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NURS783 Exam 2 > Postpartum > Flashcards

Postpartum Flashcards

1
Q

immediate postpartum period

A

6-12h

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2
Q

late postpartum period

A

up to 6 months

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3
Q

What is the location of the uterus 2 days postpartum?

A

at or slightly below maternal umbilicus

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4
Q

What is the size and consistency of the uterus 2 days PP?

A

like a softball

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5
Q

When does uteral involution begin?

A

2 days after birth

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6
Q

What will pts experience as the uterus involutes?

A

intense contractions for first 3 days

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7
Q

Why may a uterus fail to involute?

A
  • atony
  • retained placental fragments
  • lacerations
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8
Q

lochia rubra

A
  • red
  • days 1-3 PP
  • should not contain large (larger than dime) clots
  • distinct fleshy odor
  • blood, debris from placenta, membranes, vernix, lanugo, decidual tissue
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9
Q

How does the cervix appear immediately PP?

A
  • stretched
  • edematous
  • bruised
  • abraded
  • lacerated
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10
Q

What promotes vulvar tone?

A

decreasing progesterone levels

vaginal edema should resolve in 3-4 days PP

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11
Q

When should the uterus be completely involuted?

A

10-14 days PP

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12
Q

lochia serosa

A
  • pink
  • days 3-10 PP
  • blood, mucous, invading leukocytes
  • occurs as endometrium is regenerated
  • placental site exfoliated and remodeled
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13
Q

eschar bleeding

A
  • occurs at 10 days PP
  • is placenta “scab”
  • bright, red bleeding should only lasting a few hours
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14
Q

How does the cervix appear at 1 week PP?

A
  • nearly closed
  • thickened
  • almost regained pre-pregnant size and shape
  • os will be wider, transverse slit (vs circular)
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15
Q

How long does it take the placental attachment site to heal?

A

6 weeks

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16
Q

lochia alba

A
  • pink, yellow, white

- up to 4 weeks

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17
Q

When does vaginal ruggae return?

A

@ 3wks, but less prominent

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18
Q

When does vaginal epithelium proliferate?

A

@ 4 wks PP

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19
Q

What is the state of the vagina at 6 wks PP?

A
  • epithelium reconstructed
  • tone mostly restored
  • never completely regains nulliparous shape and tone
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20
Q

T or F: there is an increase in breast cancer dx’ed during pregnancy

A

true

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21
Q

T or F: breast cancer detected PP has worse outcomes

A

true

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22
Q

When do people who are not breastfeeding experience engorgement?

A

days 2-4 PP

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23
Q

What should be assessed during the PP abdominal exam?

A
  • incision site: s/s infection (redness, warmth, drainage, dehiscence); staples removed on day 4 PP
  • involution
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24
Q

Describe involution of the uterus

A
  • descends 1 finger breadth per day from umbilicus to pubis symphysis
  • by 1 week PP, should be halfway between
  • fundus no longer palpable at 2 weeks
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25
Q

How long does it take the perineum to heal?

A

2-6 weeks (longer w/ extensive tearing)

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26
Q

What may be used if granulation tissue is noted on the perineum?

A

silver nitrate

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27
Q

When is a rectal exam indicated PP?

A
  • after 3rd or 4th degree laceration

- reports of fecal incontinence –> examine rectovaginal wall

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28
Q

When does normal pregnancy edema dissipate?

A

by 2 weeks PP

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29
Q

What are differential dx’s if pt is saturating maxi pad in <1h?

A
  • hemorrhage
  • endometritis
  • retained products of conception
30
Q

What are differential dx’s if pt is passing golfball-sized clots?

A
  • hemorrhage
  • endometritis
  • retained products of conception
31
Q

What are differential dx’s if return of bright red bleeding?

A
  • hemorrhage
  • endoemtritis
  • eschar bleeding
  • overextension
32
Q

What are differential dx’s if temp > 101º?

A
  • endometritis
  • mastitis
  • viral infection
33
Q

What are PP s/s of PP preeclampsia?

A
  • severe headache
  • visual disturbances
  • seizure
34
Q

What are differential dx’s if pt has warm, hard spot on breast?

A
  • plugged duct

- mastitis

35
Q

What are differential dx’s if pt has warm area, pain, or edema in calf?

A
  • DVT

- superficial thrombosis

36
Q

What is s/s of pulmonary emboli?

A

chest pain

37
Q

What are s/s that indicate a person is overexerting PP?

A
  • heavier, brighter lochia
  • increased pain
  • SOB
  • lightheadedness
38
Q

How many extra calories does breastfeeding require?

A

500 kcals

39
Q

How can pain from involution be managed?

