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OB > OB Exam 2 Pt 1 > Flashcards

OB Exam 2 Pt 1 Flashcards

1
Q

Psychology (see the section regarding the psychologic perspective) places responsible for all behavior upon whom?

A

Upon the individual. Pg 97 ch 5

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2
Q

Which races and cultures are exempt from abuse?

A

None. All races and ethnicities are at risk. Pg 101 ch 5

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3
Q

What impact does intimate partner violence have on pregnancy?

A

It has negative effects for both mother and fetus: depression, suicide,low-weight gain, infections and substance abuse in the mother. These also affect the fetus and trauma to the mother may cause trauma to the fetus including low-birth weight, preterm birth, fetal demise, premature separation of the placenta and hemorrhage. Pg. 103 ch 5

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4
Q

Which women should nurses assess for potential abuse?

A

All women. Pg. 104 ch 5

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5
Q

Before taking evidence, including photographs, of a rape victim, what legal process must be followed first?

A

Consent must be obtained. Pg 113 ch 5

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6
Q

What is attachment?

A

The process by which parents come to love and accept a child and a child comes to love and accept a parent. Pg 507. ch 22

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7
Q

The prenatal behaviors listed on pg. 508 (Table 22-2) are things the nurse may look for to assess bonding. The first one is easy to note. Which is it?

A

Looks, gazes; takes in physical characteristics of infant; assumes en face position. Eye contact. ch 22

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8
Q

On pg. 512, the textbook states that rather than a crisis, parenthood is ______________.

A

A developmental transition. ch 22

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9
Q

What percentage of women experience PP blues?

A

50 – 80% ch 22

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10
Q

How many days into the PP period do the PP blues peak?

A

5th – 10th day PP ch 22

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11
Q

List several signs or symptoms of PP blues.

A

Emotional liability, crying, depression, let-down feeling, restlessness, fatigue, insomnia, headache, anxiety, sadness and anger. ch 22

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12
Q

What are the traits of an adolescent that may interfere with ability to parent effectively?

A

Egocentricity and concrete thinking. Pg. 519. ch 22

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13
Q

What is involution and when does it begin?

A

Return of the uterus to its non-pregnant state after birth after expulsion of the placenta with contraction of the uterine muscle. It begins immediately after the placenta is born. Pg. 478. ch 20

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14
Q

How does breastfeeding in the fourth stage of labor prevent maternal hemorrhage? (See my notes in the study guide).

A

By aiding the contraction of the uterus through oxytocin release. (From my notes.) ch 20

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15
Q

Where is the fundus (the top part of the uterus) after the third stage of labor?

A

Midline, 2 cm below the umbilicus, the fundus resting on the sacral promontory. ch 20

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16
Q

12 hours after birth, where is the fundus in relation to the abdominal wall?

A

At the level of the umbilicus ch 20

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17
Q

How much does the fundus descend each postpartum day?

A

1 – 2 cm each day ch 20

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18
Q

By what time should the uterus be unpalpable through the abdominal wall (because it has descended below the symphysis pubis)?

A

The book says 2 weeks, (pg. 478), but the illustration on pg. 479 shows it is below the symphysis at 10 days. ch 20

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19
Q

How does the size of the uterus change with each pregnancy?

A

There is a slight increase in uterine size after each pregnancy. Pg. 478 ch 20

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20
Q

What is subinvolution of the uterus?

A

Failure of the uterus to return to non-pregnancy state. ch 20

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21
Q

What are the most common causes of subinvolution?

A

Retained placental fragments and infection. Pg. 478. ch 20

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22
Q

How is postpartum hemostasis achieved?

A

Primarily by compression of intramyometrial blood vessels as the uterus contracts. Pg. 478. ch 20

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23
Q

After expulsion of the placenta, which hormone is usually administered to enhance uterine contractility?

A

Pitocin (oxytocin). ch 20

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24
Q

What are afterpains?

A

Uncomfortable cramping caused by relaxation and vigorous contractions in the puerperium. Pg. 479. ch 20

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25
Q

What are the 3 varieties of lochia?

A

Rubra, serosa, alba. Pg. 479 ch 20

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26
Q

How long should each stage of the lochias last?

A

Rubra: 3 – 4 days; Serosa: 22 – 27 days; Alba: Starts 10 days PP, lasts 10 – 14 days.

