OB Exam 3 Flashcards
A patient just delivered vaginally and had an EBL of 650mL. Should you be concerned?
Yes. This indicates hemorrhage.
A post partum patient with hx of cardiovascular disease might have more challenges r/t to what change during birth?
Fluid loss
What are the main ways that women lose fluid post partum?
Blood loss, urine output, sweat.
A patient that is 1 day postpartum has recorded output of 130mL in the last hour, how should the nurse address this finding?
Keep monitoring. This is a normal finding for the first 2-3 days.
In a postpartum patient, when should BP and HR return to normal levels?
Within a few hours
What might elevated HR indicate in a postpartum patient?
Impending shock
What is difference between increased temperature in the mother during first 24 hours after giving birth vs after the first 24 hours.
Maternal fever after the first 24 hours is abnormal and should be addressed. Maternal fever in first 24 hours is usually related to the stress of giving birth.
Rubra. What and why?
Bright red discharge. Just blood
Serosa. What and why?
Pinkish/ brownish discharge. WBCs, blood, and debris
Alba. What and why?
Whiteish/yellow color. WBCs and bacteria.
The nurse knows the client understand the correct process for completing Kegel exercises when she says ….
A. I contract my thighs, buttocks, and abdomen.
B. I do 10 of these exercises everyday
C. I stand while doing these exercises
D. I pretend that I am trying to stop the flow of urine mid stream.
D
Is involution a normal finding?
Yes. Involution is the return of the uterus to non-pregnant state.
Location of fundus over time.
- At birth = at umbilicus
- Moves down 1cm every 24 hours
- Cannot be palpated by 2 weeks
- Returns to prepregnant state by 6 weeks.
A mother is breastfeeding her baby and says, “I already had this baby, why am I still cramping?”, how should the nurse respond?
Educate the mother by telling her that breastfeeding releases oxytocin, which causes contraction of uterus (cramping)
The nurse feels swelling on the newborn’s scalp that crosses suture lines. What is this called?
Caput succadaneum
What is the reason the nurse administers Vitamin K to the newborn?
Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.
A patient who is 1 month postpartum states that she has been feeling fatigued, very irritated/angry, and says she wants to just be alone and let her husband take care of her child. What condition does the nurse suspect?
Postpartum depression.
A patient is 2 weeks postpartum and states that she’s been very sad and that she’s been seeing military patrolling outside her house because they want to get her and her baby. While reviewing the chart, the nurse finds that she has significant history of bipolar disorder, what condition does the nurse suspect?
Postpartum psychosis.
A patient that is 2 days postpartum states that she is feeling upset/ emotional. She denies having feelings of wanting to harm herself or the baby. What condition does the nurse suspect?
Postpartum blues.
The nurse recognizes that these 4 meds are used to treat PPH:
- Carboprost tromethamine (Hemabate)
- Oxytocin
- Misoprostol (Cytotec)
- Methylergonovine (Methergine)
A nurse is an assessing a patient who just recently gave birth. The nurse knows the patient changed their pad 20 minutes ago, but when the nurse checks now, the pad is fully saturated. What does the nurse suspect is happening? What should the nurse do first?
-The nurse should suspect PPH.
- The nurse should check for boggy fundus, then massage fungus until it’s firm.
The nurse is caring for a patient that is suffering a PPH. The nurse has been massaging the fundus for several minutes and all medications have been administered but there is still bleeding, the fundus is still boggy, and the patient’s LOC is decreasing along w/ BP. What would be the next actions?
Bimanual fundal massage, bakri balloon.
The provider performs bimanual massage and places a bakri balloon but there are still signs of bleeding, what would the next action be?
Transfer to IR to plug uterine arteries.
All options for PPH treatment have been exhausted and the patient is still declining. What is the last resort procedure that can be done as a life-saving measure?
Hysterectomy.
A nurse is educating a new mother about how to prevent or minimize physiologic jaundice. What teaching should she include?
Adequate/ frequent feeding can help to prevent or minimize physiologic jaundice.
How can the nurse tell if a newborn is getting enough breastmilk?
Measure output. The number of wet diapers should be at least the same as the babies age in days for the first few days. Baby should be content between feedings. 6-8 diapers a day after first few days.
A nurse is caring for a newborn that is 8 hours old. On assessment the nurse notes yellowing of the skin and sclera. What is this finding called?
Pathologic jaundice
A nurse is caring for a newborn with pathologic jaundice. The nurse knows that this is usually a result of what?
Hemolysis r/t Rh or ABO incompatibility.
The nurse is talking to a new mother that is 2 days postpartum. She is concerned because she notices yellowing of her child’s skin. How does the nurse explain this finding?
This is physiologic jaundice and it is a common finding in newborns.
A mother gives birth to her baby at 35 weeks. How should this baby be classified?
Late pre-term.
What are concerns the nurse may have r/t pre-term babies?
Immaturity of organ systems, respiratory issues, LBW, hypotonia, difficulty with thermoregulation, hypoglycemia, hyperbilirubinemia, sepsis.
A mother that has been resting on the unit begins to complain of pain in her right calf. Upon assessment, the calf is swollen and red. What does the nurse suspect?
TED
A nurse recognizes that hydration, ambulation, SCDs, and enoxaparin all have what purpose in common?
Prevention of TED.
What would be a reason to hold a methylergonovine dose?
HTN
