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256 Cards in this Set

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Product of conception from the 2nd to 3rd week of development
embryo
child in utero from after the 8th week following conception
fetus
first 6 wks of the post partum period
fourth trimester
upper portion of the uterus
fundus
total number of pregnancies
gravida
primigravida:
a woman who is having her first pregnancy
multigravida:
a woman who has had at least one pregnancy before
The process by which the uterus shrinks and returns to a non-pregnant state
involution
total number of births after point of viability
para
puerperium means
post partum period
term infant would be a live infant born:
b/n 38-42 wks gestation
point at which fetus is capable of surviving outside the uterus
viability
how many wks is a fetus viable?

What is the fetal wt. that the fetus will be viable at?
>500g
Check consistency of uterus: it should feel:
firm and grapefruit like
if the uterus is soft and flabby:
boggy uterus
when is the most dangerous time for the mom?
first hour PP
There are 10 factors that can retard involution. What are they?
a,a,a,f,g,i,m,p,p,p
-anesthesia (esp. general
-anything that overstreches muscle fibers
-anything that interferes with muscle contraction (meds)
-full bladder
-grand multiparity (6+ viable preg's)
-infection
-multiple gestation (ex.twins)
-polyhydramnios >1.5L
-prolonged/diff. labor
-presence of amniotic membranes or placenta fragments
to assess the uterine fundus, make sure pt. is in what position?
flat bed
when assessing the uterine fundus, place hand:____________. then palpate by placing other hand:_________
just above symphysis pubis.