A
  • empty bladder prior to breastfeeding (which stimulates contractions)
  • lie in prone position - puts constant pressure on uterus
  • ibuprofen 600mg q6h
40
Q

When does fertility return in the non-lactating person?

A

4-6 weeks PP

41
Q

When does fertility return in the lactating person?

A

depends on duration and frequency of lactation

  • 55-67% anovulatory in first month
42
Q

T or F: fertility can return before menses returns

A

TRUE!

43
Q

Explain the “rule of threes”

A
  • if exclusively breastfeeding, contraception should be used @ 3mo PP
  • if partial breastfeeding, contraception should be used @ 3 weeks PP
44
Q

When is the best time to place an IUD PP?

A
  • <10min after delivery
    OR
  • after 4wks PP
45
Q

puerperal fever

A

T≥100.4º during PP period

46
Q

7 Ws of febrile morbidity

A

1) womb (chorio)
2) wound
3) water (dehydration)
4) weaning (breast engorgment, mastitis)
5) wind (resp illness)
6) walking (DVT)
7) wonder drug (drugs that elevate temp)

47
Q

What puts PP people at greater risk of infection?

A

1) wound/tissue trauma during birth
2) placenta separation site
3) incision from C/S

48
Q

endometritis

A

uterine infection

49
Q

What prophylaxis does ACOG recommend for all C/S?

A

abx prophylaxis w/in 60min of beginning surgery

50
Q

T or F: amniotomy increases risk of uterine infection

A

false

*artificial rupture of membranes

51
Q

What is the most common reason for readmission PP?

A

uterine or wound infection

52
Q

What may cause subinvolution?

A

1) retained placenta
2) uterine infection
3) excessive maternal activity

53
Q

How is subinvolution managed?

A

1) rest, fluids, nutrition, social support
2) methylergonovine 0.2mg PO q40h for 24-48h
3) f/u in 1-2 weeks

54
Q

Homan’s sign

A

increase in calf pain w/ dorsiflexion of foot

55
Q

When can delayed PP hemorrhage occur?

A

24h-12wks PP

  • most occur w/in 2 wks
56
Q

What causes delayed PP hemorrhage?

A

1) uterine atony
2) subinvolution
3) consider retained placental fragments (rare)

57
Q

How should delayed PP hemorrhage be managed?

A

1) test for von Willebrand’s disease if hemorrhage occurs 2-4 days PP
2) utertonics (e.g. methylergonovine, oxytocin)
3) MD may use suction in cause of retained placenta

58
Q

bonding

A

the emotional tie that mother develops w/ unborn baby and later, the newborn

provides powerful source of motivation

59
Q

taking in phase

A

phase of PP adjustment that involves reviewing labor and birth

60
Q

taking hold phase

A

mother assumes tasks of mothering, care of baby and self, along w/ attention to family and support network

61
Q

What are features of baby blues?

A
  • tearful
  • irritability
  • mood swings
  • fatigue
  • appetite changes
62
Q

What are features of PP depression?

A
  • same as baby blues
  • lack of interest in baby
  • sleep disturbances
  • guilt, shame
  • feelings of isolation
  • hopelessness
  • loss of pleasure
  • feelings of harming baby, self
63
Q

What are features of PP psychosis?

A
  • hallucinations
  • delusions
  • inability to communicate
  • rapid mood changes
  • paranoia
  • inability to sleep
  • hyperactivity
  • disorganized thoughts
64
Q

What is first-line tx for PPD?

A

SSRIs

65
Q

Why might pts see immediate PP weight loss?

A

fluid retention may be present for 1-2 weeks

66
Q

When does most PP weight loss occur?

A

b/w 6wks and 6mo PP

67
Q

Describe the position of the uterus:

  • immediately PP
  • 1-2h
  • 12h
  • 24h
  • 3 days
  • 7 days
  • 14 days
A
  • immediately PP: at umbilicus
  • 1-2h: b/w umbilicus and symphysis pubis
  • 12h: 1 cm above umbilicus
  • 24h: 1 cm below umbilicus
  • 3 days: 3 cm below umbilicus
  • 7 days: at symphysis
  • 14 days: non-palpable
68
Q

ebb phase

A

fluid retention PP

69
Q

flow phase

A

diuresis that occurs 4-7 days PP

70
Q

What is the effect of pregnancy estrogen on hair?

A

remains in prolonged anagen (growth) phase –> full head of hair

71
Q

telogen gravidarum/tellugen effluvium

A

PP hair loss d/t entrance into catagen (involution) and telogen (resting) phases w/ shifting hormone levels

72
Q

Define PP hemorrhage

A

cumulative blood loss of ≥1000mL OR blood loss accompanied by s/s of hypovolemia w/in 24h after delivery

NURS783 Exam 2 (6 decks)

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