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6TH SEMESTER > OB EXAM 6 > Flashcards

OB EXAM 6 Flashcards

1
Q

Early PPH

A

within 24 hours after delivery

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2
Q

late PPH is

A

more than 24 hours after delivery but less than 6 weeks post op

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3
Q

causes of early PPH

A

uterine atony

lacerations

hematomas

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4
Q

causes of late PPH

A

sub involution of uterus

hematomas

endometriosis

retained placental fragments

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5
Q

not returning to normal position, MAIN CAUSE OF PPH

A

subinvolution of uterus

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6
Q

sx of PPH

A
  • Excessive or bright red bleeding
  • Boggy fundus that does not respond to massage
  • Abnormal clots
  • High temp
  • Any unusual pelvic discomfort or back pain
  • Persistent bleeding with firm uterus
  • Increased pulse of dec BP
  • Hematoma formation in area of perineal area
  • Dec level of consciousness (late sign)
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7
Q

• Leading cause of PPH

A

uterine atony

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8
Q

greatest risk for uterine atony is?

A

first hour after birth

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9
Q

factors associated with PPH

A

high parity

hydraminos

macrosomic fetus

multifetal gestation

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10
Q

treatment of uterine atony

A

see if funds is displaced

check for lochia

check Hgb and Hct

ensure PIT is on

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11
Q

if PIT isn’t working mom will get

A

Cytotec (oral or suppository)

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12
Q

if cytotec doesn’t work

A

methergine IM

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13
Q

if all the oxytocic drugs don’t work to treat uterine atony, mom will get?

A

blood transfusion

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14
Q

provider will do what with uterine atony?

A

bimanual compression

or uterine packing

or hysterectomy

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15
Q

placenta is considered retained if it is not delivered within

A

30 min after birth

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16
Q

initial management of retained placenta

A

manual separation and removal

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17
Q

• In rare instances there may be abnormal adherence of the placenta to the _____.

A

myometrium.

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18
Q

3 examples of placental adherance

A

placenta accrete

placenta increta

placenta percreta

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19
Q

bottom side

A

acretta

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20
Q

middle, deeper penetration

A

increta

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21
Q

top, perforation of uterus by placenta

A

percreta

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22
Q

retained placenta can cause

A

bleeding

surgery

hysterectomy

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23
Q

suspected if bleeding continues with firm uterus

A

lacterations of the genital tract

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24
Q

where are lacerations found

A

vagina

cervix

labia

perineum

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25
Q

most common lacerations

A

perineum

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26
Q

how are lacerations classified

A

first

second

third

fourth degree

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27
Q

assessment findings with lacerations

A

firm uterus @ umbilicus

slow trickle or oozing blood heavier than normal

longer lasting bleeding with clots

tachycardia

hypotension d/t bleeding

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28
Q

medical management of lacerations

A

inspection by healthcare provider

surgical repair of lacerations

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29
Q

nursing actions for lacerations

A

monitor VS

blood loss

notify HCP of firm funds but heavier than normal bleeding

admin pain meds

stool softeners

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30
Q

types of hematomas

A

vulvar

vaginal

retroperitoneal

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31
Q

most common hematoma

A

vulvar

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32
Q

most common sx of hematoma

A

pain

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33
Q

risk factors for hematoma

A

episiotomy

forceps delivery

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34
Q

assessment findings with hematomas

A

• women with severe pain in perineal area not relived with analgesics, usually not visualized but complain of heaviness or fullness in vagina, or rectal pain, if in rectum will see swelling, tenderness,

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35
Q

medical management is that hematomas usually ________.

