Postpartum Exam 5

Front 1

What does postpartum mean?

Back 1

Period when the reproductive tract returns to the normal, nonpregnant state

Front 2

When does pp period start?

Back 2

immediately p delivery

Front 3

When does the pp period end?

Back 3

6wks p birth

Front 4

What are the 3 psychological changes in pp period?

Back 4

Taking in phase
Taking hold phase
Letting go phase

Front 5

Taking in phase starts when?

Back 5

First 2-3 days

Front 6

Loss of 500 ml or more of blood after vaginal birth or 1000 ml or more after cesarean birth

Back 6

Postpartum hemorrhage (PPH)

Front 7

Excessive blood loss that occurs within 24 hours after birth and is most often caused by marked uterine hypotonia

Back 7

Early (acute primary) PPH

Front 8

Blood loss that occurs more than 24 hours after birth but less that 6 weeks after the birth

Back 8

Late (secondary) PPH

Front 9

Marked hypotonia of the uterus; the uterus fails to contract well or maintain contraction

Back 9

Uterine atony

Front 10

Collection of blood in the connective tissue as a result of blood vessel damage. __________ are the most common type

Back 10

Pelvic hematoma; vulvar hematomas

Front 11

_________ are usually associated with a forceps-assisted birth, an episiotomy or primigravidity.

Back 11

vaginal hematomas

Front 12

Unusual placental adherence in which there is slight penetration of the myometrium by placental trophoblast.

Back 12

placenta accreta

Front 13

Turning of the uterus inside out after birth.

Back 13

inversion

Front 14

Emergency situation in which profuse blood loss (hemorrhage) can result in severely compromised perfusion of body organs. Death may occur.

Back 14

Hemorrhagic (hypovolemic) shock

Front 15

Coagulopathy resulting from an autoimmune disorder in which antiplatelet antibodies decrease the life span of the platelets.

Back 15

Idiopathis thrombocytopenic purpura

Front 16

Pathologic form of clotting that is diffuse and consumes large amounts of clotting factors

Back 16

disseminated intravascular coagulation (DIC)

Front 17

formation of a blood clot or clots inside a blood vessel.

Back 17

thrombosis

Front 18

Inflammation of a vein with clot formation.

Back 18

Thrombophlebitis

Front 19

Clot involves the superficial saphenous venous system.

Back 19

superficial venous thrombosis

Front 20

_________ clot involvement can extend from the foot to the iliofemoral region.

Back 20

Deep vein thrombosis (DVT)

Front 21

Complication occurring when part of blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs.

Back 21

pulmonary embolism

Front 22

clinical infection of the genital canal that occurs within 28 days after a miscarriage, induced abortion, or childbirth. In the U.S., it is defined as a temperature of 38C or more on 2 successive days of the first 10 postpartum days (not counting the first 24 hours after birth)

Back 22

Postpartum; puerperal infection

Front 23

Infection of the lining of the uterus; is the most common cause of postpartum infection and usually begins as a localized infection at the placental site.

Back 23

Endometritis

Front 24

Infection of the breast affecting approximately 2% to 10% of women, soon after childbirth, most of whom are first-time breast feeding mothers; it almost always is unilateral and develops well after lactation has been established.

Back 24

Mastitis

Front 25

downward displacement of the uterus, with degrees of displacement from mild to complete

Back 25

Uterine prolapse

Front 26

Uncontrollable leakage of urine

Back 26

Urinary incontinence

Front 27

Perforations between genital tract organs

Back 27

Fistula

Front 28

An intense and pervasive sadness with severe and labile mood swings; it is more serious and persistent then postpartum blues. Intense fears, anger, anxiety, and despondency that persist past and the baby's first few weeks are not a normal part of postpartum blues

Back 28

PP depression

Front 29

Syndrome most often characterized by depression , delusions, and thoughts by the mother of harming either herself or her infant.

Back 29

PP Psychosis

Front 30

State the 2-fold focus of medical management of hemorrhagic shock
hemorrhage.

Back 30

Restore circulating blood volume to enhance perfusion of vital organs and treat the cause of the

Front 31

Identify the priority nursing interventions for postpartum hemorrhage. Including the rationale for each intervention identified.

Back 31

1. cite interventions related to improving and monitoring tissue perfusion
2. treat the cause of the hemorrhage,
3. enhance healing
4. supporting the woman and her family
5. fostering maternal-infant attachment as appropriate
6. plan for discharge

Front 32

Identify measures found to be effective in preventing genital tract infection during postpartum period.

