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Obstetrics/Gynecolog
| Question | Answer |
|---|---|
| What is postpartum? | From the delivery of the placenta & membranes to the return of a woman's reproductive system to its non-pregnant state - approx 6 weeks. |
| What is involution? | the process by which the uterus returns to its normal size. |
| What is evidence of satisfactory involution? | Firmness of uterus, rate of uterine descent & nature of lochia. |
| What is evidence of satisfactory involution? | Firmness of uterus, rate of uterine descent & nature of lochia. |
| What is the #1 postpartum concern? | Hemorrhage |
| What are S/S of hemorrhage? | Increase pulse rate, decrease in BP, excessive bright red bleeding, boggy uterus that does not respond to massage, unusual pelvic discomfort or back pain, cold, clammy skin |
| What are the panic levels for H&H? | Hb <5.0g/dl & Hct of <20%, hemoglobin will decrease 1 to 1.5 g/dl & hematocrit will decrease 2-4% per 500 ml of blood loss |
| What are the early or immediate causes of hemorrhage? | blood loss greater than 500 ml in first 24 hrs caused by uterine atony, laceration of the genital tract, retained placenta, adherent placenta. |
| What are later causes of hemorrhage? | Retained placenta and infection are the most common causes. |
| What is lochia? | the decidua (lining) which is cast off down to myometrium, a new endometrium is formed |
| What is lochia RUBRA and how long does it last? | Bright red, tends to clot, serosanguineous, becoming more serous and less bloody - last 1-3 days. |
| What is lochia SEROSA and how long does it last? | Dark red (or pinkish) to brond, sheds of decidua, looks less like blood - lasts 3-10 days |
| What is lochi ALBA and how long does it last? | Whitish/yellowish discharge - lasts 10-14 days, may last 3-6 weeks and remain normal. |
| What is diastasis abdominis? | separation of the rectus abdominis muscles may occur leaving part of abdominal wall with no support except skin, subcutaneous fat, fascia & peritoneum. |
| Why is bathing so important? | There is an increased risk for infection during postpartum. |
| What is an episiotomy? | A surgical incision of the perineal body - assess using REEDA - redness, edema, echymosis, discharge, approximation |
| What is a laceration? | A tear in the perineal body which occurs in varying degrees. |
| 1st degree laceration | tear through skin & structures that are superficial to muscle |
| 2nd degree laceration | extends through perineal muscles - much like an episiotomy |
| 3rd degree laceration | continues through anal sphincter muscle |
| 4th degree laceration | involves anterior rectal wall |
| Sulcus tear | tear into the tissue of the vagina |
| What are some concerns involving the bladder? | Pt should void within 6-8 hours following delivery, check for bladder distention if less than adequate amount voided - retention with overflow |
| What can cause bowel dysfunction? | Delay in bowel function can be due to loss of abdominal muscle tone, fear of pain, sluggishness due to progesterone effect on smooth muscle function. |
| How ofter should vitals be checked after delivery? | Q15 minutes for 1st hour, q30 minutes for 2nd hour, q4 hours for 24 hours then q8 hours. |
| What are considered the standard vital signs? | Temp, resp, pulse, BP, lochia, fundus & appearance of sutures |
| What does BUBBLE HE stand for? | Breasts, uterus, bladder, bowel function, lochia, episiotomy (or laceration) Homnam's sign, emotional status. |
| How are the breasts assessed? | Are they soft, firm or filling? Any discharge - type & amount, Nipples cracked/lesions? Unusual contour? |
| How is the uterus assessed? | Is it firm? Is it descending? Location & position in abdomen |
| How is the bowel assessed? | Check for flatus/bowel sounds, rectal pressure. Teach need for extra fluids, fiber |
| How is lochia assessed? | Assess for amount: scant, light, moderate, heavy, excessive, assess for odor, clots |
| How is an episiotomy or laceration assessed? | Assess for redness, edema, echymosis, discharge & approximation |
| What is assessed in regards to emotional status? | Is the mother dependent or independent? Is she depressed, is she bonding with the baby, does she understand whats going on? |
| What does antepartum mean? | The time between conception and onset of labor, used interchangeably with prenatal |
