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Nursing 132 Final Exam > OB Test # 3 Postpartum > Flashcards

OB Test # 3 Postpartum Flashcards

1
Q

What are the 4 Postpartum Cervical changes?

A

1) Spongy and formless
2) Admits two fingers
3) Shape of os is permanently changed
4) Dimple to slit appearance

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2
Q

(T/F) Edema of the vagina is one of the postpartum changes a woman should expect.

A

True

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3
Q

What are the 3 postpartum perineal changes?

A

1) Edema and bruising
2) Episiotomy and lacerated edges
3) Ecchymosis (may delay healing)
* Complete healing takes 4-6 months

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4
Q

What are the 4 postpartum musculoskeletal system changes?

A

1) Muscle fatigue and aches
2) Abdominal wall loose
3) Striae
4) Diastasis recti abdominis

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5
Q

What are the 6 Postpartum urinary tract changes?

A

1) ⬆ Bladder capacity
2) Swelling and bruising of tissues
3) ⬇ sensitivity to pressure
4) Pueperal diuresis (2-3 L after oxytocin DCd) can lead to pulmonary edema.
5) Stasis > UTI
6) Hematuria

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6
Q

What are the 6 Postpartum neurological changes?

A

1) Headaches and migraines because of fluid shifts and leakage of CSF into the extradural space
2) Women with epilepsy have a 9x ⬆ chance of having a seizure > retitration of antiepileptic drugs.
3) Multiple sclerosis
4) Guillain-Barré Syndrome
5) Myasthenia Gravis

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7
Q

What are the 3 postpartum endocrine changes?

A

1) Rapid decline in placental hormones > mood swings and hot flashes.
2) Blood sugar quickly returns to normal
3) Diabetics may go into a “honeymoon” period (less need for insulin).

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8
Q

What are the 6 postpartum changes in vital sign?

A

1) Afebrile, except for the first 24 hours
2) Transient rise in BP
3) Orthostatic hypotension
4) Reflex bradycardia
5) Late preeclampsia
6) BP may be low due to blood loss

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9
Q

What are the 5 nursing interventions to be implemented for engorged breasts?

A

1) Ice packs
2) Support bras at all times
3) No heat (vasodilation increases engorgement)
4) Tylenol
5) Feed the baby

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10
Q

What are the 4 SxS of Mastitis (breast infection)?

A

1) Warmth
2) Redness of one or both
3) Triangular flush
4) Discolored or foul smelling milk or discharge

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11
Q

Define PP Hemorrhage and explain how it is measured?

A

Postpartum Hemorrhage - Bleeding more the 500mL, can be measured by weighing the pad or chux (each gram = 1mL).

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12
Q

(T/F) Postpartum low estrogen levels are responsible for vaginal changes such as dyspareunia (vaginal pain with sex)?

A

True

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13
Q

(T/F) Nonbreastfeeding postpartum women ovulate and menstruate sooner than a postpartum woman who breast feeds.

A

True - Nonbreastfeeding women menstruate 6-10 wks postpartum and ovulate 5-11 wks postpartum, while breast feeding women menstruate and ovulate 3 months postpartum.

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14
Q

What is normal weight loss for the postpartum woman?

A

1) 10-12 lbs initial loss
2) 5 lbs loss from puerperal diuresis
* should return to prepregnant weight in about 6-8 wks

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15
Q

Describe the engorgement of the breasts from postpartum day 0-3.

A

1) PP day 0 - soft no change
2) PP day 1 - filling
3) PP day 2 - firm
4) PP day 3 - hard and tender

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16
Q

(T/F) An abscess can form as a result of mastitis.

A

True

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17
Q

What are the 5 methods used to manage Mastitis?

A

1) ⬆ Fluid intake
2) Supportive bra
3) Frequent breast feeding
4) Analgesics, antipyretics, and antibiotics
5) Local application of warmth, moist heat or ice packs

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18
Q

What is the usual level of utero involution after birth and what is the usual rate of descent?

A

Level of involution is usually at the umbilicus after birth and descent is about 1cm (1 finger) each day

19
Q

The fundus should be assessed q.15 mins for the first hour for firmness, height, and position. What should be done if it isn’t firm?

A

Massage it until firm and check for clots or full bladder. ALWAYS support the bottom of the uterus during any assessment of the the fundus.

20
Q

What’s the difference between early PPH and late PPH?

A

1) Early PPH - happens in the first 24 hrs after childbirth. The blood volume and cardiac output is increased and the normal mechanism for homeostasis after expulsion of the placenta > contraction of interlacing uterine muscles.
2) Late PPH - blood loss of 500mL or more that happens within 24 hrs to 6 wks after child birth

21
Q

What are the 8 risk factors for PPH?

A

1) Uterine Antony
2) Lacerations
3) Retained placental fragments
4) Hematomas
5) Uterine inversion or rupture
6) Problems of placental implantation
7) coagulation disorders
8) Operative birth

22
Q

What are the 6 SxS of Uterine Atony?

