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OB NUR 359 > OB Lecture 2 Postpartum > Flashcards

OB Lecture 2 Postpartum Flashcards

1
Q

Gravida

A

Number of times pregnant regardless of duration or outcome

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2
Q

Para

A

Number of pregnancies completed past 20 weeks (Must have been delivered)

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3
Q

Abortion

A

Any loss of pregnancy before 20 weeks or weight less than 500gms.

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4
Q

Spontaneous vs Induced abortions

A

Spontaneous = miscarriage

Induced = Planned

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5
Q

Term birth

A

Birth occurring between 38 and 42nd weeks

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6
Q

Preterm birth

A

Birth after the 20th week but before the 38th week

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7
Q

Postterm birth

A

Birth after the 42nd week

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8
Q

Trimester

A

Division of pregnancy into 3 equal parts of 13 weeks each

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9
Q

4 digit PARA (TPAL)

A

T: All births complete after 37wks

P: All births at preterms (20-37weeks)

A: Abortions either SAB or TAB (Before 20 weeks)

L: Current living children

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10
Q

Multipara

A

Women who gave birth more than 2 times over 20 weeks

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11
Q

Multigravida

A

Women who has been pregnant more than once regardless of outcome

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12
Q

Nullipara

A

A woman never completed pregnancy past 20 weeks

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13
Q

Nulligravida

A

Women who have never been pregnant

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14
Q

Primipara

A

Women who gave birth for first time of pregnancy that lasted 20 weeks

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15
Q

Primigravida

A

Woman who is pregnant for the first time

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16
Q

Postpartum coagulation for women?

A

Increased clotting factors expected. Clotting where placenta was.

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17
Q

Cardiac output for pulse and BP?

A

Low pulse and high BP

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18
Q

How may fluid be excreted and whats expected?

A

Increased urination
Diaphoresis
Expect wet bed sheets and frequent urination

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19
Q

What to expect during first void postpartum?

A

Expect patient to be dizzy, do not leave her first void - risk for falls

First few voids must be measured

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20
Q

What is normal WBC count for women postpartum?

A

25-30

Normal is usually 5-10

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21
Q

How much blood is lost during vaginal and c-section deliveries.

A

200-300 vaginal

700-1000 C-Section

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22
Q

When will RBC return to normal postpartum?
Hgb/Hct?

A

Within 2-3weeks

Hgb - 12-16

Hct 37-47%

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23
Q

Inspection of breast should consist of what?

A

Bra, Shape, contour, general symmetry, and nipples

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24
Q

What to look for in temperature of breasts?

A

Red and Hot can indicate mastitis so pay attention to temperature and color

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25
Q

Where to palpate the breast for milk?

A

The upper outer quadrant to feel for firmness indicating milk production

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26
Q

What begin milk production in the breasts?

What is it called before its breast milk?

A

Placental delivery

Colostrum

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27
Q

When teaching new mothers how long to breast feed what do we tell them?

A

Breast feed or pump every 2-3 hours no matter for how long but at least for 10-15minutes on each side.

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28
Q

What is the 8 day rule?

A

8th day of life:
8 feedings a day
8 wet diapers
8oz of gained weight
8 glasses of water for mom

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29
Q

How long for breast milk to start producing postpartum?

A

2-3 days after placental delivery

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30
Q

When does colostrum begin to develop during pregnancy?

A

Around 13 weeks

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31
Q

If baby is premature what happens to breast milk?

A

It increases in calorie count and protein

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32
Q

Nutritional essentials for a breast feeding mother?

A

2800 calories
Increase in fluid (8glasses a day)
Calcium intake

33
Q

How to position baby during breastfeed?

A

Parallel to moms breast
Tickle the lower lip
Place babys entire mouth over the areola

34
Q

How often to feed baby?

A

Every 2 to 3 hours
Baby may sleep longer is fed more frequently

IF BABY IS SLEEPING MORE THAN 3 HOURS WAKE THE BABY UP

35
Q

Advantage of breast feeding?

A

Bonding
Immunity - up to 6 mos
Natural feeding
Less ear infections & illnesses for baby
FREE

36
Q

Why does nipple crackling occur?

A

Tongue is on areola it should be under it to help milk the nipple

37
Q

LATCH
L stands for?

A

Latching can be separated

Is baby?:

Too sleepy or reluctant to latch

Repeated attempts
Hold nipple to mouth
Simulate to suck

Grasps breast
Tongue down
Lips flanged
Rhythmic sucking

38
Q

LATCH
A stands for?

A

Audible swallowing

None

A few with stimulation

Spontaneous or intermittent <24 hours old
Spontaneous & frequent >24 hours old

39
Q

LATCH

T stands for?

A

Type of nipple

Inverted

Flat

Everted (after stimulation)

40
Q

LATCH
C is for?

A

Comfort (Breast/Nipple)

Is it:

Engorged
Cracked, bleeding, blisters, bruising.

Filling
Redness, small blisters or bruising

Soft and tender

41
Q

LATCH
H is for?

A

Hold (Positioning)

Full assist (staff holds baby or breast)

Minimal assistance
staff teaches and mom takes over

No assistance from the staff
Mother able to position and hold infant.

42
Q

Three types of Lochia?

