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maternity > exam 3 > Flashcards

exam 3 Flashcards

1
Q

How long does the post partum period last

A

6 weeks or longer

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2
Q

other words for post partum

A

puerperium
4th trimester

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3
Q

what does skin to skin do for baby

A

encourage to breast feed (bc of rooting), maintain there blood sugar, and maintain there temperature

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4
Q

how often does assessment need to occur in post partum moms

A

every 15 mins for first hour
then every 30 mins for a hour
then every hour

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5
Q

why do we want post partum mom to empty bladder often

A

a full bladder misplaces uterus

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6
Q

what vitals may be increased after birth

A

temp- from dehydration
pulse - may be high initially and could increase if hemorrhage (hypovolemia)
BP- if too high monitor for preeclampsia

monitor low RR if on narcotics

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7
Q

labs to monitor postpartum

A

hemoglobin and hematocrit will be decreased

WBC may increase to 25-30k

coagulation factors increased- risk for DVT

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8
Q

possible causes of infection in post partum

A

Uterine infection can occur, UTI, infection at surgical site or laceration, mastitis

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9
Q

avg blood loss from vaginal delivery

A

300-500mL

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10
Q

avg blood loss for C section

A

500-1000 mL

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11
Q

Involution of fundus

A

return to non-pregnant state

fundus descends about 1cm/day
no longer palpable in week 2

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12
Q

uterine atony

A

uterus isn’t contracting

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13
Q

sub-involution

A

failure of fundus to return to pre-pregnant state.

usually due to retained placental fragments or infection

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14
Q

how does bleeding slow after birth

A

contractions compress blood vessels
oxytocin strengthens contractions
breast feeding stimulates contractions
pitocin gaven to further contract uterus

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15
Q

after birth pains and interventions

A

caused by contraction of uterus

apply warmth, analgesics, early ambulation, distraction, education

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16
Q

best non opioid analgesic for post partum

A

ibuprofen advil

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17
Q

post partum lochia

A

lochia rubra- bright/dark red blood 1-3 days after delivery

lochia serosa- pink/brown blood 3-10 days after delivery

lochia alba- white discharge 2-6 weeks after delivery

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18
Q

what else can cause vaginal bleeding besides placenta detachment

A

unrepaired lacerations

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19
Q

nonlochial bleeding

A

More common with instrument births like vacuum assisted

spirts with firm uterus
excessive bleeding continues
bright red
hematoma

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20
Q

REEDA- perineum assessment

A

Redness
Edema
Ecchymosis
Drainage
Approximation

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21
Q

treating post partum hemorrhoids and perineal lacerations

A

ice
sitz bath
analgesics
cleanse the area
OTC ointments or supplements
lie down as much as possible

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22
Q

kegel exercise benefits

A

urinary bowel incontinence
strengthening pelvic floor
easy labor and delivery
healing hemorrhoids

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23
Q

what hormones decrease with delivery

A

hCG
estrogen
progesterone
hCS
cortisol
insulinase

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24
Q

what hormones increase in post partum

A

prolactin when breast feeding

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25
Q

when do post partum moms get periods

A

depends on if breastfeeding

not breast feeding- within 12 weeks

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26
Q

when does breast milk come in

A

2-5 days after delivery

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27
Q

colostrum

A

yellow thick fluid that comes from breath prior to milk, nutritious

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28
Q

what helps with non-breastfeeding breast

A

ice (no heat!)
wear snug bra
avoid stimulation
anti-inflam meds
cabbage leaves
monitor for engorgement

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29
Q

when can post partum moms eat

A

vaginal- as tolerated

c section- after return of normal bowel sounds

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30
Q

what are some normal findings to mom that may occur after birth

A

difficulty voiding
pelvic soreness
headaches
fatigue
diastasis recti abdominis
possible hair loss
flare up of autoimmune diseases

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31
Q

when does post partum moms cardiac output return to normal

A

by 6 months, but it will start decreasing 2 weeks post partum

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32
Q

C section needs

A

asses foley
assess bowel sounds
inspect abdominal incisions for REEDA
early ambulation
avoid carbonated beverages
encourage turn, cough, deep breath every 2 hours
perform ROM exercises
SCDs

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33
Q

meds for hemorrhage treatment or prevention

A

oxytocin
methylergometrine
carboprost tromethamine
misoprostol

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34
Q

antihypertensive meds

A

nifedipine
labetalol
hydralazine

35
Q

vaccinations for post partum moms

A

MMR
varicella
Tdap
Flu

rhogam if needed

36
Q

BUBBLE post partum assessment

A

Breast
Uterus
Bowels
Bladder
Lochia
Episiostomy/laceration

37
Q

new borns and mother health promotion act of 1996

A

vaginal delivery hospital stay- at least 48 hours id needed

C section- 96 hours as needed

38
Q

Healthy outcomes of mothers transitioning to parenting

A

subjective well being
role mastery
well being of interprofessinal relationships

39
Q

acquaintance

A

mom is touching, exploring, making eye contact with baby

starts to bond

40
Q

mutuality

A

infant behaviors elicits corresponding parent behaviors
infant wants response

41
Q

what is claiming identified by

A

likeness
differences
uniqueness

42
Q

reciprocity and synchrony

A

mutually gratifying interaction among mother, infant, father

Takes a few weeks to develop. When parents learn baby’s needs by baby’s signals

43
Q

3 phases of maternal post partum adjustment

A

taking in- for 1-2 days after delivery. Mom needs food and sleep

taking hold - 2nd-3rd day. mom focuses for care of baby and is ready to take charge

letting go- focus becomes family

44
Q

post partum blues

A

Transient period of depression. This occurs first few days after delivery, mom has a little bit of sadness. Only last 3-5 days. If last longer than 2 weeks- screen for PPD

