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OB Exam Two > Chapter 11 and 12 > Flashcards

Chapter 11 and 12 Flashcards

1
Q

what is the timeframe for post partum

A

Immediately after birth of baby and in six weeks after birth

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2
Q

how long does the hospital stay postpartum

A

mom stays 48 hours for vaginal birth and 72 hours for C-section

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3
Q

what are some common fears postpartum

A

newborn abduction and newborn switching

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4
Q

what are some interventions you can do for fear of newborn abduction and newborn switching

A

ID bracelets right when the baby is born, it is checked every time in and out of the room, security system a sensor on the ankle umbilical clamp it locks down the unit if sensor gets too close to the door, the baby could stay in the room, the nurse badge needs to be visible and have identifier that shows that they work on the floor

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5
Q

how often do you assess postpartum

A

vaginal birth Q 15 minutes X2 hours, then queue 4hours for 8 hours then Q8 to 12 hours for C sections Q 30 minutes for four hours then Q1 hour for three hours then queue 4 to 8 hours

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6
Q

what are the ss of postpartum chills

A

uncontrollable shaking within two hours postpartum, sometimes not cold it is normal and will go away

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7
Q

what is the treatment for postpartum chills

A

warm drinks more blankets

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8
Q

what is the blood pressure do postpartum

A

decrease blood pressure can be normal or mean uterine hemorrhage

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9
Q

what are the signs of a preeclampsia headache

A

headache, blurred vision, epigastric pain, edema, photophobia, proteinuria

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10
Q

what are the signs of leaking cerebral spinal fluid headache

A

headache when sitting up and goes away when laying down

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11
Q

what is the temperature do postpartum

A

increase temp within first 24 hours as normal because exertion from delivery, dehydration from no food or water, after the first 24 hours the patient should be afebrile 100.4 or more could mean infection

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12
Q

what is the heart rate do postpartum

A

bradycardia normal and 1st 6 to 10 days

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13
Q

how do you diagnose postpartum preeclampsia with blood pressure

A

increase systolic blood pressure of 30, 15 in diastolic or 140 / 80

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14
Q

what do respirations do postpartum

A

may have increased because of fear, pain, excitement, exertion, excessive blood loss

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15
Q

what are the signs of pulmonary embolism

A

sudden tachypnea, abnormal lung sounds, chest pain, anxiety, call rapid and give O2

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16
Q

what in the breasts produce milk

A

mammary glands

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17
Q

what happens to the areola in breasts during postpartum

A

darkens and enlarges with pregnancy main ducks coverage and open into the nipple

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18
Q

what does the quantity of milk depend on

A

how the baby feeds the more nursing the more milk that will be produced

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19
Q

what are the milk production cells

A

alveoli ducts that collect milk from the alveolus and transport it towards the nips

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20
Q

when does breast firming happen and what does it mean

A

milk coming in about 3 days postpartum the breast will start to fill can cause increase in temperature four to five days milk will leak

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21
Q

what are Montgomery tubercles

A

emit waxy substance that lubricates the nips it acts as an anti infective to protect the nips

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22
Q

how should you wash the nips

A

water only soap will dry them out and cause cracking

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23
Q

what are some uterus complications postpartum

A

uterine atony meaning lack of muscle tone causes boggy uterus

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24
Q

what is involution

A

process of uterus returning to pre pregnancy state results from decrease in size of myometrial cells

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25
Q

why are there contractions after delivery

A

prevent hemorrhage the contraction is sealing off for the placenta was implanted into the uterine lining

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26
Q

when should the mom void postpartum

A

6 to 8 hours of 150 MLS/hr, to avoid urinary retention or stasis by the 2nd to 5th day should be getting 3000 milliliters per day

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27
Q

what causes decreased bladder tone

A

edema from pressure of presenting part and labor, effects of progesterone on smooth muscle, mucosa hyperemia from increased blood vessel size

