurse offer the mother for perineal pain?Warmth. Distraction. Imagery. Therapeutic Touch. Relaxation. Interaction with the infant. Ice pack. Topical Ointments. Dry heat. Cleansing with a squeeze bottle. Shower. Tub Bath.
16.What non-pharmacological interventions can be offered for breast pain?Application of ice, heat, or cabbage leaves and wearing a well-fitted support bra.
17.Post C/S women can have a great deal of pain and may want to use the strongest pain killers they have ordered. What effect can opiods have on the intestinal system which is already compromised from the effects of childbirth?Decreased intestinal mobility
18.Which intervention is successful in preventing thromboembolism?Early ambulation
19.Within how many hours should the postpartum (pp) woman void? What amount is expected as a minimum?6-8 hours, 150ml
20.What is engorgement and when is it likely to occur?Swelling of breast tissue caused by increased blood and lymph supply to the breasts as the body produces milk, occurs about 72-96hrs after birth.
21.If a woman is not immune to rubella, how and when will the nurse vaccinate her?Subq, immediate postpartum period, they are to avoid getting pregnant for 1 month
22.The vaccine is teratogenic. What information should the nurse give the woman to prevent these effects?Mother should avoid becoming pregnant for 1 month after receiving vaccine.
23.When and how much RhoGam should be given postpartum?Within 72hrs after birth, 300mcg (1 vial) IM
24.When should women come in for their first postpartum check-up if they have had a vaginal delivery? A C/S?6 weeks, 2 weeks after C/S