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OB > post-partum (unit 2) > Flashcards

post-partum (unit 2) Flashcards

1
Q

uterus involution

A

•uterus returns to pre-pregnant size/shape
•causes sharp afterpains (ct.)
•lowers 1 cm/day
•by PP day 10, uterus within pelvis and non palpable
*WNL at 4-6 weeks pp

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2
Q

lochia-discharge

A
  • Rubra- birth-PP 3
  • Serosa- PP day 4-10
  • Alba (yellow)- PP day 11-wk 6
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3
Q

Why might a patient
“gush” blood upon
standing up from a
supine position?

A
  • blood may have pooled in the vaginal vault while the patient rested in a supine position
  • also have some clots
  • As long as the increased flow resolves and the patient’s uterus is firm and ML, she is ok
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4
Q

cervix PP

A
  • immediately post SVD, wide enough for hand
  • after 1 wk- pencil eraser
  • external os from round to slit
  • possible lacerations
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5
Q

vagina PP

A
  • immediately post SVD- edematous w/ rugae
  • after 6 wk- pre-preggo size
  • atrophic until menses resumes
  • lacerations possible
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6
Q

dyspareunia

A
  • dryness and itching of vagina
  • r/t declining estrogen levels b/c diminishes lubrication
  • esp. common in BF b/c prolactin antagonizes estrogen
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7
Q

perineum PP

A
  • edema/bruising
  • lacerations (1-4 degree)
  • episiotomy
  • lacerations
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8
Q

1st degree perineal laceration

A

•extends thru skin/structures to superficial muscles

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9
Q

2nd degree perineal laceration

A

•extends thru muscles of perineal body

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10
Q

3rd degree perineal laceration

A

•extends thru anal sphincter muscle

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11
Q

4th degree perineal laceration

A
  • involves anterior rectal wall
  • rare
  • require more intervention
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12
Q

perineum discomfort tx

A
  • ice for first 48 hrs

* then sit baths bid

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13
Q

estimated blood loss (EBL)

A

•lose 500cc blood SVD
•lose 1000cc blood C/S
•also lose blood volume when diaphoresis/diuresis PP
*orthostatic hypotension common

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14
Q

what does declining estrogen levels PP cause

A
  • no lubrication of vagina

* diaphoresis

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15
Q

why don’t mom’s go into hypovolumetric shock during delivery?

A
  • blood flow to placenta diverted during delivery

* rapid reduction in uterine size

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16
Q

cardiac output PP

A
  • elevation of pulse, SV, and CO for first hr
  • gradual decrease to prepreggo
  • brady common 1-2 days PP b/c dec. blood volume (trying to maintain CO)
  • if tacky check for infection
  • baseline by 8-10 wks
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17
Q

coagulation PP

A

•hypercoagulated in pregnancy and PP for 2-3 wks b/c have increased fibrinogen
**risk for DVT for up to 6 months

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18
Q

labs PP

A 
•elevated WBC (25,000) for 2 wks
•H&H hard to assess and only addressed if hct <18 and symptomatic
-dizzy
-pallor
-weak
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19
Q

GI PP

A

•constipation
•BM incontinence if operative vaginal birth
•hunger
•thirst
*keep NPO until sounds, then clear liquids until flatus

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20
Q

why constipation PP

A
  • inc. progesterone slows peristalsis
  • long NPO
  • painful BM from trauma
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21
Q

why hunger/thirst PP

A
  • long NPO
  • large energy expenditure
  • early diuresis
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22
Q

urinary system PP

A 
•excessive diuresis w/in 2 days (3000cc/day)
•r/o distended bladder d/t
-dec. tone
-trauma
-diuresis
-anesthesia (epidural -> retention)
*high risk for UTI/postpartum hemorrhage
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23
Q

musculoskeletal PP

A
  • aches/pains/fatigue
  • relaxin WNL w/in few days, but can cause early hip pain
  • diastasis recti possible
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24
Q

musculoskeletal 6-8 wks PP

A
  • joint return to normal
  • feet permanently enlarged
  • muscle tone restored b/c progesterone dec.
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25
Q

integumentary PP

A
  • melanin dec. -> linea nigra, chloasma fade
  • estrogen dec. -> palmar erythema, spider nevi fade
  • striae gravidarum fade to silver (never go away)
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26
Q

endocrine PP

A
  • menses w/in 4-6 wk (if not BF)
  • ovulation before menses so BC crucial
  • estrogen, progesterone, HPL, HCG decline
  • prolactin decline at 3 wk if not BF
  • resolution of GDM
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27
Q

why does prolactin delay menses/ovulation

A
  • suppresses the release of LH and FSH

* still need BC

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28
Q

what causes lactation

A
  • rapid falling levels of estrogen and progesterone
  • increasing levels of prolactin
  • increasing oxytocin (let down)
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29
Q

weight loss PP

A

•12 lbs at delivery
•8-9 lbs at 2 wks
•pre-preggo at 6 mo-yr
*BF slower loss of adipose tissue INITIALLY