45
Q

sibling adaption to new child

A

may be come jealous, especially around age 2/3

may see regression

46
Q

concerns of adolescent mother

A

uses less verbal interaction
less responsive
interacts less positively

assess interaction, support, discharge, knowledge, maturity

47
Q

what makes adolescent pregnancy successful

A

support system
maturity

48
Q

how much blood loss is considered a hemorrhage

A

more than 500 mL vaginally or more than 1000 mL c section

49
Q

early/primary PPH

A

within first 24 hours of birth

50
Q

late/secondary PPH

A

after first 24 hours to up to 12 weeks

51
Q

PPH causes

A

uterine atony
retained placental fragments
lacerations of genital tract
hematomas
sub involution of uterus

52
Q

risk factors of uterine atony

A

high parity
multiple gestation
precipitous labor
prolonged labor- uterus is tired
fetal demise (death)
magnesium sulfate- relaxes uterus
tocolytic agents
augmented labor
c section
chorioamnionitis

Think- what led to uterus being extremely stretched

53
Q

the 4 Ts

A

what causes PPH
tone = main problem. Uterus over stretched

tissue= placenta retained

trauma = lacerations

thrombin = bleeding disorders

54
Q

When should placenta deliver on own after birth

A

30 mins

55
Q

what needs to be done if placenta doesn’t deliver on its own

A

a manual contraction needs to be done which puts at risk for PPH if there is part of placenta left over. The uterus may also get scraped. The mom is also at risk for infection if its done manual

56
Q

decidua

A

normal placenta adherenece

57
Q

accreta

A

placenta attached to myometrium wall

the most common abnormal placenta adherence

58
Q

increta

A

placenta invading into uterine wall

abnormal

59
Q

pancreta

A

placenta protrudes its self out to other organs

abnormal

60
Q

what to assess for if there is bleeding but uterus is firm

A

laceration

61
Q

what to assess for if there is no bleeding but vital sign changes

A

hematoma

62
Q

what can be done if uterus is boggy

A

empty bladder
give uterotonics then reassess

if still boggy:
o2
labs
IV fluids or blood possible
possible surgery is persists

63
Q

signs of PPH

A

excessive or bright red bleeding
boggy fundus
abnormal clots
high temp
unusual pelvic discomfort/backache
persistent bleeding
rise in level of fundus
increased pulse/decreased BP (late sign)
hematoma
decreased LOC

64
Q

PPH interventions

A

perform fundal massage and check for clots
eliminate bladder distention
assess for shock
administer fluids, blood
administer uterotonic meds
o2
labs- CBC, blood type and crossmatch, coagulation studies
assess circulatory status

65
Q

what needs to be given with blood in PPH

A

clotting factors- so mom doesnt bleed everything you have her

66
Q

What is the most objective and least invasive assessment of adequate organ perfusion and oxygenation

A

urine output

67
Q

meds for PPH

A

pitocin- helps contract
methergine- helps contract
hemabate- helps contract
misoprostol- helps contract
tranexamic acid- helps mom clot

68
Q

what is hemabate contraindicated in

A

asthma

69
Q

side effect of hemabate (carboprost)

A

awful diarrhea

70
Q

what is methergine contradicted in

A

HTN

71
Q

hypovolemic shock s/s

A

rapid, shallow respirations
irregular pulse
decreased BP (late sign)
cool, clammy, pale skin
decreased urinary output
lethargy
anxiety
decreased venous pressure

72
Q

DVT s/s

A

pain
redness
warmth
enlarged vein
possible low grade temp

73
Q

DVT prevention

A

EARLY AMBULATION

74
Q

Pulm embolusm s/s

A

Dyspnea, chest pain, tachycardia, nervousness

75
Q

thromboembolic interventions

A

heat
elevation
bedrest
analgesics- NSAID
compression stockings
anticoagulant therapy
monitor for PE

76
Q

Endometritits

A

infection in lining of uterus

77
Q

puerperal sepsis

A

any infection of the genital canal within 28 days after miscarriage, abortion or birth

78
Q

post partum infections

A

wound infections
UTI
mastitis- feels like flu
puerperal sepsis

79
Q

post partum depression s/s

A

usually occurs in first 2 weeks and can last up to a year

Loss of appetite
Insomnia
Intense irritability and anger
Overwhelming fatigue
Loss of interest in sex
Lack of joy in life
Feelings of shame, guilt or inadequacy
Severe mood swings
Difficulty bonding with your baby
Withdrawal from family and friends
Thoughts of harming yourself or your baby

80
Q

risk factors for developing PPD

A

primigravida, bipolar, family history, complications

81
Q

PPD w psychotic features

A

confusion/disorientation
hallucinations
paranoria
attempts to harm self or baby

82
Q

POST- when to call 911

A

pain in chest
obstructed breathing
seizures
thoughts of harming

83
Q

BIRTH- call your healthcare provider

A

bleeding
incision that isnt healing
red/swollen leg
temp above 100.4
headache

maternity (4 decks)

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