A

evacuated

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36
Q

Nursing actions for hematomas

A

• apply ice to peritoneal area for first 24 hours, assess pain level, describe pain to identify where coming from, VS (changes will be d/t blood loss, bleeding into hematoma), admin analgesics per order, check Hgb and Hct, notify health care provider of results

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37
Q

inversion of the uterus AKA

A

uterine prolapse

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38
Q

uterus turned inside out after birth

rare but potentially life threatening event

A

uterine prolapse

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39
Q

contributing factors for uterine prolapse:

A

fundal implantation of placenta, vigorous fundal pressure,
excessive traction to the cord,
uterine atony, and
adherent placental tissue.

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40
Q

presenting signs of uterine prolapse

A

at risk for going into shock

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41
Q

treatment of uterine prolapse

A

relax uterus so HCP can put uterus back and reposition in the pelvis

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42
Q

once positioned, give mom with uterine prolapse

A

oxytocin and ATB

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43
Q

do you massage after repositioning uterine prolapse

A

NO

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44
Q

is a medical condition in which after childbirth, the uterus does not return to its normal size.

A

subinvolution

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45
Q

causes of subinvolution

A

retained placental fragments and pelvic infection

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46
Q

sx of subinvolution

A

prolonged lochial discharge

irregular or excessive bleeding

sometimes hemorrhage

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47
Q

nursing interventions of subinvolution

A

sx need to be reported, ways to reduce infection

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48
Q

tx subinvolution with

A

ergotrate or methergine orally to help uterine contract

or ATB if caused by infection

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49
Q

loss of 50% blood

A

hemorrhagic shock

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50
Q

medical management of hemorrhagic shock

A

restore circulating volume and treat cause of hemorrhage

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51
Q

sx of shock

A

bleeding (soaked pad in 15 min)

rapid shallow resp.

rapid weak irreg. pulse

decreased BP (late sign)

cool pale clammy skin

decreased urinary output

lethargy —> coma

anxiety —> coma

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52
Q

interventions for hemorrhagic shock

A 
o	Get help
o	Notify physician
o	Start iv if doesn’t have one
o	Start oxytoxics
o	Give O2 10-12 L/min
o	Monitor vitals 
o	No foley 
o	Admin blood products as ordered
o	Assess for any fluid overload
o	Monitor lab values
o	Evaluate for DIC
o	Ensure no reaction to blood transfusion
o	Be admin any other meds ordered
o	Possible prep for surgery
o	Be charting incident when resolved
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53
Q

Venous Thromboembolic Disorders

A

superficial venous thrombosis

DVT

Pulmonary embolism

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54
Q

warm red area in calf, uncommon now d/t?

A

superficial venous thrombosis

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55
Q

initial low grade fever followed by higher temp and chills

A

DVT

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56
Q

risk factors for pulmonary embolism

A

c-section

obesity

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57
Q

how to prevent PE

A

compression stockings

freq. position changes

early ambulation

rest with leg elevated

heparin or coumadin

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58
Q

hx of PE….she can’t use what?

A

birth control pill

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59
Q

post partum infections AKA

A

puerperal infection

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60
Q

• Any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion, or birth

A

post partum infections

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61
Q

post partum infections is defined as presence of a fever of ____ or more on 2 successive days

A

100.4

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62
Q

common causes of PP infections

A

endometriosis

wound infections

UTIs

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63
Q

♣ Infection of the lining of the uterus

♣ Most common, mainly cesarean delivery

A

endometriosis

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64
Q

sx of endometriosis

A

♣ fever, chills, nausea, fatigue/lethargy, pelvic pain, uterine tenderness, foul smelling profuse lochia