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28
Q

how long does it take placental implantation to heal

A

six to seven weeks postpartum via exfoliation and results in uterine scarring

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29
Q

what does the relaxin hormone do

A

slows bowel activity causing Constipation

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30
Q

when should the mom have a bowel movement postpartum

A

first two to three days postpartum

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31
Q

besides relaxing what are some other causes of Constipation

A

meds, abdominal muscles have been stretched, hemorrhoids, sore, episiotomy or laceration, dehydration, decreased gastric motility related to hormones

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32
Q

what is lochia comprised of

A

erythrocytes, epithelial cells, blood, fragments of decidua (uterine tissue), mucus or bacteria

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33
Q

when do the edges of an episiotomy become fused

A

1st 24 hours

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34
Q

what is the treatment for Constipation

A

increase fiber, ambulate, drink more water, stool softeners

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35
Q

what color is lochia ruba and when do you see it

A

one to three days bright red

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36
Q

what color is lochia serosa and when do you see it

A

4 to 10 days pinkish brownish color

37
Q

what color is lochia Alba and when do you see it

A

over 10 days white to yellow color

38
Q

what is the treatment for hemorrhoids

A

ice packs, which Hazel, laying on side, topical ointments, sit on firm surface because soft surfaces will decrease blood flow and increase pain

39
Q

what is after pain postpartum

A

intermittent uterine contractions it is worse for multi Paris, pain or worse when breastfeeding because of the release of oxytocin

40
Q

what are some interventions you can do for pain postpartum

A

sitz bath, cold first 24 hours then heat, topical creams and sprays can also use non pharmacological methods

41
Q

when should postpartum pain end

A

5 to 7 days

42
Q

what medication can you give prior to breastfeeding for pain

A

Motrin give 30 minutes before

43
Q

what should you document for postpartum pain

A

onset, location, type, duration, factors that make it better or worse

44
Q

what is hemorrhage and when do you see it

A

first one to two hours observe closely for hemorrhage it is blood loss over 1000 MLS for C-section or 500 MLS for vaginal birth

45
Q

when is late postpartum hemorrhage

A

after first 24 hours and up to 12 weeks

46
Q

what is postpartum hemorrhage caused by

A

retained placenta fragments, sub involution of uterus

47
Q

when is early postpartum hemorrhage

A

within the 1st 24 hours postpartum more likely in the first four

48
Q

What is early postpartum hemorrhage caused by

A

laceration, uterine atony, hematoma

49
Q

what are the signs of early shock

A

restlessness, increased heart rate, pallor, cold clammy hands, decrease UOP

50
Q

what is the management done for hemorrhage

A

stop the blood loss, first you want to massage the uterus, IV fluids, blood transfusion, O2, Foley Cath vital signs including fundus and lochia Q 15 minutes till stable, uterine packing, balloon tamponade, ligation of uterine arteries, hysterectomy, give oxytocin/methergine/hemabate

51
Q

what could bleeding without clots mean

A

retaining placental fragments

52
Q

what could bright red bleeding with clots mean

A

laceration

53
Q

after the dangers of hemorrhage and shock have passed what are you worried about now

A

infection especially uterine infection

54
Q

what are the risks for infection

A

the uterine cavity because it’s an open wound, placental site because it’s an open wound, surgical incision, cracks in the nips, increased pH in vaginal secretions

55
Q

how do you prevent infection postpartum

A

wash hands, keep incisions clean with Perry bottle frequent pad changing after every feed, check incisions, pat after voiding from front to back, sitz bath

56
Q

what do hemoglobin levels do postpartum

A

decrease one gram from vaginal, 2 grams for C-section normal is 12 to 16

57
Q

what does estrogen and progestrogen do postpartum

A

dramatically decrease after delivery of placenta, also signals pituitary gland to release prolactin which prepares for lactation

58
Q

what does hematocrit do postpartum

A

should return to pre pregnancy levels by four to six weeks normal is 36 to 48%

59
Q

what is a hematoma

A

localized collection of blood under the skin following injury or laceration of blood vessels without injury to outer tissue, often in vulva but can occur in vaginal wall

60
Q

what are the risks for hematoma

A

lacerations, episiotomies, operative vaginal deliveries like forceps, difficult or prolonged second stage of delivery, nulli para

