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106 Cards in this Set
- Front
- Back
- 3rd side (hint)
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how long is the postpartum period?
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up to 6 weeks after birth
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What does the immediate postpartum period range?
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first 24 hours
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what range does the early postpartum period cover?
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1st week
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What does the late postpartum period cover?
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weeks 2 - 6
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The shrinking or returning to normal size of the uterus, cervix, and vagina is called the process of what?
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involution
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How is involution assessed?
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by measuring fundal height
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Immediately after delivery how should the fundus feel and where should it be?
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firm and located in the midline halfway between the umbilicus and symphysis pubis
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One hour after delivery how should the uterus and fundus be?
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uterus should be contracted firmly, and fundus midline at the level of the umbilicus
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The day after delivery the fundus should be where?
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1cm below the umbilicus
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How does the fundus change in location after the first day up to about the 10th day?
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1cm per day until it has descended below the level of the pubic bone and can no longer be palpated
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Breast feeding stimulates ______ release from the woman's posterior pituitary gland, which stimulates the uterus to contract.
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oxytocin
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What does a full bladder do to uterine contactions?
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impedes them by pushing upward on the uterus and displacing it.
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What can hinder contraction of the uterus?
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full bladder, multifetal pregnancy, hydramnios, maternal exhaustion, excessive analgesia, retained placental fragments, infection, and grand multiparity.
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How does a boggy uterus feel?
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soft and spongy, instead of firm and well contracted.
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What causes a boggy uterus?
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when the uterus does not contact effectively, blood and clots collect in the uterus, which makes it more difficult for the uterus to contract. leading to...
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What causes afterpains?
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after delivery, the uterus contracts and relaxes at intervals which leads to afterpains.
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what can breast feeding do to afterpains?
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release of oxytocin increases the duration and intensity of afterpains.
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What is lochia composed of?
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blood, mucus, tissue, and white blood cells.
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Explain which lochia this is: occurs during the first 3 to 4 days, is of small to moderate amount, is composed mostly of blood, is dark red in color, and has a fleshy odor.
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lochia rubra
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what is this lochia: occurs during days 4 to 10, decreases to a small amount, and takes on a brown-ish or pinkish color.
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lochia serosa
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what is this lochia: occurs after day 10, and becomes white or pale yellow because the bleeding has stopped and the discharge is now composed mostly of white blood cells.
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lochia alba
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how long may lochia occur?
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within 6 weeks, but usually stops around 2-3 weeks.
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Does lochia contain large clots?
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it should never have that nasty shit in there!
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What are abnormal findings in lochia?
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reversal of pattern (serosa back to rubra), lochia that fails to decrease in amount or actually increases, or malodorous lochia.
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How soon can ovulation occur after delivery?
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as soon as 3 weeks.
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When do menstrual periods begin after delivery?
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within 6 to 8 weeks with nonbreastfeeding.
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If you breast feed when should menstrual cycle begin again?
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as long as 18 months later
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Can a woman have menstrual bleeding without ovulating?
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yes
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Can ovulation occur without return of menstrual blood?
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yes
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How long until the cervix usually recovers after vaginal birth?
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6 weeks
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How are the walls of the vagina right after delivery?
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smooth
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how long until the walls of the vagina regain rugae after delivery?
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3 weeks
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What is dyspareunia?
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pussy desert (the hot desert, not the pie desert) sick fuck!
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Why would a woman have pussy dryness while breast feeding?
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because breast feeding suppresses ovulation, estrogen levels remain lower in the lactating woman, which leads to it.
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How long does it take for an episiotomy to heal?
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several weeks
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Prolactin levels rise when what levels fall after delivery of the placenta?
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estrogen and progesterone
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sucking on the teet causes what levels to rise?
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prolactin
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what day does breast milk usually start a squirting?
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3rd day
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Normal vaginal delivery usually has how much blood loss?
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300-500ml
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Csection usually has how much blood loss?
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500-1,000ml
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How are the plasma and fibrinogen levels during postpartum?
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high
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For every 250ml of blood loss, the hematocrit and hemoglobin will fall how many points?
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hemat - 2
hemog - 1 |
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What causes risk for DVT postpartum?
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high plasma and fibrinogen levels, dehydration, immobility, and trauma.
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How high is the WBC usually in postpartum?
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15,000 to 20,000 / mL
may be as high as 30k |
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What is normal for the womans heart rate during the first week postpartum?
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slow. as low as 50 bpm is normal.
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What is diastasis recti abdominis?
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condition in which the abdominal muscles separate during the pregnancy, leaving part of the abd wall without muscular support.
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How long after delivery is the bowel function supposed to be returned to normal?
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end of 1st week
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postpartum what is urinary output like?
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exceeds intake. Transient glycosuria, proteinuria, and ketonuria are normal.
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If you palpate the fundus and find that it is above the umbilicus, deviated to the right side, and boggy, what is the most likely cause?
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full bladder
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hydronephrosis, dilation of the renal pelvis and ureters, is normal or abnormal during pregnancy? If it occurs when does it go away?
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normal - 4 weeks
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Hydronephrosis and urinary stasis predispose you to what?