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65
Q

tx of endometriosis

A

ATB

pain relief

well hydrated

plenty of rest

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66
Q

♣ Often develop after mothers are discharged home

♣ Typically cesarean incision, repaired lacerations, or episiotomy site

A

wound infections

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67
Q

sx of wound infections

A 
fever, 
edema, 
erythema, 
pain/tenderness, 
sero-purulent drainage, 
wound separation
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68
Q

tx of wound infections

A

ATB therapy

wound debridement

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69
Q

comfort measures for wound infections

A

perineal care

sitz baths

warm compresses

analgesics as ordered

educate on good hygiene and self care

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70
Q

risk factors for UTIs

A

catheterization

freq. pelvic exams

hx UTI

Csection birth

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71
Q

sx of UTI

A

dysurina

freq. uregency

low grade fever

complain of urinary retention

hematuria

flank pain

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72
Q

tx of UTI

A

ATB

analgesic

well hydrated

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73
Q

goal of PP woman

A

nurse provides family-centered care that focuses on assessment and support of a woman’s physiologic and emotional adaptation after birth

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74
Q

typical hospital stay after vag birth

A

1-2 days

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75
Q

typical hospital stay after c-section

A

3-4 days

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76
Q

fourth stage of labor is?

A

first 1-2 hours after delivery

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77
Q

ϖ Critical time for mother and newborn

both are recovering from stress of labor and delivery and getting acquainted with each other and family members

A

fourth stage of labor (early PP)

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78
Q

fourth stage of labor is a good time to intiate

A

breast feeding because it contracts the uterus

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79
Q

can be given IM to patient if Pitocin is not working

A

ϖ Methergine:

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80
Q

all vital signs except ____ are done every 15 min in 4th stage?

A

temp

81
Q

when is temp taken?

A

beginning and end of recovery period

82
Q

ϖ Besides vital signs, assessments includes

A

checking the fundus, lochia, episiotomy or lacerations, recording intake and output, status of IV, recording any meds being administered (every 15 minutes vital signs)

83
Q

are common and are not from infection

A

tremors or shivering

84
Q

tremors or shivering may be because of?

A

pelvic pressure

85
Q

response of transition from mother to fetus during placental separation

A

tremors or shivering

86
Q

reaction to adrenaline produced during labor

response to epidural

A

tremors or shivering

87
Q

interventions for tremors

A

warm blanket

reassure woman its normal response

88
Q

what could trigger tremors

A

loss of fluid and blood during delivery

89
Q

when can woman after vag delivery eat?

A

right after

90
Q

when can woman eat after c section

A

12-24 hours after

91
Q

ϖ From their initial contact with postpartum women, nurses prepare the mother for?

A

her return home

92
Q

LOS (length of stay) depends on many factors:

A

o Physical condition of the mother and infant

o Mental and emotional status of the mother

o Social support at home

o Client education needs

o Financial constraints that may become a problem for the mother

93
Q

o provided minimum federal standards for healthcare coverage of mothers and their newborns

A

Newborns’ and Mothers’ Health Protection Act of 1996

94
Q

Under this act, all health plans are required to allow the new mother and infant to remain in the hospital for ___ hours after a normal vaginal delivery

A

48

95
Q

Under this act, all health plans are required to allow the new mother and infant to remain in the hospital for ____hours following a Cesarean birth

A

96 (3-4 days),

96
Q

♣ This law came about because healthcare providers were concerned about the shortened stays mothers often do not show medical problems until the first ____ hours after delivery

A

24

97
Q

ϖ Criteria for early discharge

A

o Stays must be long enough for mother to be recovered and sufficiently care the newborn and herself

98
Q

o Nurses can be held liable for ________ if mother is discharged before her condition is stable

A

abandonment

99
Q

o Hematocrit levels drop moderately for__-___ days, then increases

A

3-4

100
Q

how much will H and H drop with every 500 ml of blood loss

A

Hgb drops 1-1.5

Hct drops 3-4%

101
Q

o Anything above _____ cc of blood loss would constitute postpartum hemorrhage

A

1000

102
Q

• At delivery, fundus is

A

2 cm under umbilicus

103
Q

• 12 hours after fundus is

A

even with umbilicus

104
Q

how to minimize infection

A 
change linens freq.
woman need slippers
hand washing
standard precautions
perineal are
105
Q

o During PP period, with the exception of first 24 hours, patient should be

A

afebrile

106
Q

♣ Maternal temperature of up to ____ may occur after childbirth as a result of exertion and dehydration of labor

A

100.4

107
Q

♣ Increase in temp between ____-____ may occur during first 24 hours after mother’s milk comes in

A

100-102.2

108
Q

♣ Fever in the PP woman is defined as temp greater than ____ or more on two successive days, not counting the first 24 hours

A

100.4

109
Q

single most significant risk for infection

A

• cesarean delivery

110
Q

Within ___ hours of delivery, you’ll find the fundus midline with the umbilicus and it should be firm.

