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OB > Test 3 Blueprint (1) > Flashcards

Test 3 Blueprint (1) Flashcards

1
Q

How frequently should the nurse perform focused PP assessments after delivery?

A

1st Hour: q15 min
2nd Hour: q30 min if stable
Then every hour for 4 hr
Then every 4-8 hr until discharge

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2
Q

What are the classifications & length of discharge after birth?

A

Rubra (1-3 days)
Serosa (4-10 days)
Alba (11-6 wks)

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3
Q

List the levels and values of lochia rubra.

A

Scant ( 10 cm)
Heavy (pad saturated within 2 hr)
Excessive blood loss (pad saturated in 15 min or less, pooling of blood under buttocks)

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4
Q

What is the consistency of each lochia?

A

Rubra: bright red, bloody, fleshy odor, small clots
Serosa: pinkish brown, serosanguineous consistency
Alba: yellowish, white creamy color, fleshy odor

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5
Q

What does REEDA stand for?

A 
Redness
Edema
Ecchymosis
Drainage
Approximation
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6
Q

What are the steps with uterine involution?

A

(Remember 1 & 2)

  • 1-2 cm below the umbilicus immediately after birth
  • Within 12 hrs rises to umbilicus or slightly above, then…
  • Descends 1-2 cm/day
  • Nonpalpable by 2 weeks
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7
Q

Contractions are initiated and/or maintained by the hormone _____ from the _____ _____ gland.

A

(Remember “OPP”)
oxytocin
posterior pituitary

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8
Q

What 2 meds are administered in PP to maintain a contracted uterus?

A

Pitocin & Methergine (methylergonovine)

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9
Q

What assessment should be made before administering Methergine?

A

Check BP –> hold med if greater than 140/90 or greater

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10
Q

Afterpains are more common in ____ & ____ clients.

A

multigravidas & breastfeeding

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11
Q

When should pain meds/NSAIDS be given to relieve afterpains?

A

before breastfeeding

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12
Q

What is the importance of the process of exfoliation?

A

Tissue regeneration at site of implantation without scar tissue

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13
Q

What should we be concerned about if lochia reverts back to an earlier stage (ex/ serosa then back to rubra)?

A

1) hemorrhage from retained placental fragments

2) infection

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14
Q

What is uterine atony?

A

Uterine muscles fail to contract sufficiently after birth; feels soft and boggy

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15
Q

Atonic uterus leads to…

A

postpartum hemorrhage

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16
Q

What is the most common reason for PP hemorrhage?

A

atonic uterus

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17
Q

When you weigh a peri pad, 1 g equals…

A

1 mL

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18
Q

What is the priority intervention when a PP client is bleeding excessively or if they pass a clot?

A
  • check consistency and location of fundus
  • check for distended bladder
  • massage the uterus
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19
Q

What is the #1 reason for a boggy uterus?

A

full bladder

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20
Q

How do you decide if the uterus is boggy b/c bladder is full or for some other reason?

A

If the fundus is pushed up above where it should be for the day postpartum; or if the fundus is to the left/right

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21
Q

What symptoms would you assess for if the pt’s peri pad is soaked within 1 hours?

A
  • lightheaded
  • nauseated
  • acts anxious, c/o air hunger
  • ashen or grayish skin
  • skin coll & clammy
  • increased HR
  • decreased BP
22
Q

What labs are drawn on mom 12-24 hrs post delivery?

A
  • H&H (esp. c-sec)
  • urinalysis, culture, sensitivity
  • Rubella titer
  • Rh status
23
Q

What do we teach a pt receiving the rubella vaccine?

A
  • if not immune, admin vaccine after birth then again 1 month later
  • avoid pregnancy 1 month after each dose
  • may develop rash
  • safe for breastfeeding
  • allergy to duck eggs may cause hypersensitivity
24
Q

What test checks for Rh antibodies in mom’s blood?

A

Indirect Coombs test

25
Q

When is Rhogam admin?

A

Mid pregnancy
With any invasive procedures
Within 72 hrs postpartum (300 mcg IM)

26
Q

What temperature PP indicates infection?

A

> 100.4

27
Q

What can tachycardia indicate?

A
  • pain
  • fever
  • dehydration
  • hemorrhage
28
Q

What is normal HR?

A

50-90 bpm

29
Q

What is normal resp rate?

A

16-24 breaths/min

30
Q

What do crackles indicate?

A

possible fluid overload

31
Q

What is normal for the breasts:
Days 1-2
Days 2-3
Days 3-5

A

Days 1-2: soft
Days 2-3: filling
Days 3-5: full, soften w/ BF (milk in)

32
Q

Signs of engorgement:

A

Firmness, heat, pain

33
Q

After the first 24 hrs, at what rate should the uterus involute?

A

~ 1 cm/day

34
Q

Excessive discomfort of the perineum indicates:
1st 1-2 days
After day 3

A

1st 1-2 days: hematoma

After day 3: infection

35
Q

Diuresis begins ____ hrs PP; can void ____ ml/day.

A

~ 12 hrs PP

3000 ml/day

36
Q

What days should a BM be seen PP?

A

2-3 days

37
Q

What are normal deep tendon reflexes?

A

1+ to 2+

38
Q

What do DTRs >/= 3+ indicate? Why?

A

Preeclampsia

The more responsive the DTRs, the closer the pt is to seizure activity

39
Q

What are signs of uterine infection PP?

A
  • lochia has offensive odor
  • lochia reverts to earlier stage color or amount
  • lochia persists beyond normal time
40
Q

Interventions for episiotomy discomfort?

A

Ice pack
Sitz bath (after 24 hrs)
Anesthetic sprays
Witch hazel pads

41
Q

What causes frequent and perfuse urination and sweating?

A

Fluid shift, the high fluid volume during pregnancy is no longer needed PP

42
Q

Marked diuresis, decreased bladder sensitivity, and overdistension of the bladder can lead to…

A

problems with urinary elimination, esp. UTI

43
Q

Why is the PP client at risk for thrombus?

A
  • activation of blood clotting factors

- immobility

44
Q

What is the best prevention of thrombus formation?

A

early ambulation

45
Q

What are symptoms of deep vein thrombosis?

A
  • reddened, warm area over the affected vein

- pain/tenderness on ambulation

46
Q

What is the usual treatment for DVT?

A
  • bed rest
  • moist heat
  • anticoagulant (Heparin)
    • Don’t perform Homan’s sign if leg pain, could dislodge clot if there is one.
47
Q

What is the greatest danger after development of a thrombus (or thrombophlebitis)?

A
  • the thrombus will become a moving clot or embolus
48
Q

What should be suspected if mom is leaning over trying to get a breath?

A

Pulmonary embolism

49
Q

What anticoagulant would be given to the lactating client if needed? Why?

A

Heparin

Doesn’t cross into the breast milk as much

50
Q

What is the normal lab value for maternal WBCs during PP?

A

20,000 to 25,000 mm3

51
Q

What are the 2 major problems with full bladder in the PP pt?

A

1) Atonic uterus - pushes uterus upward, prevents contraction
2) UTI - retention & stasis of urine r/t decreased muscle

OB (12 decks)

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