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OB Exam 1 > Postpartum (chapter 20 and 21) > Flashcards

Postpartum (chapter 20 and 21) Flashcards

1
Q

involution

A

CHANGES IN THE REPRODUCTIVE ORGANS AFTER CHILDBIRTH. USUALLY IDENTIFIED AS THE FIRST 6 WEEKS AFTER BIRTH. (reproductive organs returning to normal)

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2
Q

during involution to uterus

A

GOES FROM 2.2 LBS. TO 2 OZS.

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3
Q

during involution what kind of pains does the mother have

A

afterbirth pains, uterus contracts after birth, important to contract, helps get rid of tissues and prevent bleeding

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4
Q

during involution retractability

A

reduces bleeding

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5
Q

uterine involution changes

A

uterus will shrink in size at time of deliervery 1-2 cm above umbilicus, then goes down everyday (will change with triplets or premature) , measured by finger

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6
Q

10 days after birth

A

should not be able to palpate the fundus at all

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7
Q

measure fundus with

A

finger breath

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8
Q

subinvolution

A

uterus does not return to scale

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9
Q

uterine atony

A

when uterus does not contract (soft uterus)

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10
Q

patient needs to be able to do ab exercises to

A

bring abs back together and strengthen them

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11
Q

lochia -

A

blood loss (varies from woman to woman

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12
Q

lochia rubra -

A

immediately after birth, lasts 2 days

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13
Q

lochia seresa -

A

3-4 days pink/white

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14
Q

lochia alba -

A

up to 2 weeks, yellowish

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15
Q

most dangerous time

A

24 hours after delivery

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16
Q

if heavy amount of lochia then

A

assess, check atoney and intervene appropriately

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17
Q

later postpartum hemorrhage -

A

tears and trauma from baby

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18
Q

before pregnancy what is the shape of the cervix

A

round

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19
Q

By 2-3 days after delivery the service is how many cms dilated

A

2-3 cms

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20
Q

By 1 week after delivery cervix is

A

1cm dilated

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21
Q

after delivery the cervix will

A

have a slit, rather than a round opening at the cervical os

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22
Q

what reappears in vagina 3-4 weeks after birth

A

rugae (rippled vagina, not smooth)

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23
Q

after birth what happens to the cervix

A

never goes back to being round

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24
Q

Possible causes of pain Postpartum

A

Dyspareunia, Hemorrhoids, After Birth, Contractions, Episiotomys/lacerations

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25
Dyspareunia
pain with intercourse
26
Hemorrhoids
get worse during birth process because of pressure
27
After Birth Contractions
good thing because they prevent post pertium hem and atony, help uterus contract but can be painful, may have more contractions if breast feeding
28
Episiotomy
An incision of the perineum just before birth to widen the vaginal orifice and prevent tearing (should only use when necessary; hard to heel and could cause painful intercourse for the rest of woman's life)
29
First Episiotomy
skin only
30
Second Episiotomy
skin and muscle tissue
31
Third Episiotomy
into the rectal sphincter (don't give enemas or suppositories)
32
Fourth Episiotomy
through the rectal sphincter and into the rectum (don't give enemas or suppositories)
33
how to assess every incision
REEDA - redness, edema, ecchymosis (black and blue), drainage, approximation
34
median or midline Episiotomy
heels easier
35
Mediolateral Episiotomy
can make wider opening, bypass rectal sphincter but more painful and harder to heal
36
Assessing the woman’s bladder for distension after delivery
if have distended bladder can cause atony and excessive bleeding; encourage pt to void, ask last time she voided; make sure uterus stays firm and is not deviated and at normal height; if can't void increase risk for UTI may cause uterine atony and maybe excessive bleeding
37
Signs of a Distended Bladder
Location of fundus above baseline level (determine with empty bladder) Fundus displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis Frequent voidings of less than 150 ml of urine
38
massaging the fundus
support at pubis because if you don't uterus can turn inside out (uterus inversion)
39
Dilation of ureters can increase (urinary problem)
UTI occurance
40
Urinary
Dilation of ureters can increase UTI occurance Elevated BUN with autolysis of uterine tissue—WNL’s in 6 wks. Diuresis Diaphoresis
41
diuresis
excessive elimination, increases by 30-40% during pregnancy, has to get rid of fluid
42
diaphoresis
excessive sweating; helps get rid of extra fluid
43
P.P. release of 30-40% of plasma fluid after delivery
lose up to 500 mls with birth especially with C section, which is why there is excess fluid
44
Hypervolemia
helps with fluid loss at delivery
45
vasodilation
with fluid back into C-V system to be excreated
46
watch for orthostatic hypertension if
fluid drops too quickly
47
WBC
increase till 2-6 weeks after delivery, good if infection occurs with trauma
48
measure number of RBC in particular amount of fluid
so with extra fluid looks like less RBC and will go back to normal after excess fluid is loss
49
Thrombophlebitis development
clot formation
50
cardiovascular
P.P. release of 30-40% of plasma fluid after delivery Hypervolemia helps with fluid loss at delivery and then vasdiodilation with fluid back into C-V system to be excreated Hgb., HCT, WBC Thrombophlebitis development
51
Postpartum Assessments
Vital signs ( Blood pressure, Orthostatic hypotension, Pulse, Respirations, Temperature); Fundus; Lochia; Bladder elimination; Perineum; Breasts; Lower extremities; Edema and deep tendon reflexes; Pain
52
Nursing diagnosis
``` Bleeding Infection Pain Elimination Bonding Parenting Individualized concerns-stress, impaired parenting, rest, etc. ```
53
Rhogam
1st - 28 weeks to Rh- mom; 2nd 72 hours post delivery - want to desensitize mom so she doesn't kill next baby
54
Rh- mom and Rh+ baby and antrogen coombs test
moms baby says its a foreign response and forms antibodies that attach to baby's RBCs and destroys them; passive antibodies make baby think its already produced antibodies
55
rubella
postpartum, tell mother not to get pregnant 3 months after getting injected to protect next baby; congunited defects if she gets rubella with baby
56
for future pregnancies -
Rubella Varicella (chicken pox shot) Tetanus-Diphtheria-acellular pertussis (to protect from pertussis) protect herself and exposure of child
57
in order to give rhogam then
mother negative and baby positive
58
if baby Rh- then
no reason for rhogam
59
signs and symptoms of pain
temp of 104, local pain in breast bilaterally, persistent perineum pain, burning/UTI complications, redness/warmth/largeness of legs
60
dark, heavy lochia after 10 days, signs of redness/warmth in leg could be
a clot
61
if breast feeding when can have extra pounds with
enough protein and exercise
62
Discharge
Signs of complications Sexual activity/contraception Medications Mother-Baby care
63
signs and symptoms of pain
temp of 104, local pain in breast bilaterally, persistent perineum pain, burning/UTI complications, redness/warmth/largeness of legs
64
dark, heavy lochia after 10 days, signs of redness/warmth in leg could be
a clot
65
if breast feeding when can have extra pounds with
enough protein and exercise
66
Discharge
Signs of complications Sexual activity/contraception Medications Mother-Baby care

OB Exam 1 (11 decks)

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