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27
Q

Is there more lochia after C/S or SVD? (Cesarean or spontaneous vaginal delivery)

A

SVD. Pg. 479 ch 20

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28
Q

If lochia rubra recurs at 7 – 14 days postpartum, what is the likely site from which the bleeding is issuing?

A

The healing placental site. ch 20

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29
Q

What are signs of postpartum endometritis?

A

Continued lochia with fever, pain with abdominal tenderness. ch 20

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30
Q

What should be the odor of normal lochia?

A

Normal menstrual flow odor ch 20

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31
Q

How long should it take for an episiotomy to heal?

A

2 – 3 weeks for initial healing, 4 – 6 months for complete ch 20

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32
Q

What exercises are recommended after childbirth to help strengthen the perineal muscles?

A

Kegels. Pg. 481. ch 20

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33
Q

Which hormone in the puerperium seems to inhibit ovulation?

A

Prolactin. Pg. 481. ch 20

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34
Q

When does ovulation occur (use the mean/average times) in non-lactating vs. in lactating women?

A

70 – 75 days (non-breastfeeding) vs. 6 months (breastfeeding). (average times, then may range from 2.5 months to 6 months.) pg.481. ch 20

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35
Q

Will women ovulate before or after their first postpartum menses?

A

Some ovulate before the first menses, some after. Pg. 481. ch 20

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36
Q

Is the first menses postpartum heavier or lighter than the woman’s usual period?

A

Heavier. ch 20

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37
Q

How long does it take for the distended abdominal muscles to return to the pre-pregnancy state? (Yeah, give us what the book says—some of us think it never does!)

A

6 weeks. Pg. 481 ch 20

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38
Q

In some cases the abdominal muscles actually separate due to uterine distension. What is this called?

A

Diastasis recti abdominis ch 20

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39
Q

Why do postpartum women have elevated BUN and proteinuria?

A

Because of the breakdown, or autolysis, of protein in the involuting uterine wall. Pg 482. ch 20

40
Q

Besides losing fluids through the renal system, which other method do postpartum women use to eliminate accumulated fluid? (Meaning they will need to change clothes more often.)

A

Profuse diaphoresis. Pg. 581 ch 20

41
Q

Women often do not feel the urge to void in the immediate postpartum, even when the bladder is full. How does this affect the uterus? (Know this well—it is usually on tests.)

A

A full bladder pushes the uterus to the side and prevents it from contracting. Pg. 482. ch 20

42
Q

What are the causes of postpartal constipation?

A

Decreased tone in intestines during labor, prelabor diarrhea, lack of food during labor and dehydration, perineal tenderness causing mom to resist urge to defecate, and sometimes anal lacerations. ch 20

43
Q

What are two causes of postpartal anal incontinence?

A

Operative vaginal birth (forceps or vacuum) and anal lacerations. Pg. 482. ch 20

44
Q

The breasts begin the lactation process by secreting colostrum. When does the real milk come in?

A

72 – 96 hours. Pg. 482 (Three to 4 days! I find this more in primiparas and it seems to be much less in multis). ch 20

45
Q

Should the woman who does not plan to lactate pump her breasts or allow the baby to suckle to relieve engorgement on the 3rd or 4th postpartum day? Why?

A

No! Nipple stimulation is avoided. If sucking is never begun, lactation (esp. the associated tissue enlargement/fullness) stops within about a week. Pg. 482 ch 20

46
Q

How much blood is lost during a SVD? During a C/S?

A

300 - 500 ml – SVD; 500 - 1000 ml C/S. Pg. 483. ch 20

47
Q

The WBC count in pregnancy is about 12,000 /mm3. What happens to the WBC level during the first 10 – 12 days after birth?

A

Increases to 20,000 to 25,000/mm3. ch 20

48
Q

Clotting factors are elevated during pregnancy. What happens to them in the postpartum?

A

They stay high for some time. Pg. 483. ch 20

49
Q

Varicosities can occur in women’s legs and vulva during pregnancy (especially in grand multigravidas). How do these change in the puerperium?

A

They begin to regress immediately after childbirth. Pg. 484. ch 20

50
Q

Many women get carpal tunnel syndrome during pregnancy. How does this change in the postpartum time?

