OB exam 3 Flashcards
What is it called when the uterus returns to its normal size?
uterine involution
Where should the fundus be on the day of birth
at the level of the umbilicus
How fast does the uterus go back down
1 cm every 24 hours
if the client is 3 days pp, where would the fundus be palpable
3 cm below umbilicus
When the uterus fails to return to its non pregnant state, what is this called
subinvolution
what keeps the uterus from returning to its nonpregnant state
retained placental fragments, infection
is subinvolution noticed right after birth
NO
What stops the bleedings after birth
compression of the blood vessels from uterine contraction
What hormone stimulates uterine contractions
oxytocin
What may make afterpains worse
breastfeeding
Why does breastfeeding make afterpains worse
causes a release of oxytocin, which stimulates uterine contractions more
What are the stages of lochia
1: Rubra
2: Serosa
3: Alba
what is the rubra stage of lochia? how long does it last?
heavy period, red, that lasts the first 3-4 days
small clots
what is the serosa stage of lochia? How long does it last?
pink or brownish
Old blood, serum, WBC, and debris
usually lasts 10-14 days
what is the alba stage of lochia? how long does it last?
white, mostly white blood cells that lasts up to 2 months, may be mistaken for yeast so educate (should not have a foul smell)
How to know if lochia is a normal amount?
clots the size of a dime is normal
Amounts of lochia
scant
light
moderate
heavy
what is too much lochia
more than 1 full saturated pad in an hour
What area is the most trauma located pp
the perineum
What do we do for normal perineal swelling
ice
how long does it take for an episiotomy to heal?
4-6 months
Hormones drop suddenly, what happens:
reverse of GD
type 1 DM require less insulin
low estrogen = diuresis
menopause symptoms
non lactating women can ovulate as soon as 4 weeks postpartum
they can get pregnant
What happens to the bladder after pregnancy
decreased sensation
Diruesis occurs within 12 hours of birth, what does this place the pt at risk for
URINARY RETENTION
Bladder distention can cause
excessive bleeding because it displaced the uterus
What is the normal expected blood loss
250-500 ml Vaginal
500-100 ml C section
(above these indicates hemorrhage)
What happens to vital signs after birth
return to normal but may have some orthostatic hypotension
What does an elevated pulse indicate postpartum
impending shock
What vital sign may we need to watch with opioid or anesthesia
respirations
what happens with temperature postpartum
elevation over 100.4 is not uncommon in the 1st 24 hours
after first 24 hours, should not be >100.4 (infection)
What changed in the blood PP
WBC count is elevated for 4-7 days
20,000-30,000
what happens to coagulation factors pp
they go back down after about 3 weeks
what does the increase in fibrogen after birth put the mom at risk for
thromboembolism
When caring for a postpartum c section, what reduces the risk for DVT?
apply SCD in bed
administer heparin if ordered
inspect the lower extremities for heat, redness, or swelling at least once per day
What do we do for suspected DVT?
do not massage the legs
d dimer and venous duplex ultrasound
don’t have the pt walking around until evaluated
What is diastasis recti
gap in muscles above the umbilicus gets bigger
The immune system reboots after pregnancy, this causes…
flare ups of autoimmune disorders
What blood type is concerning from mom and baby
mom rh -
baby rh +
what do we give to mom with Rh - and baby with Rh +
rhogam within 72 hours of birth to be most effective
no woman should be discharged until:
recovered from anesthesia
hemodynamically stable
no excessive bleeding
routine pp labs
H/H
Rh blood type
rubella immunity
most common cause of excessive bleeding
uterine atony
what is the actions for boggy fundus
massage the fundus, empty the bladder, administer oxytocin
what are signs of hypovolemic shock
pad saturated less than an hour, feel funny, nausea, see stars
tachycardia at first
hypotension later
what are the interventions for hypovolemic shock
FIRST- assess and massage the uterus
call for help
uterotonic med
indwelling catheter
VS
admins oxygen, HOB down
blood products
What statement indicates kegels are done correctly
i pretend that i am trying to stop the flow of urine midstream
if we are getting a patient up to go to the bathroom what would be the most concerning
i feel dizzy
if a patient is dizzy, what do we assess first
fundus and amount of bleeding
if the fundus is boggy and right of the midline, with steady red bleeding, what actions should we do
massage the uterus
catheterize bladder
notify charge nurse
TdaP explanation post birth
Pertussis, or whooping cough, is a severe infection for a newborn, and newborns can’t be vaccinated. This vaccine will keep you from giving pertussis to your baby
Danger signs at home pp
fever chills, foul vaginal odor, abdominal pain, heavy bleeding, pp depression, no sex until healed after checkup
when should moms follow-up be
3 weeks for vaginal birth, and then at 3 months
when should baby’s follow-up be
within 48 hours of discharge
What is EBL criteria in pp hemorrhage with c section
100ml and more
what is the EBL criteria for a pp hemorrhage with a vaginal delivery
greater than 500 ml
actions for postpartum hemorrhage
palpate and massage fundus until firm
make sure clots are out
empty the bladder
administer oxytocin
replace fluids
flat or trendelenburg
What meds can be used to make the uterus contract to stop the bleeding?
