OB Test # 3 Postpartum

Question 1

What are the 4 Postpartum Cervical changes?

Answer 1

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

Question 2

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

Answer 2

True

Question 3

What are the 3 postpartum perineal changes?

Answer 3

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

Question 4

What are the 4 postpartum musculoskeletal system changes?

Answer 4

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

Question 5

What are the 6 Postpartum urinary tract changes?

Answer 5

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

Question 6

What are the 6 Postpartum neurological changes?

Answer 6

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

Question 7

What are the 3 postpartum endocrine changes?

Answer 7

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).

Question 8

What are the 6 postpartum changes in vital sign?

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

Define PP Hemorrhage and explain how it is measured?

Answer 11

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

Question 12

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

Answer 12

True

Question 13

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

Answer 13

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

Question 14

What is normal weight loss for the postpartum woman?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

True

Question 17

What are the 5 methods used to manage Mastitis?

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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?

Answer 19

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.

Question 20

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

Answer 20

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

Question 21

What are the 8 risk factors for PPH?

Answer 21

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

Question 22

What are the 6 SxS of Uterine Atony?

Answer 22

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

Question 23

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

Answer 23

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

Question 24

What are the 2 etiologies/causes of late PPH?

Answer 24

1) Delayed involution > uterine infection

2) Retained placental fragments

Question 25

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

Answer 25

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

Question 26

Explain the bladder assessment portion of BUBBLE-HIE.

Answer 26

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

Question 27

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

Answer 27

True

Question 28

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

Answer 28

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

Question 29

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

Answer 29

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

Question 30

Describe the following degrees of laceration as it applies to child birth: 1) 1st Degree 2) 2nd Degree 3) 3rd Degree 4) 4th Degree

Answer 30

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

Question 31

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

Answer 31

* use the REEDA Method: 1) Redness 2) Edema 3) Ecchymosis 4) Discharge 5) Approximation

Question 32

How is an episiotomy/laceration cared for?

Answer 32

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

Question 33

Describe what a positive Homan's sign is.

Answer 33

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.

Question 34

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

Answer 34

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.

Question 35

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

Answer 35

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.

Question 36

What are he SxS of mild and severe Endometritis?

Answer 36

1) Mild cases - Bloody/foul smelling vaginal discharge. | 2) Sever cases - Uterine tenderness, sawtooth temperature spikes, tachycardia, chills, purulent/foul smelling lochia.

Question 37

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

Answer 37

1 month

Question 38

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

Answer 38

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.

Question 39

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

Answer 39

True

Question 40

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

Answer 40

* 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

Question 41

Which hormone stimulates breast development and milk production?

Answer 41

Prolactin

Question 42

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

Answer 42

Oxytocin

Question 43

What can cause and inhibit the letdown reflex?

Answer 43

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