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OB test 3 > Postpartum Nursing > Flashcards

Postpartum Nursing Flashcards

1
Q

True or False
A woman should be afebrile.

A

True

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2
Q

Temperature may be ____ for 24 hours after the breast milk comes in.

A

increased

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3
Q

You will see a transient rise in ____ ___ but it will return to pre-pregnancy baseline in a few days following delivery.

A

Blood pressure

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4
Q

Low BP can be a sign of:
decreased _____ pressure
OR
_____ _____ r/t hypovolemia

A

intrapelvic
postpartum hemorrhage

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5
Q

High BP can be due to:
excessive use of ____
________
postpartum _____ ______

A

oxytocin
vasopressors
pre-eclampsia

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6
Q

Postpartum women will be slightly ____ for the first 6-10 days secondary to decreased cardiac effort, decreased blood volume, and increased stroke volume

A

bradycardic

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7
Q

What is tachycardia a sign of in a postpartum woman?

A

hypovolemia
infection
anxiety
pain
***requires further nursing assessment

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8
Q

The uterus rapidly decreases in size to pre-pregnancy size in a process called ____.

A

involution

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9
Q

Placental site heals by _____.

A

exfoliation

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10
Q

The fundus will be at the level of the umbilicus ___ hours postpartum.

A

12

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11
Q

The fundus will be 1 cm below the umbilicus on the ___ postpartum day.

A

first

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12
Q

The fundus will descend 1 cm per day until it is in the pelvis on the ___ day.
*NO longer palpable

A

10th

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13
Q

The uterus will will reach its pre-pregnant size by __ - __ weeks postpartum.

A

5-6

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14
Q

When documenting a fundal check, the nurse should include?

A
  1. Consistency
  2. Location
  3. Height
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15
Q

When completing fundal palpation, the nurse should have 1 hand above the ___ ___ & 1 hand at the level of ____. Press inward and downward.

A

symphysis pubis
umbilicus

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16
Q

If you do not support the lower uterine segment when doing fundal palpation, it could result in?

A

uterine inversion & hemorrhage

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17
Q

What potential risk is greatest if the fundus is boggy?

A

Increased bleeding

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18
Q

How does a well-contracted fundus feel?

A

firm, round, and midline

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19
Q

How would you document the amount of lochia present?

A

scant, small, moderate, or heavy

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20
Q

True or False
Lochia should have a foul odor.

A

FALSE, it should never have a foul odor because this indicates infection

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21
Q

Lochia rubra is ___ ___
It is seen for the first __-__ days
It has a fleshy odor and small clots are common

A

bright red
2-3

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22
Q

Lochia serosa is ___
It is seen for days __-__

A

pink
3-10

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23
Q

Lochia alba is ___
This will continue until the ___ is ___

A

white
cervix is closed

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24
Q

Normal vaginal blood loss is between ___ - ____ mL

A

200-500

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25
Q

Normal cesarean blood loss is between ___ - ____ mL

A

700-1000

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26
Q

For every ___ mL of blood loss, hemoglobin drops 1-1.5 and hematocrit drops __-__%

A

500
3-4%

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27
Q

1 gram = how many mL of blood?

A

1 mL

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28
Q

A postpartum hemorrhage is defined as blood loss > ___ mL after childbirth OR clinically drop of hematocrit ___ or more from pre-delivery value

A

500
10%

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29
Q

___ (primary) postpartum hemorrhage is within the first ___ hours after delivery
*this is MORE common

A

Early
24

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30
Q

___ (secondary) postpartum hemorrhage is from ___ hours to ___ ___ after delivery.
This is due to _____ (failure to return to normal uterine size)

A

Late
24 hours - 6 weeks
sub involution

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31
Q

____ is the most important in management, identify risk factors

A

Prevention

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32
Q

What is the goal of postpartum hemorrhage treatment?

A

Maintain Hgb >8 g/dl
Plt count > 75,000

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33
Q

Some treatment options for a postpartum hemorrhage are:
Correct ____
manual ____
Oxytocin, __, Hemabate, __
Administer ___ products
balloon ____
B-lynch suture
________

A

**hypovolemia
compression
methergine, cytotec
blood
tamponade
hysterectomy

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34
Q

What are the 4 T’s?

