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OB Exam 2 > Chapter 21 & 22 > Flashcards

Chapter 21 & 22 Flashcards

1
Q

Describe components of a systematic postpartum assessment.

A 
B - breasts
U - uterus
B - bladder
B - bowel
L - lochia
E - episiotomy
E - emotional state 
"For first assessment, you will perform a full comprehensive assessment + BUBBLEE, then for each subsequent pp assessment it is just BUBBLEE"
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2
Q

When Does discharge planning begin?

A

At time of admission

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3
Q

How long can the mother stay in hospital for recovery after delivering vaginally and C-section? (Also, how many hours is considered “early discharge”?

A

Vaginally - 48 hours / Early = 24 hours

C-Section - 72-96 hours / Early = 48 hours

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4
Q

What are the routine labs that are completed for the pp woman?

A

Hgb, Hct, Clean catch urinalysis/culture; Immunity and Rh Factor (if unknown)

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5
Q

(T/F) It is okay for an infant to be carried out of the room in a staff members arms

A

F - They are always wheeled in a bassinet

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6
Q

How do you perform a breast assessment?

A

Inspect breasts
Palpate for fullness, tenderness, lumps
Assess nipples (intact, inverted, flat, size)
Check for colostrum, milk (Dont Squeeze!)
Find out how well newborn is latching
Breast care teaching – teach correct techniques, manual expression

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7
Q

What is the difference between engorgement and mastitis? (Etiology, When does it usually occur, appearance or breasts/areolae, and how long does it last)

A

Engorgement – swelling of breast tissue brought about by an increase in blood and lymph supply to the breast as the body produces milk; Blood vessels become congested - fluid leaks into surrounding tissue causing edema
Occurs 3 – 5 days after birth when the milk ‘comes in’
Breasts – firm, tender, hot, shinny
Areolae – firm, nipples flatten
Lasts for about 24 hours
//////////////////////////////////////////////////////////////////////////////////////
Mastitis – infection in a breast, usually confined to a milk duct
Presents as influenza-like symptoms (fever, chills, body aches, headache), redness and tenderness in the affected breast
Usually occur in upper outer quadrant of breast
* Untreated engorgement can lead to mastitis

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8
Q

How To Treat Engorgement?

A

Frequent feeding (q 2-3 hours or on demand)
Manual expression of milk or pumping
Warm compress before feeding (to vasodilate) and ice packs after feeding (to vasoconstrict)
Chilled cabbage leaves
Pain medication (anti-inflammatory, Ibuprofen)

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9
Q

How long should a women be encouraged to exclusively breastfeed?

A

6 months

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10
Q

What are the causes and treatment of mastitis?

A

Causes – inadequate emptying of breasts (engorgement), cracked nipples (entry of organisms, staph, strep, E. coli)
Tx – ABX therapy, analgesic, anti-pyretic, fluids, rest

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11
Q

How do you assess the uterus and what is considered normal?

where should it be and what is the consistency

A

PALPATE: Uterine fundus – firm, midline, first 24 hrs at level of umbilicus; involutes ~1cm/day
Also, determine bladder distention level - if bladder is distended, uterus cannot contract
Tip: Palpate the uterus regardless of c-section

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12
Q

If the bladder is full, what complications may arise in regards to the uterus and how could you tell?

A

Excessive bleeding

A distended bladder will push uterus to the side.

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13
Q

Two main causes of excessive bleeding?

A

Uterine atony and bladder distention

Uterine atony often results from retained placental fragments.

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14
Q

What are some support measures to help woman stimulate voiding?

A

walk her to restroom (or assist on bed pan)
have woman listen to running water
place hands in warm water
pouring water from a bottle over perineum
sitz bath
*sterile catheter if measures were unsuccessful

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15
Q

How do you estimate blood loss?

A

Hbg,Hct

Weigh the blood (1g = 1ml)

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16
Q

If bleeding occurs in presence of contracted uterus, what could it be?

A

Could be vaginal or vulvar hematomas or unrepaired lacerations of vagina/cervix, also examine perineum.

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17
Q

What are some reliable indicators of impending hypovolemic shock?

A

Initially -> pulse (Tachycardia)
Also Assess -> Respiration (Tachypnea), skin condition, urinary output, and LOC
Tip – BP is not a reliable sign b/c it doesn’t drop until woman has lost 40% of blood volume

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18
Q

Steps to be taken when assessing bowel/bladder?

(How often should she void, how many ml should be there,

A

PALPATE: bladder for distention
Mother should void spontaneously within 6-8 hours pp. with a volume of at least 150ml is expected for each void - Encourage emptying of bladder q 2 to 3 hrs
Full bladder displaces uterus
Find out last bowel movement; request stool softener prn

19
Q

Renal Suppositories/Enemas contraindicated in which woman?

A

Renal suppositories/enemas not to be administered in women with 3rd or 4th degree perineal lacerations
Tip: With a 4th degree episiotomy, patient MUST shit at least once before discharge

20
Q

Name two interventions that can help relieve flatulence

A

Rocking in a chair and ambulation can help relieve flatulence

21
Q

Steps to take when assessing lochia and episiotomy

A
  • Assess quantity and type (rubra, serosa, alba)

- Inspect perineum (pain, edema, sutures, whether intact)

22
Q

What is the ideal time to initiate breastfeeding?