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30
Q

initial PP assessment

A
  • begin 4th stage
  • frequent VS, fundus, lochia
  • pain
  • IV site/patency
  • bladder
  • LE movement
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31
Q

VS 4th stage

A
  • q15min x 4 hr
  • q30min x 2 hr
  • qhr x 2 hr
  • q4-8 hrs
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32
Q

BUBBLE HE

A
  • breasts
  • uterus
  • bladder
  • bowel
  • Lochia
  • Episiotomy
  • Homan’s sign
  • Emotions
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33
Q

PP breast assessment

A

•soft, nontender first 2 days
•firm/lumpy/fuller 72-96 hrs b/c colostrum mature milk
*s/sx fullness subside w/ BF

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34
Q

PP uterus assessment

A
  • have pt void first
  • massage/expel clots
  • provide meds if needed (Pitocin, methergine, cytotec)
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35
Q

u/1,2… (u-1,2…)

A
  • fundus below umbilicus

* how many fingers below (subjective)

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36
Q

1,2…/u (u+1,2…)

A
  • fundus above umbilicus

* how many fingers above (subjective)

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37
Q

problem w/ distended bladder

A

•uterus elevates to R
•uterus can’t ctx/drain
•uterus retains lochia and can cause excessive bleeding
*can’t DC if < 30 cc/hr

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38
Q

PP lochia

A

•constant trickle dangerous (MD)
•excessive amnt w/ ctx indicates unrepaired laceration (MD)
•foul smell could be infection (tenderness/temp/tachy)
*goal < 1 pad/hr

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39
Q

PP episiotomy/incision assessment

A 
R- redness
E- edema
E- ecchymosis
D- discharge
A- approximation
*indicates infection IF accompanied by pain
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40
Q

LE assessment PP

A
  • edema/varicose veins possible

* DTRs should be 1+ or 2+ b/c brisk hyper reflexes indicates pre-eclampsia

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41
Q

dec. BP PP could be…

A
  • dehydration

* hypovolemia

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42
Q

inc. BP PP could be

A

•pre-eclampsia

*compare to admission BP

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43
Q

tachycardia PP

A

•could b from excitement, fatigue, dehydration, hypovolemia
•check fundus, lochia, CBC
•may be early s/sx of shock
*brady would be from blood vol. dec.

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44
Q

temp. PP

A
  • elevated up to 100.4 expected first 24 hr

* if 100.4 or > for more than 24 hr, notify MD

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45
Q

promoting comfort PP

A
  • assess/tx pain
  • 3000cc fluids/day
  • regular diet
  • adequate rest/sleep
46
Q

Rhogam PP

A
  • given if mom Rh- and baby Rh+

* given w/in 72 hrs

47
Q

Kleinhauer-Betke

A

•drawn w/ CBC PP to determine ant of fetal blood in maternal circulation
*if > 15 mL, increase Rhogam

48
Q

MMR vaccine

A
  • all child-bearing should have, esp. if non-immune
  • DON’T become preg for 1 month
  • Rubella during prig devastating for fetus
49
Q

breast care for lactating mom

A
  • avoid soap/lotion to nipples
  • feed baby on demand
  • keep nipples dry (pat)
  • use lanolin for nipple trauma
  • good support bra
  • cabbage leaves/ibprofen/ice for engorgement (ONLY BF mom cam pump)
50
Q

kegal exercises PP

A
  • will strenghten perineal muscle
  • tighten muscle (stop urine), hold 10 sec, relax
  • do 5 times daily
51
Q

PP danger signs to report to MD

A
  • fever > 100.4
  • localized breast edema (esp. w/ flu s/sx)
  • persistent abd tenderness/pelvic pressure
  • persistent perineal pain
  • UTI
  • lochia change
  • DVT s/sx
52
Q

criteria for D/C

A
  • free of infection s/sx
  • able to void > 30cc/hr
  • fundal ht/lochia WNL
  • H&H WNL
  • Rhogam/rubella vaccinated
  • educated on danger signs
  • mom able to reach HCP in emergency
53
Q

bondings

A
  • developed by attachment and physical contact b/t parents and infant
  • love and acceptance
  • enhanced in 1st hr of life
  • maternal touch is key
54
Q

early post-partum hemorrhage

A
  • occurs w/in 24 hrs after delivery
  • vaginal: > 500cc blood loss
  • C/S: > 1000cc blood loss
  • caused by uterine atony or trauma r/t laceration
55
Q