| What does intrapartum mean? | The time between the beginning of labor and the birth of the infant. |
| What does puerperium or postpartum mean? | The number of pregnancies in which the fetus has reached 20 or more weeks gestation when they are born regardless of live or still born. |
| What does para mean? | The number of pregnancies in which the fetus has reached 20 or more weeks gestation when they are born regardless of live or still born. |
| What does abortion mean? | Birth that occurs prior to the 20 weeks, either selective or spontaneous. Therapeutic - done to save mother or non-viable fetus. |
| What is preterm or premature labor? | Labor that occurs after 20 weeks but before completion of 37 weeks. |
| What is considered a term pregnancy? | A pregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks |
| What does TPAL stand for? | TPAL replaces para & gives more information. T = term infants, P = preterm infants, A = abortions (spontaneous or selective), L = currently living children |
| What is considered a still birth? | A baby born dead at 20 or more weeks gestation. |
| What is a neonate? | First 28 days after birth. |
| What is viability? | Capacity to live outside the uterus - about 22-25 weeks gestation. |
| What is placenta ACCRETA? | Slight penetration of placenta into the myometrium |
| What is placenta INCRETA? | Deep penetration of the placenta into the myometrium |
| What is placenta PERCRETA? | Perforation of the uterus by the placenta. |
| What is hydroamios & macrosomia and how does it affect the uterus? | Hydraminos is too much amnionic fluid, macrosomia is a large baby. Both stretch the uterus more than normal and make it hard for the uterus to contract after birth. |
| How are hematomas related to delivery? | There is an injury to a blood vessel, vulvar, vaginal, subperitoneal causing a collection of blood in the pelvic tissue, can lead to postpartum hemorrhage. |
| What are S/S of a hematoma? | Vulvar - most common & most can be seen, Upper vaginal - difficulty voiding due to pressure on urethra or meatus, Upward - severe lateral uterine pain, flank pain, abdominal distention. May have S/S of shock without blood loss & a well contracted uterus. |
| What is the first sign of infection? | Presence of a fever of 100.4 |
| What can happen to the infant if infection is present? | Leading cause of newborn sepsis & meningitis, infant infected through vaginal birth, can lead to death or severe neurological damage. Routine screening done at 32-36 weeks. Ampicillin or gentamycin can be given during labor. |
| What is metritis? | Infection of the muscle of the uterus |
| What is endometritis? | Infection at the placental site |
| What is parametritis? | Infection of the pelvic connective tissue. |
| What is salpingitis & ooporitis? | Infection of the tubes & ovaries. |
| What is thrombophelpitis? | An infection of the lining of a vessel in which a clot attaches to the vessel wall. |
| What are the classic signs of a polmonary emboli? | Sudden onset of SOB, chest pain, tachypnea, dyspnea, apprehension, cough, hempotysis, diaphoresis, fever, circumoral cyanosis. |
| What causes an amniotic fluid embolism? | A small tear in the amnion or chorion high in the uterus allows fluid to enter maternal circulation. |
| What is disseminated intravascular coagulation? | The coagulation sequence is activated by injury to the epithelium, or by bacterial particles or other foreign material. The result is disseminated clotting causing organ damage due to small clot occluding capillaries and consumptions of clotting factors. |
| What are the psychological adjustment stages? | Taking in, taking hold and letting go. |
| What are the characteristics of the taking in phase? | Consists of days 1-3, pts are passive & dependent, preoccupied with own needs, talkative, identifying and interpreting infant, gentle finger touch. |
| What are the characteristics of the taking hold phase? | Consists of days 3 to 2 weeks. Pts resume control of life, concern with control of body functions, worry about quality and quantity of breast milk and ability to feed baby. |
| What are the characteristics of the letting go phase? | Accept and realize the physical separation of infant and relinquish role of childless individual. Challenge - extreme exhaustion of night time care and sleep deprivation, anticipatory guidance needed regarding the realities of motherhood. |