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UTI
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Immediately after delivery of infant and placenta how much weight is lost?
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10-12lbs
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How much weight is usually lost in the early postpartum period because of fluid loss?
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5lbs
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How long until the average woman returns to prepregnancy state weight wise?
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6 months
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What are the three phases of psychological adaptation?
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taking in, taking hold, and letting go
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Explain the taking in phase.
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mother is dependent on others, focused concern on herself, not a good time to teach newborn care.
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Explain taking hold phase.
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she becomes receptive to infant care instruction, starts taking care of the kid more, may last from 2 days to several weeks.
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Explain letting go phase.
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she begins to see her infant as separate from herself.
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What is the enface position?
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face to face with infant and mother
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what is postpartum blues?
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a temporary depression that usually begins on the 3rd day and lasts for 2 or 3 days. tearful, have difficulty sleeping and eating, and feel generally let down.
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Most women who delivery vaginally, go home when?
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24-48 hours
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during the first hour after delivery when are vital signs of the woman assessed?
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every 15 minutes
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How often should a head to toe assessment be done on the woman?
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at least every shift
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What should you inspect the breast and nipples for?
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signs of engorgement, redness, or cracks.
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How should the breasts feel during the first postpartum day?
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soft
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test
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test
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How should the breasts feel during the first postpartum day?
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soft
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When should the breasts begin to fill with milk?
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2nd and 3rd days
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When palpating the fundus what position should she be in?
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supine
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How much should the woman be voiding each time?
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more than 100ml
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When assessing the womans perineum what position should she be in?
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sims
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What is the homans sign?
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dorsiflexing the foot, should be no pain in the calf
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What labs are usually taken on the woman after delivery?
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hemoglobin and hematocrit, rubella status
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Parasympathetic Nervous System
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The division of the autonomic nervous system that calms the body, conserving its energy.
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You can feel "sympathetic" alone, most the time your not going to completely calm down until you talk to someone, which means there will be a pair of you "para"sympathetic
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Bright red bleeding that occurs in a steady stream in the presence of a firm fundus is most likely caused by what?
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a vaginal or cervical laceration that was not repaired
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Why should the patient report any very painful, soft, and possibly pulsing, masses palpable in the perineal area?
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because these are signs of hematoma formation
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If a woman is breast feeding, then what is the best way to help ease the pain in the breasts?
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warmth
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If a woman is not breast feeding and has painful boobies, what is the best way to ease the pain?
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cool compresses. ice.
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If the woman has cracks or fissures in her nipples, what can she do?
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use lanolin-based cream. mild analgesic. Also, put a little milk on the nip and let it air dry.
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What medication is good for managing afterpains?
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ibuprofen and nsaids. Should time it 30-45 minutes before breast feeding.
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What nonpharmacologic ways can you help manage afterpains?
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warm compresses to the abdomen, positioning, adequate rest and nutrition, and early ambulation.
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When applying a perineal ice pack, what position should she be in?
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dorsal recumbent.
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How long should you leave a perineal ice pack on for?
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20 on 20 off - within the first 24 hours
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after 24 hours, what should she do for perineal pain?
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warm sitz baths, mild analgesics combined with a narcotic.
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What are hazel pads or benzocaine sprays helpful with?
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perineal pain and hemi pain
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What should be of alert right after birth when the woman first gets up?
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fainting. That nigga may faint because of postural hypotension.
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What respiratory rate should you report?
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12 or under
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How often should the IV site be assessed?
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every 2 hours
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What is administered if respirations fall under 12?
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naloxone (narcan)
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When does breakthrough pain occur?
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occurs when the basal dose of analgesia does not control the pain adequately.
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When pruritus hits a bitch, a common side effect of narcotics given by spinal route, what do you give them to help?
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antipruritic such as benadryl, lotion, back rub, cool compresses, naloxone (narcan)
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What does naloxone (narcan) reverse the effect of?
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narcotics
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To avoid the farts, what should she do?
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ambulate, avoid hot or cold beverages, carbonation, and straws.
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What position allows gas to PEWWWWWWW out that ass?
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left side. Yup. That's the fart side.
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If the woman is Rh negative and the baby is is Rh positive, wtf do you do?
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RhoGAM to the momma. within 72hrs
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When the momma gets a rubella vaccine, how long should she wait to pregnant?
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at least 3 months.
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What are the 5million postpartum danger signs?
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fever 100.4+, shaking chills, localized reddened painful area on boobs, dysuria, SOB, abd pain/back pain, foul smelling vagina junk, heavy lochia flow, ......... more
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What should you clean those titties with?
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water
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When should the fundus no longer be palpable?
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10th day
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Where is RhoGAM injected?
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deltoid or gluteal
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What are contraindications to the rubella vaccine?
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sensitive to neomycin, immunosuppressed, has received a blood product within the past 3 months.
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How long does lochia rubra usually last?
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2-3 days
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How long does lochia serosa usually last?
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the remainder of the first week after delivery.
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After the first week, what should lochia be?
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alba
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What is great with cramping?
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ibuprofen
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breast feeding women should increase by how many claries?
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500 total
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