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Kol- OB > Postpartum > Flashcards

Postpartum Flashcards

1
Q

What does BUBBLE stand for?

A

BUBBLE
• B- breasts
◦ pain, redness, cracking, soreness
• U- uterus
◦ fundal height, placement, consistency
• B- bowel
◦ might be difficult to have first bowel movement, prophylactic stool softener
• B- bladder
◦ 12 hours post birth –> diuresis expected
• L- lochia
◦ vagincal bleeding (color, odor, consistency, amount [COCA])
• E- episiotomy
◦ approximation of edges, edema, ecchymosis

• H- hamens sign,
◦ check for DVT -move toes to nose, if pain in calf check for DVT –> false positives common!
• E- emotional status

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2
Q

Return of uterus to pre-pregnancy state =

A

involution

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3
Q

3 fundal assessment pieces

A

consistency (not boggy), location (midline), height

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4
Q

how does height of uterus change after birth?

A

◦ height drops immediately after birth and then it goes back up, drops one finger down each day

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5
Q

when palpating the uterus always suppport….

A

lower uterine segment

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6
Q

if you don’t support the uterus when palpating what can happen?

A

inversion, hemorrhage

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7
Q

scant lochia = < ___ cm

A

2.5

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8
Q

light lochai = ____ - ____ cm

A

2.5-10

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9
Q

moderate lochia = > _____ cm

A

10

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10
Q

heavy lochia =

A

1 pad saturated in 2 hours

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11
Q

excessive lochia =

A

pad saturated in <15 min or pooling under buttocks

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12
Q

re: type of lochia:

1-3 days after delivery, dark red color, blood consistency, can contain small lcots
◦ amount similar to heavy period about 2 hour after delivery

A

rubra

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13
Q

re lochia type:

4-10 days after delivery, can increase with physical acticivty

A

lochia serosa

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14
Q

re lochia type:

10 days-8 weeks, yellowish white creamy color, fleshy odor, mucus and leukocytes

A

lochia alba

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15
Q

circling back - 3 types of lochia ?

A

rubra - 1-3 days
Serosa- 4-10 days
alba- 10 day- 8 weeks

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16
Q

chill or not chill:

if you have lochia serosa and then have lochia rubra

A

not chill!

**Shouldn’t go back! Always want to be moving forward through stages

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17
Q

Assessment of perineum/ episiotom

A
  • Redness
  • Edema
  • Ecchymosis
  • Discharge
  • Approximation of edges of episiotomy or laceration

REEDA

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18
Q

perineal hematoma feels like

A

acute sharp stabbing pain

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19
Q

when do we see colostrum vs breast milk

A
  • Colostrum = Secretion during pregnancy and 2 to 3 days after birth
  • Milk = comes in 3 to 5 days after delivery
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20
Q

to know that bebe is getting enough titty milk what do we assess?

A

counting the number of wet diapers (6-8 in 24 hours period but not the first few days)

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21
Q

how often to titty feed the bebe?

A

every 2 to 3 hours and on demand - 15 -20 minutes on each breast

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22
Q

engorgement onset can be as early as. _____

A

day 2-5

23
Q

why dem nipz getting cracked?

A

not latching properly

24
Q

uh oh- mastitis! what are the s/s?

A

◦ infection! not just engorged, systemic, fever, reddened area, chills, headache, antibiotic

– pump and dump if abx not safe for baby

25
Q

general guidelines for positioning baby for breastfeeding?

A

◦ alignment- hip and shoulders in a line
◦ nipple and part of areola in mouth
◦ C hold above and below breast
◦ chin presses toward breast and nose goes away
◦ no pinching or pain + tugging sensation

  • alternate offering different breast first
  • no pacifier/bottle during first 3-4 weeks until breast feeding is established
26
Q

normal or not normal to have uterine contractions with breast feeding? why?

A

normal-

• breastfeeding releases oxytocin causing uterine contractions to increase uterine tone

27
Q

how quickly do we want preggo to start breastfeeding after birth?

