Module 6 Postpartum Flash Cards

Question 1

Discuss the hematologic changes in the PP patient:

Answer 1

Clotting factors 1,2,7,8,9,12 decrease until normalization at 8 w PP

Protein S and C (inhibit coagulation) increase until normalization at 4-8w PP

Question 2

On what day PP is the fundus palpable above the symphysis pubis?

Answer 2

7 days

Question 3

On what day PP is the fundus no longer palpable abdominally?

Answer 3

10-14 days (2 weeks)

Question 4

Describe the timing and presentation of lochia rubra.

Answer 4

3-5d long

primarily blood, red or brownish red in color

Question 5

Describe the timing and presentation of lochia serosa.

Answer 5

Mean duration is 22 days

primarily wound exudate and leukocytes with some blood
pinkish brown color

Question 6

Describe the timing and presentation of lochia alba.

Answer 6

Thru day 33-ish

primarily leukocytes
white or yellowish-white in color

Question 7

Describe the timing and presentation of eschar bleeding.

Answer 7

Day 7-14

Transient increase in red bleeding

Question 8

During what time frame should rhogam be given if needed?

Answer 8

Rhogam should be administered within 72 hours. Should be given even up to 14 days after birth. Standard 300 mcg dose

Question 9

Which vaccines can/should be given PP?

Answer 9

Offer: Flu, TDAP

For non-immune: MMR and varicella

Hep B and HPV-can complete series

Question 10

Describe the Hep B vaccine schedule

Answer 10

3 doses given over 16 weeks. 2nd dose 4w after 1st, 3rd dose 8w after 2nd

Question 11

Describe the age-specific HPV vaccine schedule.

Answer 11

Ages 9-14: 2 doses (6-12 months apart)-if incomplete by age 15, just one dose is needed to complete

Ages 15-45: 3 doses. 2nd dose 1-2m after first, 3rd dose 6m after 2nd.

Question 12

What pain medications can be offered for mild PP pain?

Answer 12

APAP and Ibuprofen

Question 13

What pain medications can be offered for moderate PP pain?

Answer 13

APAP, Ibuprofen, Norco, Vicoden, Roxi

Question 14

What pain medications can be offered for severe PP pain?

Answer 14

Toradol

Question 15

What type of RX meds can be given for hemorrhoids?

Answer 15

Hydrocortisone

Question 16

What is the exercise recommendation for 18+ y/o?

Answer 16

150 minutes of moderate-intensity aerobic activity each week with
Muscle strengthening 2+ days per week

Question 17

What Dx should be considered in a patient with a fever in the first 10 days PP?

Answer 17

Endometritis, wound infection, UTIs

Question 18

What is the classic triad of symptoms for endometritis?

Answer 18

Fever, tachycardia, uterine tenderness

Question 19

What are risk factors for endometritis?

Answer 19

BV, obesity, DM, anemia, HIV, PTB, post-term pregnancy, C/S, chorio, internal monitoring, manual removal of the placenta, meconium (thick), operative vaginal, prolonged labor, PROM

Question 20

How should you respond to a patient who presents with one of the following? HYPOTENSION, TACHYPNEA, O2SAT less than 95% or Shortness of Air

Answer 20

*** CONSULTATION should be obtained rapidly for any woman who has signs or symptoms that indicate she is at risk for severe morbidity

Question 21

When should endometrial or blood cultures be obtained?

Answer 21

Endometrial cultures ARE NOT obtained

Blood cultures are not obtained unless the patient is acutely ill because most women respond well to empiric treatment

Question 22

What is the gold standard of treatment for endometritis?

Answer 22

IV Clindamycin (Cleocin) 900 mg IV and gentamicin (Garamycin) 1.5 mg/kg q 8 hours
OR ( DOXYCYCLINE & METRONIDAZOLE)

Treatment should be continued until 24-28 hours afebrile. Mild endometritis may be offered PO ABX

Question 23

At what point after initiating treatment for endometritis should you consult/refer?

Answer 23

If she remains febrile after 24-48hrs

Question 24

How does a UTI/pyelo present PP?

Answer 24

urinary frequency, urgency, dysuria, or lower abdominal pain
low-grade fever
flank pain
CVAT
nausea and vomiting
HOWEVER: PP women often DO NOT have, dysuria, frequency or urgency

Question 25

How should the APRN/CNM manage a PP hematoma?

Answer 25

PHYSICIAN CONSULT IS NECESSARY for evaluation and plan

Note: Large hematomas or those continuing to grow: indicates active bleeding. Small and moderately sized that are not growing can be managed expectantly

Question 26

How should a secondary PPH without infection be managed?

Answer 26

methylergonovine (Methergine) 0.2 mg PO q 3-4 hours x 24- 48 hours

Question 27

How should a secondary PPH WITH infection be managed?

Answer 27

broad-spectrum antibiotics: ampicillin-sulbactam or cefoxitin
if chlamydia is suspected: azithromycin 1g PO (one dose) added to the above regimine
IV or PO depending on the severity of her symptoms

Question 28

How should the APRN/CNM manage PP cardiomyopathy?

Answer 28

PROMPT referral to Physician, preferably a cardiologist

Question 29

What are the S/S of PP cardiomopathy?

Answer 29

Marked SOA
orthopnea (the sensation of breathlessness in the recumbent position, relieved by sitting or standing.) NIH.gov
tachycardia
palpitations
chest pain
cough
edema

PE:
crackles at base of lungs
pitting edema
jugular vein distention
a heart sound
laterally shifted point of max impulse with auscultation

Question 30

What is the gold standard for dx of PP cardiomyopathy?

Answer 30

Echocardiogram (echo) (definitive dx)
12 lead electrocardiogram (ECG) (can rule out other causes. 50% of people with PPCM have a normal ECG)
OR
or Markedly elevated BNP

Question 31

At what PP point does “baby blues” become a dx of PPD?

Answer 31

2 week mark is past Baby Blues and into PPD

Question 32

Which SSRI is best for a BF patient?

Answer 32

Zoloft

Question 33

Which SSRI should not be used in pregnancy?

Answer 33

Paxil

Question 34

Who should be prescribes Bupropion (Wellbutrin) cautiously?

Answer 34

Someone with a seizure disorder

Question 35

What is first line for mastitis?

Answer 35

Dicloxacillin (Dynapen) 500 mg QID for 10-14 days OR
Cephalexin (Keflex) 500 mg QID for 10-14 days

If PCN allergic:
Clindamycin 300 mg QID QID x 10-14 days
Or Erythromycin 250 mg or 500 mg QID x 10-14 days

Question 36

How can a patient be counseled that wants to lose weight PP?

Answer 36

Safely exercise 45 min a day 4 days/week
May decrease daily intake by 500 calories
Safe weight loss of 1 lb per week
Recommended maximum weight loss after the 1st mo PP is 4.5 lbs/ month