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OB-Exam 2 Flashcards

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1
Q

Physiological change of uterus postpartum

A

Shrinks down back to pre-pregnancy state
-Goes from the size of a watermelon back to about a lemon or orange
-Placenta removed (7cm wound on the inside) needs to heal
-contractions help the uterus heal, help stop bleeding

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2
Q

where is fundus found immediately after delivery etc.

A

found slightly below the umbilicus, and within one hour goes up to the level of the umbilicus
-from there shrinks down one finger a day

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3
Q

When would the uterus be back to the pelvic cavity

A

around day 9-10, and you can no longer palpate.

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4
Q

What can assist uterine involution

A

Breastfeeding (releases oxytocin -> causes contraction)
Ambulation (gravity helps bring uterus down)

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5
Q

What can slow down uterine Involution

A

Having multiple fetuses (twins triplets), having repeated births, and excessive narcotics (analgesics)

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6
Q

What is the cervical os

A

the opening between the cervix and the upper part of the uterus

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7
Q

Physiological changes postpartum for Cervical os

A

Nulliparous cervix - has not given birth, little circle
Multiparous cervix- has given birth , wider hole.

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8
Q

Hormones after birth

A

-progesterone and estrogen decrease right after birth.
-As you breastfeed those hormones will fluctuate as you feed (oxytocin and prolactin)

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9
Q

Around how soon after birth will FSH elevate and what will it cause

A

around 12 days, and this will return the menses

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10
Q

If you are breastfeeding how soon will menstruation return

A

4-6 months and if not breastfeeding 6-10 weeks.

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11
Q

When can contraceptives be discussed

A

after postpartum

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12
Q

Lacogenesis 1

A

16 weeks gestation process that creates colostrum

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13
Q

Lactogensis 2

A

triggered by birth, once the baby and placenta are delivered, an increase in oxytocin helps start creating and producing more colostrum

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14
Q

Lactogensis 3

A
  • around day 10 milk supply will strat to stabilize
    -the more the mom puts baby on the breast the more stimulation the more milk will be produced
    (supply and demand)
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15
Q

Lactogenesis 4

A

involution- baby will strat weening ff

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16
Q

What could low and high BP postpartum indicate?

A

-Low BP: if she lost a lot of blood she could be hypovolemic, and she might need a transfusion
-High Bo: 140/90 could be developing pre-eclampsia (check urine for protein)

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17
Q

Postpartum maternal assessment

A

-slight temp increase due to dehydration
-pulse slightly decreased for about 1 week (due to decreased pressure on the vena cava)
-BP should return to pre-pregnancy BP
-Pain increases after birth

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18
Q

Maternal Assssment Postpartum
(Breast)

A

-Colostrum present during first 1-3 days ( normal)
-Milk production 3-5 days (supply and demand
-engorgement is common and normal (breast will feel full, tender, and heavy)

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19
Q

Maternal Assssment Postpartum
(Uterus) what are the three things you assess for?

A

consistency, location, and fundal height

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20
Q

Treatment and Education for breast engorgement

A

Keep breastfeeding every 2-3 hours or on demand, if the baby skips a feeding you should pump
-warm shower, supportive bra, massage breast, cold compress after feeding to decrease inflammation (no heat causes already increased blood flow)

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21
Q

Engorgement can lead to -> Mastitis (explain)

A

Infection of the milk duct due to bacteria
-encourage good hand hygiene, keep breasts clean
-cracking and bleeding from nipples could be a source of infection
-make sure the baby has a good latch.
-Make sure antibiotics ordered

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22
Q

If mom does not plan to breastfeed what education can you offer?

A

Wear a tight supportive bra, avoid any nipple stimulation, use a cold compress, and take analgesics to help with discomfort.