| How does postpartum depression differ from baby blues? | Symptoms persist longer than 2 weeks and intensify. |
| What can cause an elevated temp? | A temp elevated to 100.4* in the 1st 24 hours post delivery can be due to exertion & dehydration. |
| What is mastitis? | An infection of the breast tissue. More common in breast feeding mothers. |
| What is Aminocentesis? | Removal of some fluid surrounding the fetus for analysis, Fetus is locationa is identifiied by Ultra sound to the procedure. result may take a month |
| Aminocentesis use to check for? | Spina bifida, Rh compability, Immature lungs, Down syndrome |
| What is Chorionic Villus sampling? | Removal of placental tissue for analysis from the uterus during early pregnancy. Ultra sound help guide the procedure |
| How long to get result for Chorionic Villus Sampling? | 1-2 week. Can be preformed earlier than ammiocentesis |
| Chorionic Villus Sampling used to check? | Tay-Sachs Disease, Down Syndrome, Other Disorder |
| what do you need to monitor the patient? | Infection, Miscarriage, Bleeding |
| What is Prfeclampsia? | Presence of protein in the urine, and increased BP during pregnancy |
| What are the symtoms of Preclampsia? | Abormal Rapid Weight gain, Headaches, Peripheral Edema,Nausea, Anxiety, Hypertension, Low Urination frequency |
| What are the treatment for Preclampsia? | Deliver the baby, Bed Rest, Medication |
| What kind of test for Preclampsia? | Proteinuria, BP check, Weight gain analysis, Thrombocytopenia, Evidence of edema |
| What may occur when induced labor? | Eclampsia, HELLP Syndrome. High Derum Creatine, Prolonged Elevated Diastolic BP >100mmHh, Trombocytopenia, Abnormal fetal growth |
| What is Eclampsia? | Seizures occuring during pregnancy |
| What is symtoms for Eclampsia? | Weight gain sudden, seizure, Trauma, Abdominal pain, Pre- eclampsia |
| What type of test for Eclampsia? | Check liver function test, Check BP, Proteinuria presence, Apnea |
| What is Amniotic Fluid? | is a clear, slightly yellowish liquid that surrounds the unborn baby ... The amount of amniotic fluid is greatest at about 34 weeks gestation |
| Function of Amniotic Fluid? | Allows normal lung developement, Freedom for movement, Fetus temperature regulation, Trauma Prevention |
| What is Oligohydramnios? | Low levelof Amniotic Fluid that can cause: Fetal abnormaliries, Ruptured membranes and Fetus disorder |
| What is Polyhydamnios? | High levels of Amniotic fluid that can cause:Gestational diabetes and Congenital Defect |
| Polyhydaminos causes? | Beckwith-Wiedemann Syndrome, Hydrops fetalis, Multiple fetus developement, Anencephaly, Esophageal Atresia, Gastroschisis |
| What is Sheehan's Syndrome? | Hypopituitarism caused by Uterine Hemorrhage during childbirth. The pituitary gland is unable to function due to blood loss |
| Synptoms for Sheehan's Syndrome are? | Amenorrhea, Fatigue, Unable to breast-feed baby, Anxiety, Decreased BP, Hair loss |
| Type of test for Sheehan's Syndrome | CT Scan of Pituatary gland, Check Pituitary gland hormone levels |
| Treatment for Sheehan;s Syndrome | Hormone Therapy |
| What is Breast Infection/Mastitis? | Infection or inflamation due to bacterial infection (S.aureus) |
| What is Atrophic Vaginitis? | Low estrogen levels cause inflamation of the vagina.Most common after menopause |
| What are the symptoms for Atrophic vaginitis? | Pain whith intercourse, Ithing pain, Vaginal discharge, vaginal irritation after intercourse |
| Treatment for Atrophic vaginitis? | Hormone therapy, vaginal lubricant |
| what is Cervitis? | Infection, foreign bodies, or chemicals that causes inflammation of the cervix |
| Symptoms for Cervitis? | PAin with intercourse, vaginal discharge, Pervic pain, Vaginal pain |
| Test for Cervitis? | Pelvic examination, STD test, Pap smear |
| Treatment for Cervitis? | Laser therapy, antibiotic/antifungal, Cryosurgery |
| What is Pelvic inflammatory disease? | Infection of yhe fallopian tubes, uterus or ovaries caused by STD's in the majoe cases |
| Symptomsfor Pelvic inflammatory disease? | Vaginal discharge, fever, pain with intercourse, nausea, urination painful, low BP, no menstruation |
| Treatment for Pelvic inflammatory disease? | Antibiotic, surgery |
Created by:
lgultom1
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