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NURS783 Exam 2 > Postpartum > Flashcards

Postpartum Flashcards

(72 cards)

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1
Q

immediate postpartum period

A

6-12h

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2
Q

late postpartum period

A

up to 6 months

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3
Q

What is the location of the uterus 2 days postpartum?

A

at or slightly below maternal umbilicus

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4
Q

What is the size and consistency of the uterus 2 days PP?

A

like a softball

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5
Q

When does uteral involution begin?

A

2 days after birth

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6
Q

What will pts experience as the uterus involutes?

A

intense contractions for first 3 days

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7
Q

Why may a uterus fail to involute?

A
  • atony
  • retained placental fragments
  • lacerations
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8
Q

lochia rubra

A
  • red
  • days 1-3 PP
  • should not contain large (larger than dime) clots
  • distinct fleshy odor
  • blood, debris from placenta, membranes, vernix, lanugo, decidual tissue
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9
Q

How does the cervix appear immediately PP?

A
  • stretched
  • edematous
  • bruised
  • abraded
  • lacerated
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10
Q

What promotes vulvar tone?

A

decreasing progesterone levels

vaginal edema should resolve in 3-4 days PP

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11
Q

When should the uterus be completely involuted?

A

10-14 days PP

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12
Q

lochia serosa

A
  • pink
  • days 3-10 PP
  • blood, mucous, invading leukocytes
  • occurs as endometrium is regenerated
  • placental site exfoliated and remodeled
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13
Q

eschar bleeding

A
  • occurs at 10 days PP
  • is placenta “scab”
  • bright, red bleeding should only lasting a few hours
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14
Q

How does the cervix appear at 1 week PP?

A
  • nearly closed
  • thickened
  • almost regained pre-pregnant size and shape
  • os will be wider, transverse slit (vs circular)
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15
Q

How long does it take the placental attachment site to heal?

A

6 weeks

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16
Q

lochia alba

A
  • pink, yellow, white

- up to 4 weeks

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17
Q

When does vaginal ruggae return?

A

@ 3wks, but less prominent

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18
Q

When does vaginal epithelium proliferate?

A

@ 4 wks PP

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19
Q

What is the state of the vagina at 6 wks PP?

A
  • epithelium reconstructed
  • tone mostly restored
  • never completely regains nulliparous shape and tone
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20
Q

T or F: there is an increase in breast cancer dx’ed during pregnancy

A

true

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21
Q

T or F: breast cancer detected PP has worse outcomes

A

true

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22
Q

When do people who are not breastfeeding experience engorgement?

A

days 2-4 PP

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23
Q

What should be assessed during the PP abdominal exam?

A
  • incision site: s/s infection (redness, warmth, drainage, dehiscence); staples removed on day 4 PP
  • involution
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24
Q