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23
Q

Explain the different assessments of the uterus postpartum

A

Consistency: Firm (Hard) or Boggy (soft)
location: usually found midline (if deviated to L or R could be due to full bladder)
Fundal Height: document in relation to umbilicus -> measured in fingerbreadths or centimeters

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24
Q

explain different ways of writing where the uterus is located

A

Number and then U (3/U) how many above the umbilicus
u/u at the umbilicus
u then number (u/1) how many below the uterus

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25
Fundal Exam- postpartum
Mom should be supine laying flat for proper feeling
26
Lochia postpartum
-bloody discharge after birth -asses with color, amount, odor, consistency
27
If the fundus is not firm and mom is actively bleeding what is something you could actively do in that moment?
Fundal massage, if it doesn't work call for help think hemorrhage
28
How many mLs of blood is normal after vaginal and C-section delivery and what's considered a hemorrhage
Vaginal: should be less than 500 mLs anything over is considered hemorrhage. C-Section: should be less than 1000 mLs anything over = postpartum hemorrhage
29
Explain different types of lochia
Lochia rubra: bright red blood, 1-3 days postpartum Lochia Serosa: pinkish brownish 4-10 days postpartum Lochia alba whitish can last up to 6 weeks after birth
30
Measuring the amount of lochia
Scant: less than 2.5 cm Light: 2.5cm - 10cm Moderate: >10cm Heavy: One pad saturated in 2 hours Excessive: One pad saturated in 15 minutes (check for hemorrhage)
31
Perineum assessment postpartum
Could be edematous (swollen with fluid), tender, ecchymosis (bruising), tearing Offer Car and comfort, witch hazel pad, numbing spray, and hydrocortisone cream for hemorrhoids.
32
types of tears
1st degree- tear through skin and epithelium 2nd degree- tear through fascia and muscle 3rd degree- fascia + muscle and anal sphincter 4th degree- fascia + muscle and internal and external anal sphincter
33
Bladder assessment postpartum
encourage frequent urination -If they had a foley make sure they urinate within 6 hours ( a full bladder can cause the uterus to deviate and not contract properly)
34
Postpartum bowels
Increase fiber and doffer stool softener. Avoid straining If they have hemorrhoids hydrocortisone cream can be given to help.
35
Cesarean section nursing care postpartum
-Incision site: could be closed with staples, steri-strips, dressing, or glue. -Measure output with Foley and make sure they can void, -Make sure to have DVT prophylaxis encourage them to try to stand and walk -Require pain management IV toradol for the first 24 hours surgical site: note any redness, swelling, pus, etc, -Auscultate for bowel sounds and make sure they are passing gas
36
Education for C-sections for moms
make sure the incision stays clean and dry no harsh or scented soaps pain management education on signs of infection
37
Rho(D) immune globulin (RhoGAM)
Rh+ has Rh antigen on the surface Rh- does not have antigen If mom is Rh - and Bbay is Rh + it could cause complications -If mom is Rh- she is gonna get RhoGAM during her pregnancy as well as any procedures that could mix her blood with babies blood -automatically get it at about 26 weeks - Postpartum if the baby is Rh+ then she'll get RhoGam again after delivery within 72 hours
38
Postpartum Maternal Attachment Bonding
should happen immediately after delivery for both mom & dad -make eye contact, touching baby, looking at the baby, feeding the baby
39
Phases of Maternal Adjustment
Taking in: focused on her own needs but excited, talking Taking hold: focused on maternal role, wants to take charge, wants to learn and practice, hands-on Letting go: family starts to settle into their roles, settling into family life
40
Postpartum blues
A huge shift in hormones -It is normal for a mom to start crying within the 1st-2 weeks but should subside
41
Postpartum blues education
- encourage support, rest, proper nutrition, educate on PPD, and follow-up with the provider
42
Postpartum Depression
Persistent sadness that goes on past those 1-2 weeks -intense mood swings, irritability, not taking care of herself or baby, feelings of guilt and anxiety -Edinburgh will be due before discharge and then again at 4 weeks
43
Postpartum depression education
Recommend counseling, antidepressant medications, family/community support, rest & Nutrition
44
postpartum Psychosis
medical emergency, considered a crisis -intrusive thoughts, seeing things, hearing voices