A

Postpartum diuresis relieves carpal tunnel syndrome. ch 20

51
Q

The Newborn’s and Mothers’ Health Protection Act of 1996 gives minimum standards for insurance companies on how long women can stay in the hospital after delivery. What is the minimum time for vaginal and surgical deliveries? (Note that under certain conditions they can leave earlier – Box 21-1.)

A

48 hours for vaginal births and 96 for C/S. ch 21

52
Q

Note the legal tip on in the section on criteria for discharge. Nurses are responsible for showing in their assessments that women are stable before they can be discharged. What is the charge that could be leveled at a nurse for allowing a patient to be discharged too early?

A

Abandonment. Pg 489 ch 21

53
Q

It is important, during the short time during which they are in the hospital, to educate women in ways of preventing postpartal infection. Wiping from front-to-back becomes hugely important in this time period, and what other consideration of this nature is also important? (In regard to the peri pad?)

A

Apply the peri pad from front to back each time she uses the bathroom. ch 21

54
Q

What is the most frequent cause of excessive bleeding after birth?

A

Uterine atony—failure of the uterus to contract firmly. ch 21

55
Q

What is the time frame—in minutes—that your book gives for an example of excessive bleeding?

A

Saturating a pad in 15 minutes; it also mentions doing so in an hour is also bleeding too heavily. Pg 493 also, emergency box. ch 21

56
Q

How can good fundal tone, a firm contracting uterus be maintained—which intervention should the nurse use to assist this?

A

Fundal massage, (also of course encouraging breastfeeding). Pg 494 ch 21

57
Q

A woman is hemorrhaging severely. The nurse has several responsibilities. What should the nurse do, according to the legal tip on page 489?

A

Remain with the woman and call for help. Pg 489. ch 21

58
Q

How can a full bladder impede the uterus from contracting?

A

By pushing the uterus to the side and a little up. ch 21

59
Q

What non-pharmacological interventions can a nurse offer the mother for perineal pain?

A

Use a pillow when sitting, ice packs, topical application, dry heat, cleansing with a squeeze bottle, shower, tub bath or sitz bath. Box 21-2

60
Q

What non-pharmacological interventions can be offered for breast pain?

A

Application of ice, heat, cabbage leaves and wearing a well fitted support bra. Pg. 495 ch 21

61
Q

Post C/S women can have a great deal of pain and may want to use the strongest pain killers they have ordered. What effect can opiods have on the intestinal system which is already compromised from the effects of childbirth?

A

Decreased intestinal motility. (Not mentioned in this chapter but is a common effect.) ch 21

62
Q

Which intervention is successful in preventing thromboembolism?

A

Early ambulation. Pg 496. ch 21

63
Q

Within how many hours should the postpartum (pp) woman void? What among is expected as a minimum?

A

Within 6 – 8 hours (usually 6 is the limit) and it must be 150 ml. Pg 496 ch 21

64
Q

What is engorgement and when is it likely to occur?

A

Swelling of breast tissue caused by increased blood and lymph supply to the breasts as the body produces milk, occurring at about 72 – 96 hours after birth. Pg 499. ch 21

65
Q

If a woman is not immune to rubella, how and when will the nurse vaccinate her?

A

A SQ injection in the immediate PP period. Pg. 499 ch 21

66
Q

The vaccine is teratogenic. What information should the nurse give the woman to prevent these effects?

A

She should not get pregnant for at least a month. Pg 499 ch 21

67
Q

When and how much RhoGam should be given postpartum?

A

300 mcg within 72 hours ch 21

68
Q

When should women come in for their first postpartum check-up if they have had a vaginal delivery? A C/S?

A

6 weeks, usually 2 weeks. Pg 504. ch 21

69
Q

In terms of blood loss, how has PPH traditionally been defined?

A

Loss of > 500 ml of blood with a SVD and > 1000 ml of blood with a C/S. Also, a 10% change in hematocrit. Pg. 824. ch 34

70
Q

On page 824, a comment about blood loss estimation is made. Does it state that it is over or underestimated, and how much?

A

Underestimated by 50%. ch 34

71
Q

Early PPH occurs within ____ hours of birth; late occurs after ____ and up to ___ to _____ weeks PP.

A

24, 24, 6 Pg 975 ch 34

72
Q

Excessive bleeding between separation of the placenta and its expulsion may be due to which iatrogenic causes? (Iatrogenic: meaning a condition caused inadvertently by a member of the medical staff.)

