Week 1 Flashcards
who defines is family
patient
G/P
- G
gravida
- number of pregnancy gone past 20 weeks
G/P
term - term - term - term
gone to term - preterm - abortion - living
G2 P2-0-0-2
G2: number of preg gone past 20 weeks
P2: term
0: preterm
0: abortion
2: living
EDC
due date
primigravida
pregnant for the first time
multigravida
2 or more pregnancies
who might have longer labor
primigravida
precipitous
quick birth
who is going to have a precipitous birth multi or primi
multi
SVD
spontaneous vaginal delivery
LDRP
labor
delivery
recovery
postpartum
PP
post partum
C/S
cesarean section
typical hospital stay for vginal birth
1-2 days
how long does the mom and newborn have to stay and why
24 hours so complete the new born screening
postpartum peroid
- begin and end
delivery to the return of the reproductive system to the non pregnant state (6-8 weeks)
post partum is also called
puerperium (4th trimester)
puerperium
4th trimester
- post partum
involution
returns to pre pregnant state
within 12 hours of birth where will the fundus be palpated at
1cm above the umbilicus
fundus descends how much per day
1-2 cm
what does a boggy fundus feel like
soft
what is happening when the fundus is boggy
uterus cannot clamp down and usually there will be hemorrhage
when should the fundus not be palpable
2 weeks PP
subinvolution
uterus is not clamping down
what is sub involution usually caused by
retained placental fragments
why do we need to inspect the placenta after delivery
ensure no piece is left in the uterus
what can a full bladder contribute to
hemorrhage since the uterus cannot clamp down
also contributes to the fundus moving to the side making it hard to feel where it is located at
endo oxytocin
from the brain
exo oxytocin
Pitocin med
golden hour
1st hour after birth
what does breast feeding do for the uterus and clamping down
helps clamp down due to secreted oxytocin during breast feeding
when do we give a bolus of pit
after the baby is born
afterpains are going to be stronger in who
multi woman (loss of uterine tone)
over distened uterine muscle because its more the uterus has to clamp down
- multifetal (twins)
- polyhydraminos
- macrosomia
polyhydramnios
increase amniotic fluid
macrosomia
large baby
will the after pains be noticeable during pregnancy
yes
will after pains be notable during administration of oxytocin
yes
placental site is normally healed when
6wks pp
if placental does not separate in 30 min
bimanual exam
lochia is
combination of blood, mucus, and tissue discharged from uterine lining
3 types of lochia
rubra
serosa
alba
rubra lochia
red/brown
heavyish flow
smaller clots
1-3 days
serosa lochia
pink/brown
small amounts of blood
very little amounts of clots
3-10 days
alba lochia
yellowish white
WBC, tissue, bacteria
10-14 days but can last longer
what is abnormal with all lochia
foul odor
saturation of perineal pad in ____ mins or less is considered excessive and may indicate PPH
15 mins
normal vaginal delivery blood loss
<500
normal CS blood loss
<1000
1mL of blood on linens =
1 g in weight
round cervix
never gone through labor
slit like cervix
gone through labor
besides the vaginal and uterus what is the other most important organ in L and D
bladder
presence of free flowing bright red blood may indicate
cervical laceration
if bleeding we
massage the fundus
if the patient is bleeding but you massage the fundus and it is firm what might it be
cervical laceration
hematoma
accumulation of blood in pelvic tissue
s/s of hematoma
unrelenting pain
pressure in vagina or rectum
late signs of hematoma (aka blood loss)
tachy
increase RR
low BP
episiotomies that are healing well are only visible when
pt is laying on side
episiotomies heal within
2-3 weeks
what is abnormal with an episiotomies and may be signs of infection
redness
warmth
swelling
discharge
separation from edges
1st degree tear
superficial to muscle
2nd degree tear
extends through the muscles of the perineal3
3rd degree
through anal sphincter
4th degree
involves anterior rectal wall
uterthral tear
upward from the vaginal towards the urethra
not uncommon to void excess of _______mL per day during first several days PP
3000
colostrum is secreted when
shortly after birth
is colostrum high or small volumes
small since the infants stomach is so small it does not need alot
what should we educate to the mom not wanting to breast feed
tight bra and ice to decrease swelling and stimulation
- No hot shower this will stimulate the breast to make more milk
HR, SV, and CO _________ immediately after giving birth
increase
due to the hemodynamic changes what might be a result
orthostatic hypotension
education on ortho hypo
sit slow and dangle
normally increased blood volume is eliminated within first ___ weeks after delivery
2
pregnancy is a ________ state
hypercoaguble state
- due to increase in fibrinogen and clotting factors
since pregnancy is hypercoaguble this means they are at risk for
DVT
why might WBC increase after birth
boys response to wound in uterus
what is a common complaint of PP
headache
why might headache be caused
hormonal shift or spinal from epidural
TX for hormonal headache
decrease light and noise
increase caffeine
TX for spinal headache
blood patch
preeclampsia can occur for ____ weeks after delivery
4 weeks
what do mothers need to be taught if they go to ED
they are in the PP peroid
what changes in the musculoskeletal
change in center of gravity
- increase fall risk
joints where might not return to normal
feet
atony
bleeding
- lack of tone (boggy)
what is the most frequent cause of uterine bleeding after birth
atony
why might atony be caused
retained placental fragments
we should always screen for what before discharge
depression
what might be common during the childbirth phase
tremors or chills
C section is a post op patient, what should we manage
abdominal dressing
LOC
IV
I and O
cardiac
Bowel sounds
Lung sounds
IS
pain
anesthesia
BUBBLEHE
breast
uterus
bowel
bladder
loch
episiotomy
homans sign (DVT)
emotions
when breastfeeding, why should the baby have the whole areola in the mouth not just the nipple
it could lead to tissue damagef
firm breasts mean
milk is in
we need to assess for what of the fundus
height
location
tone
patient should void every
2 hours
why might fundal assessments be uncomfy in CS patients
assessing right above scar
bowel Q
last BM
passing gass
distension
for assessment of lochia and episiotomies we need to assess for
bleeding, amount, color, character, odor
prevent infection
hand washing and perineal hygiene of the peri bottle
what position should the patient be in when assessing for episiotomies
side
do we do homans sign and why
no because you can dislodge the clot
what to assess for in DVT
redness
warm
pedal pulses
ambulation
emotions
assess between
family members
REEDA
redness
ecchymosis
edema
discharge
approximation
perineal care
ice packs
peri bottle
analgesics
if our patient is sitting down, how might we instruct them so they do not put pressure on perineum
tightening glutes prior to sitting to avoid pressure on perineum
what to assess for during the transition to parent hood
feelings about self
relationships of family origin
social support networks
relationship with partner and infant
maternal adaption 3 phases
- talking in or dependent phase
- taking hold
- letting go or interdependent phase
- taking in or dependent phase
first 24 hours after birth
meet her basic needs
(love self)
- taking hold
2-3 days to several weeks
care of newborn and competent mothering
(love self)
3.letting go or interdepent phase
forward movement of family as unit
(love us)
avanced maternal age
> 35 years
sibbling adapation
regression
discharge starts on
admission
blurred vision and severe headaches might be a sign of
blood pressure
POST BIRTH warning signs
P: pain in chest
O: obstructed breathing
S: seizures
T: thoughts of harming
B: bleeding (excessive)
I: incision not healing
R: redness in calf
T: >100.4 temp, foul smelling discharge
H: headache that does not improve with Tylenol
