OB Class 3

Question 0

where is the fundus within 12hrs of delivery

Answer 0

it rises to about the level of the umbilicus

Question 1

where is the fundus immediately after delivery

Answer 1

midway between the symphysis pubis and umbilicus

:it is about the size of a large grapefruit

Question 2

what is the result of subinvolution

Answer 2

postpartum hemorrhage

Question 3

what are risks for increased afterpains

Answer 3

• being a multipara
• :multiple stretching of muscle fibers leads to loss of muscle tone that causes alternate contraction and relaxation of the uterus

Question 4

what increases afterpains

Answer 4

multifetal pregnancy
large infant
hydramnios
retained blood clots are present

Question 5

what are interventions for afterpains

Answer 5

help keep the uterus contracted to provide relief

:decreases rapidly after 48hrs

Question 6

lochia rubra normal characteristics

Answer 6

days 1-3
bloody, small clots, fleshy earthy odor
red or red/brown

Question 7

Lochia serosa normal characteristics

Answer 7

days 1-4
decreased amount
serosanguineous
pink or brown tinged

Question 8

how long does it take for vagina to complete involution and gain approximately the same size and contour it had before pregnancy

Answer 8

6-10weeks

Question 9

what are possible causes of postpartum dyspareunia (discomfort during sex) in lactating women

Answer 9

ovarian function and estrogen production isnt well established during lactation leading to vaginal dryness and discomfort during sex

Question 10

what normal changes in coagulation occur during the postpartum period

Answer 10

plasma fibrinogen increases

: takes 4-6 weeks before the hemostasis returns to normal prepregnant levels

Question 11

what puts women at increased risk of urinary distention and emptying issues postpartum

Answer 11

urethra, bladder, and tissue around urinary meatus become edematous

Question 12

how does the displaced uterus cause uterine atony and increased bleeding

Answer 12

the displacement results in decreased uterine muscle contraction (uterine atony) leading to excessive bleeding

Question 13

why are protein and acetone often present in the urine during the first few days postpartum

Answer 13

:acetone suggest dehydration

:mild proteinuria is the result of catabolic processes involved in uterine involution

Question 14

what changes occur to the skin and hair during the postpartum period

Answer 14

:pigmentation begins to recede
:stretch marks gradually fad to silvery lines
:hair loss begins 4-20weeks after delivery and is regrown in 4-6months

Question 15

what s/s may indicate developing or worsening preeclampsia

Answer 15

headache
proteinuria
blurred vision
photophobia
abdominal pain

Question 16

discuss menses

Answer 16

ovulation may occur before menses

frequent breastfeeding is likely to delay menses

Question 17

how much weight is lost during childbirth

Answer 17

approximately 12lbs lost during childbirth

Question 18

when should RhoGAM be administered

Answer 18

:mother is Rh (-) and baby is Rh (+)
:mother isnt sensitized
**give w/in 72hrs after childbirth

Question 19

Vitals after vaginal birth

Answer 19

BP: 140/90 and below
PR: 40-50
result of large amoung ot blood that returns to central circulation
Temp: 100.4 and below
Fundus: attached or near level of umbilicus

Question 20

Intervention with less than 12-14 RR and less than 95%O2 sat

Answer 20

notify anesthesiologist
elevate head of bed
admin oxygen
admin narcan (lasts 30min)
****narcan reduces level of pain relief

Question 21

pt teaching: how to suppress lactation

Answer 21

:manage discomfort by applying ice
:wear a well fitting bra or sports bra 24hrs a day until breast become soft
:refrain from stimulating breasts
:dont allow warm water to fall directly on breasts during showers

Question 22

criteria for discharge

Answer 22

:no complications and assessments are normal
:mother has received instructions on self care and deviations from normal to report
:mother has received instructions on postpartum activity

Question 23

newborn’s calorie intake for breast feeding

Answer 23

39-45 Kcal/lb each day

Question 24

newborn’s calorie intake for bottle fed

Answer 24

45-50 Kcal/lb each day

Question 25

amount of wet diaper r/t feedings after day 2

Answer 25

1-2 wet diapers

Question 26

amount of wet diaper r/t feedings after day 3

Answer 26

3 wet diapers

Question 27

amount of wet diaper r/t feedings after day 4

Answer 27

6 wet diapers

Question 28

after 24hrs fundus goes down… each day

Answer 28

goes down 1cm a day

Question 29

intervention for pt postpartum that is still preeclamptic

Answer 29

continue on mag sulfate 24hrs to prevent seizures and improve BP

Question 30

postpartum common findings

Answer 30

decreased fibrinogen
diuresis and diaphoresis
fatigue
cramps (lasts about 2-4days)
temp 100.4
WBC up to 30,000 (usual first 24hrs)