Module 6 Postpartum Flash Cards

1
Q

Discuss the hematologic changes in the PP patient:

A

Clotting factors 1,2,7,8,9,12 decrease until normalization at 8 w PP

Protein S and C (inhibit coagulation) increase until normalization at 4-8w PP

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2
Q

On what day PP is the fundus palpable above the symphysis pubis?

A

7 days

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3
Q

On what day PP is the fundus no longer palpable abdominally?

A

10-14 days (2 weeks)

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4
Q

Describe the timing and presentation of lochia rubra.

A

3-5d long

primarily blood, red or brownish red in color

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5
Q

Describe the timing and presentation of lochia serosa.

A

Mean duration is 22 days

primarily wound exudate and leukocytes with some blood
pinkish brown color

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6
Q

Describe the timing and presentation of lochia alba.

A

Thru day 33-ish

primarily leukocytes
white or yellowish-white in color

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7
Q

Describe the timing and presentation of eschar bleeding.

A

Day 7-14

Transient increase in red bleeding

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8
Q

During what time frame should rhogam be given if needed?

A

Rhogam should be administered within 72 hours. Should be given even up to 14 days after birth. Standard 300 mcg dose

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9
Q

Which vaccines can/should be given PP?

A

Offer: Flu, TDAP

For non-immune: MMR and varicella

Hep B and HPV-can complete series

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10
Q

Describe the Hep B vaccine schedule

A

3 doses given over 16 weeks. 2nd dose 4w after 1st, 3rd dose 8w after 2nd

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11
Q

Describe the age-specific HPV vaccine schedule.

A

Ages 9-14: 2 doses (6-12 months apart)-if incomplete by age 15, just one dose is needed to complete

Ages 15-45: 3 doses. 2nd dose 1-2m after first, 3rd dose 6m after 2nd.

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12
Q

What pain medications can be offered for mild PP pain?

A

APAP and Ibuprofen

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13
Q

What pain medications can be offered for moderate PP pain?

A

APAP, Ibuprofen, Norco, Vicoden, Roxi

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14
Q

What pain medications can be offered for severe PP pain?

A

Toradol

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15
Q

What type of RX meds can be given for hemorrhoids?

A

Hydrocortisone

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16
Q

What is the exercise recommendation for 18+ y/o?

A

150 minutes of moderate-intensity aerobic activity each week with
Muscle strengthening 2+ days per week

17
Q

What Dx should be considered in a patient with a fever in the first 10 days PP?

A

Endometritis, wound infection, UTIs

18
Q

What is the classic triad of symptoms for endometritis?

A

Fever, tachycardia, uterine tenderness

19
Q

What are risk factors for endometritis?

A

BV, obesity, DM, anemia, HIV, PTB, post-term pregnancy, C/S, chorio, internal monitoring, manual removal of the placenta, meconium (thick), operative vaginal, prolonged labor, PROM

20
Q

How should you respond to a patient who presents with one of the following? HYPOTENSION, TACHYPNEA, O2SAT less than 95% or Shortness of Air

A

*** CONSULTATION should be obtained rapidly for any woman who has signs or symptoms that indicate she is at risk for severe morbidity

21
Q

When should endometrial or blood cultures be obtained?

A

Endometrial cultures ARE NOT obtained

Blood cultures are not obtained unless the patient is acutely ill because most women respond well to empiric treatment

22
Q

What is the gold standard of treatment for endometritis?

A

IV Clindamycin (Cleocin) 900 mg IV and gentamicin (Garamycin) 1.5 mg/kg q 8 hours
OR ( DOXYCYCLINE & METRONIDAZOLE)

Treatment should be continued until 24-28 hours afebrile. Mild endometritis may be offered PO ABX

23
Q

At what point after initiating treatment for endometritis should you consult/refer?

A

If she remains febrile after 24-48hrs

24
Q

How does a UTI/pyelo present PP?

A

urinary frequency, urgency, dysuria, or lower abdominal pain
low-grade fever
flank pain
CVAT
nausea and vomiting
HOWEVER: PP women often DO NOT have, dysuria, frequency or urgency

25
Q

How should the APRN/CNM manage a PP hematoma?

A

PHYSICIAN CONSULT IS NECESSARY for evaluation and plan

Note: Large hematomas or those continuing to grow: indicates active bleeding. Small and moderately sized that are not growing can be managed expectantly

26
Q

How should a secondary PPH without infection be managed?

A

methylergonovine (Methergine) 0.2 mg PO q 3-4 hours x 24- 48 hours

27
Q

How should a secondary PPH WITH infection be managed?

A

broad-spectrum antibiotics: ampicillin-sulbactam or cefoxitin
if chlamydia is suspected: azithromycin 1g PO (one dose) added to the above regimine
IV or PO depending on the severity of her symptoms

28
Q

How should the APRN/CNM manage PP cardiomyopathy?

A

PROMPT referral to Physician, preferably a cardiologist

29
Q

What are the S/S of PP cardiomopathy?

A

Marked SOA
orthopnea (the sensation of breathlessness in the recumbent position, relieved by sitting or standing.) NIH.gov
tachycardia
palpitations
chest pain
cough
edema

PE:
crackles at base of lungs
pitting edema
jugular vein distention
a heart sound
laterally shifted point of max impulse with auscultation

30
Q

What is the gold standard for dx of PP cardiomyopathy?

A

Echocardiogram (echo) (definitive dx)
12 lead electrocardiogram (ECG) (can rule out other causes. 50% of people with PPCM have a normal ECG)
OR
or Markedly elevated BNP

31
Q

At what PP point does “baby blues” become a dx of PPD?

A

2 week mark is past Baby Blues and into PPD

32
Q

Which SSRI is best for a BF patient?

A

Zoloft

33
Q

Which SSRI should not be used in pregnancy?

A

Paxil

34
Q

Who should be prescribes Bupropion (Wellbutrin) cautiously?

A

Someone with a seizure disorder

35
Q

What is first line for mastitis?

A

Dicloxacillin (Dynapen) 500 mg QID for 10-14 days OR
Cephalexin (Keflex) 500 mg QID for 10-14 days

If PCN allergic:
Clindamycin 300 mg QID QID x 10-14 days
Or Erythromycin 250 mg or 500 mg QID x 10-14 days

36
Q

How can a patient be counseled that wants to lose weight PP?

A

Safely exercise 45 min a day 4 days/week
May decrease daily intake by 500 calories
Safe weight loss of 1 lb per week
Recommended maximum weight loss after the 1st mo PP is 4.5 lbs/ month