61
Q

what is the treatment for hematoma

A

if three to five centimeters palliative care with ice packs for first 24 hours, pain meds and observation if over 5 centimeters then incision and drainage which will increase the risk for infection

62
Q

what are the signs of the hematoma

A

swelling, redness, warmth, pelvic pain, increased pulse, decreased BP, decrease HCT, fundal check is normal, moderate to scant lochia which is normal

63
Q

what happens with ovulation postpartum

A

menstruation usually resumes 6 to 8 weeks for non breastfeeding if they are exclusively breastfeeding they may not ovulate for three months most men straight by 12th week first cycle is anovulatory but ovulation can proceed menstruation

64
Q

what is mastitis

A

usually two to three weeks postpartum, milk stasis or infection entering cracks in the nips

65
Q

what are the signs of mastitis

A

redness, heat, tenderness, edema

66
Q

what is the treatment for mastitis

A

antibiotics, removing milk from breasts, lots of hydration, applying heat or cold for comfort

67
Q

What is the appearance postpartum

A

they still look pregnant because abdominal muscles have been stretched takes 6 to 8 weeks to get back to pre pregnancy

68
Q

What is diastasis

A

separation of abdominal muscles

69
Q

what is the teaching of exercise postpartum

A

If they exercise before and during they could probably go back to a modified workout they’re starting a new routine that could take 10 to 12 weeks

70
Q

what is rubella vaccine given postpartum

A

if not immune then it is given immediately postpartum to prevent complications for future pregnancies teach that you should not get pregnant at least one month after

71
Q

who gets RhoGAM

A

given to RH- mom who has Rh+ baby gets 128 weeks and another one 72 hours postpartum

72
Q

what is the taking in phase

A

it is early in postpartum the mom is passive with care, reliving birthing experience, focusing on food fluids and restorative sleep

73
Q

what is the taking hold phase

A

mom cares for infant, increased concern for body function, cares for herself, interested in learning to care for baby

74
Q

what is the letting go phase

A

mom lets go of previous role and sees parenting as primary role, reconciles with how birth went and how she wanted it to go

75
Q

what are postpartum Blues

A

normal to feel a little down but overall happy with life related to withdrawal of estrogen and progesterone and cortisol

76
Q

what is the treatment for postpartum Blues

A

support and reassurance

77
Q

what is postpartum depression and when does it happen

A

two to four weeks postpartum persistent mood of unhappiness, mom can’t care for herself or baby

78
Q

what are signs of postpartum depression

A

sleep issues, guilt, fatigue, helplessness, worthlessness feeling

79
Q

what is the treatment for postpartum depression

A

referred promptly for eval

80
Q

what are the signs of postpartum psychosis

A

delusions, hallucinations, agitation, inability to sleep, irrational behavior

81
Q

what assessment is done for postpartum psychosis

A

Edinburg assessment

82
Q

how often should a mom pee postpartum

A

Q4 hours need to change Perry pad every time

83
Q

what are the signs of a UTI

A

painful urination, foul odor to urine, lower abdominal pain

84
Q

how often should you use a Peribottle or sitz bath

A

three times a day should be used until bleeding stopped or perineal discomfort relieved

85
Q

what should you teach a mom who had a vaginal delivery when to call the doctor

A

temp 100.4 or more, flu like symptoms, assess for bleeding like soaking a pad in an hour or more bright red bleeding, large clots, foul smelling discharge

86
Q

what should you teach the mom to avoid postpartum

A

tampons, douches, sex or anything up the vagina for six weeks

87
Q

what is the teaching involved for C sections postpartum

A

pat incision dry, steri strips will eventually fall off, call the doctor of signs of infection including temp, drainage, swelling, watch for dehiscence

88
Q

what should you encourage postpartum for nutrition

A

well balanced diet including healthy low fat diet with protein carbs fruit and veggies

89
Q

when is follow up postpartum

A

two weeks and six weeks for C-section six weeks for vaginal

OB Exam Two (8 decks)

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