Mod 4

Question 1

what does BUBBLEHE stand for?

Answer 1

B – Breast (soft, engorged) Nipples (inverted, soreness)
U – Uterus Fundus (position, consistency) If C-Section (incision)
B – Bowel Sounds (active, hyperactive, hypoactive) Bowel movement Passing Flatus
B – Bladder (voiding, straight cath, foley) Emptying
L – Lochia (type, amount)
E – Episiotomy/Laceration (See REEDA)
H – Homans’s Sign
E – Edema (location and amount)

Question 2

What does REEDA stand for?

Answer 2

R – Redness
E – Ecchymosis
E – Edema
D – Discharge
A – Approximation

Question 3

what should the lochia look like day 4-10?

Answer 3

serosa (brownish red or pink)

Question 4

should a temp be 100.4 after the first 24 hours?

Answer 4

No

Question 5

If a patient has an overdistended bladder what could it cause?

Answer 5

uterine atony or excessive lochia

Question 6

The patient has rubra (dark red) lochia for how many days?

Answer 6

1-3 days

Question 7

after 10 day the lochia should turn to what?

Answer 7

alba (yellowish or whitish)

Question 8

what is a positive homan’s sign?

Answer 8

pain in the ankle or calf ( possible DVT)

Question 9

where should the uterus be with in the first 24 hours?

Answer 9

midline at the umbilicus

Question 10

What is involution?

Answer 10

return of the uterus to its non-pregnant state.

Question 11

what is Subinvolution?

Answer 11

delayed return of the enlarged uterus to normal size and function

Question 12

what are S/S of Subinvolution?

Answer 12

prolonged lochia discharge
irregular or excessive bleeding
hemorrhage

Question 13

what cause Subinvolution?

Answer 13

retained central fragments and pelvic infection

Question 14

what causes involution?

Answer 14

After birth, the decrease in these hormones causes autolysis – the self-destruction of excess hypertrophies tissue.

Question 15

What hormone are responsible for the growth of the uterus during pregnancy?

Answer 15

estrogen and progesterone

Question 16

How do we measure the fundus?

Answer 16

It is measured in centimeters

Question 17

where should the uterus be on the 6th post partum day?

Answer 17

half way between the umbilicus and the symphysis pubis.

Question 18

At the end of the third stage of labor, the uterus is where?

Answer 18

in the midline, approximately 2cm below the level of the umbilicus.

Question 19

where is the uterus 12 hours postpartum?

Answer 19

Within 12 hours it can rise to approximately 1cm above the umbilicus.

Question 20

By 24 hours after birth, the uterus is located where?

Answer 20

By 24 hours after birth, the uterus is the same size as it was at 20 weeks gestation.

Question 21

each 24 hours the uterus will descend by how much?

Answer 21

during the next few days descends 1-2cm every 24 hours

Question 22

when should the uterus no longer be palpable?

Answer 22

after 2 weeks and by 6 weeks, it should have returned to its new pre-pregnant size.

Question 23

What are contractions?

Answer 23

Tightening of the uterine smooth muscle

Question 24

How do they prevent postpartum bleeding?

Answer 24

Contraction of the smooth uterine muscle causes compression of intramyometrial blood vessels rather than by platelet aggregation and clot formation.

Question 25

What are afterpains?

Answer 25

contractions you have after you deliver the baby. It’s the uterus’ way of trying to keep the tone and it keeps you from bleeding and it helps that involution process. The problem is, this can be painful.

Question 26

What are the indications that a mom will likely experience more severe afterpains?

Answer 26

1st time mom’s (mild)
overdistended 
macrosomic babies
polyhydramios
multigestational

Question 27

How is involution of the uterus determined through physical assessment? Describe the process of ‘checking the fundus’

Answer 27

We check the firmness of the fundus and its location. This is done in relation to the umbilicus. While checking the fundus we have to support it at the symphysis pubis pole which you can feel between your thumb and finger. You have to support it while you are massaging the fundus if it is needed. We don’t massage unless the fundus is boggy. But if we do, you have to support that pole or you can invert the uterus, and this is considered a medical emergency.

Question 28

What is colostrum?

Answer 28

Early milk that is a clear yellow fluid.

Question 29

What are the benefits of colostrum?

Answer 29

It provides the newborn with passive immunities from the mom.

Question 30

When does the mature milk ‘come in?

Answer 30

72-96 hours after birth

Question 31

when would engorgement occur?

Answer 31

3rd or 4th postpartum day of a non-breast feeding mother.

Question 32

How can engorgement be treated?

Answer 32

by waiting 24-36 hours and wearing a breast binder, supportive, well-fitting bra, ice packs, fresh cabbage leaves, and mild analgesics.

Question 33

to avoid engorgement what should be avoided?

Answer 33

nipple stimulation, hot showers that will allow mild to be expressed, or suckling of the nipple.

Question 34

What is the criteria for discharge?

Answer 34

Both mom and baby will be stable. Mom has to be confident that she can provide care for her infant and herself, there has to be adequate support systems in place and access to follow up care.

Question 35

What is the legislation regarding hospital stays?

Answer 35

In 1996 legislation was passed called the newborn and mothers protection act. This allowed for an uncomplicated vaginal delivery to remain hospitalized up to 48 hours and a c-section to stay for up to 96 hours.

Question 36

Should you relay on BP to determine hemorrhage?

Answer 36

NO,it will not tell us quickly enough if they are hemorrhaging. It will allow them to lose up to 40% of their blood volume before it will change.

Question 37

how far away can a baby see?

Answer 37

8- 12 inches

Question 38

What are postpartum blues?

Answer 38

postpartum blues is going to happen around the 5th day and by the 10th day it will subside. There is restlessness, fatigue, crying, emotional, but mom is still able to completely function on her own and take care of her baby.

Question 39

what is postpartum depression?

Answer 39

Postpartum depression however is a very serious condition and it can be with our without psychosis. This occurs within 4 weeks of child birth, but it can last for up to 1 year. with a true postpartum depression these woman cannot care for herself or her child. They will have homicidal or suicidal thoughts

Question 40

how often does postpartum hemorrhage occur?

Answer 40

it occurs in about 3% of births and half of these are preventable with nursing interventions, but it is among the leading causes of death in the US.

Question 41

how are most pathogens that cause diarrhea spread?

Answer 41

fecal-oral route

Question 42

The most serious and immediate physiologic disturbance associated with severe diarrheal disease are?

Answer 42

• Dehydration
• Acid-base imbalance with acidosis
• Shock that occurs when dehydration progresses to the point that the circulatory status is seriously impaired.

Question 43

what is the most important cause of serious gastroenteritis among children?

Answer 43

Rotavirus

Question 44

what are the major goals in the management of acute diarrhea

Answer 44

• Assessment of fluid and electrolyte imbalance
• Rehydration
• Maintenance fluid therapy
• Reintroduction of an adequate diet

Question 45

what is recommend ORT (oral rehydration therapy) as the therapy of choice?

Answer 45

Oral rehydration solutions (ORS)