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85 Cards in this Set

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Why does pregnancy increase the risk of thrombophlebitis?
Because of the increased clotting.
What are the cardinal movements?
*Engagement.
*Descent.
*Flexion.
*Internal rotation.
*Extension and restitution.
*external rotation.
*Expulsion.
After a C-section the woman has a Foley for approximately ____ hours. Then, we give her approximately ___ hours to empty her bladder.
24; 4
What is active labor defined as?
Cervix >90% Effaced;
<1 cm in length
3 cm dilated.
Painful contractions
Genital tract infectoins:
Choramnioitis occurs in the _____.
Endometritis occurs in the _____.
Parametritis occurs in the _____.
amniotic membrane/fluid; placental; pelvic connective tissue.
What happens in the 2nd stage of labor?
Pushing. Birth of the baby. Avg. length 30 minutes to 1 hour.
What are the stages of lochia?
Rubra (1-3 days)
Serosa (3-10 days) brownish, clear.
Alba (can continue six weeks)
What happens in the first stage of labor?
1st stage is the process of dilation.
There are three phases.
From 0-10 cm.
Avg. length 12-14 hours.
When is the highest risk of postpartum hemorrhage?
1st hours after birth.
What happens in the 3rd stage of labor?
Delivery of the placenta. Avg. length 20-30 minutes.
What are some signs of placental separation?
Uterus firm.
Change of shape from discoid to globular.
*Visible bulge above pubis.
*Apparent cord lengthening.
*Bleeding.
*Membranes/bulging at introiduc.
What is restitution in the cardinal movements?
Where the baby turns right as it is coming out of the vagina.
When do Cesarean infections occur?
3-4th day postpartum.
What happens in the 4th stage of labor?
First 2 hours of recovery time.
How long does it take the cervix to close after delivery?
Several weeks.
What is latent/prodome labor defined as?
Cervix <90% effaced.
>1 cm in length.
<3 cm
What are the symptoms of genital tract infections?
Temp.
Subinvolution.
Malaise.
Lethargy.
Chills.
Backache.
Tachycardia.
Foul smelling lochia.
What are some helpful hints during the early (latent) 1st stage of labor?
Eat and drink lightly. Ambulate.
How many days does it take for the uterus to complete involve back into the pelvis after delivery?
Approximately 9 days, starting at the umbilicus the first day and then going 1 fingerbreadth below the umbilicus with each subsequent day.
About how long does active labor last?
Approximately 3 to 4 hours; progressing about 1 cm/hour.
If a fever occurs in the first 48 hours PP, what is the most likely cause?
Atelectasis.
What are some postpartum complications?
Anemia.
Early/late postpartum hemorrhage.
Hematoma/lacerations.
Retained placental parts.
Infection.
Thrombophlebitis.
Postpartum depression.
What are the symptoms of mastitis?
Temp.
Chills.
Malaise.
Hard red, tender irregular mass in one or both breasts.
Pain.
Engorgement.
The placenta releases a hormone that works _______ insulin.
against.
What is thrombophlebitis?
An infection in lining of the vessel.
What do we assess the perineum for in the 4th stage of nursing?
Lacerations.
Swelling.
Hematoma.
If a fever occurs 3 to 7 days PP, what is the most likely cause?
Wound or septic thrombophlebitis.
A high temp >24 hours indicates ________.
Infection.
With respect to thrombophlebitis, postpartum increases risk of?
VEnous stasis.
Blood viscosity.
Limited ambulation.
Fibrinogen which peaks at 1-2 days and is elevated for 2 weeks puts the post-partum woman at risk for?
DVT.
What are the organisms causing genital tract infections?
Strep, GBS and E. Coli.
What are contractions like in the active phase of labor?
3-5 minutes apart, regular and lasting 30 to 45 seconds.
Retained placenta.
Continuous painless bleeding in the absence of lacerations or uterne atony.
Uterus remains large.
Evacuation necessary.
May cause infection, late hemorrhage.
How much dilatation occurs in active labor?
4 to 7 cm.
What are some risk factors for PP infections?
PROM.
Prolonged labor.
Vaginal exams.
What does a left shift indicate?
Infection.
What is the best prevention of thrombophlebitis?
Early ambulation or ROM.
Be cautious about a systolic BP below ____.
100.
What are the treatments for early hemorrhage treatment?
Keep bladder emptied.
Fundal massage until firm.
IV or IM Pit 10 units.
IM Methergine 0.2 mg.
Hemabate.
Evaluate response.
Remedy the cause.
What are the purpose of eosinophils?
They fight allergic reactions and parasitic infections.
When would we not give Methergine?
In someone with HTN.
How do we prepare for discharge?
Education of:
1) Self-care.
2) Nutrition to aid recovery.
3) S&S of infection
*Episiotomy.
*Incision.
*Breast.
4) How to obtain help quickly.
5) Newborn care.
6) Normal sibling adjustment patterns.
7) Sexual activity.
8) Contraception.
9) Medications.
10) Resources.


Postpartum infections occur in approximately __% of births.
6
What are some helpful hints during active labor?
Ambulation.
Position changes.
Urinate frequently.
Relaxation skills.
Massage.
Music.
Water therapy.