A

12

111
Q

the fundus Decreases ___-___ cm every 24 hours,

A

1-2

112
Q

by 2 weeks

A

you should not be able to palpate the fundus.

113
Q

o the words used to describe the amount of lochia

A

Scant, small amount, moderate, or heavy

114
Q

o Heavy blood loss is

A

one pad saturated in one hour

115
Q

ϖ prevents uterus from contracting normally

A

bladder distention

116
Q

will aid woman in relaxation to go to the bathroom.

A

Running sink water, pouring warm water over perineum, or placing woman’s hand in warm water

117
Q

o Secondly, allowing woman to _____ will relax urinary meatus

A

take a shower or sitz bath,

118
Q

o Third, ____ ______ as ordered may useful fear of pain may prevent woman from relaxing

A

administering analgesics

119
Q

o If all else fails, fourth intervention

A

in & out cauterization to drain patient’s bladder

120
Q

ϖ Common causes of pain:

A 
o	Pain from uterine contractions
o	Pain from perineal lacerations or episiotomy
o	Pain from hemorrhoids
o	Gas pains
o	Sore nipples
o	Breast engorgement
121
Q

ϖ Women most likely to experience the greatest discomfort are those who have had:

A

o Forceps or vacuum assisted operative births

o Episiotomy

122
Q

ϖ Treating pain associated with uterine contractions includes?

A

application of warmth

heating pad across abdomen

123
Q

ϖ Treating pain associated with perineal lacerations or episotomy

A

o Patient lie on her side
o Offer ice packs to perineum
o Give topical applications of anesthetic spray/lidocaine/tucks as ordered – dermaplast
o Dry heat
o Cleansing perineum with warm water from peri bottle
o Providing patient with a sitz bath

124
Q

when to give med to minimizes impact from narcotic

A

right after breastfeeding

125
Q

ϖ Women should void spontaneously __-___ hours after delivery depending on physician order

A

6-8

126
Q

ϖ Nurse should expect ____cc or more from each voiding

A

150

127
Q

ϖ Reasons for voiding difficulties

A
  1. Fear of pain with voiding
  2. Decreased bladder tone
  3. Perineal edema
  4. Perineal trauma
128
Q

med for gas

A

phazyme

129
Q
  1. First ___-___ hours after delivery excellent time to begin breastfeeding – baby is in an alert state and generally will suck well
A

1-2

130
Q

milk comes in in

A

2-3 days

131
Q

lactation suppression interventions:

A

wear tight bra 24 hrs a day.

avoid warm water on breasts

avoid pumping

132
Q

how to apply ice packs to breast

A

15 min on 45 min off

133
Q

when does lactation cease

A

few days to few weeks

134
Q

Women not immune to rubella

A

ϖ those who have never been vaccinated,

those who have had disease,

or those whose titer is less than 1:8 ratio should be vaccinated after delivery

135
Q

o Live attenuated virus is NOT communicable through breast milk – it is shed through

A

urine and other bodily fluids

136
Q

o Given early in PP period

o Recommended for women not previously vaccinated or who received more than 2 years before pregnancy

A

ϖ Tdap tetanus, diphtheria, acellular, pertussis vaccine

137
Q

If mother is Rh -

A

o given rhogam at 28 weeks and again within 48 hours of delivery

138
Q

rh immune globulin is given

A

72 hours of delivery

139
Q

o Mom Rh – and baby RH +;

