Post Pardum

Question 1

Uterine involution

Answer 1

The return of the uterus to its pre pregnancy size

Question 2

Uterine Atony

Answer 2

Failure of uterus to contact even after fundal rub
When you push on fundus it fails to firm
Soft boggy uterus above umbilicus
Steady or saturated pad after 15 minutes

Question 3

Uterine inversion

Answer 3

Uterus turns partially or entirely inside out
When you push down on fundus uterus will come out and it will be inside out

Question 4

Uterine sub involution

Answer 4

Uterus isnt decreasing in size

Question 5

Normal pulse after delivery

Answer 5

About 50 BPM due to blood loss but it is normal

Question 6

What is the reason. Mom may be tachycardia after delivery ?

Answer 6

Infection , anxiety, hypovolemic or pain

Question 7

What pulse may indicate infection or excessive blood loss

Answer 7

Over 100 BPM

Question 8

If moms respirations increase what do we suspect

Answer 8

Pulmonary embolism , uterine atony, or hemorrhage

Question 9

When is a tempature greater than 100.4 f considered a possible infection

Answer 9

If it last longer than 24 hours
But the first 24 hours it can be due to stress of labor and dehydration

Question 10

Lochia stages

Answer 10

Rubra
Serosa
Alba

Question 11

Rubra

Answer 11

Bloody small clots
Red moderate to light
Standing /breastfeeding
Fleshy odor
Day 1-3

Question 12

Abnormal for Rubra

Answer 12

Large clots
Heavy saturated pads every 15 min
Could odor
Placenta fragments

Question 13

Serosa

Answer 13

Day 4-10
Pink , brown color , light , scant
Physical activity ( increase )
Fleshy odor

Question 14

Abnormal serosa

Answer 14

Rubra after 4 days
Heavy ( saturates pad in 15 min )
Foul odor

Question 15

Alba

Answer 15

Day 10
Yellow white color

Question 16

Abnormal alba

Answer 16

Bright red ( late pp hemorrhage , foul odor )

Question 17

Expected blood loss for vag delivery

Answer 17

300-500 ml

Question 18

Exxpected blood loss for c section

Answer 18

500-1000ml

Question 19

When do pp void or should they void

Answer 19

Before 6 hours and more than 150 ml

Question 20

What happens when pp pt has not urinated over 6 hours

Answer 20

Bladder scan
Get order to straight cath
Pain meds to help relax
And encourage kegals to strengthen muscles

Question 21

When does the pelvic muscles regain their strength

Answer 21

3-6 wks

Question 22

When does abdominal wall gain its tone

Answer 22

Full 6 wks

Question 23

Diastesis recti

Answer 23

Seperation of rectus abdominal muscles

Question 24

S/s of hypovolemia

Answer 24

Tachycardia ,hypotensive ,, pale, clammy, anxious nd confused

Question 25

Hemorrhagic shock

Answer 25

Blue lips/ finger nails , decreased urine output , excessive sweating, chest pain, shallow breathing, hypotensive Can led to shock

Question 26

Laceration - signs of unrepaired

Answer 26

Continuous trickle down from vag Bleeding in spirts ( squirts) Bleeding in the presence of contracted fundus ( when it is firm )

Question 27

Early causes of hemorrhage

Answer 27

Uterine atony Laceration Hematoma

Question 28

Oxytocin adverse reactions

Answer 28

Adverse reactions- dysthrhymias, BP changes , water intoxication ,and uterine rupture

Question 29

Methylergonovine Maleate adverse effects

Answer 29

Nausea s vomiting cramping , headache, severe hypertension, bradycardia , dysrhythmias, myocardial infarctions Given IV

Question 30

Contraindications with methlergonovine maleate

Answer 30

Cardiac diseases , hypertension

Question 31

Interventions for methylergonovine maleate

Answer 31

Monitor VS Pain Headache Chest pain Shortness of breath Uterine contractions Vag bleeding

Question 32

Carboprost tromethamine adverse effects

Answer 32

Headache, nausea, vomiting, diarrhea , fever, tachycardia, hypertension, pulmonary edema

Question 33

Carboprost tromethmine contraindications

Answer 33

Asthma, cardiac, renal and hepatic diseases

Question 34

Interventions when giving Carboprost tromethamine

Answer 34

Given IM Monitor VS , vag bleeding and uterine tone

Question 35

Misoprostol

Answer 35

Given orally mostly given rectally

Question 36

Misoprostol adverse effects

Answer 36

Headache nausea, vomiting, diarrhea, fever, tachycardia, hypertension, pulmonary edema

Question 37

Interventions with Misoprostol

Answer 37

Monies VS, vag bleeding and uterine tone

Question 38

Interventions for uterine inversion

Answer 38

Stop oxytocin immediately to give us time to manually push in the uterus Give terbutaline to relax the smooth muscle to allow us to push uterus back in Antibiotics to prevent infection ( passage way for bacteria )

Question 39

Endometriosis s/s

Answer 39

Pulse over 100 Fever chillls malaise anorexia Excessive uterine tenderness Lochia returning to Rubra from serous Foul smelling or prudent Lochia Urinary frequency

Question 40

Interventions of endometriosis

Answer 40

Bed rest semi fowlers Administer iv antibiotics Antipyretics oxytocin or methlergonovine

Question 41

How many calories should a breast feeding mom increase by

Answer 41

500 calories

Question 42

Effective feeding with breastfeeding

Answer 42

Let down reflex Latch pain subsides Audible swallowing Adequate output ( 1 stool 1 urine first 24 but the 2nd 2 and 2 ) Weight gain

Question 43

Foremilk

Answer 43

Stored before feeding , high in water content

Question 44

Hindmilk

Answer 44

Produced during feeding High in fat content

Question 45

Taking in

Answer 45

24 - 48 hours Focused on own needs unable to make decisions Relives birth experience adjust to psychological changes

Question 46

taking hold phase

Answer 46

Dependent / independent Focus shift to infant and maternal role Anxious/overwhelmed about competence as mom and accepts advice May experience baby blues and fatigue Can start 2-3 dys and last for wks

Question 47

letting go phase interdependent

Answer 47

Resolve their idealized expectations of birth experience Accepts reality of infant and incorporates into lifestyle Separated new born and self confident in care taking activities Relationship with partner grows with reconnection

Question 48

Paternal

Answer 48

Engrossment (bonding) Intense interest in infant Oops forward to parenting but lacks confidence

Question 49

IPV

Answer 49

Intimate partner violence

Question 50

Magnesium sulfate

Answer 50

It is good to know if mom is taking these for preeclampsia it will slow pt down for blood clotting putting them at risk for hemorrhage

Question 51

Tocolytics

Answer 51

Also puts mom at risk for hemorrhage

Question 52

Oxytocin route and interventions

Answer 52

IV IM Monitor v/s , I&O , and monitor lung sounds