Describe involution of the uterus

A
  • descends 1 finger breadth per day from umbilicus to pubis symphysis
  • by 1 week PP, should be halfway between
  • fundus no longer palpable at 2 weeks
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25
How long does it take the perineum to heal?
2-6 weeks (longer w/ extensive tearing)
26
What may be used if granulation tissue is noted on the perineum?
silver nitrate
27
When is a rectal exam indicated PP?
- after 3rd or 4th degree laceration | - reports of fecal incontinence --> examine rectovaginal wall
28
When does normal pregnancy edema dissipate?
by 2 weeks PP
29
What are differential dx's if pt is saturating maxi pad in <1h?
- hemorrhage - endometritis - retained products of conception
30
What are differential dx's if pt is passing golfball-sized clots?
- hemorrhage - endometritis - retained products of conception
31
What are differential dx's if return of bright red bleeding?
- hemorrhage - endoemtritis - eschar bleeding - overextension
32
What are differential dx's if temp > 101º?
- endometritis - mastitis - viral infection
33
What are PP s/s of PP preeclampsia?
- severe headache - visual disturbances - seizure
34
What are differential dx's if pt has warm, hard spot on breast?
- plugged duct | - mastitis
35
What are differential dx's if pt has warm area, pain, or edema in calf?
- DVT | - superficial thrombosis
36
What is s/s of pulmonary emboli?
chest pain
37
What are s/s that indicate a person is overexerting PP?
- heavier, brighter lochia - increased pain - SOB - lightheadedness
38
How many extra calories does breastfeeding require?
500 kcals
39
How can pain from involution be managed?
- empty bladder prior to breastfeeding (which stimulates contractions) - lie in prone position - puts constant pressure on uterus - ibuprofen 600mg q6h
40
When does fertility return in the non-lactating person?
4-6 weeks PP
41
When does fertility return in the lactating person?
depends on duration and frequency of lactation - 55-67% anovulatory in first month
42
T or F: fertility can return before menses returns
TRUE!
43
Explain the "rule of threes"
- if exclusively breastfeeding, contraception should be used @ 3mo PP - if partial breastfeeding, contraception should be used @ 3 weeks PP
44
When is the best time to place an IUD PP?
- <10min after delivery OR - after 4wks PP
45
puerperal fever
T≥100.4º during PP period
46
7 Ws of febrile morbidity
1) womb (chorio) 2) wound 3) water (dehydration) 4) weaning (breast engorgment, mastitis) 5) wind (resp illness) 6) walking (DVT) 7) wonder drug (drugs that elevate temp)
47
What puts PP people at greater risk of infection?
1) wound/tissue trauma during birth 2) placenta separation site 3) incision from C/S
48
endometritis
uterine infection
49
What prophylaxis does ACOG recommend for all C/S?
abx prophylaxis w/in 60min of beginning surgery
50
T or F: amniotomy increases risk of uterine infection
false *artificial rupture of membranes
51
What is the most common reason for readmission PP?
uterine or wound infection
52
What may cause subinvolution?
1) retained placenta 2) uterine infection 3) excessive maternal activity
53
How is subinvolution managed?
1) rest, fluids, nutrition, social support 2) methylergonovine 0.2mg PO q40h for 24-48h 3) f/u in 1-2 weeks
54
Homan's sign
increase in calf pain w/ dorsiflexion of foot
55
When can delayed PP hemorrhage occur?
24h-12wks PP - most occur w/in 2 wks
56
What causes delayed PP hemorrhage?
1) uterine atony 2) subinvolution 3) consider retained placental fragments (rare)
57
How should delayed PP hemorrhage be managed?
1) test for von Willebrand's disease if hemorrhage occurs 2-4 days PP 2) utertonics (e.g. methylergonovine, oxytocin) 3) MD may use suction in cause of retained placenta
58
bonding
the emotional tie that mother develops w/ unborn baby and later, the newborn provides powerful source of motivation
59
taking in phase
phase of PP adjustment that involves reviewing labor and birth
60
taking hold phase
mother assumes tasks of mothering, care of baby and self, along w/ attention to family and support network
61
What are features of baby blues?
- tearful - irritability - mood swings - fatigue - appetite changes
62
What are features of PP depression?
- same as baby blues - lack of interest in baby - sleep disturbances - guilt, shame - feelings of isolation - hopelessness - loss of pleasure - feelings of harming baby, self
63
What are features of PP psychosis?
- hallucinations - delusions - inability to communicate - rapid mood changes - paranoia - inability to sleep - hyperactivity - disorganized thoughts
64
What is first-line tx for PPD?
SSRIs
65
Why might pts see immediate PP weight loss?
fluid retention may be present for 1-2 weeks
66
When does most PP weight loss occur?
b/w 6wks and 6mo PP
67
Describe the position of the uterus: - immediately PP - 1-2h - 12h - 24h - 3 days - 7 days - 14 days
- immediately PP: at umbilicus - 1-2h: b/w umbilicus and symphysis pubis - 12h: 1 cm above umbilicus - 24h: 1 cm below umbilicus - 3 days: 3 cm below umbilicus - 7 days: at symphysis - 14 days: non-palpable
68
ebb phase
fluid retention PP
69
flow phase
diuresis that occurs 4-7 days PP
70
What is the effect of pregnancy estrogen on hair?
remains in prolonged anagen (growth) phase --> full head of hair
71
telogen gravidarum/tellugen effluvium
PP hair loss d/t entrance into catagen (involution) and telogen (resting) phases w/ shifting hormone levels
72
Define PP hemorrhage
cumulative blood loss of ≥1000mL OR blood loss accompanied by s/s of hypovolemia w/in 24h after delivery

NURS783 Exam 2 (6 decks)

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