Ob Postpartum Nursing

Front 1

What re the main physiological maternal changes in postpartum?

Back 1

1. uterine involution
2. lochia flow
3. cervical involution
4. decreased vaginal distention
5. CV, GI, GU, and breast changes

Front 2

What are the greatest risks during postpartum period?

Back 2

hemorrhage, infection, and shock

Front 3

What does oxytocin do during postpartum?

Back 3

1. coordinated and strengthens the uterus
2. can prevent excessive bleeding and hemorrhage

Front 4

What hormones decrease after delivery of placenta?

Back 4

estrogen, progresterone, and placental enzyme insulinase

Front 5

What does the decrease in hormones after placental delivery cause?

Back 5

1. breast engorgement, decreased vaginal lubrication, increased sweating and urination from decreased estrogen
2. decreased progesterone causes increased muscle tone
3. decreased insulinase lowers blood glucose levels

Front 6

Nursing interventions for Rh-negative mothers?

Back 6

1. immune globulin within 72 hrs if infant is Rh-positive
2. Kleihauer-Betke test to determine fetal blood in circulation. above 15 ml indicates increased immune globulin

Front 7

Postpartum assessments immediately after delivery?

Back 7

1. vitals
2. uterine firmness, location in relation to umbilicus and midline of abdomen
3. vaginal bleeding

Front 8

What is the focused postpartum physical assessment entail?

Back 8

B - breasts
U - Uterus
B - Bowel and GI
B - Bladder
L - lochia (color, odor, consistency, amount) [COCA]
E - Episiotomy

Front 9

Normal fundus assessment immediately postpartum?

Back 9

firm, midline with umbilicus and at the same level

Front 10

Fundus position 12hr after birth?

Back 10

1 cm above umbilicus

Front 11

When should the fundus no longer be palpable?

Back 11

by day 10

Front 12

Nursing interventions involving uterine involution?

Back 12

1. administer oxytocics after placenta delivery

Front 13

What are some oxytocics?

Back 13

1. pitocin
2. methergine
3. Hemabate
4. Cytotec (is a prostaglandin)

Front 14

What are the three stages of lochia?

Back 14

1. rubra = bright red, fleshy odor, some clotting, lasts 1-3 days
2. Serosa = pinkish brown, serosanguineous, 4-10 days
3. Alba = yellowish, white, creamy, 11 days to 6 weeks

Front 15

Terms for lochia amount on pad?

Back 15

1. Scant (less than 2.5 cm)
2. Light (less than 10 cm)
3. Moderate (more than 10 cm)
4. Heavy (one pad saturated in 2 hr)
5. Excessive blood loss (one pad in 15 min, pooling of blood)

Front 16

Evidence for abnormal lochia?

Back 16

1. excessive spurting of bright red blood
2. numerous large clots and excessive blood loss
3. foul odor (infection)
4. Persistent lochia rubria beyond day 3 (retained placental fragments)
5. Continued flow of lochia serosa or alba beyond normal length of time (endometritis)

Front 17

Comfort measures for vagina and perineum?

Back 17

1. apply ice packs first 24-48 hrs
2. encourage sitz baths bid
3. analgesia and anesthetics

Front 18

When is colostrum secreted?

Back 18

pregnancy and 2-3 days postpartum

Front 19

Nursing intervetions for client's breast and breastfeeding?

Back 19

1. encourage early breastfeeding
2. assist client in comfortable positions for breastfeeding
3. teach the client th eimportant of proper latch techniques
4. educate that breastfeeding causes oxytocin release, which stimulates uterine contractions

Front 20

Cardiovascular changes in postapartum?

Back 20

1. decrease in blood volume
2. increased Hct and Hgb up to 72 hrs
3. leukocytosis for 10-14 days
4. coagulation elevated 2-3 weeks

Front 21

Nursing interventions for cardiovascular?

Back 21

1. inspect for signs of DVT
2. encourage ambulation
3. antiembolism socks to lower extremities if necessary

Front 22

Nursing interventions for GI and Bowel?

