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85 Cards in this Set
- Front
- Back
Why does pregnancy increase the risk of thrombophlebitis?
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Because of the increased clotting.
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What are the cardinal movements?
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*Engagement.
*Descent. *Flexion. *Internal rotation. *Extension and restitution. *external rotation. *Expulsion. |
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After a C-section the woman has a Foley for approximately ____ hours. Then, we give her approximately ___ hours to empty her bladder.
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24; 4
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What is active labor defined as?
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Cervix >90% Effaced;
<1 cm in length 3 cm dilated. Painful contractions |
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Genital tract infectoins:
Choramnioitis occurs in the _____. Endometritis occurs in the _____. Parametritis occurs in the _____. |
amniotic membrane/fluid; placental; pelvic connective tissue.
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What happens in the 2nd stage of labor?
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Pushing. Birth of the baby. Avg. length 30 minutes to 1 hour.
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What are the stages of lochia?
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Rubra (1-3 days)
Serosa (3-10 days) brownish, clear. Alba (can continue six weeks) |
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What happens in the first stage of labor?
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1st stage is the process of dilation.
There are three phases. From 0-10 cm. Avg. length 12-14 hours. |
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When is the highest risk of postpartum hemorrhage?
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1st hours after birth.
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What happens in the 3rd stage of labor?
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Delivery of the placenta. Avg. length 20-30 minutes.
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What are some signs of placental separation?
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Uterus firm.
Change of shape from discoid to globular. *Visible bulge above pubis. *Apparent cord lengthening. *Bleeding. *Membranes/bulging at introiduc. |
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What is restitution in the cardinal movements?
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Where the baby turns right as it is coming out of the vagina.
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When do Cesarean infections occur?
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3-4th day postpartum.
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What happens in the 4th stage of labor?
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First 2 hours of recovery time.
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How long does it take the cervix to close after delivery?
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Several weeks.
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What is latent/prodome labor defined as?
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Cervix <90% effaced.
>1 cm in length. <3 cm |
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What are the symptoms of genital tract infections?
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Temp.
Subinvolution. Malaise. Lethargy. Chills. Backache. Tachycardia. Foul smelling lochia. |
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What are some helpful hints during the early (latent) 1st stage of labor?
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Eat and drink lightly. Ambulate.
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How many days does it take for the uterus to complete involve back into the pelvis after delivery?
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Approximately 9 days, starting at the umbilicus the first day and then going 1 fingerbreadth below the umbilicus with each subsequent day.
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About how long does active labor last?
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Approximately 3 to 4 hours; progressing about 1 cm/hour.
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If a fever occurs in the first 48 hours PP, what is the most likely cause?
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Atelectasis.
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What are some postpartum complications?
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Anemia.
Early/late postpartum hemorrhage. Hematoma/lacerations. Retained placental parts. Infection. Thrombophlebitis. Postpartum depression. |
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What are the symptoms of mastitis?
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Temp.
Chills. Malaise. Hard red, tender irregular mass in one or both breasts. Pain. Engorgement. |
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The placenta releases a hormone that works _______ insulin.
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against.
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What is thrombophlebitis?
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An infection in lining of the vessel.
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What do we assess the perineum for in the 4th stage of nursing?
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Lacerations.
Swelling. Hematoma. |
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If a fever occurs 3 to 7 days PP, what is the most likely cause?
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Wound or septic thrombophlebitis.
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A high temp >24 hours indicates ________.
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Infection.
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With respect to thrombophlebitis, postpartum increases risk of?
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VEnous stasis.
Blood viscosity. Limited ambulation. |
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Fibrinogen which peaks at 1-2 days and is elevated for 2 weeks puts the post-partum woman at risk for?
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DVT.
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What are the organisms causing genital tract infections?
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Strep, GBS and E. Coli.
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What are contractions like in the active phase of labor?
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3-5 minutes apart, regular and lasting 30 to 45 seconds.
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Retained placenta.
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Continuous painless bleeding in the absence of lacerations or uterne atony.
Uterus remains large. Evacuation necessary. May cause infection, late hemorrhage. |
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How much dilatation occurs in active labor?
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4 to 7 cm.
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What are some risk factors for PP infections?
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PROM.
Prolonged labor. Vaginal exams. |
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What does a left shift indicate?
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Infection.
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What is the best prevention of thrombophlebitis?
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Early ambulation or ROM.
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Be cautious about a systolic BP below ____.
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100.
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What are the treatments for early hemorrhage treatment?
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Keep bladder emptied.
Fundal massage until firm. IV or IM Pit 10 units. IM Methergine 0.2 mg. Hemabate. Evaluate response. Remedy the cause. |
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What are the purpose of eosinophils?
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They fight allergic reactions and parasitic infections.
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When would we not give Methergine?
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In someone with HTN.
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How do we prepare for discharge?
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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. |
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Postpartum infections occur in approximately __% of births.
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6
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What are some helpful hints during active labor?