risk factors for PP hemorrhage

A
  • uterine atony
  • placental complications
  • precipitous delivery
  • MgSO4 therapy
  • laceration trauma/hematomas
  • inversion of uterus
  • sub involution of uterus
  • retained placental fragments
  • coagulopathies (DIC)
56
Q

causes of uterine atony

A
  • overdistention (multi GA; tumor; polyhydranious; big baby)
  • multipartiy
  • tocolytic drugs (rlx uterus)
  • prolonged/precipitous (rapid) labor/delivery
  • C/S
  • induction
57
Q

signs of early PP hemorrhage

A
  • excessive lochia
  • fundus soft/difficult the locate
  • fundus above expected level
58
Q

early PP hemorrhage tx

A
  1. fundal massage (tx for uterus)
  2. ABCs
  3. start new (lg. bore) IV for fluids
  4. admin meds/blood
  5. elevate legs (tx for shock)
59
Q

meds for early PP hemorrhage

A 
•O2- 2-3 L NC to inc. RBC sat
•oxytocin
•Methergin IM- inc. froce/freq. ctx
-contra in HTN
•carbopropst/cytotec rectal- smooth mscl. ctx
•Hemabate IM
•Hespan- vol. expander (colloid)
60
Q

anticipated action for PP hemorrhage

A
  • OR
  • D&C
  • uterine packing/Bakri balloon
  • hysterectomy
  • ICU
61
Q

shock

A
  • complication of early PP hemorrhage

* vasoconstriction -> blood shunted to vital organs (heart, lungs, brain)

62
Q

RN protocol in emergency for PP hemorrhage

A 
•Labs (H&H; T&S)
•pusle ox
•foley
•O2 by ventimask
•add. fld./lines; blood products
*autonomy when MD not present
63
Q

RN initial interventions PP hemorrhage

A
  • call for help
  • fundal massage
  • bolus Pitocin
  • continuous pulse Ox/VS
  • reverse trendelenberg
  • change pads, so can observe
  • calm pt/fam.
  • privacy
64
Q

hematoma

A
  • 250-500cc of blood collects in tissues in vulvar, vaginal, retroperitoneal area
  • may present as bluish mass
  • caused by laceration, but occurs behind it
  • severe rectal pain/pressure (normally)
  • s/sx concealed blood loss
  • trauma that can lead to early PP hemorrhage
65
Q

laceration of birth canal

A
  • bright, red bleeding w/ firmly contracted uterus, midline at expected level
  • trauma that can lead to early PP hemorrhage
66
Q

late PP hemorrhage

A
  • > 24 hr PP, but less than 2 wks PP

* caused by subinvolution

67
Q

subinvolution

A

•uterus remains enlarged w/ continued local discharge

68
Q

subinvolution causes

A
  • retained placental fragments

* endometritis (pelvic infection)

69
Q

s/sx subinvolution

A
  • prolonged, foul-smelling, excessive lochia
  • hemorrhage
  • pelvic pain/heaviness
  • backache
  • malaise
  • fatigue
  • large/soft uterus
70
Q

subinvolution tx

A
  • methergine- ctx.
  • abx
  • D&C last resort when methergine/abx not working
71
Q

thromboembolic disorders PP

A
  • major cause of maternal death
  • 5x greater occurrence in prig and PP than non-preggo
  • 3x more likely w/ C/S
72
Q

causes of thrombosis in childbearing women

A
  • venous stasis
  • hypercoagulable blood
  • vessel injury
73
Q

risk factors for thrombosis

A
  • varicose veins
  • smoking
  • obesity
  • hx of thrombophlebitis
  • clotting disorders
74
Q

SVT

A
  • in calf
  • swelling/erythema
  • tenderness/warmth
  • lg hard vein
  • pain w/ walking
75
Q

DVT

A
  • little/no s/sx
  • calf swelling/warmth/erythema
  • tenderness
  • pedal edema
  • pulses unequal
  • venous doppler dx
76
Q

prevention of thrombosis

A
  • ambulation
  • range of motion
  • avoid pillows under knees
77
Q

SVT tx

A
  • support hsoe
  • rest
  • analgesics (NO ASA or ibuprofen)
  • elevate affected leg
78
Q

DVT tx

A
  • IV heparin
  • bedrest
  • elevate
  • analgesics
  • Coumadin
  • monitor coags
  • gradual ambulation
  • DONT massage
79
Q

endometritis

A
  • 2-5 days PP
  • inflammation/infecton of endometrium
  • can spread, causing sepsis and sterility
80
Q

s/sx endometritis

A
  • fever/chills
  • tachy
  • lethargy
  • malaise
  • anorexia/nausea
  • abd/uterine pain
  • foul, purulent lochia
81
Q

endometritis tx

A
  • IV abx
  • analgesics
  • comfort
  • prevention
  • high fowlers to drain lochia
82
Q

