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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
Q

Dyspareunia

A

pain with intercourse

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26
Q

Hemorrhoids

A

get worse during birth process because of pressure

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27
Q

After Birth Contractions

A

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
Q

Episiotomy

A

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
Q

First Episiotomy

A

skin only

30
Q

Second Episiotomy

A

skin and muscle tissue

31
Q

Third Episiotomy

A

into the rectal sphincter (don’t give enemas or suppositories)

32
Q

Fourth Episiotomy

A

through the rectal sphincter and into the rectum (don’t give enemas or suppositories)

33
Q

how to assess every incision

A

REEDA - redness, edema, ecchymosis (black and blue), drainage, approximation

34
Q

median or midline Episiotomy

A

heels easier

35
Q

Mediolateral Episiotomy

A

can make wider opening, bypass rectal sphincter but more painful and harder to heal

36
Q

Assessing the woman’s bladder for distension after delivery

A

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
Q

Signs of a Distended Bladder

A

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
Q

massaging the fundus

A

support at pubis because if you don’t uterus can turn inside out (uterus inversion)

39
Q

Dilation of ureters can increase (urinary problem)

A

UTI occurance

40
Q

Urinary

A

Dilation of ureters can increase UTI occurance
Elevated BUN with autolysis of uterine tissue—WNL’s in 6 wks.
Diuresis
Diaphoresis

41
Q

diuresis

A

excessive elimination, increases by 30-40% during pregnancy, has to get rid of fluid

42
Q

diaphoresis

A

excessive sweating; helps get rid of extra fluid

43
Q

P.P. release of 30-40% of plasma fluid after delivery

A

lose up to 500 mls with birth especially with C section, which is why there is excess fluid

44
Q

Hypervolemia

A

helps with fluid loss at delivery

45
Q

vasodilation

A

with fluid back into C-V system to be excreated

46
Q

watch for orthostatic hypertension if

A

fluid drops too quickly

47
Q

WBC

A

increase till 2-6 weeks after delivery, good if infection occurs with trauma

48
Q

measure number of RBC in particular amount of fluid

A

so with extra fluid looks like less RBC and will go back to normal after excess fluid is loss

49
Q

Thrombophlebitis development

A

clot formation

50
Q

cardiovascular

A

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
Q

Postpartum Assessments

A

Vital signs ( Blood pressure, Orthostatic hypotension, Pulse, Respirations, Temperature); Fundus; Lochia; Bladder elimination; Perineum; Breasts; Lower extremities; Edema and deep tendon reflexes; Pain

52
Q

Nursing diagnosis

A 
Bleeding
Infection
Pain
Elimination
Bonding
Parenting
Individualized concerns-stress, impaired parenting, rest, etc.
53
Q

Rhogam

A

1st - 28 weeks to Rh- mom; 2nd 72 hours post delivery - want to desensitize mom so she doesn’t kill next baby

54
Q

Rh- mom and Rh+ baby and antrogen coombs test

A

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
Q

rubella

A

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
Q

for future pregnancies -

A

Rubella
Varicella (chicken pox shot)
Tetanus-Diphtheria-acellular pertussis (to protect from pertussis)
protect herself and exposure of child

57
Q

in order to give rhogam then

A

mother negative and baby positive

58
Q

if baby Rh- then

A

no reason for rhogam

59
Q

signs and symptoms of pain

A

temp of 104, local pain in breast bilaterally, persistent perineum pain, burning/UTI complications, redness/warmth/largeness of legs

60
Q

dark, heavy lochia after 10 days, signs of redness/warmth in leg could be

A

a clot

61
Q

if breast feeding when can have extra pounds with

A

enough protein and exercise

62
Q

Discharge

A

Signs of complications
Sexual activity/contraception
Medications
Mother-Baby care

63
Q

signs and symptoms of pain

A

temp of 104, local pain in breast bilaterally, persistent perineum pain, burning/UTI complications, redness/warmth/largeness of legs

64
Q

dark, heavy lochia after 10 days, signs of redness/warmth in leg could be

A

a clot

65
Q

if breast feeding when can have extra pounds with

A

enough protein and exercise

66
Q

Discharge

A

Signs of complications
Sexual activity/contraception
Medications
Mother-Baby care

OB Exam 1 (11 decks)

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