A

Undue manipulation of the fundus or excessive traction on the cord. ch 34

73
Q

Once the placenta is out, what is likely to be the cause of persistent blood loss?

A

Uterine atony or prolapse Pg 825. ch 34

74
Q

Late PPH is due to :

A

Subinvolution, endometritis or retained placental fragments ch 34

75
Q

What is uterine atony?

A

Marked hypotonia of the uterus. ch 34

76
Q

What is the leading cause of PPH, complicating 1 in 20 births?

A

Uterine atony. ch 34

77
Q

What are the signs of hemorrhage related to lacerations of the genital tract?

A

Bleeding despite a firm, contracted fundus. ch 34

78
Q

How is non-adherent retained placenta treated by the primary care provider?

A

It is manually removed, i.e., separating the placenta by pulling the edges loose with the fingers and gradually getting the entire placenta out. ch 34

79
Q

How serious is uterine inversion?

A

It is potentially life-threatening. ch 34

80
Q

List the 6 contributory factors to uterine inversion given by the book.

A

A. fundal implantation B. manual extraction of the placenta. C. short umbilical cord. D. Uterine atony. E. leimyomas. F. abnormally adherent placenta. ch 34

81
Q

What are the presenting signs of uterine inversion?

A

Hemorrhage, shock and pain in the absence of a palpable fundus abdominally. ch 34

82
Q

What is prevention in regard to uterine inversion?

A

The umbilical cord should not be pulled on strongly unless the placenta has definitely separated. Pg. 826. ch 34

83
Q

What are S/S (signs and symptoms) of subinvolution of the uterus?

A

A larger-than-normal uterus that may be boggy, also prolonged lochial discharge, excessive bleeding. ch 34

84
Q

Why can a full bladder cause bleeding in the immediate postpartum?

A

A distended bladder can displace the uterus and prevent it from contracting. (See my notes on this in the previous couple of chapters.) ch 34

85
Q

After making sure the bladder is empty and massaging the uterus, which 5 meds listed by your book be given, and by which routes?

A

Pitocin by IM or IV; Methergine, IM, po or intrauterine; prostaglandin F2 alpha IM; Dinoprostone or Cytotec by rectal or vaginal suppository. Pg. 827. ch 34

86
Q

PPH can occur at home after the woman has been discharged. What is the nurses’ most important intervention/prevention of this, engaged in before the woman is ever discharged?

A

Discharge teaching about this. ch 34

87
Q

For which conditions should the ergots (ergonovine or methylergonovine) not be given? .

A

Hypertension or cardiovascular disease. In this case, we would use only Pitocin. ch 34

88
Q

What type of shock are we most likely to see postpartum?

A

Hypovolemic or hemorrhagic. Pg.830. ch 34

89
Q

What percentage of blood may be lost before the postpartum woman demonstrates the classic signs of shock?

A

30 – 40 %. ch 34

90
Q

What are the 2 major causes of thromboembolic disease in the OB setting?

A

Venous stasis, and hypercoagulation. Pg. 832. ch 34

91
Q

Why has incidence of thromboembolic disease declined in the last 20 years?

A

Because of early ambulation. ch 34

92
Q

Physical exam is not terribly sensitive in discovering venous thromboembolism, but we still use it—it does catch some cases. Which non-invasive diagnostic method is commonly used to determine the diagnosis of a thromboembolus.?

A

Real-time and color doppler. Pg 833. ch 34

93
Q

What are S/S endometritis, the most common postpartum infection?

A

Fever, increased pulse, chills, anorexia, nausea, fatigue, lethargy, pelvic pain, uterine tenderness, foul smelling profuse lochia, increased RBC sed. Rate, leukocytosis, anemia. Pg 834. ch 34

94
Q

UTI occurs in ____% to ____% of postpartum women?

A

2 – 4 %. Pg 987. ch 34

95
Q

Mastitis usually will not manifest before discharge so the nurse must teach the patient how to recognize it and what to do about it. List the most common signs of it.

A

Chills, fever, malaise local tenderness,pain swelling redness, swelling of lymph nodes in the axilla. Pg 834. ch 34

96
Q

What is typical treatment of mastitis?

A

Heat or cold, adequate support, hydration analgesics and antibiotics. Pg. 835. ch 34

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