Module 3/4 BBB Practice Questions Flashcards
What cardiovascular changes occur immediately PP?
There is an increase in cardiac output and stroke volume, temporary increase in size of left atrium of the heart
What is the expected shift in stroke volume and cardiac output PP?
an 80% increase
What is the expected vital sign changes in a patient immediately PP?
Decrease in heart rate and no change in mean arterial BP
How long does it take for a PP persons blood volume to stabilize and normalize?
Stabilize: 1-2 days
Normalize: 2 weeks
If a patient loosed 500 ml of blood at delivery, what is the expected drop in hgb?
1gm
If a patient loosed 250 ml of blood at delivery, what is the expected drop in hct?
1%
Describe the stages and times of lochia.
Rubra: 3-5 days bright red/brown
Serosa: 5-22 days mucous/pink
Alba: day 10-6w pp whitish
Eschar: bright red bleeding
What is involution?
Contractions cause the uterus to return to being a pelvic organ/prepregnant state
What is happening during involution in regards to pathophysiology?
- Uterine contractions (“after pains”)
- Autolysis of excess tissue (decreasing the number and size of myometrial cells)
- Placental site/endometrial regeneration
What is the rate at which the uterus shrinks per day?
1 fingerbreadth/cm per day
When would we expect to not to be able to palpate the fundus?
By 14 days PP. At this point it should be in the pelvis
If a fundus is palpable at 14+ weeks, what should we be considering as a possibility?
Subinvolution
Could be due to: Retained products, fibroids, infection (endometritis), exhaustion (not evidence-based), bleeding/clots
What can make afterpains more painful?
Breastfeeding, full bladder, anything that makes the uterus larger (multiple pregnancy, polyhydramnios, retained placenta, multiparas)
What can be done to assist with afterpains?
Empty the bladder before breastfeeding, lay in prone position with a pillow under the abdomen, NSAIDs (ibuprofen)
What education should we provide about NSAIDs?
Encourage patient to eat to avoid stomach upset, may increase bleeding
How long should we expect afterpains to last?
Just a few days, 3 days
What should we consider if a patient has afterpains past three days or has new pain? What should you do?
Retained products, infections or other problems. They need to be seen now.
What symptoms of healing with lacerations and episiotomies may a patient experience?
Itching, burning, tightness, etc.
What is the relationship between estrogen and pain?
Estrogen causes heightened pain sensitivity. Estrogen drops postpartum so patients are less sensitized to pain.
When do we given rhogam in pregnancy?
Without complications, the patient gets 300 at 28 weeks or if there is complications like bleeding, they get 50 earlier.
When do we not give rhogam postpartum?
When the mother and baby are both Rh negative
Why do we care about Rh status of mother and baby?
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.
Why do we care about the TDAP vaccine in pregnancy?
Pertussis in the vaccine will protect baby from whooping cough, and it is not made as a solo vaccine.
Do we always give TDAP postpartum?
Only if it has been more than 10 years since their last vaccine.
What can patients do to prevent hemorrhoids?
Increase activity, increase fluids, increase fiber, don’t strain, and don’t sit on the toilet for long periods, stool softeners.
What can we tell a patient that is afraid to pass a BM after a delivery with a laceration?
Tell them that they will not tear their stitches when stooling
What non-pharm treatments can be used for hemorrhoids?
Cool and/or warm sitz baths; warm and/or cold compress
What pharm treatments can be used for hemorrhoids?
Lidocaine jelly, benzocaine, hemorrhoid cream, corticosteroids, tucks pads
How much fluid does a patient void daily after delivery? How much is normal in one void?
3000 ml/day, 500 ml in one void
Why do patients sweat and void frequently after delivery?
Their body is processing all the fluid they longer need
When can we tell a patient to expect to begin diuresis and how long will it last?
can happen within 12 hours and last up to 3 weeks
What is diastasis recti?
Weakening of the abdominal muscles during pregnancy causing separation
What should we educate out patients NOT to do if they have diastasis recti?
Sit ups and crunches
What should we educate out patients TO do if they have diastasis recti?
Strengthen their core/back
What are some signs of positive bonding?
Talking about the baby, looking at baby, taking care of baby, holding the baby, looking face to face
How can we as providers help promote family boding?
Include the siblings in care, start bonding antepartum, encourage partner to ask patient what they can help with or to share the responsibilities, etc.
What are the symptoms associated with baby blues?
Emotional, decreased/increased appetitie crying, anxiety, tearfulness, can still care for self and baby
What are the symptoms associated with exhaustion/PP fatigue?
Irritable, crying, exhausted. Can be diagnosed by the patient getting good sleep. Can diagnose based on sleep pattern
What are some signs of PP depression?
Unable to care for self or baby, lasts longer than two weeks
How should we respond to PP depression?
Refer to psych, therapy, and social work
Can start medication (most often Zoloft)
When do hyperpigmentation and hair changes typically resolve PP?
6 months for skin
4-6 months of regular hair growth established. Hair loss is not normal after 6 months
What is the current recommendations with when a patient can resume sex/intimacy?
When the perineum has healed, they are ready, the bleeding has ceased, and there is a contraception plan if wanted.
When will menses resume for a non lactating patient PP?
4-6 months
What are implicit biases? Explicit?
Implicit: Unconscious attitudes or stereotypes that affect our understanding
Explicit: biases we are aware of (ex. over racism)
What is the primary difference between PP baby blues and Postpartum depression/psychosis?
Duration and severity of symptoms
What symptoms may be present with postpartum psychosis that are not present with PP baby blues or PP depression?
Visual and auditory hallucinations. Delusional beliefs. Likely to have suicidal ideation or thoughts of the infant being harmed
