OB Exam 2 Study Guide 12/03/2016
Fundal Assessment
• Actions/Interventions
o Determine tone
▪ Firm=contracted
▪ Soft=boggy
Indicates
... [Show More] uterus is not contracting and places the woman at an increased risk for excessive blood loss
Massage fundus w/palm of hand in a circular motion until firm
to stimulate contraction
• Reevaluate w/in 30 mins
Give oxytocin to stimulate smooth muscle of uterus to contract
Physiological changes in PP
• Assessment & Care
o Reproductive
▪ Assess uterus for location, position, and tone of fundus
Potential complications that
may lead to postpartum hemorrhage are greatest within the first hour following delivery
▪ Measure the distance between the
fundus and umbilicus
Each finger breadth=1cm
▪ Determine position of uterus
Shifted to side may indicate distended bladder
If deviated, soft, or elevated above the umbilicus, have pt void
o Endometrium
▪ Assess lochia to monitor blood loss
Scant (<1in), light (<4in), moderate (<6in), heavy (pad saturated)
Measure clots—10g=10mL of blood loss
(Table 12-2 pg. 313)
o Vaginal/perineum
▪ Assess perineum using
REEDA
Redness, edema, ecchymosis, discharge,
approximation of edges of episiotomy or laceration
▪ Position in side lying position for better visualization
▪ Apply ice or cold sitz baths for first 24 hours; warm sitz baths after 24 hours twice a day for 20 mins
▪ Give peri-bottle w/warm water to rinse area after elimination
▪ Tighten gluteal muscle as she sits down and to relax muscles after she is seated
o Cardiovascular
▪ Assess pulse & BP—every 15 mins for the first hour
▪ Assess for orthostatic hypotension
▪ Assess for venous thrombosis
Homan’s sign
Calf tenderness, edema, and sensation of warmth
Encourage early ambulation
▪ Assess for postpartum chills and give warm blanket
o Breast
▪ Breastfeeding:
Inspect for signs of engorgement:hard, swollen, red, tender/painful, warm to touch, throbbing sensation, increased temperature
Assess nipples for nipple tissue breakdown: cracked, blistered,
or reddened areas
Tx: frequent feedings to empty breasts and prevent milk stasis, warm compresses and massage, supportive bra
▪ Non-breastfeeding:
Supportive bra, avoid stimulating breasts, ice packs to breasts, subsides w/in 24 hours
▪ Assess for plugged milk ducts
Frequent feedings, changing feeding position, warms compresses and massages, wear supportive bra
o Immune
▪ Common for mild temperature elevations during first 24 hrs postbirth
▪ Immunize for rubella before discharge
▪ Rh isoimmunization
First injection given at 28 weeks, second given if she is Coombs’ negative
o Endocrine
▪ Nonlactating: menses begins 7-9 weeks post-birth
Ovulation usually occurs by the fourth cycle
▪ Lactating: suppresses menses and ovulation and is dependent upon length and amount of breastfeeding
▪ Need to use some form of contraception in both situations
Contraception Method [Show Less]