Back 32

good prenatal nutrition to control anemia and intrapartal hemorrhage, perineal hygiene, adherence to aseptic technique

Front 33

BUBBLE HE

Back 33

Breasts
Uterus
Bladder
Bowel
Lochia
Episiotomy
Homan's sign
emotions/engagement

Front 34

What can an elevated temp mean?

Back 34

*normal during 1st 24 hrs
*sign of dehydration after 1st 24 hrs
*sign of infection after 1st 24 hrs

Front 35

Bradycardia can mean what?

Back 35

normal finding after delivery.
40-70 is normal after delivery, usually comes back to normal by day 3-4.

Front 36

Tachycardia
over 100bpm
sign of:

Back 36

infection
hemorrhage
pain
anxiety

Front 37

Elevated blood pressure can indicate what?

Back 37

PIH
Hx of chronic HTN

Front 38

Lowered blood pressure can indicate what?

Back 38

orthostatic hypotension
shock
hypovolemia

Front 39

Breasts

Back 39

assess breasts/nipples
"do they feel different today?"
soft, firm, can be lumpy
secretion of colostrum/lactation

Front 40

Uterus

Back 40

*assess the process of involution
*fundal height - usually at umbilicus during 1st 12 hrs, starts to decrease at 12 hrs, some drop right away (decreases 1cm each day)
*consistency - firm, round, smooth, not "boggy"; should feel like a tennis ball.
*uterus location - midline but can shift over to side especially if bladder is full

Front 41

Bladder

Back 41

cath'd immediately post delivery in L&D. C-sections have foley; vaginals straight cath'd.
Assess for bladder distention.
Measure urinary output (hoping for 300ml)

Front 42

Bowel

Back 42

Assessment of bowels - gas counts as BM
auscultate bowel sounds
"any gas pains?"
BM usually 2-3 days post delivery

Front 43

Lochia

Back 43

*amount - red drainage - tells us how the lining is healing. Vaginal has lots of red drainage. Watch for how often pads are being changed, if q hr=too much, hemorrhaging.

Color:
Rubra - red (0-3 days)
Serosa - pinkish red (3-10 days)
Alba - white (10 days-6wks)

Odor: musty/musky odor, should not be obnoxious

Should not be green, should not have any sutures in pad.

Front 44

Episiotomy

Back 44

if green, gaping holes, sutures laying on pad = big probs (infection).
Look for anything abnormal
Hematomas
ecchymosis
edema

Front 45

Homan's Sign

Back 45

assessing for thrombophlebitis.
Looking for a cluster of symptoms:
>swelling - measure calf to see difference b/t two calves
>redness or any change in color (pale white)
>Warmth
>unilateral calf pain; other leg would be normal
>all these symptoms would happen on one leg

Front 46

Emotions/Engagement

Back 46

Observe bonding behavior:
>attachment
>en face (lift baby up & look eye-to-eye)

Front 47

What are the 3 psychological changes of the PP period?

Back 47

*taking in - 1st day, mother taking in all the info
*taking hold - 2nd day, takes hold of mother role & starts caring for baby
*letting go - more for first time mom; let go of their previous role

**Assess ability to care for newborn.

Front 48

S/S and Tx of of Endometritis?

Back 48

Endometritis
localized infection of uterine wall.
develops 2-7 days post delivery
Tx: IV anti-Bs, analgesics, antipyretics; fluids, comfort measures
Probable need for re-hospitalization & isolation

Front 49

REEDA stands for what?

Back 49

Redness, Echymosis, Edema, Drainage, Approximation

Front 50

S/S and Tx for wound infection?

Back 50

C-section or episiotomy
Assess REEDA (redness, erythema, edema, drainage, approximation), odor
TX: opening & cleaning wound, meds (anti-Bs, analgesics); fluids

Front 51

S/S and Tx for Mastitis?

Back 51

*concern if mom is breastfeeding; cannot breastfeed if draining.
*acute infection of glandular tissue of the breast
*Staph or E.Coli
*assess: unilateral condition; engorgement; nipple drainage; flu-like symptoms
TX: drain abscess; meds (anti-Bs & analgesics); firm supportive bra, ice packs

Front 52

S/S and Tx for UTI?

Back 52

*Risk factors: indwelling catheter, c-section
*Assess: c/o burning on urination, urgency, frequency, fever
TX: meds, fluids, repeat urine cultures until UTI is gone.

Front 53

S/S and Tx for DVT?

