EXAM 3

Question 1

Things to avoid during postpartum:

Answer 1

Postpartum hemorrhage. Number one cause of PP hemorrhage is uterine atony (boggy or soft uterus) you want uterus to be firm so you need to assess and massage the fundus

Question 2

If uterus is deviated to the right:

Answer 2

Could mean that the bladder is full, which can also cause the uterus to become soft

Question 3

A patient just delivered (postpartum) and develops hypotension, looks pale, and is sitting in a pool of blood:

Answer 3

Assess and evaluate the firmness of the uterus

Question 4

Indication of mastitis?

Answer 4

Inflammation, redness, pain in ONE side of the breast. If both breast then it just means engorgement

Question 5

Actions/teaching to take following a C-section:

Answer 5

-Give reasons to call the provider -> unrelieved pain, infection on incision site such as discharge and fever
-Continue prenatal vitamins for the iron and increase fluids

Question 6

Actions/teaching to take following a C-section:

Answer 6

Give reasons to call the provider- unrelieved pain, infection on incision site such as discharge and fever

Question 7

Patient saturated 2 pads in 30 minutes:

Answer 7

Massage the uterus

Question 8

When does breast milk come postpartum?

Answer 8

Usually 3-5 days. 3rd day is colostrum and milk follows, this is also the same time when breasts get engorged

Question 9

Boggy uterus and deviated to the right, what actions would you do?

Answer 9

Assist patient to the bathroom because it could mean the bladder is full. Then assess the fundus

Question 10

What are some reasons the patient would have uterine atony?

Answer 10

Large baby = large placenta = more bleeding in placental site = more risk for trauma such as lacerations of the cervix and vagina = hemorrhage

Question 11

3 periods of adjustment:

Answer 11

Taking in phase- most excited about birth
Taking hold-
Letting go- becoming more independent

Question 12

Why would we massage a uterus?

Answer 12

To contract it/to make it smaller and make it firm

Question 13

Endometritis signs and symptoms:

Answer 13

Infection of the uterus- fever, unrelieved pain, pelvic pain

Question 14

Complications that can occur in postpartum period:

Answer 14

Infection, DVT (especially s/p c-section are more at risk) so encourage ambulation. If DVT is suspected, elevate the legs to help with venous return and relieve pain

Question 15

Postpartum baby blues, depression, psychosis:

Answer 15

Baby blues end the first week and if it continues more than a week then seek medical help because it can indicate PP depression or psychosis. And always ask if having any thoughts of harming self or baby

Question 16

How to evaluate a patient experiencing pp complications:

Answer 16

Signs of shock- tachycardia, tachypnea, hypotension. If patient received epidural (hypotension), if receiving magnesium (respiratory depression)

Question 17

Medications for PP hemorrhage:

Answer 17

Pitocin- help contract uterus and induce labor
Methergine- avoid with HTN and preeclampsia
Cytotec-
Hemabate- avoid with hx of asthma. And always ask for PRN Imodium because s/e is diarrhea

Question 18

If uterus is firm:

Answer 18

No need to massage, just assess

Question 19

Lochia:

Answer 19

-Rubra (red), serosa(pinkish), alba (yellow)

Question 20

When assessing uterus:

Answer 20

Should be midline or above the umbilicus

Question 21

sub-involution (bad)

Answer 21

-Involution (uterus goes back to pre pregnant stage)
-Subinvolution is where uterus is not progressing the way its supposed to be d/t infection, boggy uterus. So what you wanna do is ASSESS. And then the meds to admin (oxytocin, hemabate, methergine, cytotec) don’t give terbutaline because it stops the contractions.
Assess VS, amount of vaginal bleeding, number of saturated pads, H&H, fundal height

Question 22

Ways of reducing perineal infection:

Answer 22

-Wipe front to back, hand hygiene, use a peri bottle, pat the area dry

Question 23

12 hours PP where should uterus be?

Answer 23

-At or level (midline) of the umbilicus, firm.

Question 24

If patient has gotten uterotonics, what would indicate effectiveness?

Answer 24

Firm uterus

Question 25

Things to reduce breastfeeding discomfort:

Answer 25

Apply breast milk on the nipple before feeding, feed on breast thats less sore, make sure baby sucks on areola as well not only nipple because it can cause sore nipples

Question 26

Routes for uterotonics:

Answer 26

Methergine and hemabate: IM
Pitocin and TXA: IV
Cytotec: Oral, vag, rectal