45
What are the 4 critical factors that influence labor and what is a way to remember them?
The 4 P's 1. passage 2. passenger 3. powers 4. psych
46
The birth passage
the way the fetus takes to exit the uterus
47
What sections is the pelvis divided into
inlet, pelvic cavity, outlet
48
What are the different types of pelvis with an explanation
1. Gynecoid: Nice opening (wide heart) 2. Android: Triangle shape (narrow heart) 3. Anthropoid: Good shape (long heart) 4. Platypelloid: difficult to get into but can be done (squished heart)
49
Which type of pelvis is most favorable for delivery?
gynecoid and anthropoid.
50
Labor is a series of events affected by the coordination of the four essential factors. One factor is the pelvis. What are the other three factors?
Fetus (passenger), Contractions (power), Psychological Response (psych)
51
Passenger ( the fetus and placenta)
Passenger needs to cooperate for effective labor
52
factors affecting the ability of passenger to exit the pelvis.
Fetal presentation: part of the fetus that enters the pelvic cavity first (how the fetus will present itself) Fetal Lie: maternal longitudinal axis and fetal longitudinal axis (how are they lying in the womb? prefer up & down) Fetal Attitude:Relation of fetal parts to one another (what degree of flexion? We want high tucked like a ball) Fetal Position: Position of fetus in relation to the maternal pelvis Station: Fetal descent in relation to ischial spines (How far down is the baby descending into the pelvic cavity)
53
Passenger: presentation
the way baby will present itself: Head, Butt, Shoulder Head: Occiput (favorable what we want) Butt: Breech Shoulder: Transverse
54
Where is the occiput?
hand on neck then pus up a little
55
Passenger: Presentations Types of Breech
Knees extended -> toes to head Frank Breech Knees flexed -> pretzel ball complete breech Neither hips or knees flexed, foot out -> footling breech
56
Passenger: Lie
Looking at the fetal axis in relation to mothers Transverse: fetal axis horizontal Longitudinal: fetal axis parallel
57
Fetal Attitude
degree of flexion in the fetus What we want (full flexion) is the head to be flexed forward with the chin almost resting on the chest and arms and legs flexed. Moderate flexion there is some space between the chin and chest Partial flexion: they are looking up meaning the brow will be the presenting part
58
Fetal Position
We want to know where the baby's occiput is in relation to the mom's pelvis. posterior slightly higher than the anterior *important to know where to put the fetal heart monitor*
59
Passenger: Engagement
Floating: head directed down toward pelvis but can still easily move away from inlet Dipping: The fetal head dips into the inlet but can be moved away *Engaged: when baby's head is in the inlet of the pelvis
60
Passenger: station
The way nurses measure as the baby comes down into the pelvic cavity. (Feel for ischial spine) Anything above the ischial spine is - anything below is + if it is at 0 it's engaged +3& +4 means crowning
61
Upon completion of a vaginal examination on a laboring woman, the nurse records 6cm, 80%, -1. Interpret the data above.
6cm dilated, 80% effaced (thinned out), 1cm above ischial spines
62
Powers: Physiologic forces of labor
muscles for contraction - primary force Mom using abdominal muscles to push: secondary force
63
What is a true contraction?
starts at the top of the uterus which is the fundus and then sweeps down.
64
Braxton hicks contractions
Not true labor will not help the mom push the baby down and start dilation and effacement.
65
Characteristics of contractions
big wave not little wave
66
explain progesterone and estrogen's role in labor.
Helps start labor. Helps to dilate and start contractions. Progesterone: causes relaxation of smooth muscle tissue Estrogen: causes stimulation of uterine muscle contractions *connective tissue loosens and allows softening, thinning, and opening of the cervix
67
Premonitory signs of labor- Pre-laborism
Lightening: fetus descends into pelvic inlet Braxton Hicks contractions: pain contractions do not cause cervical pain Cervical Changes: cervix begins to soften and weaken Bloody show:loss of cervical ucous plug. Blood-tinged discharge Rupture of membranes: 1 in 4 labors begin with SROM Nesting: Burst of energy. usually occurs 24-48 hours b4 start of labor
68
True Labor
*Contractions produce cervical dilation* -discofort begins in back and radiates to front of abdoen -contractions increase in duration and intensity -walking intensifies contractions -resting in warm water does not decrease intensity
