OB Test 2:Postpartum Flashcards Preview

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Flashcards in OB Test 2:Postpartum Deck (27)
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0
Q

Involution

A

Process of shrinking back to normal size

The increase in cell number is permanent but size will decrease

1
Q

What is the post-partum period?

A

From birth until the mother returns to normal

6 weeks (40 days)

2
Q

Involution: fundus level

A

After birth at 12 hours: below umbilicus

4weeks: level of umbilicus

3
Q

Involution: subinvolution

A

Put pt at risk for hemorrhage from retained tissue or uterus infection

4
Q

Involution: after pains

A

Pt perceive it as cramps. Increased in multigravida, breast feeding or if uterus is over distended

5
Q

Involution: placental site

A

Heals by exfoliation, from bottom up, no scar

6
Q

Lochia colors

A

Rubra: red clots, 1st couple days
Serosa: pink, serous discharge, upto 2-6 weeks
Alba: white, creamy, 1-2 weeks

7
Q

Lochia odor

A

Non-foul

Earthy

8
Q

Lochia amount

A

C-section: scant amount until Pitosin wears off
Coninuous bright red is abnormal
Could have uterus atony (not contracted) or laceration

9
Q

Cervix conditions

A
  • friable: easy to bleed
  • may have small lacerations
  • return to normal 1 week after birth
  • cervix has no longer a circle but a sideways slip
10
Q

Vagina conditions

A
  • less rugae
  • not producing mucous
  • if breasted then ovulation is delayed
11
Q

Perineum

A

REEDA (red, edema, ecumosis, drainage, approximation)
Episiotomy
Lacerations
Hematoma: may be pushed outside & shrink quickly
Hemorroids: bleeding under skin, painful, severe blood loss

12
Q

Postpartum hormones

A
Placenta: decrease hCS (hPL) 
                Decrease estrogen
                decrease progesterone 
Pituitary: increase prolactin
Ovarian menstraul cycle: 10-12 weeks
13
Q

Abdomen

A

Decrease muscle tone (2-3 months for tone back)

Diastasis recti abdominis

14
Q

Renal system and fluid balance

A
Proteinuria
Diaphoresis and Diuresis 
  - characteristic 
  - void enormous amounts within 12 hours of delivery
  - void upto 3,000cc per day
  - elevated BUN
Bladder distention 
Kidney function returns to normal after 1 month
15
Q

Gastrointestinal changes

A

Appetite

First bowel movement takes awhile

16
Q

Breasts

A
May be lumps (milk sacs) that move around
If mom don't stimulate breast 
Day 1-2: colostrum
Day 2-3: filling
Day 3-4: engorgement, milk
Breast feeding
Non-nursing
17
Q

Cardiovascular blood loss and protective mechanisms

A
Blood loss:
   -vaginal: 500mL
   -c-section: 700-1000mL
   -1st PP: 500 mL
   -6 weeks: 500 mL
Protective mechanisms
   - placenta gone
   - estrogen decrease (vasoconstriction)
   - Diuresis (fluid moves from tissue to vascular space)
18
Q

Postpartum vital signs

A

Take all vitals
T: upto 100.4 considered normal
Related to dehydration, delivery or epidural

19
Q

Postpartum lab values

A

Hematocrit: decrease 3-4% = 1 gram
Hemoglobin: decrease 1 gram = 500 mL of blood loss
He modulation: loom anemic
Clotting factor: increase at delivery, not good infection indication

20
Q

Neurological changes

A

Decrease edema

Headaches: associated with pre-eclampsia so take her BP

21
Q

Skin and musculoskeletal changes

A

Pigmentation changes: stretch marks fade, darken areaola
Straiae gravidarum
Relaxed joints: feet may permanently grow

22
Q

Postpartum nursing care and mothers concerns

A

Wellness orientated and family centered
- physical, psychological, education
Mothers concerns
- comfort
- contact with baby
- share her story
- learn, her desire to learn to care

23
Q

Short stay maternity care

A
Newborns and mothers health protection act
   - 2 days vaginal
   - 4 days Caesarian 
Anticipatory guidance 
All PP care should include teaching
24
Q

Dx: risk for deficient fluid volume

A

Assessment: BP, P, R, fundus, Lochia, perineum, bladder
Interventions:
- massage, empty bladder, oxytocin

25
Q

Dx: risk for injury

A
Assessment: LOC, o2, legs, homans sign
Interventions:
  - ID bands
  - orient
  - prevent falls, ambulate
  - RhoGAM
  - allergies
  - call. Ell, low bed, side rails up
  - slippers
26
Q

Dx: risk for infection

A

Assessment: T, bladder, perineum, Lochia
Intervention
- 3 min scrub, hand washing
- gloves, bathing, infection control, rubella vaccine