A

Coomb’s test negative

140
Q

suppresses immune response

A

Rh immune globulin

141
Q

o if woman receives rubella vaccine at the same time as Rh immune globulin, she needs to be assessed in ____ months for a titer and she may need another dose of rubella

A

3

142
Q

3 phases of PP period

A

taking-in
taking hold
letting go

143
Q

ϖ 1 to 2 days after delivery
ϖ More focused on herself
ϖ Contemplation of recent birth experience
ϖ Assumes passive role in care – depends on others for care
ϖ Verbalizes birth experience
ϖ Sense of wonder when looking at infant
ϖ New mother will need extra food and rest
ϖ Cesarean mothers need even more rest

A

taking-in

144
Q

ϖ 2 to 7 days after delivery
ϖ Much more receptive to learning about infant care
ϖ More interested in taking care of the baby
ϖ Increased independence in care
ϖ Strong interest in caring for infant
ϖ Lack of confidence when caring for infant
ϖ Parents focus on learning to care for their new baby
ϖ Common for new mother to have temporary mood swings and feel vulnerable

A

taking hold

145
Q

ϖ 7 days after delivery, last phase
ϖ Adapts to parenthood and definition of new role as parent/caregiver
ϖ Abandons fantasy child and accepts infant as is
ϖ Recognizing infant as separate individual
ϖ Assumes role and responsibility of caregiver to infant
ϖ Couple will continue relationship they had before birth of baby
ϖ Any other siblings at home become more involved with baby also

A

letting go

146
Q

o Most couples resume sex

A

before 6 weeks postpartum

147
Q

o sex Can generally be resumed __-___ weeks after birth when bleeding has stopped and episiotomy or laceration has healed

A

2-4 weeks

148
Q

o Important to educate client that ____ needs to be re-fitted after childbirth

A

diaphragm

149
Q
  • “4th stage of labor”

* Begins after birth of baby

A

Puerperium

150
Q

Puerperium continues until when?

A

6 weeks after delivery

151
Q

reproductive organs return to non-pregnant state

A

puerperium

152
Q

nursing care during Puerperium focuses on:

A

• on immediate physical needs, emotional needs, and education

153
Q

organ we are most concerned with during puerperium

A

uterus

154
Q

process in which uterus returns to nonpregnant state

A

• Involution –

155
Q

o Compression of the intrauterine blood vessels as uterus contracts is what causes

A

homeostasis

156
Q

Immediately after delivery of placenta, uterus weights

A

~1,000 g

157
Q

hormone responsible for the strengthening rhythm of the contractions

A

• Oxytocin –

158
Q

o In 1st 1-2 hours after delivery, uterine contractions may ]

A

decrease in intensity & may become more uncoordinated

159
Q

Conditions that make involution harder, therefore cause more cramping

A

o lg baby, Multifetal pregnancies, oligohydramnios

160
Q

o If uterus doesn’t involute or shrink

o Failure of uterus to return to nonpregnant state

A

subinvolution

161
Q

most common cause of subinvolution

A

retained placental fragments or infection

162
Q

ϖ When a woman stands up for the first time, there may be gush of blood from the vagina, NOT HEMORRHAGE. Blood pools when she is laying in the bed.

A

THIS IS NORMAL

163
Q

like heavy menstrual bleed

consists of blood, decimal and thromboplastin debris

blood changes from bright red to pale

lasts for 2-3 days after delivery

may see a few clots

A

lochia rubra

164
Q

Consists of old blood, serum, leukocytes, and tissue debris

Blood changes from pale red to light brown

Begins about 3rd day PP. Can last for 22-27 days

Should not see clots

A

lochia serosa

165
Q

Consists of leukocytes, decidua, epithelial cells, mucus, serum, and bacteria

Discharge is yellow to white in color

Usually begins on 10th PP day

Lasts 10-14 days. May last longer and still be normal

A

lochia alba

166
Q

• 6 weeks (checkup) will most likely have what type of blood

A

lochia alba

167
Q

o Softens immediately after childbirth

A

cervix

168
Q

will appear bruised, mild lacerations, even microscopic lacerations places woman at risk for infection

A

ectocervix

169
Q

External cervical os never retains prepregnancy appearance—(shape of circle)

it will now look like?

