Exam 2 SG Material Flashcards
What should you do first if a patient has a heavily saturated pad?
Change pad, apply new pad, and reassess (don’t assume that patient is hemorrhaging)
What is the normal QBC of vaginal delivery? for C-section?
Vaginal: 500 mL or less
Delivery: 1,000 mL or less
Maternal mortality is defined as?
Death from complications of pregnancy/childbirth up to 1 year after birth
What are 3 goals for prevention of maternal mortality listed in Healthy People 2021?
- Reducing adolescent pregnancy (eg: use of birth control)
- Reducing maternal mortality rate
- Reducing infant mortality rate
What is uterine involution?
Uterus returning back to pre-pregnancy size
By what day should the uterus NOT be palpable?
Day 10 after delivery
If the uterus is shifted to one side during fundus assessment, what should the nurse do?
Encourage mom to void (shifted uterus indicates bladder distention)
What is the purpose of applying pressure to the lower uterine segment while palpating the fundus?
To prevent uterine inversion
Endometrial healing is assessed by?
Assessing lochia (color, amount, odor)
Perineum is assessed every shift using the acronym REEDA which stands for:
Redness, Edema, Ecchymosis, Discharge, Approximation of edges of episiotomy or laceration
What are the 4 degrees of laceration?
1st: vaginal mucous membranes and the perineal skin
2nd: vaginal mucous membranes, perineal skin, and the fascia of the perineal body
3rd: perineal skin, vaginal mucous membranes, rectal sphincter
4th: perineal skin and fascia, vaginal mucous membranes, rectal sphincter, and the rectal mucosa and lumen
What is a midline episiotomy?
Incision that is midline on the perineum; heal more quickly and cause less pain then a mediolateral episiotomy
What is a mediolateral episiotomy?
Incision that is made at a 45-degree angle to the perineum
Patient education for non-breastfeeding women? (3)
- Wear a supportive bra 24 hrs a day
- Ice packs to breast/cold showers
- Avoid expressing or stimulating the breast avoiding heat
What is the #1 cause of postpartum hemorrhage?
Uterine atony
Blood loss is indicated by which s/s?
High HR, Low BP
Women are at risk for orthostatic hypotension during the first postpartum week when standing from a seated or prone position. Interventions include:
- Instructing the woman to rise slowly to a standing position
- Assisting the woman when ambulating during the first 24 hrs postbirth
- Help the woman when sitting if she becomes dizzy or faint
Postpartum assessments/interventions: (2)
- Apply compression stockings to prevent DVT
- Assess for infection: temperature changes, chills, tachycardia (fever: >38 C)
What is a hematoma?
Blood pocket in the vaginal area after a vaginal delivery; very painful; changes in BP and HR
Women who are receiving oxytocin or tocolytics (eg: magnesium sulfate or terbutaline) are at risk for?
Pulmonary edema (fluid retention)
How often should the nurse assess respirations postpartum?
Every 15 mins for the first hour, every 30 mins for the second hour, every 4 hrs for the next 22 hrs, every shift after the first 24 hrs
What is the normal respiration rate and oxygen saturation for women postpartum?
12-20 bpm; 95% or higher
Rhogam injection is given at ___ weeks for MOTHERS with a blood type of ____.
28 weeks; negative blood type
What will the mother receive if the baby is delivered and has a Rh (+) blood type?
Mother gets a second dose of Rhogam before discharge (alleviates all antibodies for second or third pregnancy)
What if the baby is delivered and has a Rh(-) blood type?
Mother does not need a second dose of Rhogam
When is the only time that an Rh(-) mom will NOT need a Rhogam injection?
If the DAD is Rh (-) because Rh (-) is a recessive gene, so the baby will definitely be Rh (-)
Postpartum vaccinations include (4)
- Tdap (tetanus, diptheria, and pertussis)
- Hep B
- Varicella
- Influenza
How much is a woman expected to void postbirth?
300 cc within 2 to 4 hours after delivery
Early voiding decreases the risk of?
- cystitis
- prevents bladder distension which could lead to uterine atony and postpartum hemorrhage
Cystitis
- bladder inflammation/infection
- s/s: frequency, urgency, pain/burning on urination
- tx: antibiotic therapy, increased hydration, rest
Changes in the endocrine system are indicated in changes in hormones after delivery of the placenta; including:
estrogen, progesterone, prolactin. Which increase and decrease?
Estrogen: levels begin to rise after the first week postpartum
Progesterone: decrease
Prolactin: increases in women who are lactating; decrease for nonlactating women
Diaphoresis is expected in the first few postpartum weeks in response to decreased ____ levels. Profuse sweating assists the body in excreting the _____.
Estrogen; increased fluid accumulated during pregnancy
Pertaining to the muscular system, the nurse should assess for: (4)
- Diastasis recti abdominis: can feel the separation of the rectus muscle when assessing the fundus; normal and will diminish over time
- Decreased nerve sensation for women who received an epidural during labor with full sensation returning within a few hours postbirth
- Headache: associated with preeclampsia or spinal or epidural anesthesia
- Fatigue: common complaint during postpartum
Direutics such as collaise to avoid pushing can help prevent?
Postpartum hemorrhage
Expectation in GI system in postpartum women? (2)
- appetite increases
- weight loss
Teach lactating women who are breastfeeding to increase caloric intake by ___ to ___ calories a day
500-1,000 calories a day
Guidelines recommend that all women attend a postpartum follow up visit ____ weeks after birth
4-6 weeks
Assessment used to screen for postpartum depression
Edinburgh Postnatal Depression Scale