69
False Labor
*contractions produce no effect on the cervix* - contractions lessened by walking, or warm water -discomfort primarily in abdomen
70
ROM
Rupture of Membranes -can be spontaneous or artificial -Prolonged ROM (>24hrs) can lead to infection - If ruptured: note color, odor, consistency and test with Nitrazine papers to confirm
71
What color will nitrazine paper turn if it is positive for amniotic fluid?
Blue
72
How many stages are there of labor and general description?
First Stage: Latent, Active, Transition (effacement & Dilation) Second stage: Pushing, delivery of baby Third Stage: Delivery of Placenta Fourth stage: Recovery
73
First Stage: Latent Phase
Very beginning, regular contractions -cervical effacement and dilation begin (0-5cm)
74
First Stage: Active phase/ Transition Phase *Physiological Changes
Nursing Interventions: monitor FHR, watch contractions, do vaginal checks, ask mom about bladder distention -Begins at 6c and ends at 10cm - Fetus begins to descend into the pelvis
75
First Stage: Active phase/ Transition Phase *psychological Changes
- Excitement & Fear -Fear of loss of control -Anxiety increases Transition - locked in in the zone
76
Second Stage *Physiologic Changes
-Begins with complete cervical dilation and ends with the birth of an infant -Perineum begins to bulge, flatten, and move anteriorly as the fetus descends
77
Second Stage *Psychological Changes
May feel a sense of purpose and may feel out of control or frightened
78
Third Stage * physiologic changes
-Placental separation: The uterus contracts and the placenta begins to separate -Placental delivery: The woman bears down and delivers the placenta (the doctor can put slight traction on the cord to assist delivery of the placenta
79
Third Stage * psychological changes
Women may feel relief at the completion of birth, the woman focuses on the infant and may not recognize the pain, etc.
80
Fourth Stage *Physiologic Changes
-Increased pulse and decreased blood pressure -uterus remains contracted and located between the umbilicus and symphysis pubis -Women may experience shaking - Urine may be retained Psych. feeling of euphoria and energized at childbirth
81
What is the recovery & postpartum assessment
BUBBLE-HE Breast, Uterus, Bowel, Bladder, Lochia, Episiotoy/ Tear, Hemorrhoids, Emotional state
82
Cardiovascular changes (intrapartum) Mom
cardiac output increases blood pressure will increase with each contraction may rise with pushing may decrease with epidural
83
Respiratory changes (intrapartum) Mom
increase in O2 demand & consumption Increase RR Mild respiratory acidosis (can occur by tie of birth)
84
Gi changes (intrapartum) Mom
- Decreased Gastric Motility -Prolonged gastric emptying -loose bowel movements as contractions strengthen
85
Renal changes (intrapartum) Mom
-Edema may occur at bladder due to pressure of fetal head
86
Immune changes (intrapartum) Mom
spike in WBC normal and could have a drop in glucose
87
Types of pains in mom (intrapartum)
First stage: Pain comes from dilation of the cervix and stretching of the lower uterine segment, shell feels pressure Second Stage: Due to contractions and perineum pain Third Stage: Pain fro detaching placenta
88
Fetal responses (intrapartum, )
BP decreases at peak of each contraction to long of a contraction can hold blood in the baby -can experience edema and carpet -can experience an increase in HR
89
Leopold Maneuvers
The most important part is finding the fetal back -palpate the top of the fundus and determine if it's the head or the bum, Paulick's grip to pinch babies head and determine if its engaged with the pelvis
90
After doing Leopold's maneuvers, the nurse determines that the fetus is in the ROA position. To best auscultate the fetal heart tones, the Doppler is best placed
Below the umbilicus on the right side Remember: if you hear the heartbeat the loudest above the mothers umbilicus baby ay be breach
91
Assessing a contraction
We can palpate a contraction - We can feel the fundus and determine the frequency, duration, and intensity
92
Cool way to determine the intensity of contraction
Intensity (mild, moderate, or strong) Mild- nose Moderate-Chin Strong-Forehead
93
Cervical Assessment
Determine dilation & effacement evaluated by vaginal exam
94
How do you gauge dilation
insert index and middle fingers against the cervix and determine the opening size. Before labor begins the cervix is long and the sides feel thick. The canal is closed
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