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OB Lab handout/study guide

Immediately after birth, the uterus is the size of a what? Grapefruit
The fundus descends by ___ per day until ___ when it is within the pelvic cavity and cannot be palpated anymore. 1 cm; 10-14th day
T/F: At 12 hours after the delivery, the fundus should not be above the umbilicus. False
The fundus should be found ___ and if it is shifted to the right, the ___ may be distended. midline; bladder
List the signs of a distended bladder: -Fundus displaced from midline -Excessive lochia -Bladder discomfort -Bulge of bladder above symphysis -Frequent voiding
Urinary retention and over-distention of the bladder may cause ___ and ____. UTI; PP hemorrhage
If fundus is boggy, the uterine muscle must be stimulated to contract by gently ___ Massaging the uterus
Massaging helps to expel any uterine ___ Clots
Afterpains are felt most by women who are multiparas, breastfeeding, or are primaparas whose uterine has been over-distended by what possible 4 things? 1.infant sucking --> 2.increased oxytocin --> 3.uterine contractions --> 4.mod/severe cramping (this was a very poorly worded question - above is the sequence of events leading to afterpains)
___ refers to the slower than expected return of the uterus to its non-pregnant size. subinvolution
Subinvolution is usually seen after the mother goes home, so it is important for nursing to teach her what before discharge? teach her how to palpate/assess fundus------teach what to expect in lochia changes
Medical intervention for sub involution is oral ___ methergine - a drug to decrease bleeding
Early PP hemorrhage for a vaginal delivery is defined as a blood loss of greater than ___ ml in the first ___ hours. 500; 24
What are the 2 major causes of early PP hemorrhage? 1. Uterine atony 2. Trauma to the birth canal during labor and delivery
List the early signs of PP hemorrhage. -Uncontracted uterus -Large gush or slow, steady trickle of blood from the vagina -Saturation of more than 1 peri pad/hour -Severe, unrelieved peri or rectal pain -Tachycardia
Excessive lochia in the presence of a firm fundus suggest what? Lacerations of the birth canal; health care provider must be notified so laceration can be repaired
Including precipitate of labor or delivery, prolonged labor, Cesarian birth, and clotting disorder, List the predisposing factors for PP hemorrhage: -Overdistention of uterus -Multipara (>5) -Tocolytic drugs -Forceps/vacuum extractor -Manual placenta removal -Gen. anesthesia -Low implantation placenta -Admin. of certain RX's -Choriamnionitis -Disseminated intra-vascular clotting
Foul odor of the lochia suggests what? Endometrial infection
List the 3 types of lochia and at what day post childbirth you would see each: 1. Lochia Rubera (days 1-3) 2. Lochia Serosa (days 4-10) 3. Lochia Alba (after day 11)
You have a woman who has a boggy fundus, heavy bleeding, and unchanged VS. You help her to void and massage her fundus. This does not change the boggy fundus or heavy bleeding. What do you do next? 1. give oxytocin if ordered 2. notify HCP
How long does it usually take for an episiotomy to heal? 4-6 months
List the risks of an episiotomy -Infection -Perineal pain -Increased blood loss -Can decrease sexual satisfaction and comfort
A fourth degree laceration extends through the anal sphincter and into the ___ ___ Recatal mucosa
The 2 types of episiotomies are ___ and ___ Medial-lateral; median-midline
What is the key to reducing the risk for an episiotomy? Gradual stretching of the perineum
When assessing an episiotomy or perineal laceration, what are the 5 signs you are going to look for: Redness, Edema, Ecchymosis (bruising), Discharge, Approximation (REEDA)
You would suspect a ___ if you assessed extensive bruising or asymmetric edema. Hematoma
List 3 comfort measures you can provide to a new mother for perineal pain 1. Cold packs for 24 hours, followed by warm sits baths 2. Topical antiseptic spray 3. Analgesics (Tylenol/Ibuprofen/Narcotics)
How do cold packs help the new mother? Vasoconstriction, reducing edema, and providing for numbing of the area
How does sitz baths help the new mother? Increases circulation to promote healing
T/F: There is no guarantee that a woman will not tear in addition to an episiotomy. True
The definition of a version is: Changing the fetal position from Breech, shoulder or oblique presentation to cephalic...this avoids a C/S (C-section)and is done by ABD manipulation
In what instance is an internal version done? in emergency situations
Before and external version, the nurse should expect a ___ ___ test to be done and a ___ drug to be given Non-Stress, tocolytic (terbutaline)(for uterine relaxation)
What effect on the fetus might you see during an external version? ___ Should it persist after the procedure? ?bradycardia
Pain after an external version could mean what? An abruption
What are the maternal risks of forceps or vacuum assisted delivery? Laceration or Hematoma of Vagina
What are the risks to the newborn (from forceps or vacuum assisted delivery)? ecchymosis----facial/scalp lacerations or abrasions-----facial nerve injury-----cephalhematoma-----intracranial hemorrhage
List the maternal indications for a vacuum extraction to decrease 2nd stage labor trauma
Immediately after delivery of a forceps-assisted birth, the nurse should assess the newborn for ___ forcep marks or trauma
