OB Test 2:Postpartum

Question 0

Involution

Answer 0

Process of shrinking back to normal size

The increase in cell number is permanent but size will decrease

Question 1

What is the post-partum period?

Answer 1

From birth until the mother returns to normal

6 weeks (40 days)

Question 2

Involution: fundus level

Answer 2

After birth at 12 hours: below umbilicus

4weeks: level of umbilicus

Question 3

Involution: subinvolution

Answer 3

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

Question 4

Involution: after pains

Answer 4

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

Question 5

Involution: placental site

Answer 5

Heals by exfoliation, from bottom up, no scar

Question 6

Lochia colors

Answer 6

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

Question 7

Lochia odor

Answer 7

Non-foul

Earthy

Question 8

Lochia amount

Answer 8

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

Question 9

Cervix conditions

Answer 9

• 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

Question 10

Vagina conditions

Answer 10

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

Question 11

Perineum

Answer 11

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

Question 12

Postpartum hormones

Answer 12

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

Question 13

Abdomen

Answer 13

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

Diastasis recti abdominis

Question 14

Renal system and fluid balance

Answer 14

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

Question 15

Gastrointestinal changes

Answer 15

Appetite

First bowel movement takes awhile

Question 16

Breasts

Answer 16

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

Question 17

Cardiovascular blood loss and protective mechanisms

Answer 17

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)

Question 18

Postpartum vital signs

Answer 18

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

Question 19

Postpartum lab values

Answer 19

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

Question 20

Neurological changes

Answer 20

Decrease edema

Headaches: associated with pre-eclampsia so take her BP

Question 21

Skin and musculoskeletal changes

Answer 21

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

Question 22

Postpartum nursing care and mothers concerns

Answer 22

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

Question 23

Short stay maternity care

Answer 23

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

Question 24

Dx: risk for deficient fluid volume

Answer 24

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

Question 25

Dx: risk for injury

Answer 25

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

Question 26

Dx: risk for infection

Answer 26

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