Back 53

*Clot formation attached to vessel wall
*Risk Factors: Hx of DVT/PE, venous stasis (on complete bedrest), hypercoagulation, smoking, over 35, multiparity
*Prevention is goal with early ambulation.
*Assess: unilateral findings of + homan's sign, calf pain, swelling, color change, warmth; low pulse ox.
*TX: bedrest (RN can delegate), elevation of leg (RN intervention), Meds (analgesics & anticoagulants)

Front 54

S/S and Tx for PE?

Back 54

High mortality rate; fast deterioration
*Assess: sudden sharp chest pain, tachycardia, cough, hemoptysis, SOB
*TX: bedrest, heparin therapy, O2 therapy

Front 55

Reduction in size of the uterus after birth & its return to its nonpregnant condition?

Back 55

Involution

Front 56

Painful uterine cramps that occur intermittently for 2 or 3 days after the birth & results from contractile efforts of the uterus to return to its normal involuted condition?

Back 56

Afterbirth pains

Front 57

Vaginal discharge during the puerperium consisting of blood, tissue, and mucus?

Back 57

Lochia

Front 58

The large upper end of the uterus?

Back 58

Fundus

Front 59

Period after the third stage of labor & lasting until involution of the uterus takes place, usually approximately 3 to 6 wks; fourth trimester of pregnancy

Back 59

Puerperium

Front 60

Assessment of lochia
day 1-3

Back 60

lochia rubra- consists mainly of blood and decidual and trophoblastic debris

Front 61

Assessment of lochia
Day 4-10

Back 61

Lochia serosa consists of old blood, serum, leukocytes, and tissue debris. The median duration of lochia serosa discharge is 22-27 days. serosanguineous; pink or brown

Front 62

Assessment of lochia
day 11-21

Back 62

Lochia alba - 10 days p birth. drainage b/comes yellow to white- consists of leukocytes, decidua, epithelial cells, mucous, serum and bacteria. Can last 2-6wks

Front 63

Involution Process consists of what 2 things?

Back 63

1) contraction of muscle fibers (pitocin after delivery)
2) catabolism; the regeneration of the uterine epithelium

Front 64

Decent of uterus
after 24 hours

Back 64

1 cm per day

Front 65

Lacerations of the Vagina
1st degree

Back 65

superficial - involves the vaginal mucousa or perineal skin

Front 66

Lacerations of the vagina
2nd degree

Back 66

Extends through muscles of perineal body.

Front 67

Lacerations of the vagina
3rd degree

Back 67

Continues to anal sphincter

Front 68

Lacerations of the vagina
4th degree

Back 68

extends through the anal schincter into the rectal mucousa

Front 69

Increase in maternal cardiac output is caused by what?

Back 69

1) increased blood flow back to the heart when blood from uteroplacental unit has returned to central circulation
2) the mobilization of excess extracellular fluid into the vascular compartment

Front 70

Postpartum WBC?

Back 70

Marked increased (to 30,000) back to normal by 4-7 days postpartum

Front 71

Postpartum realxin does what?

Back 71

Relaxin levels decrease to help pelvis and hips return to normal position, but may cause achiness in these areas

Front 72

Resumption of menstration happens when?

Back 72

Usually within 7-9 weeks after childbirth
-if lactating- 12 weeks to 18 months

Front 73

Initiates making of breast milk within 2-3 day?

Back 73

Prolactin

Front 74

Necessary for milk ejection or "let down)?

Back 74

Oxytocin

Front 75

Who is at High risk for Hemorrhage?

Back 75

Multiparity
over distension of the uterus
precipitous labor
prolonged labor
rtained palcenta
placenta previa/abruptos placenta
induction/augmeantaion
admin of tocolytics to stop contractions
operative procedures

Front 76

What is the first sign that a pp pt is bleeding?

Back 76

Increase HR

Front 77

What are the medications used for uterine atony?

Back 77

Oxytocin
Methergine
Hemabate
Cytotec

Front 78

What is the 2nd cause of PP hemorrhage?

Back 78

Lacerations

Front 79

4th main cause of PP hemorrhage?

Back 79

Disseminated Intravascular Coagulation (DIC)

Front 80

Who is at a high risk for infection ?

Back 80

Operative procedures
multiple cervical exams
prolonged labor
manual extraction of placenta
DM
indwelling catheter
Anmeia

Front 81

Signs of distended bladder?