A

ideal time to initiate is within 1-2 hours after birth

23
Q

What are the immunizations to be given upon discharge? (if not immune)

A
  • Rubella vaccination: given on discharge as MMR 0.5 ml SQ
  • Varicella vaccination: given on discharge, second dose at routine pp visit (4-8wks)
  • Tetanus-Diphtheria-Acellular Pertussis (Tdap) vaccine: given upon discharge to protect women against pertussis and to decrease risk of infant’s exposure
  • Rh Isoimmunization – Rh immune globin (Rhogam) prevents the Rh negative mother whose had a Rh positive fetus from making antibodies -given within 72 hours after birth
24
Q

When is PP Depression Screening recommended?

A

Routine Postpartum Depression screening recommended during infant follow up visits at 1st, 2, and 4th months

25
Q

Asian culture effect on pp period? (likely not going to drink this type of fluid)

A

women likely not going to drink cold or iced water pp and often refuse cold packs or pads

26
Q

When discussing discharge planning, what do you inform the patient?
(When can you resume sexual activities, recommended contraceptive type, when is the f/u for women, when is the f/u for the newborn)

A
  • Self-care teaching & signs of complications
  • Sexual activity & contraception (wait 6 weeks)
  • Routine 6 week appt. with OB or midwife/ 2weeks if c-section
  • Newborn f/u within 3-5 days after birth or 48-72 hours after discharge and again at 2 wks

Tip - Oral contraceptives can interfere with milk production: condoms, spermicide, etc. non hormonal methods are best AND women who are breastfeeding often have vaginal dryness

27
Q

Definition: process by which a parent comes to love and accept a child and a child comes to love and accept a parent

A

Attachment

28
Q

Definition: emotional feelings between parent and newborn that begin during pregnancy or shortly after birth

A

Bonding

29
Q

Definition: process used by parents (both parents) to get to know or become familiar with their new infant

A

Acquaintance

an important step in attachment – use eye contact, touch, talk to become acquainted

30
Q

Definition: the infants behavior/characteristics elicit a corresponding set of parental behaviors/characteristics

A

Mutuality

31
Q

Definition: infant moves in time to the rhythms of adult speech. An essential factor in the process of maternal-infant bonding

A

Entrainment

32
Q

Definition: infant being in tune with the mother’s natural rhythms. Mother’s heartbeat can calm a crying baby

A

Biorhythmicity

33
Q

Definition: term used to describe the father’s absorption, preoccupation, and interest in the infant

A

Engrossment

34
Q

Name the phases of pp adjustment

A

Dependent, Taking-in-phase
Dependent-independent, Taking hold phase
Interdependent, Letting-go-phase

35
Q

Characteristics of Dependent, Taking In Phase

A 
First 24 hours to 48 hours
Focus: self and meeting of basic needs.
Reliance on others to meet needs for comfort, rest, closeness, and nourishment
Excited and talkative
Desire to review birth experience
36
Q

Characteristics of Dependent-Independent, Taking Hold Phase

A

Starts second or third day; lasts 10 days to weeks
Focus: care of baby and competent mothering
Desire to take charge
Still has need for nurturing and acceptance by others
Eagerness to learn and practice (period for teaching by nurses)
Handling of physical discomforts and emotional changes
Possible experience with ‘blues’

37
Q

Characteristics of Interdependent, Letting-Go Phase

A

Focus: forward movement of family as unit with interacting members
Reassertion of relationship with partner
Resumption of sexual intimacy
Resolution of individual roles

38
Q

Define PP Blues, when does it usually begin, and how long does it last?

A

Postpartum blues or baby blues – a let down feeling accompanied by irritability and anxiety
Women emotionally labile and crying with no apparent cause
Usually begins 2 to 3 days after birth and lasts for 1 to 2 weeks

39
Q

Define PPD, when does it occur, and how do you manage?

A

A mood disorder characterized by severe depression that occurs within the first 6 to 12 months postpartum
Mx - supportive care, antidepressant medication, psychotherapy

40
Q

Definition: a variant of bipolar disorder and is the most serious form of postpartum mood disorders

A

PP Psychosis

41
Q

S/S of PP Psychosis

A

auditory or visual hallucinations, paranoid or grandiose delusions, disorientation, poor judgment leading to risk for suicide or homicide

42
Q

Management of PP Psychosis

A

Mx: hospitalization to psy unit, psy eval., antidepressant and antipsychotic drug tx, psychotherapy

43
Q

4 Phases of Fatherhood

A

1st – INTENTION of becoming an emotionally involved father with deep connections to infant
2nd – CONFRONT reality, men realize that their expectations were inconsistent with the realities of life with a newborn (sadness, frustration, jealousy, etc)
3rd – Working to CREATE THE ROLE of involved father
4th – Reap REWARDS, reciprocity with infant (6wks – 2 months)

OB Exam 2 (3 decks)

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