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NM 705 Postpartum and Newborn > Module 3/4 BBB Practice Questions > Flashcards

Module 3/4 BBB Practice Questions Flashcards

1
Q

What cardiovascular changes occur immediately PP?

A

There is an increase in cardiac output and stroke volume, temporary increase in size of left atrium of the heart

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2
Q

What is the expected shift in stroke volume and cardiac output PP?

A

an 80% increase

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3
Q

What is the expected vital sign changes in a patient immediately PP?

A

Decrease in heart rate and no change in mean arterial BP

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4
Q

How long does it take for a PP persons blood volume to stabilize and normalize?

A

Stabilize: 1-2 days
Normalize: 2 weeks

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5
Q

If a patient loosed 500 ml of blood at delivery, what is the expected drop in hgb?

A

1gm

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6
Q

If a patient loosed 250 ml of blood at delivery, what is the expected drop in hct?

A

1%

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7
Q

Describe the stages and times of lochia.

A

Rubra: 3-5 days bright red/brown
Serosa: 5-22 days mucous/pink
Alba: day 10-6w pp whitish
Eschar: bright red bleeding

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8
Q

What is involution?

A

Contractions cause the uterus to return to being a pelvic organ/prepregnant state

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9
Q

What is happening during involution in regards to pathophysiology?

A
  1. Uterine contractions (“after pains”)
  2. Autolysis of excess tissue (decreasing the number and size of myometrial cells)
  3. Placental site/endometrial regeneration
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10
Q

What is the rate at which the uterus shrinks per day?

A

1 fingerbreadth/cm per day

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11
Q

When would we expect to not to be able to palpate the fundus?

A

By 14 days PP. At this point it should be in the pelvis

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12
Q

If a fundus is palpable at 14+ weeks, what should we be considering as a possibility?

A

Subinvolution
Could be due to: Retained products, fibroids, infection (endometritis), exhaustion (not evidence-based), bleeding/clots

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13
Q

What can make afterpains more painful?

A

Breastfeeding, full bladder, anything that makes the uterus larger (multiple pregnancy, polyhydramnios, retained placenta, multiparas)

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14
Q

What can be done to assist with afterpains?

A

Empty the bladder before breastfeeding, lay in prone position with a pillow under the abdomen, NSAIDs (ibuprofen)

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15
Q

What education should we provide about NSAIDs?

A

Encourage patient to eat to avoid stomach upset, may increase bleeding

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16
Q

How long should we expect afterpains to last?

A

Just a few days, 3 days

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17
Q

What should we consider if a patient has afterpains past three days or has new pain? What should you do?

A

Retained products, infections or other problems. They need to be seen now.

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18
Q

What symptoms of healing with lacerations and episiotomies may a patient experience?

A

Itching, burning, tightness, etc.

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19
Q

What is the relationship between estrogen and pain?

A

Estrogen causes heightened pain sensitivity. Estrogen drops postpartum so patients are less sensitized to pain.

20
Q

When do we given rhogam in pregnancy?

A

Without complications, the patient gets 300 at 28 weeks or if there is complications like bleeding, they get 50 earlier.

21
Q

When do we not give rhogam postpartum?

A

When the mother and baby are both Rh negative

22
Q

Why do we care about Rh status of mother and baby?

A

Rh negative mothers exposed to Rh positive blood from a baby, the mother’s body builds up antibodies to that blood type. This can affect a future pregnancy. There is potential that mothers body will attack a future pregnancy if the baby is Rh positive.

23
Q

Why do we care about the TDAP vaccine in pregnancy?

A

Pertussis in the vaccine will protect baby from whooping cough, and it is not made as a solo vaccine.

24
Q

Do we always give TDAP postpartum?

A

Only if it has been more than 10 years since their last vaccine.

25
Q

What can patients do to prevent hemorrhoids?

A

Increase activity, increase fluids, increase fiber, don’t strain, and don’t sit on the toilet for long periods, stool softeners.

26
Q

What can we tell a patient that is afraid to pass a BM after a delivery with a laceration?

A

Tell them that they will not tear their stitches when stooling

27
Q

What non-pharm treatments can be used for hemorrhoids?

A

Cool and/or warm sitz baths; warm and/or cold compress

28
Q

What pharm treatments can be used for hemorrhoids?

A

Lidocaine jelly, benzocaine, hemorrhoid cream, corticosteroids, tucks pads

29
Q

How much fluid does a patient void daily after delivery? How much is normal in one void?

A

3000 ml/day, 500 ml in one void

30
Q

Why do patients sweat and void frequently after delivery?

A

Their body is processing all the fluid they longer need

31
Q

When can we tell a patient to expect to begin diuresis and how long will it last?

A

can happen within 12 hours and last up to 3 weeks

32
Q

What is diastasis recti?

A

Weakening of the abdominal muscles during pregnancy causing separation

33
Q

What should we educate out patients NOT to do if they have diastasis recti?

A

Sit ups and crunches

34
Q

What should we educate out patients TO do if they have diastasis recti?

A

Strengthen their core/back

35
Q

What are some signs of positive bonding?

A

Talking about the baby, looking at baby, taking care of baby, holding the baby, looking face to face

36
Q

How can we as providers help promote family boding?

A

Include the siblings in care, start bonding antepartum, encourage partner to ask patient what they can help with or to share the responsibilities, etc.

37
Q

What are the symptoms associated with baby blues?

A

Emotional, decreased/increased appetitie crying, anxiety, tearfulness, can still care for self and baby

38
Q

What are the symptoms associated with exhaustion/PP fatigue?

A

Irritable, crying, exhausted. Can be diagnosed by the patient getting good sleep. Can diagnose based on sleep pattern

39
Q

What are some signs of PP depression?

A

Unable to care for self or baby, lasts longer than two weeks

40
Q

How should we respond to PP depression?

A

Refer to psych, therapy, and social work

Can start medication (most often Zoloft)

41
Q

When do hyperpigmentation and hair changes typically resolve PP?

A

6 months for skin
4-6 months of regular hair growth established. Hair loss is not normal after 6 months

42
Q

What is the current recommendations with when a patient can resume sex/intimacy?

A

When the perineum has healed, they are ready, the bleeding has ceased, and there is a contraception plan if wanted.

43
Q

When will menses resume for a non lactating patient PP?

A

4-6 months

44
Q

What are implicit biases? Explicit?

A

Implicit: Unconscious attitudes or stereotypes that affect our understanding
Explicit: biases we are aware of (ex. over racism)

45
Q

What is the primary difference between PP baby blues and Postpartum depression/psychosis?

A

Duration and severity of symptoms

46
Q

What symptoms may be present with postpartum psychosis that are not present with PP baby blues or PP depression?

A

Visual and auditory hallucinations. Delusional beliefs. Likely to have suicidal ideation or thoughts of the infant being harmed

NM 705 Postpartum and Newborn (13 decks)

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