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OB-Postpartum
| Question | Answer |
|---|---|
| 1-inflammation of the wall of the uterus; the term pelvic inflammatory disease (PID) is often used for this disease; 2-inflammation of the functional lining of the uterus | 1-metritis; 2-endometritis |
| Signs-fever, abdominal pain, uterine tenderness, fatigue, heavy lochia (possibly foul smelling); Diagnose-obtain blood cultures and blood counts; Treat-ATBs, proper pericare, pain management, fluids, balanced diet, ambulation and support | metritis |
| An infection of the bladder; risk for pyelonephritis | cystitis |
| Risks-foley catheter, overdistended bladder, operative vaginal procedures; Diagnose-UA/C&S; Treat-ATBs , increase fluids, voiding every 2 hours, frequent pad changes and perineal hygiene | cystitis |
| inflammation of the mammary gland; a common problem that may occur within the first 2 days to 2 weeks postpartum; breast abscess may develop if not treated adequately | mastitis |
| treat with antibiotics & continue to feed/pump; non-breastfeeding---tight fitting bra, ice packs, cabbage leaves, no stimulation, analgesics | mastitis |
| flu-like symptoms (including malaise, fever, and chills); tender, hot, red, painful area on one breast; inflammation of breast area; breast tenderness; cracking of skin around nipple or areola; breast distention with milk | mastitis |
| rapid cycling mood Sx during first postpartum week typically; exhibits mild depressive symptoms of anxiety, irritability, mood swings, tearfulness, increased sensitivity, despondency, feelings of being overwhelmed, difficulty thinking clearly, and fatigue | postpartum blues |
| feel worse over time; changes in mood and behavior do not go away on their own; may persist for a minimum of six months if untreated; symptoms last longer, are more severe, and require treatment | postpartum depression (PPD) |
| the uterus returns to its normal size through a gradual process; involves retrogressive changes that return it to its nonpregnant size and condition | uterine involution |
| **vaginal discharge that occurs after birth from seperation of placenta from uterus; continues for approximately four to eight weeks; results from involution | **lochia |
| **discharge that is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 5 days after birth | **lochia rubra |
| **pinkish brown discharge; expelled 6 to 10 days postpartum; primarily contains leukocytes, decidual tissue, red blood cells, and serous fluid | **lochia serosa |
| **creamy white or light brown discharge; consists of leukocytes, decidual tissue, and reduced fluid content; occurs from days 10 to 14 but can last 3 to 6 weeks postpartum in some women and still be considered normal | **lochia alba |
| intermittent uterine contractions; more discomfort w/multiparas or multiples d/t irregular stretching of uterus; experienced 2-3 days after birth; breastfeeding or Pitocin increase severity experienced; Tx-mild analgesic or heat pack over abdomen | afterpains |
| VS changes in postpartum woman 1st 24-hours | temp elevated (100.4F), decreased pulse (50-90bpm), resp. usually normal, B/P has transient rise in systolic/diastolic pressure then consistent with baseline |
| What does BUBBLE-HE stand for? | breasts, uterus, bladder, bowels, lochia, episiotomy/perineum, Homan's sign, emotional status |
| BUBBLE-HE: breasts | inspect nipples (everted, flat, inverted?), breast tissue (soft, filling, firm?), temp and color (pink, warm, cool, red-streaked?) |
| BUBBLE-HE: uterus | location (midline or deviated to either left or right side?), tone (firm, firm with massage, boggy?) |
| BUBBLE-HE: bladder | voiding (spontaneous or via catheter?), palpable or nonpalpable?, color/odor/amount of urine, dysuria? |
| BUBBLE-HE: bowels | date/time of last BM, presence of flatus and hunger? |
| BUBBLE-HE: lochia | color/amount/presence of clots?, free flow of lochia? type of lochia |
| BUBBLE-HE: episiotomy/perineum | type? other tissue trauma (ie-lacerations)? assess using REEDA (redness, edema, ecchymosis, discharge, approximation) |
| What is REEDA? | redness, edema, ecchymosis, discharge, approximation |
| BUBBLE-HE: Homan's sign | dorsiflexion of foot, pain in calf if positive |
| BUBBLE-HE: emotional status | bonding? postpartum blues/depression/psychosis |
| behaviors indicating hallucinations or delusional thoughts of self-harm or harming the infant; Sx: pronounced sadness, disorientation, confusion, paranoia; typically predicated by depressive episodes | postpartum psychosis |
| Assessing for psychosocial issues with transition to parenting | Assess for behaviors that facilitate and indicate bonding or lack thereof; assess for manifestations of mood swings, conflict about role, or personal insecurity |
| first 24-48 hrs; mother focuses on meeting personal needs, relies on others for assistance, excited/talkative, need to review birth experience with others, examines newborn | taking-in phase (dependent) |
| begins day 2 or 3 and may last up to several weeks; mother focuses on baby care & improving competency, wants to take charge but needs acceptance, wants to learn/practice, dealing w/physical & emotional discomforts (can experience "baby blues") | taking-hold phase (dependent-independent) |