at level of uterus
does palpating the fundus hurt the client?
not if done correctly
Health History: When taking the general history of the mom, find out: (6)
-age
-support systems
-Living children
-housing
-education/occupation level
-general health
Health history: When assessing pp mom, take her pregnancy history which includes: (gpeqc)
-gravida
-para
-EDC
-quickening (rxn to)
-complications (diabetes/htn/bonding)
It's important to take Labor and Delivery history, including what maternal data?
(lptaaell)
-length of labor
-position of fetus
-type of delivery
-analgesia
-anesthesia
-episiotomy
-lacerations
-labor complications (fetal distress/meconium aspiration)
It's important to take Labor and Delivery history, including what newborn data?
(gqamc)
-gender
-wt.
-apgar
-method of feeding
-congenital anomalies
what lab data might you look at in the pp mom?
hgb/hct
plasma fibrinogen
why do you look at the pp mom's h+h?
determine bld loss during delivery
Should the plasma fibrinogen be low or high in the pp mom?
elevated
What does plasma fibrinogen do?
seals off, so there isn't hemorrhage when placenta separates.
it's important to do a pp assessment how often?
at least 1x per shift
Physical assessment in PP mom:
1. Provide for ______
2. Time for_______
3. Have woman ___ prior to assessment
4. assess_______ status
5. perform general ___ assessment
1. privacy
2. teaching
3. void
4. psychosocial
5. postpartum
during the physical assessment of the pp client, why is it important for the woman to void first?
full bladder will displace uterus
look at pp woman's conjunctiva to:
check for dehydration
BUBBLE B assessment stands for
breasts
uterus (loc/firmness)
bowels
bladder
lochia
episiotomy/lacerations
bonding
with a pp woman who had a vaginal delivery, how often do we take vital signs?
q4h for 24h
with a pp woman who had a C/S delivery, how often do we take vital signs?
q4h for 48h
contraction of uterus seals placental site
physiology of uterine involution
with uterine involution, the endometrium should regenerate in approximately:
3wks
Uterine involution: the healing process:
leaves no scars
Uterine involution: does the uterus return to the pre pregnant state?
no, never
the wt. of the uterus immediately following delivery is
1000g
the wt. of the uterus at the end of the first wk
500g
when involution is complete, what will the wt. of the uterus be?
50-60g
*Placement of the uterus: 2-12 hr PP, the uterus:
rises to level of umbilicus to 2 fingerbreadths above
*Placement of the uterus: 12-24 hr PP, fundus of uterus:
at umbilicus
the uterus descends at the rate of _____ daily
1FB
10-14 days PP, the uterus contracts and is where?
beneath the pelvic bone and can't be palpated
Placement of the uterus: 1-2h PP, where is the uterus?
2-3FB below umbilicus
relationship of involution to lactation: Breast feeding helps ___________. It doesn't prevent _______.
-contract the uterus
-hemorrhage
___________: these are intermittent contractions that persist after delivery
afterpains
give _______ before nursing
pain meds
Nursing care for Boggy uterus: First:
massage uterus
Nursing care for boggy uterus: if the uterus is shifted to R/L:
have pt. void
If the uterus remains boggy and you have massaged it and the woman has voided, what do you do?
notify physician/CNM
If the uterus remains boggy and you have massaged it and the woman has voided, you would be calling the physician/cnm. While you're calling, do what?
put baby on breast
What's another name for methylergonovine?
methergine
what two routes can metergine be given?
IM/PO
Methergine is usually given IM or PO, but in emergencies it can be given:
IV
What is the freq. methergine (methylergonovine) can be given?
q2-4h up to five doses
what is the usual dose of methergine (methylergonovine)?
0.2mg
methergine (methylergonovine) is given for what?
prevents/treats PP hemorrhage
What is another word for oxytocin?
pitccin
What two routes is oxytocin (pitocin) given?
IM or IV
When oxytocin (pitocin) is given Intravenously, what do we hang it with?
lactated ringers
or normal saline
whats the usual IM dose of oxytocin (pitocin)?
10-20U
whats the usual IV dose of oxytocin (pitocin)?
10-40mg
What are some reasons oxytocin (pitocin) is given?
-induction of labor
-facilitation of UC's
-PP control of bleeding
2 other names for the medication prostaglandin are:
prostin
hemabate
what is the usual route/dose of prostaglandin?
0.25mg IM
If prostaglandin is given intramyometrially (middle layer of uterine wall), how often is it given? up to how many doses?
q15-90min up to 8 doses
Nursing care for involutional pain: types of medication:
1. motrin (ibuprofin)
2. percocet (oxycodone/acetaminophen)
3. Darvon (propoxphene)
4. Tylenol (acetaminophen)
5. PCA
______ can be used as adjuvents to percocet
motrin (ibuprofin) or Tylenol (acetaminophen)
_______ may be used as adjuvent to darvon
tylenol
Nursing care for involutional pain: may have PCA via _____ ______
epidural catheter
Nursing care for involutional pain: If PP woman has epidural catheter, check that:
it's taped on
How long will the C/S mom have PCA?
for a day
Pain medications may not reach milk until _____. They will be out of system when?
30 mins of more
48hrs
When should you remove foley?
1h after epidural cath is removed
Postpartum vaginal discharge aka
lochia
what does lochia consist of? (4)
bld fragments
mucous
bacteria
luekocytes
Physiology of Lochia: Decidua basalis separates into 2 layers. The inner layer creates ___ _______. The outer layer becomes _____.
new endometrium
lochia
This type of lochia may be dark red in color initially on the first day. It may include several small clots, NOT LARGE CLOTS.
lochia rubra
On the 2nd-3rd day PP, lochia should be:
dark red with no clots
This type of lochia is pink or brownish in color and thinner consistency.
lochia serosa
How long does lochia serosa last?
1wk
this type of lochia is creamy white or yellow, leukocytes and deciidua.
lochia alba
how long does lochia alba last?
3wks
when lochia alba ceases, it generally indicates:
cervix is healed
so the order of lochia is:
rubra
serosa
alba
we should not see a reverse in the stages of lochia. if we do, then do what?
call health care provider
Lochia should be draining, not _____. This could indicate a tear.
spurting
Evaluating lochia flow: Assess for: (5)
-character
-amt
-clots
-pattern
-odor
To assess amt of lochia, look at pad.