A

within 1 hour if no complications

28
Q

re: maternal role attainment phases::
taking in, taking hold, or letting go:

first 24-48 hours 
•  Focus on personal needs
•  Rely on others for assistance
•  Excitement and talkative 
•  Recounts birth experience with others
A

taking in

29
Q

re: maternal role attainment phases::
taking in, taking hold, or letting go:

  • Starts day 2 or 3 and last 10 days to several weeks
  • Focus on baby care and newborn skills and improving competency as caregiver
  • Need acceptance
  • Want to learn and practice
  • Experiencing physical and emotional discomforts
A

taking hold

30
Q

re: maternal role attainment phases::
taking in, taking hold, or letting go:

  • Focus on the family as a unit
  • Resumption of role
A

letting go

31
Q

blues, depression of psychosis:

  • Tearfulness, insomnia, lack of appetite, feelings of letdown or inadequacies
  • Usually resolves in 10 days without intervention
A

postpartum blues

32
Q

blues, depression of psychosis:

  • Persistent feelings of sadness and intense mood swings
  • Occurs within 6 months of delivery
  • Interventions usually necessary
A

post partum depression

33
Q

blues, depression of psychosis:

  • Confusion, disorientation, hallucinations, delusions, obsessive behaviors, paranoia
  • Develops within the first 2 to 3 weeks postpartum
  • The client may attempt to harm herself or her infant
  • Psychiatric care
A

postpartum psychosis

34
Q

causes of mastitis?

A

‣ milk stasis causes by blocked duct, engorgement, underwire bra
‣ cracked/fissured/trauma nipple
‣ poor breastfeeding technique
‣ decrease frequency of lactation
‣ contamination of breast due to poor hygiene

35
Q

findings for mastitis?

A

‣ painful, tender, localized hard mass, reddened area
‣ usually on 1 breast
‣ flu like sxs - chills, fever, fatigue
‣ axillary adenopathy on affected side

36
Q

interventions for mastitis?

A

‣ abx
‣ hygiene
‣ empty breast completely, air dry nipples, frequency 2-4 hours
‣ proper positioning/latching

37
Q

this is an infection of uterine lining

A

• Endometritis

38
Q

onset of Endometritis

A

3-5 days postpartum @ site of placental attachment

39
Q

endometritis findings?

A

‣ *pelvis pain/tenderness, chills, fatigue, loss of appetite
‣ dark profuse lochia, odorous lochia, tachycardia

40
Q

Postpartum hemorrhage =
◦ EBL > _____ with vaginal delivery
◦ EBL > _____ with c-section

A

◦ EBL > 500 with vaginal delivery

◦ EBL > 1000 with c-section

41
Q

findings for post partum hemorrhage?

A

cool, pallor, hypotension, tachycardia , bright red blood, uterine atony

42
Q

what is uterine atony?

A

• inability of uterus to contract –> fundus massage!

43
Q

what is placenta accrete?

A

placenta grows too deeply into the uterine wall

–> hemorrhage

44
Q

what is placenta increta?

A

placental villi extend into the myometrium

–> hemorrhage

45
Q

what is placenta precreta?

A

placenta attaches itself to myometrium and grows through the uterus and potentially to the nearby organs

–>hemorrhage

46
Q

what is subinvolution of uterus?

A

remains enlarged and not going back down

47
Q

if fundus is firm but there is bright read bleeding our concerns are

A

laceration or hematoma

48
Q

meds for postpartum hemorrhage:

A 
Oxytocin – Pitocin 
Methylergonovine maleate – Methergine
Carboprost tromethamine – Hemabate 
Misoprostol – Cytotec 
Dinoprostone – Prostin E2
49
Q

dosing/admin for oxytocin for postpartum hemorrhage?

A
  • Stimulates uterine smooth muscle / Contractions
  • 10 units IM
  • 10-40 units in 1000 ml crystalloid IV fluid
50
Q

Methylergonovine maleate – Methergine is contraindicated in….

A

high blood pressure!

51
Q

admin of Methylergonovine maleate – Methergine for postpartum hemorrhage

A
  • 0.1 – 0.2 mg IM every 2-4 hours

* Followed by 0.2 mg PO every 4-6 hours X 24 hours (for 6 doses)

52
Q

Carboprost tromethamine – Hemabate is contraindicated in….

A

asthma!

53
Q

admin of Carboprost tromethamine – Hemabate for postpartum hemorrhage?

A
  • Stimulates contractions of the myometrium (prostaglandin analogue)
  • 0.25mg (250 mcg) IM
54
Q

admin of misprostol for postpartum hemorrhage?

A
  • Stimulates powerful contractions of the myometrium (prostaglandin analogue
  • 800-1000 mcg rectally

Kol- OB (20 decks)

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