| final phase of maternal role attainment; focuses on family as a unit, reestablishes relationships with other people, adapts to parenthood through her new role as a mother, assumes the responsibility and care of the newborn with a bit more confidence now | letting-go phase (interdependent) |
| Which cultures have hot–cold beliefs? | Latin American, African, and Asian |
| Hot-cold belief: Because childbirth involves the loss of blood, which is considered ____ , the postpartum period is considered ___ , so the mother must balance that with the intake of ____ food. | hot, cold, hot |
| Frequency of postpartum assessments | first hour: every 15 minutes; second hour: every 30 minutes; then every 4 hours; after 24 hours: every 8 hours |
| this may occur due to blood volume that increases substantially during pregnancy | maternal hypervolemia |
| result of sudden release of pressure on pelvic nerves after birth, response to fetus-to-mother transfusion that occurred during placental separation, reaction to anesthetic, or reaction to maternal adrenaline production at birth | postpartum chill |
| treatment for postpartum chill | warm drink and blankets, comfort measures |
| yellow-gold liquid secreted from breasts; aka early milk | colostrum |
| how much blood loss typically for vaginal delivery? for C-section? what percent drop in H&H levels? | vaginal ~500mL, C-section ~1000ml, 10% drop in H&H levels |
| **uterine fundus to or through the cervix so that the uterus is turned inside out after birth; multiparaous women are at particular risk for this; Tx: pessary devices, Kegel exercises, hysterectomy | **uterine inversion/prolapse |
| occurs with increased blood loss (>500mL for vaginal, >1000mL for C-section) | postpartum hemorrhage |
| two complications that can occur following postpartum hemorrhage | hypovolemic shock and anemia |
| inability of the uterine muscle to contract adequately after birth; can lead to postpartum hemorrhage | uterine atony |
| med that helps control postpartum hemorrhage; stimulates the uterus; prevent and treat postpartum hemorrhage due to atony or subinvolution | methylergonovine (Methergine) |
| med to promote uterine contractions; stimulates the uterus to contract to control bleeding from the placental site | oxytocin (Pitocin) |
| incomplete involution of the uterus or failure to return to its normal size and condition after birth | subinvolution of the uterus |
| benefits of breastfeeding | bonding, immunity, right/correct nutrients, convenience |
| positions for breastfeeding | cradle, side lying, football hold |
| **normal fundal measurements at birth and 1st, 2nd, and 3rd days? | **U-0, U-1, U-2, U-3 |
| nursing care for a patient with postpartum hemorrhage | fundal massage, assess source of bleeding, IVF, IV Pitocin, pad count, Hemabate (carboprost tromethamine) IM |
| How do you care for a patient with an episiotomy? | ice packs first 24-hrs, peri-bottle, sitz baths (started on day 2-4), tucks pads |
| steps for using a sitz bath | set up sitz bath, fill water bladder with warm tap water, water bladder above head, control flow |
| perineum care on a patient | peri-bottle, sitz bath, clean pad, no soap/lotion |
| How can an ileus be prevented after a C-section birth? | ambulation, antiemetics, increase diet slowly (liquids eventually to solids) |
| DVT prevention after a C-section | SCDs, ambulation, ROM exercises, Lovenox (hemorrhage???) |
| painful intercourse | dyspareunia |
| calf pain that occurs when the foot is dorsiflexed | Homan's sign |
| **retrogressive changes that return the reproductive organs to their non-pregnancy state | **involution |
| method to increase tone of muscles around the vagina and urinary meatus | Kegel exercises |
| top portion of uterus | fundus |
| lower portion of uterus | cervix |
| development of an emotional tie to the infant | attachment |
| long-term development of affection between the infant and significant other | bonding |
| intense fascination between father and newborn | engrossment |
| this hormone stimulates milk secretion | prolactin |
| What are the four Ts that need to be assessed in a possible case of postpartum hemorrhage? | tone, trauma, tissue, thrombin |
| Mother calls in to report she has a temp of 102 and gives limited info (C-section 7 days ago). What are most likely types of infection she may have contracted? | cystitis, incision infection, metritis, mastitis |
| nursing interventions to promote parental role adaptation and parent-newborn attachment | return demonstration of baby care, model good bonding behavior, talk to baby calmly and often |
| Mother is A- blood type, baby is O+. What is given during postpartum period and when is it given? | Rhogam, within 72-hours post-delivery |
| ice x 24-hours, then heat, pain meds, possibly surgically drain | perineal hematoma |
| management/care includes ATBs, clean/dry dressing | infected incision |
| the small hole at the center of the cervix; will have slit-like appearance post-vaginal birth | cervical os |
| Who's gonna rock this test? | You are, you rock star!!! |
Created by:
nurse savage
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