Exam 3 pt 2

Question 1

what is classified as a hemorrhage

Answer 1

> 500 EBL for vag delivery
1000 EBL for Csection
OR peripad saturation in 15 min or less

Question 2

failure of the uterus to return to a nonpregnant state

Answer 2

sub involution

Question 3

recognized causes of subinvolution

Answer 3

• retained placental fragments

- pelvic infection

Question 4

s/s of sub involution

Answer 4

• prolonged lochial discharge
• irregular or excessive bleeding
• sometimes hemorrhage
• boggy uterus or larger than normal

Question 5

med treatment of sub involution

Answer 5

Ergonovine or methylergonovine

Question 6

other treatment of sub involution

Answer 6

dilation and curettage may be performed to remove retained placental fragments
antibiotic therapy if cause is infection

Question 7

if woman’s uterus is not firm…

Answer 7

perform uterine massage and allow her to void

Question 8

cardiovascular system changes postpartum

Answer 8

blood volume decreases
cardiac output decreases
hematocrit, hemoglobin, and WBC changes

Question 9

gastrointestinal system changes postpartum

Answer 9

• abdomen returns to post pregnancy 6 wks after birth
• striae may persist
• diastasis recti abdominis
• lukewarm quick shower
• blood goes to abdominal organs not brain*can cause HYPOTENSION

Question 10

when can pt eat post partum

Answer 10

when you are sure they are not going back to OR

monitor for 1-3 hours, if scant bleeding then can eat

Question 11

describe bowel evacuation post partum

Answer 11

occurs 2-3 days after childbirth

Question 12

urinary system changes postpartum

Answer 12

diuresis and diaphoresis

Question 13

what urine component disappears by 1 wk post partum

Answer 13

renal glycosuria because HPL hormone is gone

Question 14

why does postpartal diuresis occur

Answer 14

getting rid of the fluid given in labor and the 1000 mL plasma

Question 15

how often should you monitor pt for bladder distention postpartum

Answer 15

Q1H, catheters if necessary Q4H

Question 16

musculoskeletal system changes postpartum

Answer 16

pelvis returns to pre pregnancy position(hip pain)

joints are stabilized 6-8 wks after birth due to RELAXIN

Question 17

endocrine system changes postpartum

Answer 17

• decrease in estrogen and progesterone

- pituitary hormones, ovarian function, and prolactin stay elevated in breastfeeding mother

Question 18

integumentary system changes postpartum

Answer 18

hair falls out may lose 20% of hair and cholasma disappears

Question 19

when does ovulation occur if not lactating

Answer 19

27 days after birth

Question 20

when does ovulation occur if lactating

Answer 20

70-75 days after birth

Question 21

what birth control pills can be given if breastfeeding

Answer 21

progesterone only* (no estrogen to be able to breast feed so IUD or depo)

Question 22

immune system changes postpartum

Answer 22

need for rubella vaccine determined

Question 23

when is mom given RHOGAM postpartum

Answer 23

if mom is Rh negative and the baby is Rh positive RHOGAM is given within 72 hours of delivery

Question 24

describe milk 24 hours after delivery then 72-96 hours after

Answer 24

24 hrs- milk is thick (colostrum)

72-96 hrs-milk matures based on supply demand

Question 25

very condensed breast milk | very rich in fats and nutrients because baby's stomach is very small and can only handle a little bit

Answer 25

colostrum

Question 26

engorgement support

Answer 26

frequent feedings, moist heat PRN, supportive bra, allow milk to dry on areolas, lanolin

Question 27

important to remember when breastfeeding

Answer 27

need to alternate breast every feed

Question 28

when does engorgement of breasts occur

Answer 28

in 24-36 hrs after milk comes in

Question 29

relief for nonbreastfeeding mothers

Answer 29

ice packs,cold cabbage Q2H, ASA/Motrin, NO heat, NO massage/stimulation/expression of milk

Question 30

do not let nonbreastfeeding mothers....

Answer 30

pump/feed even once d/t supply demand system

Question 31

when does the amount of menstrual flow return to prepregnancy volume

Answer 31

within 3-4 cycles (first menstrual cycle is heavier than normal)

Question 32

red discharge in the hospital that should subside by 5 days

Answer 32

rubra

Question 33

serous discharge, blood with serum up to 3-4 wks

Answer 33

serosa

Question 34

white discharge, WBC shedding with mucus

Answer 34

alba

Question 35

describe the different levels of peripad saturation

Answer 35

``` scant-less than 1 in light-less than 4 in moderate- >4 in heavy- saturation of peripad in 1 hr *hemorrhage- saturation of peripad in 15 min ```

Question 36

Rubin Stages of Development

Answer 36

1) Taking In 2) Taking Hold 3) Letting Go

Question 37

describe the Taking In stage

Answer 37

``` day 1 (first 24 hrs for vag and first 48 hrs for csec) focus is self and meeting basic needs ```

Question 38

describe the Taking hold stage

Answer 38

begins after day 1 (>25 hrs for vag and >49 hrs for csec) focus is care of baby and competent mothering optimal teaching period by nurses

Question 39

describe the letting go stage

Answer 39

begins after taking hold phase (abt 2 wks) | focus is forward movement of family as a unit with interacting members

Question 40

what psychological change is common following birth

Answer 40

labile emotions/fluctuate (fatigued and tired d/t loss of placenta and rapid shift of hormones)

Question 41

what are the postpartum blues

Answer 41

occur 1-10 days after birth weepy (loss of placenta) approx. 50-80% of all women emotional and liable for no reason

Question 42

symptoms of postpartum blues

Answer 42

depression, a let down feeling, restlessness, fatigue, insomnia, headache, anxiety, sadness, and anger

Question 43

coping with postpartum blues

Answer 43

rest, relaxation techniques, self care, plan a day out, talk with partner

Question 44

describe depression potpartum

Answer 44

usually starts at 2 wks and lasts up to one year grossly underdiagnosed, underassessed tense, irritable, sleeplessness, feels inept as mother

Question 45

what do we give mothers for depression

Answer 45

SSRIs and birth control

Question 46

describe psychosis postpartum

Answer 46

rare occurs within 3 weeks postpartum bipolar or major depression precipates it

Question 47

what elevates risk of psyhological risks postpartum

Answer 47

history of previous psychological history (anxiety/depression) *the worse the psychiatric illness, the more we worry about them and the greater risk they are

Question 48

C-section post op assessment

Answer 48

``` assess uterine firmness/position assess lochia and incision site for bleeding assess abdominal distention ambulate and warm compress assess bowel sounds inspect dressing for infection assess lungs ```

Question 49

abdominal distention can have referred pain where

Answer 49

to shoulder

Question 50

cannot feed pt until...

Answer 50

bowel sounds return