Back 81

Fundus is above baseline level(when empty)
-displaced fundus
-excessive lochia
-bladder discomfort
-buldge of bladder above symphysis
-frequent voidings of less tham 150 mL

Front 82

Post epidural respiration?

Back 82

- if declining or less than 12 - notify anesthesiologist immediately
-elevate HOB
-administer O2 and apply pulse ox
-follow protocol for narcan
-observe for reoccurance of decreased resp
-narcan effects pain relief

Front 83

PP s/s that should be reported?

Back 83

fever
-redness, swelling or pain in either breast that is not relived by support or analgesics
-perisistant abd tenderness
- feelings of pelvic fullness or pressure
- persistant perineal pain
-frequency, urgency or burning on urination
-change in character of lochia
-localized redness, tenderness or warmth of the legs
-separation of of or foul drainage from c sect ins

Front 84

PP blues begins when?

Back 84

Begins at first week and lasts no longer than the 2nd week

Front 85

S/S of PP blues?

Back 85

insomnia
irritabilty
fatigue
tearfulness
mood instability
anxiety

Front 86

What are some key nursing activities days 1-3 postpartum?

Back 86

Monitor and prevent complications
Facilitate breastfeeding or bottle feeding
Promote comfort
Encourage family bonding
Teaching

Front 87

Why might a postpartum temperature be slightly elevated?

Back 87

Exertion and dehydration.

Front 88

What may indicate infection after 48 hrs postpartum?

Back 88

An elevated temperature.

Front 89

What may a rapid pulse be indicative of PP?

Back 89

Infection or hemorrhage

Front 90

What is colostrum?

Back 90

A thin fluid that is the precursor of milk.

Front 91

When does breast milk come in?

Back 91

2nd-3rd day PP

Front 92

When does engorgement occur?

Back 92

2nd-3rd PP

Front 93

What are some nursing interventions for engorgement?

Back 93

Apply warm packs
Pump
Hand expression

Front 94

What role does oxytocin do for breast feeding?

Back 94

It causes the milk to be expressed from the alveoli into the larger ducts, which lead to the nipples. (let down)

Front 95

When does menstruation return for lactating mothers?

Back 95

5-6 months later depending on how long the mother breast feeds.

Front 96

When does menstruation return for non lactating mothers?

Back 96

About 8 weeks after delivery.

Front 97

Can a woman conceive even if no menstruation occurs?

Back 97

Yes

Front 98

What should be assessed when assessing breast feeding?

Back 98

The knowledge of breastfeeding
Infant's maturity level and gestational age
Infant's ability to suck
Infant's ability to correctly latch-on
Infant for clicking noises when breastfeeding
Mother for pain when infant sucks
Assess for milk let-down

Front 99

What is mastitis?

Back 99

A breast infection usually caused by staphylococcus aureus.

Front 100

What are the symptoms of mastitis?

Back 100

Fever, headache, warm, reddened, painful area of the breast.

Front 101

Should a mother with mastitis still feed on the side that is infected?

Back 101

Yes, in fact more so.

Front 102

If a woman is bottle feeding how can they reduce engorgement?

Back 102

Wear tight bras.
Apply a cabbage leaf.
Cold vs. hot packs.

Front 103

How much formula should the infant take during each feeding while in the hospital (bottle fed)?

Back 103

1 - 1.5 oz every 3-4 hours.

Front 104

How do you know if the baby is getting enough to eat?

Back 104

Look at their diaper and assess the output.

Front 105

How long should a baby nurse on each side?

Back 105

10-15 min.

Front 106

What are the 3 types of lochia?

Back 106

Rubra, serosa, and alba.

Front 107

What are you looking for when assessing the fundus?

Back 107

The height
The firmness
The position.

Front 108

Are clots ok?

Back 108

Up to the size of a plum.

Front 109

What might the vagina look like following delivery?
.

Back 109

Edematous and possibly bruised.

Front 110

Why is thrombophlebitis more common in prgenant/postpartum women?

Back 110

Because of the increased vascularity of pregnancy.

Front 111

How do you check for a DVT?

Back 111

Do a calf assessment.

Front 112

How low might the hgb values be in a postpartum woman?

Back 112

9 or sometimes slightly lower.

Front 113

Why do you want the mother to be up and walking as soon as possible after delivery?

Back 113

To prevent clots.

Front 114

What are 3 interventions for low hgb?

Back 114

1.Iron supplement
2.Iron rich foods
3.Blood products

Front 115

How long do the postpartum blues normally last?

Back 115

1-2 weeks.