oxytocin
methylergonovine
misoprostol
carboprost tromethamine
what should we monitor for with oxytocin
water intoxication
what is water intoxication a risk with oxytocin
similar to ADH
what is the mechanism of action of oxytocin
stimulates uterus to intermittently contract
what is the risk with misoprostol
can cause diarrhea and fever
what is the mechanism of misoprostol
prostaglandin that contracts the uterus
what does methylergonovine do to the uterus
causes tonic contraction, which means it clamps down and stays that way
what is the risk with methylergonovine
hypertension because it is a systemic vasoconstrictor
what is carboprost tromethamine used for
contracts the uterus and blood vessels
what are the side effects of carboprost tromethamine
causes fever, nausea, diarrhea, chills and hypertension
with what patient should carboprost methylergonovine be avoided with
patients with asthma or pre existing hypertension
what medications can cause postpartum hemorrhage
oxytocin and magnesium sulfate
why does oxytocin cause postpartum hemorrhage
receptors become desensitized if it is a long induced labor with pitocin
Pt states “I don’t know what happened, it all just came when I stood up. I am so dizzy and lightheaded.” What do you assess?
Risk factors for postpartum hemmorrhage
long or short labor
big baby
induced with pitocin
more than 5 pregnancies
over distended uterus
traumatic birth
magnesium sulfate
uterine infection
previous pregnancy with uterine atony
What are the coagulopathies that can cause postpartum hemorrhage?
idiopathic thrombocytopenia purpura
von Wiledbrans disease- hemophilia
DIC
What are signs of thromboembolic disease
unilateral leg pain, swelling, warmth
What is the biggest concern with a DVT
development of a pulmonary embolism
what are signs of a pulmonary embolism
sudden dyspnea, chest pain, tachypnea, tachycardia, syncope, cough
what do we do if we suspect a pulmonary embolism
call a code
administer oxygen and fluids
heparin administration
what are labs to confirm thromboembolic disease
PT/PTT, fibrogen, d-dimer
prevention of DVT
early ambulation, do not massage the leg
what are risk factors for dvt
c section, history of clots, obesity, c section, sedentary
What are the signs of endometritis
high fever, chill, severe uterine tenderness
if we suspect endometritis, what is our first action
palpate the uterus for tenderness- want to make sure that is where the infection is
what is the treatment for endometritis
pain management and antibiotics
What are signs of infection in the c section incision site?
swelling, purulent discharge, increased pain
What are the first signs of mastitis
flu like symptoms
What is the management of mastitis
empty the breasts, frequent feedings, pain management, warm soaks, rest, safe abx if needed
What is the first thing to evaluate with postpartum depression
safety of the mom and baby
What are baby blues compared to postpartum depression
usually self limiting, go away on their own in 10 days or so
what is the treatment for baby blue
rest, support, reassurance, understanding
what is the symptoms of postpartum depression
persistent symptoms for more than 2 weeks for up to 6 months after birth, irritability, anger, somatic syndrome, change in baseline, social withdrawal, does not go away on its own
What are the red flags for postpartum psychosis
hallucinations, delusions, thoughts to harm self or baby – need hospitalization and do not leave alone
when to initiate breastfeeding
initiate within an hour
avoid any supplemental feedings
avoid artificial nipples – wears baby out with pacifier and then don’t want to eat
how to know if baby is getting enough milk
output - # of wet diapers
if mom is having pain with breastfeeding, what is the first thing we check
check the latch – the nipple should be towards the top of the mouth
should the mom make a time limit for the baby who is breastfeeding
no, allow on one side until stop, then burp, then the other side
what is the dark milk made during pregnancy and the first few days after birth
colostrum – has great immunological properties
how often do newborns feed
ever 1-3 hours, 10-12 times per day
how many wet diapers should there be
minimum of wet diapers as days old
What 4 things should the nurse ask as they enter the birthing room
full term baby?
GBS status, meconium fluid
trauma during birth
maternal pain meds- opioids
fetal monitor status
what is needed to open the alevoli
surfactant and positive pressure
if you could only choose one item to have with known fetal distress, which would you chose and why
positive pressure ventilation bag and mask – pop those alveoli open to help take that first breath
How do you use a bulb syringe
suction the mouth and then each nose- babies nose breath so we want to clear the secretions closest to their lungs first
what are the four different types of heat loss
radiation
convection
conduction
evaporation
what is radiation heat loss and how do we prevent it
loss of heat from body to cooler solid surface in proximity, keep the baby away from the cold window
what is convection heat loss and how do we prevent it
loss of heat from the body to cooler room air, keep the temperature of the room up and avoid drafts
what is conduction heat loss and how do we prevent it
loss of body heat to touching a colder surface, skin to skin with mom, preheat radiant warmer, warm blankets
what is evaporation heat loss and how do we prevent it
loss of heat when liquid on the body evaporates, dry the baby off
How to check the heart rate when they are fresh out
listen over the left chest for 6 seconds and multiply by 10 – we want a quick HR because it is changing so rapidly
central cyanosis
not normal
acrocyanosis
normal
what should we do to prevent low blood sugar in newborn
initiate feedings during the first hour
what is physiologic jaundice
appears after the first 24 hours of life
resolves without treatment
bilirubin decreases between 4-10 days
what causes physiologic jaundice
immature liver
extra RBC
what is pathologic jaundice
appears in the first 24 hours
what causes pathologic jaundice
maternal NB blood incompatability
sepsis
trauma
liver disease
kernicterus
long term irreversible neuro changes from the neurotoxic high bilirubin levels in pathologic jaundice