A

Rubra - Bright red 2-3 days
Serosa - Pink to brown 4-10 days
Alba - White to yellow up to 6 weeks

43
Q

Amount of lochia?

A

Scant
Light
Moderate
Heavy - changes pad every hour, think of hemorrhaging

44
Q

Texture of lochia?

A

Is it easily able to seperate or not? If yes it is a clot if no it is placenta and needs to be checked ASAP

45
Q

Assessment of legs postpartum?

A

Homans sign - No pain = normal
Peripheral edema - normal
Variscosities

46
Q

Uterus involution What is occuring?

A

Uterine contractions to help shed the endometrium, heal the placenta location, and allow it to be smooth with no scars for the next pregnancy

47
Q

What are afterpains? How to relieve the pain?

A

Intermitted uterine contractions that are uncomfortable

Place in prone position with pillow on abdomen, helps center uterus

48
Q

How long for involution period to last?

49
Q

Assessing the fundal height, and position?

A

Fundus should be below umbilicus and go down 1cm a day

Should be midline, if left or right = full bladder

50
Q

Assessment of bowels postpartum?

A

Hypoactive bowel sounds is normal
She can eat whatever she wants

First stool is 2-3 days after
May need laxative or stool softener

51
Q

How long until fundus is no longer palpable?

A

No longer palpable after 14 days

52
Q

Assessing bladder postpartum?

A

Woman must empty bladder within 6-8 hours if she cant she needs foley.

53
Q

Risks of distended bladder?

A

Risk of uti r/t urinary retention

Risk of hemorrhaging as it interferes with contractions

54
Q

What to look for in distended bladder?

A

Fundus location
Excessive lochia
Discomfort in the bladder region
Symphysis bulge
Frequent voids less than 150mL

55
Q

Pericare - sitz bath and peribottle recommendations?

A

Sitz - 4x daily for 20 min

Peribottle - Warm water and use front to back after using the restroom

56
Q

Emotional status - Dependent -Taking in

A

First 24 hours last 1-2 days

Reviews experience
Basic needs and self-care
Excited to talk

57
Q

Emotional status - Dependent/Independent - Taking hold

A

Starts 2nd to 3rd day and last up to 10 days or several weeks

Takes charge
Baby blues
Engaged to learn and be competent mother
Physical discomfort and emotional changes

58
Q

Emotional status - Interdependent - Letting go

A

Sees baby as a separate person

Moves forward with family as a unit

59
Q

Bonding

A

Unidirectional bond from parent to baby

60
Q

Attachment

A

Baby becomes attached to parents
Begins during pregnancy and lasts for months after

61
Q

Postpartum musculoskeletal system?

A

Muscles and joints are fatigued and achy for 1-2 days

Risk of diastasis recti adominis

62
Q

How to reduce musculoskeletal discomfort

A

Exercises to strengthen the abs

Good posture

Body mechanics - When picking up and placing baby down using the abdominal muscle for support

63
Q

How long before returning to exercises postpartum?

64
Q

How does breastfeeding affect menses and ovulation?

A

Ovulation and menses may be delayed

Ovulation can happen before their first menses

65
Q

Breastfeeding mothers are more likely to experience what symptoms?

A

Vaginal dryness due to low estrogen

66
Q

How long after should they be using protection?

A

Up to 6 weeks

67
Q

Parental role of attainment? Anticipatory

A

Anticipating the perfect parenting

68
Q

Parental role of attainment. Formal

A

Reality hits, proper way of doing things with parents

69
Q

Parental role of attainment. Informal

A

Change how you do things and do them the way you decide (Ex: 3. point turn)

70
Q

Parental role of attainment. Personal

A

Doing it my way. May follow the rules but to my own way

71
Q

Bleeding medications postpartum?

A

Oxytocin

Methergine - methylergonovine - If still issue with hemorrhaging after pitocin

Prostaglandin F

72
Q

Side effects and contraindications to postpartum bleeding medications

A

Oxytocin - Watch for fluid overload & hypertension

Methergine - Used if pitocin doesn’t work. Do not give in hypertensive patients

Prostaglandin F - Do not give to asthmatics

73
Q

Rubella vaccine eductation

A

Tite 1:10, do NOT get pregnant for 3 months after vaccine

Depo Provera shot may be given to avoid pregnancy

74
Q

Pain medications postpartum

A

NSAIDs

Oxycodone/Acetominophen (Percocet)

PCA - Morphine for C - section

75
Q

Laxative for postpartum use?

A

Docusate (Senna) -Causes diarrhea

76
Q

When is RhoGAM given?

A

Rh (-) mom
Rh (+) Baby

Do not give if both baby and mom are negative
Do not give rubella vaccine for 3 months

77
Q

What to palpate for in breasts postpartum?

A

Thickness-engorgement
Temperate - mastitis
Tenderness

78
Q

What are risk factors foor postpartum hemorrhage?

A
  1. Grand multiparity
  2. Overdistended uterus -(Twins/triplets/hydramnios)
  3. Rapid, precipitous or prolonged labor
  4. Retained placenta
  5. Placenta previa or abruptio placenta
  6. Meds (tocolytics, oxytocin)
  7. Operate procedures
  8. Coag defect

OB NUR 359 (4 decks)

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