Scant=
Light=
large=
<1 in
1-2 in
saturated (do pad count, may mean hemorrhage)
pt. should not go home if lochia is:
clotting
To assess lochia pattern means describe if lochia is: __________. Flow with increase with _________. Flow will pool with ________.
pooling/spurting
ambulation
sitting
when assessing odor of lochia, you know that:
there should be no odor
Teach the PP pt. what about lochia?
-change pads freq (b/c they're a breeding ground for organisms)
-nothing in vagina before 6wk checkup
Physiological changes occur to the cervix during puerperium. these changes happen to the ______ and the ______
-internal os
-external os
What physiological change happens to the internal os during puerperium (pp)?
closes back to what it was prior pregnancy
What physiological change happens to the external os during puerperium (pp)?
never returns to prenatal state
Vagina: physiological changes during the puerperium(post partum): Takes _______ of PP period to fully involute and will return approximately to pre pregnant state.
entire 6 wks
Breast feeding mom may c/o of what changes in her vagina?
vaginal dryness
why do breast feeding moms experience vaginal dryness?
because estrogen hasn't returned to normal yet.
Assessment of the perineum includes assessing: (4)....remember REEDA which stands for:____
-intactness
-episiotomy
-lacerations
-hemorrhoids

REEDA- redness, ecchymosis, edema, drainage, approximation
For hemorrhoids:
use tucks in witch hazel
When assessing an episiotomy:
edges should be approximated
Perineum may be too edematous to check:_________
episiotomy
With lacerations, how long does the bruising last until healing?
2-3wks
warm water bottle (used as external flush)
peribottle
When providing nursing care of the perineum, place patient in what position?
sims position
Nursing care of the perineum includes:
chaph
-changing pads
-hygenic care
-application of ice/warmth
-protective devices
-hemorrhoidal care
Nursing care of the perineum of the C-section mom: provide pericare _____ on bedpan if unable to perform for self.
q3-4h
Nursing care of the perineum of the C-section mom: can usually shower:
on PP day2
Hormonal changes in puerperium: name four Placental hormones:
-HCG (human chrionic gonadotropin)
-HPL (human placenta lactogen)
-Estrogen
-Progesterone
Hormonal changes in puerperium:

____ is undetectable within 1 wk PP
HCG (human chrionic gonadotropin) pregnancy hormone
Hormonal changes in puerperium:

_____ is undetectable within 24 hrs PP (bld sugar drops)
HPL (human placenta lactogen)
Hormonal changes in puerperium: ________ and ______ decrease and begin to rise again _____PP in non lactating woman.
estrogen
progesterone
2wks
If women is lactating, estrogen and progesterone are _________
suppressed
what are 3 ovarian hormones?
-prolactin
-FSH (follicle stimulating hormone)
-LH (leutenizing hormone)
what is the ovarian hormone associated with lactation?
prolactin
What happens to prolactin with pregnancy?
it increases
Without lactation, prolactin levels decline to prepregnant state within _______
2wks
Prolactin concentration is influenced by
amt of breastfeeding.
FSH and LD are LOW for all women for ______ PP
10-12 days
Non Lactating women:

-Resumption of menstruation:
-Resumption of ovulation:
-avg 70-75 days
-50% ovulate c 1st menstrual cycle
Lactating women:

-Resumption of menstruation:
-Resumption of ovulation:
-avg by 6 months
-avg 190 days
In order for lactating woman to resume ovulation, she must have:
one or more anovulatory cycle prior to first ovulatory cycle
breast feeding is not a reliable method of __________
birth control
increased diuresis (water loss) and diaphoresis accounts for _____ wt. loss
5lb
Expected blood loss with the normal vaginal delivery:
300-500mL
Expected blood loss with c/s delivery?
500-1000mL
When will blood work be normal after woman gives birth?
3wks pp
Breastfeeding moms need to increase intake by ____mL of usual intake
500
Circulatory status changes PP:
(5)
ecccd
expected bld loss
changes in plasma volume
changes in hct
changes in clotting time
diuresis/diaphoresis
Teaching r/t fluid volume changes:

1. Diuresis/diaphoresis continues for:
2. increase ____ glasses of fluid per day more then usual intake.
3. Breastfeeding mom's increase intake by ____mL of usual intake
1. 2-5 days
2. 3-4
3. 500mL
teach client signs of pulmonary embolism:
SOB
Doom
tachycardia
check what to r/o PE?
homan's sign
Three changes with bld values during puerperium:
-coagulation factors
-elevated leukocytes (WBCs)
-changes in hct
This happens with long/difficult labor as defense mechanism against infection/helps with healing.
elevated leukocytes (WBC)
average # of leukocytes for 10-12 PP:______. Sometimes ____-_____are common results
12,000
20,000-25,000
Temperature: consider infection if T > ______F after first 24 hrs
100.4
Temp may be increased from inflammation, but if >24 hrs PP, it's probably:_________
infection
Blood pressure should:
remain stable after birth (or what it was like prelabor.)
BP will be increased if PP woman had:
PIH
Postpartum woman's pulse is generally b/n:
50-70bpm.
Postpartum woman's pulse is generally returns to pre pregnancy level within ______
8-10wks
respirations: should be no changes or back to prepregnancy state in ______
6-8wks
Breath sounds are assess only with _______ or with clients who have had __________
C/S
resp hx incl. URI, asthma
Nutritional status: PP woman's appetite:
hungry and thirsty!!!
Nutritional status: PP woman's initial wt. loss from infant/placenta/fluid:
10-12lbs
Nutritional status: PP woman's wt. loss from diuresis and diaphoresis:
5lbs
Nutritional status: PP woman should be at prepregnant wt (if gained 25-30lbs) within __________
6-8wks
PP mother often loses wt. more rapidly if
breast feeding
Nursing care about dietary needs: Calories needed:______-_____calories. If breastfeeding increase by 500 calories, so ____ calories.
2200-2300
2800
continue use of prenatal vitamins/iron until when?
6wk check up
why do women take prenatal vitamins until 6wk checkup?
they're needed for tissue repair
Elimination status: Urinary: Diuresis:
increased in first 24 hrs
Elimination status: Urinary: difficulty voiding PP b/c: (2)
-edema/swelling around urethra
-meds slow sensation
Elimination status: Urinary: effect of full bladder:
displaces uterus, can decrease uterine involution causing increased risk of hemorrhage
Elimination status: Urinary: Hematuria may been seen ____PP. It may be a ____
2-3 wk
UTI
Nursing care r/t urinary elimination: OOB when?
1h after delivery
Nursing care r/t urinary elimination: If bladder is distended, or pt. hasn't voided c in 6h:
get order for catheterization.
Nursing care r/t urinary elimination: if pt. voids <100mL c in 6 hrs after delivery:
cath for residual
Nursing care r/t urinary elimination: If PP pt. voids >150mL
leave cath
bladder will be back to normal in ___-___days
5-7
Elimination status: bowel: Physiological changes of GI tract:
Gi tract is sluggish
GI tract may be sluggish due to _____, ______ or from ______.
hormones
disruption
analgesia
Elimination status: bowel: encourage:
fiber
stool softener
fluid
when can pp pt. take a laxative?
2-3days after delivery
nursing care for hemorrhoids:
-pain meds/sprays/suppositories
-avoid straining
-stiz bath (for pain)
Musculoskeletal status: abdomen: Uterine ligaments (round and broad) are________ and will involute in _______
stretched
6wks
Musculoskeletal status: abdominal wall:_____ and _____
loose/flabby
Musculoskeletal status: abdominal wall: with exercise muscle tone improves in ____-____-
2-3months
Musculoskeletal status: diastasis recti abdomnius:
may not go back together after pregnancy
Musculoskeletal status: ambulation includes assessment of ______ _____ and nursing care for ____ _____
lower extremities
muscular aches
Musculoskeletal status: ambulation. Assessment of lower extremities is important especially hx of:
pih, edema, thrombophlebitis
Comfort Rest status: following birth, woman often feels simultaneously: eee
exhausted
euphoric
exhilirated
Comfort Rest status: following birth, woman often wants visitors. Nurse should:
take charge of multivisitors if woman needs rest
Comfort Rest status: there is a ______________in peurperium
need for sleep
Comfort Rest status: effects of spinal anesthesia may cause PP woman to develop:
spinal h/a
if PP woman develops spinal headache, put her in what position for 6-12hrs? What other 3 things could you do? An IV might be started for ______.
-laying flat
-increase fluids/pain meds
-close blinds
-nausea
Comfort Rest status: the post partum chill does not mean:
infection
Comfort Rest status: the post partum chill is r/t ____ and ____ changes
pressure/temp (neurological)
if PP mom is experiencing PP chill: (2)
be supportive
give warm blankets
Psycho-social changes: The taking in phase is aka
dependent phase
Psycho-social changes: during the taking in phase, PP mom may be:
very passive
somewhat dependent
Psycho-social changes: how long does the taking in phase last?
24-48h
Psycho-social changes: during the taking in phase, PP mother may be preoccupied with:
own needs.
Psycho-social changes: dont assume PP mother:
understands teaching
Psycho-social changes: the taking hold phase (dependent-independent phase) begins PP day _ to around __days
2
10
Psycho-social changes: During the taking hold phase, the mother feels:
more rested/ready to resume control
Psycho-social changes: the letting go phase is completed at approx. _____PP
6wks
Psycho-social changes: the letting go phase is aka
the accepting phase
Psycho-social changes: during the letting go phase: PP mom is accepting:
the reality of birth
Psycho-social changes: during the letting go phase, the PP mom is figuring out:
how they'll manage (work etc)
Psycho-social changes: attachment process: what are some factors they may affect bonding?
rest
cultures
not planned
Psycho-social changes: what is a sign of poor attachment?
complaining about changing diaper/drooling etc
Psycho-social changes: tell woman she may get baby blues. This is due to hormonal changes. Tell her she may be ___ and it may happen ___-___PP
weepy
1day-1wk
Psycho-social changes: PP depression may go on for:
months!
Psycho-social changes: nursing care to promote attachment: (3)
maternal, family, sibling attachment
Charting:
1._______on all PP clients
2. ___ ___ ____ will also incl. all post op assessments
3.all ______need additional notes (pain, dvt, poor bonding etc.)
1. bubble b
2. c/s dar notes
3. abnormals
Post Partum assessment: temperature: for first 2-24 hours, may have a slight elevation (100.4F) due to:
dehydration/fatigue
Post Partum assessment: temperature: after first 24 hrs, should be
WNL
Post Partum assessment: temperature: for a temp over 100.4, _____ needs to be r/o
sepsis
Post Partum assessment: pulse: for first 2-24 hours, may exhibit bradycardia (___-___bpm) due to decreased cardiac output, decreased blood volume and normal cardiac changes
50-70
Post Partum assessment: pulse: after first 24hours:
should be WNL
Post Partum assessment: pulse: tachycardia may indicate:
excessive PP bleeding
Post Partum assessment: respirations:
no significatn changes in PP period
Post Partum assessment: Blood pressure: for the first 24 hours:
should remain WNL
Post Partum assessment: Blood pressure: low bp may indicate
excessive PP bleeding
Post Partum assessment: Blood pressure: elevated bp may indicate:
PIH
Post Partum assessment: Breasts: check breasts for:
firmness
Post Partum assessment: Breasts: firmness varies on 3 things:
parity, breastfeeding or not, PP day
Post Partum assessment: Breasts are generally _____ day of delivery to PP day 1
soft
Post Partum assessment: Breasts are generally _____ PP day 1 to PP day 2
filling
Post Partum assessment: Breasts are generally _____ PP day 2 to PP day 3
firm
Post Partum assessment: Breasts: check the woman's nipples for signs of
intactness
Post Partum assessment: Breasts: when checking the woman's nipples for signs of intactness, ask are they: (4). Do they show:
bleeding?
sore?
cracked?
red?