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Ambulation.
Position changes. Urinate frequently. Relaxation skills. Massage. Music. Water therapy. Strong encouragement. Keep a positive attitude. |
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When does late PP hemorrhage occur? What is it from? What do we do about it?
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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.
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At the incision on the abdomen, we should look at REEDA which stands for what?
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Redness.
Edema. Ecchymosis. Discharge. Approximation. |
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What do we think of when we think of UTI's?
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Voiding volume.
Symptoms of pain, fever, hematuria, distention, vaginal bleeding, backache, boggy uterus. |
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When does "laboring down" happen?
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During the transition phase. This is a deceleration phase; a 1 to 2 hour rest period between the 1st and 2nd stage.
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If a fever occurs 2 weeks PP, what is the most likely cause?
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Mastitis.
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What are some helpful hints during the transition phase of labor?
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Intense coaching, fanning, sips and chips, positioning, and reassurance.
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If a fever occurs 72 hours PP, what is the most likely cause?
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UTI. Pneumonia.
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What happens in the transition phase of labor?
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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.
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When does thrombophlebitis usually occur?
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Onset 10-20 pp days.
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What do we assess lochia for in the 4th stage?
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Amount.
COlor. Clots. Odor. Pads soaked. |
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If a fever occurs 7 to 14 days PP, what is the most likely cause?
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Wound abscess.
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The average blood loss for a vaginal delivery is ___ cc versus the CS of ____ cc.
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500; 750
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During the fourth stage of nursing we want to assess?
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1) Pulse.
2) BP. 3) Uterine involution. 4) Lochia. 5) Ability to urinate independently. 6) Perineum. 7) Emotions. |
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Individuals w/certain medical conditions may have more problems in the post-partum period. Give some examples?
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PIH. MVP. People with poor heart function.
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In the WBC differential what are the five different types of cells?
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Neutrophils.
Lymphocytes. Monocytes. Eosinophils. Basophils. |
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What is the purpose of monocytes?
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They are phagocytes which fight severe infection.
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An increased number of neutrophils indicates?
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Infection. Neutrophils are phagocytes.
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What are the key things multips want to know after childbirth?
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Sibling adjustment.
Exercise. Diet/nutrition. Fatigue. Recognizing illness. Calming a crying baby. Circumcision. |
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What might a woman's emotions be during the 1st (latent) stage of labor versus active labor?
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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.
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What are some of the things that can be done for maternal comfort during the 4th stage of labor?
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Urination.
Bathing. Food. Hydration. Rest. |
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Basophils
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Parasitic infections.
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Hgb decreases immediately after birth. It slowly rises on day ___ to ___.
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2 to 4.
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The hematocrit may increase/decrease slightly after birth.
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Increase
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There is an increased risk of __________ failure postpartum.
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heart
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What might be some normal emotions during the 4th stage?
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Fatigue.
Pain. Watch for normal patterns of maternal-infant attachment. |
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What is a normal WBC count?
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5000-10,000
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What is the significance of a shift to the left with overall leukocytosis in the WBC differential?
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There are increased immature forms (bands/stabs) in bacterial infections.
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Without lcukotycosis there is a good/poor prognosis?
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Poor.
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What are the contractions like in the 1st (early) phase of labor?
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Contractions mild, irregular; 5-30 minutes apart, lasting 10 to 30 seconds.
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There is an ________ cardiac output post-partum.
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Increased.
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What are some key things about anemia?
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Recognize EBL.
Vital signs. Impact of uterine involution. Treat with diet and vitamins. Dismissal teaching. |
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What would a temp up to 100.4 in the first 24 hours following delivery indicate?
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Dehydration.
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What are the purpose of lymphocytes?
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To fight viral infections.
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Why are platelets important in the post-partum period?
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For clotting.
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Why is it bad to have a full bladder post-partum?
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The filled bladder displaces the uterus to the side and the uterus cannot contract and bleeding becomes more profuse.
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What are some helpful hints during the 4th stage of labor?
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*Respect privacy but give good nursing care.
*Careful assessments. *Help her to get bathed. *Feed her. *Keep baby close by. *Assess baby for stability. |
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How long does it take for the vagina to regain tone?
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4-6 weeks because the rugae were stretched.
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Is leukocytosis normal in the first 2 weeks post-partum?
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Yes, it can be anywhere from 12-15,000.
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What are the key things primaps want to know after childbirth?
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Exercise.
Diet/nutrition. Fatigue. Recognizing illness. Calming a crying baby. Baby care. Baby's schedule. |
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What are some predisposing risk factors of hemorrhage?
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Previous post-partum hemorrhage or uterine surgery.
Coagulation disorders. Multiple gestations. Labor induction. Rapid or prolonged labor. Pre-eclampsia. Sepsis. Placental abnormalities. |
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What things do we want to assess for early post-partum hemorrhage?
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The fundus.
Perineum. Pads. BP Pulse. Hgb. |