A

Tone, Trauma, Tissue, Thrombin

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35
Q

Nursing care for a woman with a postpartum hemorrhage:
1. uterine ____ if a soft, boggy uterus is detected
2. frequent ___ ___
3. assess fundus and ___ often
4. encourage frequent ____ or ____ the woman
5. ____ access
6. assess abnormalities in ____ levels
7. Assess ____ output
8. encourage rest and take ____ precautions

A

massage
vital signs
bleeding
voiding or catheterize
vascular
hematocrit
urinary
safety

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36
Q

Nursing care for a patient that had an episiotomy or laceration:
- offer ___ ___ (pain/swelling)
- keep area ___ & dry (infection)
- frequent ___ ____
- clean after ___ & ____ (perineal bottle with warm water)

A

ice packs
clean
sitz baths
voiding & stooling

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37
Q

What education should be given to a mother with an episiotomy/laceration?

A
  • avoid: tampons and douches
  • pelvic rest for 6 weeks
  • complete healing = 4-6 months
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38
Q

Recommended treatment for perineal discomfort:
___ packs (first 12-24 hours)
___ baths 3-4 times daily
____ ___, don’t wipe, use warm water to clean area
encourage patient to ___ ___ before sitting
____ regimen
monitor ____

A

ice
sitz
peri-bottle
tighten buttocks
bowel
perineum

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39
Q

A perineal hematoma can occur after spontaneous or operative ____ ____

A

vaginal delivery

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40
Q

Patient usually complains of pain or an inability to void depending on the ___ and ___ of the hematoma

A

size and location

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41
Q

What is surgical treatment for a perineal hematoma?

A

incision and drainage

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42
Q

What are some conservative treatment options for a perineal hematoma?

A

ice packs, observation, pain management, bladder drainage

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43
Q

Nursing interventions for a patient with a with hemorrhoids:
1. encourage __-__ glasses of water
2. high ___ diet
3. avoid urge to ____
4. avoid ____
5. offer ___ ____
6. early ____

A

6-8
fiber
defecate
straining
stool softeners
ambulation

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44
Q

Does a patient have to have a bowel movement prior to d/c?

A

No

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45
Q

When does mensuration return in the non-breastfeeding woman?

A

7-12 weeks

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46
Q

When does ovulation occur in the non-breastfeeding woman?

A

70-75 days

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47
Q

The abdominal wall appears loose/flabby and will respond to exercise in __-__ months

A

2-3

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48
Q

Striae will take on different colors based on the mothers skin color and will ___ ___ but remain visible

A

gradually fade

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49
Q

What is diastasic recti abdominis?

A

separation of abdominal muscle (esp women with poor abdominal tone)

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50
Q

Is diastasis recti more common in mothers that had a c-section or vaginal birth?

A

c-section

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51
Q

Does diastasis recti ever fully heal?

A

No but it does respond to exercise

52
Q

Diastasis recti can cause?

A

-low back pain
-constipation
-urine leakage
-hernia

53
Q

What does recovery look like for the first hour following a c-section?

A

VS monitored closely, high risk of bleeding, epidural effect, can hold baby

54
Q

What does recovery look like for the 1st day following a c-section?

A

foley first 6-8 hours, advance diet as tolerated, pain management

55
Q

What does recovery look like for the 2nd day following a c-section?

A

walking encouraged, passing gas, IV transitioned to saline locked, shower, normal diet

56
Q

What does recovery look like for the 3rd and 4th day following a c-section?

A

bandage removed from incision, wound care teaching, staples out if used

57
Q

Following a c-section, the nurse should check the status of the ____ and report any significant ___ or ____ to the provider

A

dressings
drainage or discharge

58
Q

What is the most common organisms associated with perineal cellulitis and episiotomy?

A

Staphylococcus or Streptococcus

59
Q

Vaginal secretions contain as many as 10 billion organisms per gram of fluid. Yet, infections develop in only ___% of patients who had vaginal tears or who underwent episiotomies.