Strong encouragement.
Keep a positive attitude.
When does late PP hemorrhage occur? What is it from? What do we do about it?
From retained placental parts or subinvolution. It is excessive bleeding after 2 to 4 weeks PP. We give Methargine 0.2 mg po or gentle curettage or both. And, antibiotics for endometritis.
At the incision on the abdomen, we should look at REEDA which stands for what?
Redness.
Edema.
Ecchymosis.
Discharge.
Approximation.
What do we think of when we think of UTI's?
Voiding volume.
Symptoms of pain, fever, hematuria, distention, vaginal bleeding, backache, boggy uterus.
When does "laboring down" happen?
During the transition phase. This is a deceleration phase; a 1 to 2 hour rest period between the 1st and 2nd stage.
If a fever occurs 2 weeks PP, what is the most likely cause?
Mastitis.
What are some helpful hints during the transition phase of labor?
Intense coaching, fanning, sips and chips, positioning, and reassurance.
If a fever occurs 72 hours PP, what is the most likely cause?
UTI. Pneumonia.
What happens in the transition phase of labor?
Lasts approximately 1/2-1 hour. Dilating 7-10 cm. COntractions are most intense, 2-3 minutes apart, lasting 45 to 60 seconds. There may be severe pain, backache, pelvic pressure, trembling, N/A.
When does thrombophlebitis usually occur?
Onset 10-20 pp days.
What do we assess lochia for in the 4th stage?
Amount.
COlor.
Clots.
Odor.
Pads soaked.
If a fever occurs 7 to 14 days PP, what is the most likely cause?
Wound abscess.
The average blood loss for a vaginal delivery is ___ cc versus the CS of ____ cc.
500; 750
During the fourth stage of nursing we want to assess?
1) Pulse.
2) BP.
3) Uterine involution.
4) Lochia.
5) Ability to urinate independently.
6) Perineum.
7) Emotions.
Individuals w/certain medical conditions may have more problems in the post-partum period. Give some examples?
PIH. MVP. People with poor heart function.
In the WBC differential what are the five different types of cells?
Neutrophils.
Lymphocytes.
Monocytes.
Eosinophils.
Basophils.
What is the purpose of monocytes?
They are phagocytes which fight severe infection.
An increased number of neutrophils indicates?
Infection. Neutrophils are phagocytes.
What are the key things multips want to know after childbirth?
Sibling adjustment.
Exercise.
Diet/nutrition.
Fatigue.
Recognizing illness.
Calming a crying baby.
Circumcision.
What might a woman's emotions be during the 1st (latent) stage of labor versus active labor?
In the first stage, she may be excited, apprehensive, keeping busy or resting at night. In active labor, she may be inwardly focused, serious, can be painful and having doubts.
What are some of the things that can be done for maternal comfort during the 4th stage of labor?
Urination.
Bathing.
Food.
Hydration.
Rest.
Basophils
Parasitic infections.
Hgb decreases immediately after birth. It slowly rises on day ___ to ___.
2 to 4.
The hematocrit may increase/decrease slightly after birth.
Increase
There is an increased risk of __________ failure postpartum.
heart
What might be some normal emotions during the 4th stage?
Fatigue.
Pain.
Watch for normal patterns of maternal-infant attachment.
What is a normal WBC count?
5000-10,000
What is the significance of a shift to the left with overall leukocytosis in the WBC differential?
There are increased immature forms (bands/stabs) in bacterial infections.
Without lcukotycosis there is a good/poor prognosis?
Poor.
What are the contractions like in the 1st (early) phase of labor?
Contractions mild, irregular; 5-30 minutes apart, lasting 10 to 30 seconds.
There is an ________ cardiac output post-partum.
Increased.
What are some key things about anemia?
Recognize EBL.
Vital signs.
Impact of uterine involution.
Treat with diet and vitamins.
Dismissal teaching.
What would a temp up to 100.4 in the first 24 hours following delivery indicate?
Dehydration.
What are the purpose of lymphocytes?
To fight viral infections.
Why are platelets important in the post-partum period?
For clotting.
Why is it bad to have a full bladder post-partum?
The filled bladder displaces the uterus to the side and the uterus cannot contract and bleeding becomes more profuse.
What are some helpful hints during the 4th stage of labor?
*Respect privacy but give good nursing care.
*Careful assessments.
*Help her to get bathed.
*Feed her.
*Keep baby close by.
*Assess baby for stability.
How long does it take for the vagina to regain tone?
4-6 weeks because the rugae were stretched.
Is leukocytosis normal in the first 2 weeks post-partum?
Yes, it can be anywhere from 12-15,000.
What are the key things primaps want to know after childbirth?
Exercise.
Diet/nutrition.
Fatigue.
Recognizing illness.
Calming a crying baby.
Baby care.
Baby's schedule.
What are some predisposing risk factors of hemorrhage?
Previous post-partum hemorrhage or uterine surgery.
Coagulation disorders.
Multiple gestations.
Labor induction.
Rapid or prolonged labor.
Pre-eclampsia.
Sepsis.
Placental abnormalities.
What things do we want to assess for early post-partum hemorrhage?
The fundus.
Perineum.
Pads.
BP
Pulse.
Hgb.