A

1) A fundus that is hard to find
2) Soft or boggy fundus
3) A uterus that becomes firm when massaged but loses tone when massage is stopped.
4) A fundus that is above the expected level
5) May be slow and steady or sudden and massive
6) Excessive vaginal bleeding or large clots

23
Q

What 3 nursing interventions (besides massage the fundus) can be used for Uterine atony?

A

1) Nipple stimulation - Infant to breast feed
2) Empty the bladder
3) Administer meds - Pitocin, methergine, hemabate, or misoprostol.

24
Q

What are the 2 etiologies/causes of late PPH?

A

1) Delayed involution > uterine infection

2) Retained placental fragments

25
Q

What does each letter in the BUBBLE-HIE assessment stand for?

A

1) Breast
2) Uterus
3) Bladder
4) Bowels
5) Lochia
6) Episiotomy/Laceration
7) Homan’s sign
8) Infection
9) Emotional status

26
Q

Explain the bladder assessment portion of BUBBLE-HIE.

A

The first 2 voidings should be at least 300-400mL, if less than 150 mL, catheterize the patient.

27
Q

(T/F A distended bladder can cause displacement of the uterus and heaven bleeding.

A

True

28
Q

What nursing interventions should be implemented if heavy lochia flow is noted?

A

Massage the uterus, check for clots, check bladder for distention, and give meds.

29
Q

Describe what lochia should look like for the following postpartum periods:

1) Day 0-3
2) Day 4-11
3) Day 12 to 3 wks

A

1) Day 0-3 - Rubra (red)
2) Day 4-11- Serosa (pinkish)
3) Day 12 to 3 wks - Alba (white or clear)

30
Q

Describe the following degrees of laceration as it applies to child birth:

1) 1st Degree
2) 2nd Degree
3) 3rd Degree
4) 4th Degree

A

1) 1st Degree - Small laceration f the vagina
2) 2nd Degree - Through 1 inch of the perineum
3) 3rd Degree - To rectum, but not through it
4) 4th Degree - Through rectum

31
Q

When assessing episiotomy/laceration during BUBBLE-HIE, which method do you use and what does each letter stand for.

A
  • use the REEDA Method:
    1) Redness
    2) Edema
    3) Ecchymosis
    4) Discharge
    5) Approximation
32
Q

How is an episiotomy/laceration cared for?

A

1) ice pack for 1st 24 hrs
2) Warm sitz bath after 24 hours
3) Use of sprays and tucks
4) Water spray and use as new pad with each void

33
Q

Describe what a positive Homan’s sign is.

A

The nurse flexes the ankle of the patient, if there is pain in the calf, then it is a positive Homan’s sign. The pain is a result of thrombophlebitis.

34
Q

What causes Homan’s sign in PP women? How can it be prevented and treated?

A

PP Homan’s sign is caused by venous stasis from immobility, changes in the level of fibrinogen and other clotting factors, and possible blood vessel injury. Early ambulation, ROM exercises and SCDs can prevent it. Tx involves breast feeding elevating legs, and meds.

35
Q

What is Endometritis? What is the cause of early and late onset of Endometritis?

A

Endometrial - Infection of the uterus.

1) Early Onset - Initial 24-36 hrs PP caused by group B streptococcus.
2) Late Onset - After 36 hrs and caused by genital mycoplasmas, chlamydia, trachomatis.

36
Q

What are he SxS of mild and severe Endometritis?

A

1) Mild cases - Bloody/foul smelling vaginal discharge.

2) Sever cases - Uterine tenderness, sawtooth temperature spikes, tachycardia, chills, purulent/foul smelling lochia.

37
Q

How long after receiving a Rubella vaccine should a woman wait to get pregnant?

A

1 month

38
Q

Describe the 3 phases of the Emotional Status portion of BUBLE-HIE?

A

1) Taking In Phase - First 1-2 days after delivery, mother is tired and focused on herself.
2) Taking Hold Phase - Mother shifts focus from self to infant.
3) Letting Go Phase - Mother “lets go” of pregnancy and deals with motherhood. Deals with losses (independence) and is susceptible to depression.

39
Q

(T/F) While SOB is normal during pregnancy, it is abnormal when it happens Postpartum.

A

True

40
Q

What is the therapeutic serum level of Magnesium and what are the SxS of toxicity?

A
  • therapeutic level is 4-8mg/dL and adverse effect of toxicity includes:
    1) Respiratory depression (hold meds if < 12 breaths per min)
    2) ⬇ Urine output
    3) DTR
    4) Lethargy and ⬇ LOC
    5) Headaches, visual disturbances, & epigastric pain
    6) Pulmonary edema
41
Q

Which hormone stimulates breast development and milk production?

A

Prolactin

42
Q

Which hormone is responsible for the milk ejection or the “let down” reflex?

A

Oxytocin

43
Q

What can cause and inhibit the letdown reflex?

A

1) Causes letdown - When the mother thinks about, hears or sees the infant.
2) Inhibits letdown - Pain or fatigue

Nursing 132 Final Exam (7 decks)

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