A

shape of fish mouth

170
Q

o reason for thinness of the vaginal mucosa and absence of rugae

A

o Estrogen deprivation

171
Q

when does vagina return to pre-pregnancy size

A

6-10 weeks

172
Q

sx of hemorrhoids

A

intense itching, discomfort with sitting, bright red bleeding with bowel movement, anal pain.

173
Q

Hemorrhoids usually decrease in size within ____ weeks of childbirth. Normally there will be orders for hemorrhoid cream, Tucks pad, Sitz bath.

A

6

174
Q

o Mothers who are Type I diabetics will likely require much ___ insulin for several days after childbirth

A

less

175
Q

o responsible for suppression of ovulation

A

prolactin

176
Q

o Approx. 6 weeks needed to return to prepregnant state

A

abdomen

177
Q

o Ketonuria can occur from

A

prolonged birth or preterm labor with dehydration

178
Q

o With adequate voiding, bladder regains tone in __ days

A

7

179
Q

= clear yellow fluid will probably be seen leaking from breasts

A

Colostrum

180
Q

o breasts Gradually become fuller/heavier as colostrum transitions to milk takes place ___-___ hours PP

A

72-96

181
Q

bluish-white liquid that looks like skim milk

A

“Milk coming in”

182
Q

♣ First __ hours = imperative that she doesn’t stimulate breast/nipple in any way if she doesn’t want to breastfeed

A

36

183
Q

• Typically the period from the decision to conceive or adopt through the first months of the newborn’s life is considered the transition to parenthood

A

transition to parenthood

184
Q

who typically feels more stressed

A

father

185
Q

• The process by which a parent comes to love and accept a child and a child comes to love and accept a parent

A

Attachment/Bonding

186
Q

Communication between the infant and the parents occur through many channels.

A

touch

eye contact

voice

odor

entrainment

biorhythmicity

reciprocity

synchrony

187
Q

♣ believes in infant massage

A

India

188
Q

don’t touch baby because of evil spirits

A

european

189
Q

o Infants respond to ____-_____ voices and can distinguish their mother’s voice from others soon after birth.

A

higher-pitched

190
Q

o They wave their arms, lift their heads, and kick their legs, seemingly “dancing in tune” to the _____ _____.

A

parents voice

191
Q

o Refers to the infant being in tune with the mothers natural biological rhythms

A

• Biorhythmicity

192
Q

o The mother’s heart beat or a recording of a heartbeat can

A

sooth a crying infant.

193
Q

o Is a type of body movement or behavior that provides the observer w/ cues

o A body movement or behavior that sends a message to the observer

A

• Reciprocity

194
Q

• EX OF Reciprocity

A

o A response to each other’s behaviors; if a baby cries the mother picks them up

195
Q

o Refers to the “fit” between the infants cues and the parents response

A

o Refers to the “fit” between the infants cues and the parents response

196
Q
  • women have exaggerated changes in mood and often cry easily for no apparent reason
  • Occurs within the first two weeks PP.
A

postpartum blues

197
Q

PP blues peaks when and subsides when?

A

• peak around the 5th day and subside by the 10th day.

198
Q

• Other symptoms of PP blues include

A

depression, a let-down feeling, restlessness, fatigue, insomnia, HA, anxiety, sadness, and anger.

199
Q

increases the risk of PP depressive symptoms and can have a negative effect on the maternal role attainment

A

• PP fatigue

6TH SEMESTER (22 decks)

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