Midterm test Flashcards
Gravida
Number of pregnancies
Para
Number of deliveries
Postpartum assessment: B- U- B- B- L- E- H- E- B-
B- Breasts U- Uterus B- Bladder B- Bowels L- Lochia E- Episiotomy or incisions H- Homans/leg exam E- Emotions B- Bonding
Retrogressive
Back to pre-pregnancy stage
Postpartum period
The first 6 weeks after birth
Involution
The reduction in size of the uterus after birth, and it’s return to the pre-pregnant state.
After birth the uterus descends how much per day?
1-2 cm per day
Cannot palpate abdominally after 9th day.
Uterine contractions after birth?
Strong for 1-2 hours- compress blood vessels and control bleeding, oxytocin released from pituitary to strengthen & coordinate contractions
Placental site after birth?
Vasoconstriction begins immediately
Regeneration by exfoliation of placental site in 6 weeks.
Endometrial regeneration by 3rd week.
Lochia-Uterine discharge after birth?
Consists of blood and tissue.
Rubra (red), fleshy odor - first 3-4 days.
Serosa (pinkish or brown)- 3-19 days.
Alba (yellow to white)- 10 days/2-6 weeks.
What do you need to chart about the amount of Lochia?
Scant: less than 2 in stain within 1 hr.
Small: 2-4 in within 1 hr.
Moderate: 4-6 in within 1 hr.
Heavy: 6 in or more within 1 hr.
Uterine atony
Inability of the uterus to contract.
- Bleeding dark red with clots, uterus is soft and boggy.
Retaining placenta
Bleeding dark red with clots, uterus is soft and boggy.
Lacerations of cervix or vagina
Bleeding is bright red, uterus is firm and contracted.
Risk factors for uterine atony?
-Uterine overdistension (large baby, multiple gestation).
-Bladder distention.
-Prolonged first and/or second stage labor.
-Precipitous labor.
-Labor induction and augmentation.
-Tocolytic therapy (esp mag sulfate).
-High parity.
Prolonged third stage of labor.
Diastasis Recti
Abdominal muscles may be separated. Can improve with exercise.
After birth estrogen and progesterone?
Decrease and triggers diuresis.
At birth placental hormones?
Rapidly decrease: hcg, estrogen, progesterone, and human placental lactogen. (these are prolactin inhibiting)
Pituitary hormones: prolactin?
Increased prolactin during pregnancy and postpartum suppresses ovulation.
-FSH increases as estrogen and progesterone disappear, but the presence of high levels of prolactin inhibit the ovary from responding and making more follicles.
Prolactin is affected by the frequency and the duration of breastfeeding.
If not lactating prolactin does what?
-Prolactin nearly gone by 3 weeks postpartum.
How soon after birth will ovulation happen if breastfeeding or not breast-feeding?
- Ovulation occurs approximately 27 days postpartum if not breastfeeding.
- A lactating woman will ovulate approximately 12 weeks-18 months postpartum.
Hemorrhage
Loss of >500 mL or more of blood considered hemorrhage.
Blood volume after birth?
Most extra blood volume is eliminated within 2 weeks.
Volume is completely normalized within 6 months.
Cardiac output after delivery?
Increases 30-60% immediately after delivery…
- Increased flow back to the heart from uteroplacental unit-back to central circulation.
- Decreased pressure from the uterus on vessels.
- Mobilization of excess extracellular fluid into vascular compartment.
Temperature of mother after birth?
Up to 100.0 for 24 hrs normal.
100.4 need to be concerned with infection!!!
Respirations of mother after birth?
Decrease
Pulse rate of mother after birth?
60-100, Tachycardia may be related to hypovolemia.
Blood pressure of mother after birth?
Watch for orthostatic hypotension, fluid shifts.
Hypovolemic shock
Increased heart rate.
Decreased blood pressure.
Coagulation factors are increased during pregnancy…Why might the be a problem in the postpartum period?
Higher risk of blood clots
Hypercoagulation state
Mom is in a hypercoagulable state postpartum. Increased risk if Mom in bed over 8 hrs postpartum.
Homan’s sign
Pain in calf
Warmth, redness, tenderness, induration
Glucosuria normal or not normal after birth?
Not normal
Bowel function after delivery?
May take 2-3 days to have first postpartum bowel movement. Normal function 8-14 days.
Initial weight loss after delivery?
12 lbs
How long do the “blues” last for?
no longer than 2 weeks
Depression after birth?
If the blues last longer than 2 weeks its considered depression.
Signs and symptoms of postpartum depression?
5 or more of these symptoms that last for more than 2 weeks: Anxiety Feelings of guilt Agitation Fatigue, sleeplessness Feeling unwell Irritability Difficulty concentrating, confusion Appetite changes Loss of pleasure in normal activities Crying Sadness Depression (may not be present at first) Suicidal thoughts Less responsive to infant
Chloasma
The mask of pregnancy (usually disappears after delivery).
Linea nigra
The dark line that extends from the umbilicus to the pubic area.
Striae gravidarum
Stretch marks
Rubella vaccine
Don’t get pregnant within 28 days of immunization.
Rho (D) Immune Globulin
Given within 72 hrs of the termination of all pregnancies for Rh-maternal patients (regardless of how the pregnancy was terminated).
If Rubella & Rhogam are given at the same time, when should a Rubella titer be drawn and why?
Rhogam suppresses the immune system, so if we give rubella simultaneously, we recheck rubella titer in 3 months!!
Preclampsia Assessment
Ask about: Headache Abdominal pain Vision changes Assess blood pressure, dtr's, and clonus
Post surgical care
Monitor vitals Input and output Incision care Dressing care Pain management Limited mobility
With a C-section need to watch for?
Hypotension
Respiratory depression
Headache: leakage of CSF from site of puncture. Postural changes. May also see tinnitus and photophobia, onset within 2 days of puncture and may last for days or weeks.
Treat with hydration, analgesics, bed rest, darkened room.