What is the purpose of an amniotomy? perforation amniotic sac - this rupture of membranes helps to progress labor
What are the three (four) risks of an amniotomy? cord compression 2. cord prolapse 3. infection 4. abruptio placenta (premature placental separation)
What nursing interventions are done after an amniotomy? 1. assess FHR x 1 min 2. chart fluid status - quantity/color/odor 3. Temp q2h, report if >38C 4. changes pads frequently to prevent bacteria growth in moist env
Rho immunoglobulin should be administered if the mother is Rh ___ and the newborn is Rh ___ Negative; positive
Rho immunoglobulin is given to prevent the development of maternal ___ Antibodies
If the mother does not receive Rho immunoglobulin and she begins to make antibodies, she is said to be ___ Sensitized
What can happen to the fetus if the mother develops or already has antibodies? Antibodies from mom can destroy fetal RBC's
Besides birth, what other ways can sensitization happen? -C-sections -Blood transfusion -Abortion -Amniocentesis -Miscarriage -Ectopic pregnancy -Version
All pregnant women are screed to determine if the are rubella ___ Immune
Rubella is a ___ virus Live
T/F: You can give a pregnant woman the Rubella vaccine as soon as you find that she is not immune False - must be given after birth, so she does not make antibodies
How long should a woman wait to get pregnant after receiving the Rubella vaccine? Should wait 3 months, or can get CRS (Congenital Ruebella Syndrome - which manifests as: cataracts, glaucoma, blindness, heart defects, and mental retardation). Rubella during pregnancy can cause serious fetal abnormalities
List the S/S of superficial thrombosis of thrombophlebitis -Swelling -Redness -Tenderness -Warmth -Pain when walking -Palpate enlarged vein (sometimes)
What additional symptoms would you see with DVT? -Redness -Heat -Tenderness -Positive Homan's sign
What is a positive Homan's sign? Pain in calf with dorsal flexion
What is used to confirm the dx of DVT? Ultrasound, MRI, Venograph
Why would you place warm, moist heat to an extremity affected by thrombophlebitis or DVT? Increase circulation, decrease pain
What potentially fatal complication can arise from DVT? Pulmonary embolism - a clot obstruction
List the measures to help prevent thrombophlebitis and DVT -Walking -Elevating legs -SCDs/Ted Hose
List measures to prevent abdominal distention. -early/frequent ambulation -pelvic lifts -tightening/relaxing of abd muscles -avoid carbonated beverages/straws (creates gas) -Rectal suppositories to stimulate peristalsis and the passage of flatus
Which one would be best for the immediate post-op cesarean section? Tightening and relaxing of the ABD muscles or Rectal suppositories Rectal suppositories
Normal bowel function resumes how soon after delivery? 2-3 post partum
T/F: The absence of bowel sounds is normal after delivery? False
When assessing the ABD, it should be ___, non-___ and without ___ ___ Soft; tender; epigastric pain
What is it called when the longitudinal muscles of the ABD separate? Diastasis recti
After childbirth, the ABD muscles are ___, ___ and ___. To strengthen them, you can encourage ___ Weak; soft; flabby; exercise (crunches and sit-ups
What hormone decreases after childbirth and allows pigmentation to recede? Melanocyte-stimulatin hormone
Striae gravidarum or "___ ___" gradually fade to silvery lines, but do not disappear. Stretch marks
Bonding is enhanced when parent and infant touch and interact within the first ___ minutes of life 30-60
List the nursing interventions that support bonding -Assit parents in positioning baby -Mom/baby eye contact -Point out reciprocal bonding -Encourage parents to participate in care -Model bonding behaviors -Refer to infant's characteristics positively
Eye contact, grasping and holding of a finger and being comforted by a parent's voice are newborn ___ behaviors attachement
"___ ___" is the mildest form of PP depression. These are normal and ___ Baby Blues' temporary
List the characteristics of PP depression -Panic attack (leads to CP, increased HR, increased RR's) -Refusal to eat -Inability to cope/care for baby -Hostile/easily angered toward baby -Irrational -Phobias -Hallucinations
PP depression can happen when? Immediately or months after birth - anytime within the first year
List the nursing preparations for a cesarean section -Usually epidural -NPO, except for meds to neutralize gastric acids -EFM until skin prep, wedge under hip -Labs: CBC, Type and screen, clotting studies PRN -IV line, prophylactic ABX -Skin shave and foley insertion -Provide emotional support
What are the 2 types of skin (ABD wall) incisions? 1. Pfannenstiel 2. Vertical
What are the 3 types of uterine incisions? 1. Classic 2. Low vertical 3. Low transverse
Which type of uterine incision eliminates a VBAC as an option for birth? According to Parenting Magazine - the classic incision (see pg. 225 in text book) is contraindicated for VBAC. This incision goes through the upper uterus making it more likely for rupture. The transverse is best for VBAC
PP care for the post cesarean section is the same as for vaginal delivery except for assessing what other items? -Return of motion and sensation -ABD dressing -LOC and respirations -Pain level and administer narcotics -I & O, maintain pt. IV
Created by: MEPN 2013