A

1

60
Q

Postpartum endometritis is defined as an infection the _____.

A

decidua

61
Q

What are the most common pathogens causing postpartum endometritis?

A

normal vaginal flora or gram negative organisms

62
Q

What are s/s of postpartum endometritis?

A

fever (first 24-72 h)
pain/tenderness in pelvis
tachycardia
purulent vaginal discharge

63
Q

What are risk factors for postpartum endometritis?

A

c-section delivery, prolonged rupture of membranes, prolonged use of internal fetal monitoring, GBS+

64
Q

What is the treatment for postpartum endometritis?

A

broad-spectrum antibiotics given IV until women are afebrile for 48 hours

65
Q

____ ____ is elimination of fluid/waste products through increased perspirations
-feels like menopausal hot flashes
-frequently occur at night
-no clinical significance

A

postpartum diaphoresis

66
Q

___ ___ are uterine contractions (shrinking the uterus back to normal size)

A

after pains

67
Q

After pains are more common in the____ patient or during ____

A

multiparous
nursing

68
Q

After pains usually last __-__ days.

A

2-3

69
Q

What are some treatment options for after pains?

A

lying on abd, ambulation, heat, mild analgesia

70
Q

Breastfeeding mothers increase intake by ___ kcal in addition to the 300 kcal from pregnancy.

A

200
total 500 kcal additional per day

71
Q

Non-breastfeeding mothers decrease intake by ___ kcal

A

300
return to pre-pregnancy caloric intake

72
Q

What are some abnormalities the nurse may find when assessing the breasts?

A

reddened areas or engorgement

73
Q

What should the nipples look like during an assessment?

A

soft, pliable, everted

74
Q
A
75
Q

What are some options for nipple cracking/irritation?

A
  • clean warm water, no soap
    -use absorbent breast pads
    -apply breast milk to nipples and areola after each feeding
    -apply warm compress after each feeding
76
Q

During breastfeeding, the mother should position the nipple so that the infants mouth covers a ___ portion of the areola

A

large

77
Q

To release suction, insert a ___ into the infants cheek

A

finger

78
Q

Ways to help with engorgement:
1. nurse frequently __-__ hours
2. empty each breast completely (listen for sucking without ___)
3. warm shower/compress to stimulate ____
4. alternate ____ breast with each feeding
5. ___ ____ b/w feedings for pronounced discomfort

A

1/2-3
swallowing
letdown
starting
cool compress

79
Q

What are some S/S of plugged milk ducts?

A

tenderness, lump in area of plugged milk duct

80
Q

What is the treatment for a plugged milk duct?

A

warm compress, massage prior to breastfeeding
**IF unrelieved it can lead to mastitis

81
Q

What is the most common causing organism of mastitis?

A

Staph aureaus

82
Q

What are some risk factors for mastitis?

A

sore nipples, cracked nipples, blocked milk ducts, yeast of breast or mouth

83
Q

What is the treatment plan for mastitis?

A

improve breastfeeding technique, antibiotics, anti-fungal if candida present

84
Q

What are some preventative measures for mastitis?

A

optimize breastfeeding, appropriate latch, hand washing, supportive bra, prompt attention to blocked milk ducts

85
Q

What are some complications of mastitis?

A

breast access, septicemia

86
Q

Can a breastfeeding mother continue to breastfeed while bring treated for mastitis?

A

YES, the breast milk is not contaminated

87
Q

How should a non-breastfeeding mother dry up her milk supply?

A

-tight-fitting supportive sports bra
-apply cold compresses or cabbage leaves
-avoid breast stimulation or heat to breast

88
Q

Breastfeeding mothers should NOT consume alcohol for at least __ hours before nursing and alcohol consumption should be ___ to occasional use

A

2
limited

89
Q

The muslim culture places a strong emphasis on the legal ____ of a woman and man for raising children.