UTI

A
  • cystitis, urethritis
  • dysuria/diuresis
  • tx w/ abx and cranberry juice
  • 300 mL fld./day
83
Q

PP wound infection

A
  • most common PP infection
  • episiotomy, vagina, C/S incision
  • s/sx of REEDA
84
Q

PP wound infection tx

A
  • I&D (incision & drainage)
  • abx
  • analgesics
  • remove staples/suture
  • pack
  • sitz bath/warm compress
  • freq. peri-care
  • inc. flds
85
Q

mastitis

A
  • infection of lactating breast
  • doesn’t occur w/in first few days b/c skin still in tact and no milk yet
  • more common in first BF mom
  • one breast ONLY
86
Q

mastitis causes

A
  • bacteria (staph) enter injured nipple
  • insufficient breast emptying
  • engorgement/stasis
87
Q

s/sx mastitis

A
  • flu-like
  • chills/fever/malaise
  • HA
  • localized red/inflam/tender
88
Q

mastitis tx

A 
•abx
•bedrest initially
•3000cc fld/day
•ice
•analgesics
•BF (safe) unless abscess forms or too painful (pump)
•warm shower (dilation)
•resolves in 24-48 hr
*tx crucial to avoid abscess
89
Q

mastitis prevention

A
  • empty q 2-3 hr
  • no tight bra
  • massage milk ducts while feeding
  • inc. fld intake
  • good hygiene
90
Q

baby blues

A
  • 1-2 days PP
  • rarely last > 2 wks
  • trouble sleeping/eating and tearful but not sad
  • still joyfully care for baby
  • no tx needed
91
Q

PP depression

A
  • 4 wks- 6 months PP
  • s/sx depression > 2 wks
  • persistent sadness/mood swings
  • no joy w/ infant care
  • tx w/ psychotherapy, meds, ECT
92
Q

PP psychosis

A
  • severe psychotic state
  • confusion
  • disorientation
  • AH &/or VH
  • delusion
  • obsessive behavior
  • paranoia
  • self/infant harm
  • tx w/ aggressive IN pt hospitalization
93
Q

the bigger/more stressed the uterus…

A 
•the worse the afterpains b/c has to work harder to get back to normal
•d/t
-multiple babies
-big baby
-fibroids (benign tumor)
-uterine problems
94
Q

important RN measures

A
  • check IV and assess what have/should be hanging

* ensure the foley bag below bladder

95
Q

intervention for deviated fundus PP

A
  • help to bathroom
  • if can’t urinate use running water, warm perineal, hands in water, sitz bath
  • in/out cath as last resort
96
Q

lochia assessment PP day 2

A
  • rubra/serous

* scant

97
Q

if hemorrhage from laceration trauma, uterus is…

A

•firm b/c laceration doesn’t involve the uterus, so it would be normal for PP
*firm uterus w/ bleeding is

98
Q

s/sx hypovolumetric shock

A 
•earliest sign is tachycardia
•BP inc. initially, then dec. after ⅓ vol. lost
•RR inc. to get O2 to organs
•skin cool, clammy, diminished cap refill
•pallor
•tachycardia
•hypotension
•N/V
•dec. UOP
*elevate legs
99
Q

causes of concealed blood loss

A
  • broken stitch

* hematoma

100
Q

meaty clots

A

•from uterine atony

101
Q

thin/shiny clots

A

•from trauma

102
Q

tocolytic drugs

A
  • MgSO4

* terbutaline

103
Q

trauma causes

A
  • large baby
  • operative vaginal delivery
  • soft part abnormality
  • rapid delivery
104
Q

uterine atony tx

A
  • fundal massage
  • bolus Pit.
  • meds
105
Q

trauma tx

A
  • call MD
  • ice
  • pressure
  • tx shock if occurs
106
Q

hypovolemic shock tx

A 
•trendelberg/elevate legs
•O2
•2nd IV/fluids
•admin expanders
•ABCs
*both uterine atony and trauma ultimately lead to shock
107
Q

uterine atony last resort tx

A
  • D&C
  • hysterectomy
  • packing
108
Q

trauma last resort tx

A

•repair

109
Q

when to start worrying about PP infection

A
  • if > 100.4 w/in first 24 hrs

* if 100.4 or > for more than 24 hrs

110
Q

RN action if pt calls w/ breast pain

A
  • ask if both or one breast
  • mastitis is normally just one breast
  • engorgement is both

OB (17 decks)

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