-signs of infection?
Post Partum assessment: Breasts: check for leakage. Colostrum is produced for:
first 24 hours
Post Partum assessment: Breasts: what does the speed of breast milk production vary with?
parity
Post Partum assessment: Breasts: Check the woman's breast feeding technique. Assess the ____ ___, the infant's ability to _____ __, and the ____/___ of nursing sessions.
positions used
latch on
timing/scheduling
Post Partum assessment: Client's torso: the fundus is assessed in relation to:
umbilicus
Where is the fundus immediately PP?
2-3 fingerbreadth below umbilicus
Where is the fundus at 2-12 hrs?
1FB above umbilicus
Where is the fundus at 12-24 hrs PP?
at umbilicus
after 24 hrs, the umbilicus
decreases at the rate of 1 FB per day
What 3 things do you assess about a fundus?
firm or boggy
position r/t midline
location in r/t umbilicus
What does it mean if the fundus is shifted to the R or L?
it indicates a full bladder
When assessing the abdomen, assess if it is _____ or _____. Does woman have ____ ____?
soft/distended
bowel sounds
Abdomen: with the C/S client, check the ____ and _____. Look for signs __________
incision, dressing
of infection
When assessing PP woman's bladder, we are looking to see what?
if it's distended
What do we want to know about regarding PP mother's urine output?
how freq is she voiding?
how much is she voiding?
Lochia:

Check for (3)
color
amt
odor
From day of delivery to the 2nd post partum day, what is the lochia like?
moderate to scant rubra (may have clots)
From day 2 until day 7, what does is the lochia like?
moderate to scant serosa
from day 7 until day 14, the lochia is _________. (It may last up to ____wks)
scant alba
6
What is the lochia like with a C/S client?
there is markedly less then with a vag. delivery
Lochia should have what type of odor?
menstrual, not foul
Perineal region.

A. assess the _______
B. Assess the ____/_____
C. assess for _________
A. perineum
B. episiotomy/lacerations
C. hemorrhoids
When assessing the perineal, what 4 things are we looking for?
edema
hematomas
bruising
varicosities
When assessing the episiotomy/lacerations, we are looking for 3 things:
intact
red
signs of infection
When assessing the hemorrhoids, we want to know what 2 things?
size, number
Voiding: Client is due to void ______ PP or after the removal of a catheter.
6-8h
Voiding: For the first 24 hours the woman may void up to ____mL
3000
Voiding: Teach woman that she:
may not always feel the urge to void
for 24-72 hours: _______________ until WNL
decreasing amts of urine
check the urine for 3 things:
color
cloudiness
dysuria
Bowel/defecation: Client may not have a BM before the _____ PP day
2nd-3rd
Lower extremities: Is there ____? _____?_____?_____?
edema
tenderness
redness
warmth
Besides edema, tenderness, redness and warmth, we assess 2 other things while checking the lower extremities:
homan's sign
degress of varicosities
Psychological/emotional status: The taking in phase: lasts ______PP
1-2days
Psychological/emotional status: During the taking in phase, the mother is (3)
passive
dependent
preoccupied with self
Psychological/emotional status: the mother in the taking in phase may be hesitant
in making decisions
Psychological/emotional status: the taking hold phase generally begins when?
2nd day PP
Psychological/emotional status: during the taking hold phase, the mother resumes control of life and is:
participating in care.
Psychological/emotional status: episodes of mild depression, lasting 2-3 days due to hormonal changes and psychological adjustment:
PP blues
Attachment behavior:
how does mother hold baby?