A

marriage

90
Q

Physical pain a mother endures during pregnancy/childbirth = _____ ___ in muslim culture

A

elevated status

91
Q

Cultural norms in muslim culture:
Avoid ___ contact: sign of respect
Avoid ____ of opposite sex or strangers
___ hand is unclean, use ___ hand for feeding/meds
____ covers arms/legs/chest/head
Prefer ____ birth attendant
Avoid ___, ___, gelatin due to fasting rules in Ramadan
Prefers ____ the first 2 years

A

eye
touch
left, right
Hijab
female
pork, lard
breastfeeding

92
Q

Traditional asian men frequently ___ ___ attend the delivery

A

DO NOT

93
Q

____ is the perfect labor position in asian culture

A

Squatting

94
Q

Maternal confinement after childbirth for ___ weeks is common in asian culture

A

3

95
Q

Asians may request warm water/tea and refuse __ ___

A

ice packs

96
Q

In hispanic culture, to protect herself a woman should carry a __ __ or wear a __ ___ around their waist

A

safety pin
red string

97
Q

___ food are preferred during postpartum among hispanic women

A

Hot

98
Q

In hindu culture, childbirth is a ____ activity

A

religious

99
Q

In hindu culture the baby is bathed then dressed in all new attire and the red dot is put on. Some people also name the child on the ___ day.

A

sixth

100
Q

In hindu culture, names are chose according to _____

A

astrology

101
Q

Haitian mothers are placed on strict ____ for 3 days after delivery

A

bedrest

102
Q

In Haitian culture, “White and cold” foods are believed to increase vaginal discharge/risk of ____

A

hemorrhage

103
Q

Haitian women __ ___ encourage circumcision

A

do not

104
Q

Haitian women are encourage to ___ the baby’s ____ to narrow the ____

A

pinch
nose
nostrils

105
Q

Nursing care for the mother who relinquishes her infant:

A

active listening
provide non-judgmental support
show concern and compassion
personalize care for the mother

106
Q

Nursing care for the adolescent mother post-discharge:

A

childcare
transportation
financial support
education

107
Q

____ ___ is a transient period of depression; occurs during three to seven days postpartum

A

Postpartum blues

108
Q

Postpartum blues occurs in ___ of new mothers

A

85%

109
Q

S/S of postpartum blues?

A

Roller coaster of emotions
mood swings
anger
weepiness
anorexia
difficulty sleeping
feeling of being let down

110
Q

What causes postpartum blues?

A

hormones, lack of sleep, adjusting to newborn, anxiety

111
Q

What is the treatment of postpartum blues?

A

sleep, support, time

112
Q

Postpartum depression starts within __-__ weeks of having a baby

A

1-3

113
Q

Postpartum depression occurs in __ out of ___ new mothers

A

1, 7

114
Q

S/S of postpartum depression?

A

crying for no reason, hopeless, overwhelmed, moody, irritable, panic or excessive worry, thoughts of self harm, ***risk of suicide

115
Q

What are risk factors for postpartum depression?

A

hx of depression or bipolar disorder, stressful life event, ambivalence, lack of support, age <20

116
Q

What is treatment for postpartum depression?

A

counseling, support group, medication

117
Q

What is the most effective treatment of PPD?

A

combination of psychotherapy and antidepressants

118
Q

Most woman show signs of improvement in __-___ weeks using SSRI medication

A

2-6

119
Q

PPD mothers should continue medical therapy for ___ after symptoms resolve

A

1 year

120
Q

___ ___ is an acute mental disorder or psychotic reaction following childbirth

A

postpartum psychosis

121
Q

Onset of postpartum psychosis is __- __ months after delivery, usually in the first ___ days

A

1-3
10

122
Q

S/S of postpartum psychosis?

A

insomnia, agitated or paranoid, delusions or hallucinations, impulsive, depersonalization, risk of suicide or infanticide

123
Q

risks for postpartum psychosis?

A

Hx of postpartum psychosis or hx of bipolar disorder

124
Q

___ ___ is considered a psychotic emergency that requires ____

A

Postpartum psychosis
hospitalization

125
Q

Treatment for postpartum psychosis?

A

immediate hospitalization, psychological counseling, family support/education, ECT, medications

126
Q

The greatest barrier to treatment for PPD in women is?

A

fear of stigma and lack of knowledge

OB test 3 (1 decks)

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