Back 22

1. Soften stool and promote bowel function
2. Intake and output
3. assess for hemorrhoids

Front 23

Nursing interventions for GU and Bladder?

Back 23

1. voiding 2-3hr
2. Excessive urination normal in first 2-3 days
3. Assess for distended bladder
4. Increase fluids
5. catheterize for bladder distention

Front 24

What are some signs of distended bladder?

Back 24

1. fundal height above umbilicus or baseline level
2. fundus displaced from midline to side
3. bladder bulges above symphis pubis
4. excessive lochia
5. tenderness
6. frequent voiding less than 150 ml indicates overflow

Front 25

What is the immune system interventions for nursing?

Back 25

1. SC injection of rubella vaccine postpartum if titer is less than 1:8
2. Hep B vaccine for newborns born to affected mothers within 12 hrs of birth
3. Rh-negative mothers with Rh positive infants must get immune globulin within 72 hrs
4. Varicella vaccine if not already immunized
5. tDaP status assessed for women

Front 26

What are some signs of DVT?

Back 26

1. leg pain, tenderness
2. unilateral swelling, warmth, redness
3. calf tenderness
4. MRI, Computed Tomograpy, Doppler ultrasound

Front 27

What is ITP (idiopathic thrombocytopenic pupura)?

Back 27

1. autoimmune
2. platelets attacked by antibodies
3. sever hemorrhage risk

Front 28

What is DIC (disseminated intravascular coagulation)?

Back 28

clotting and anticlotting mechanisms occur simultaneously

Front 29

What are some signs of ITP or DIC?

Back 29

1. unusual bleeding from gums or nose (epistaxis)
2. oozing of blood from incisions
3. petechia and ecchymoses
4. tachycardia, hypotension, diaphoresis
5. CBC, clotting factors

Front 30

When is bleeding a postpartum hemorrhage?

Back 30

1. >500ml after vaginal birth
2. >1,000 ml after cesarean birth

Front 31

What are some signs of postpartum hemorrhage?

Back 31

1. increase or change in lochial pattern
2. Uterine atony
3. Large blood clots
4. pad saturation 15 min or less
5. Tachycardia and hypotension
6. Hgb, Hct, PT time

Front 32

Nursing interventions during postpartum hemorrhage?

Back 32

1. monitor vitals
2. assess fundus, lochia, lacerations
3. assess bladder for distention
4. instet catheter to assess kidney function and urinary output
5. Start IV fluids with isotonic solutions
6. Oxygen 2-3 L
7. trendelenberg position

Front 33

What meds are used for postpartum hemorrhage?

Back 33

1. Oxytocin
2. Methergine (contraindicated for hypertension)
3. Cytotec
4. Hemabate

Front 34

what is uterine atony?

Back 34

Uterine muscle does not contract adequately after birth

Front 35

What are some signs of uterine atony?

Back 35

1. increased vaginal bleeding
2. uterus large and boggy
3. prolonged lochial discharge
4. tachycardia and hypotension

Front 36

What is a subinvolution of the uterus?

Back 36

1. Remained enlarged w/ continued lochial discharge

Front 37

what is inversion of the uterus?

Back 37

1. turning inside out of the uterus
2. partial or complete
3. an emergency

Front 38

What are some signs of inversion of the uterus?

Back 38

1. pain in lower abdomen
2. vaginal bleeding
3. complete sees a large, red, round mass protruding through introitus
4. partial palpates a smooth mass through dilated cervix
5. hypotension
6. dizziness

Front 39

Nursing interventions for inversion of the uterus?

Back 39

1. stop oxytocin
2. medications (brethine)
3. educate that c-sections needed for future pregnancies

Front 40

what are some signs of retained placenta?

Back 40

1. uterine atony, subinvolution, or inversion
2. excessive bleeding
3. return of lochia rubra after progression to serosa
4. elevated temperature

Front 41

Nursing interventions for retained placenta?

Back 41

1. monitor uterus position
2. monitor lochia
3. monitor vital signs
4. oxygen 2-3 L
5. Oxytocin