OB
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| what is referred to, as the 4th trimester and lasts 6 weeks after birth? | postpartum period
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| another name for postpartum period | puerperium
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| this part of puerperium covers the first 24 hrs. | immediate postpartum period
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| this part of puerperium covers the first week after delivery. | early postpartum period
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| this part of puerperium covers week 2--week 6. | late postpartum period
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| during the postpartum period, what physiologic "thing" occurs to the woman? | adaptation....her body begins the process of involution.
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| the process through which the uterus, cervix, and vagina shrink and or return to the nonpregnant state. | involution
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| immediately after the placenta is delivered, what should the nurse expect to find-in regards to the woman's fundus? | her fundus should be firm and located in the midline between the umbilicus and symphysis pubis
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| how long after delivery would the nurse expect the uterus to be firm, with the fundus midline at the level of the umbilicus? | 1 hour after delivery
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| 1 day pp: 1 cm (1 fingerbreath)below umbilicus:: 4 days pp: | 4 cm (4 fingerbreath)below umbilicus
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| you should expect the fundus to have descended below the pubic bone and no longer palpable on what day? | 10th
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| list factors that help promote uterine contraction: | breast-feeding, oxytocin, early ambulation, proper nutrition
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| your pp patient exhibits these factors (what do expect to be inhibited?): full bladder, multifetal pregnancy, hydramnios, maternal exhaustion, excessive analgesia, oxytocin use during labor and delivery, retained placental fragments, infection, grand mult | uterine involution inhibited/delayed.
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| when the uterine involution is unable to occur, this soft/spongy condition occurs..that most likely will turn into a hemorrhage if not stopped is what? | Boggy uterus
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| afterpains occur in which patient because of the uterus contracting and relaxing at interals | multipara mom
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| afterpains don't normally hurt as bad in this mom because the uterus usually stays contracted | primipara mom
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| afterpains that can hurt in both the multipara and primipara because of the release oxytocin increasing the duration and intensity of contraction | the breast-feeding mom
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| this consists of blood, mucus, and WBCs during the pp period and progresses in 3 stages | lochia
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| you expect your patient's lochia during the first 3-4 days to be rubra...what would you expect to find? | dark red, mostly blood, fleshy smell, small-moderate in amount
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| you expect to find your patient's lochia pp days 4-10 to be serosa..what are you expecting to find what? | brownish/pinkish color, decreased in amount
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| your patient is pp days 10-beyond..you expect to find her lochia to alba...which means you expect to find what? | white/yellowish coloring, mostly WBCs in the D/C, no more bleeding.
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| how long can lochia continue? | 6 weeks
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| lochia usually stops around week? | week 2-week 3
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| what 4 things should you NEVER see in the lochia, and report to your RN if they occur? | large blood clots, reversal of lochia progression, bleeding that doesn't stop or increases in amount, and malodorous lochia.
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| what's the earliest you could see ovulation occur? | week 3
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| you can tell your non-breast-feeding patient that is asking about her menses, that it could take how long for her to begin menstruating again? | around 6-8 weeks
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| you should explain to the breast-feeding mother that it might take how long for her to see her menses again? | 18 months
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| what is extremely important to teach your pp patient about the importance of contraception during this time? | even though her menses has yet to return, she can still get pregnant
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| this remains slightly open and has a slitlike appearance...this is how you can differentiate between a primipara and multipara. | external os
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| the cervix recovers by end of pp week? | end of the week 6
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| by the end of what pp week, does the vagina become smaller, yet may never truly go back to pre-pregnancy. | week 3
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| your patient is breast-feeding, and she asks about intercourse..you explain to her that because of breast-feeding her estrogen levels will remain low and can lead to vaginal dryness and dyspareunia-you know she understands what dyspareunia when she says.. | "so, it can cause me to have painful intercourse?"
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| you would expect to find your patient's labia and perineum to look like? | swelling and appeared bruised
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| you would most likely find the patient with an episiotomy/laceration fixed to have what? | dissolvable stitches and approximation
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| your patient asks how long she will have to deal with this episiotomy...what do you tell her? | it can take up to several weeks to fully heal from an episiotomy
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| antibody-rich breast secretion that's the precursor to breast milk, and usually excreted by the breasts in the last weeks of pregnancy and continues to be excreted in the first few pp days. | colostrum
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| these levels rise when both estrogen and progesterone levels fall; and suckling on the breast stimulates these levels to also rise | prolactin levels
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| prolactin stimulates milk production, and the woman should notice milk starting to come in around what pp day? | pp day 3
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| where is the fundus normally located on the day after deliver? | 1 cm below the umbilicus
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| name the 3 stages, in order, in which lochia passes. | lochia rubra (first 3-4 days); lochia serosa ( pp days 4-10); and lochia alba (pp days 10-beyond)
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| you should expect that your patient lose how much blood after a vaginal delivery? | 300-500 mL
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| you should expect that your patient lose how much blood after a cesarean delivery? | 500-1000 mL
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| the hemoglobin and hematocrit (H&H) fall by 1:2 points...so, your patient has lost a total of 500 mL...her H&H were 12 and 34...after the total bloss however, what do you expect her labs to read now? | her H&H would be now be: 10 and 30
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| dehydration, immobility and trauma can all add to the risk of what in the pp pregnant woman | DVT
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| you should expect that the pp woman's WBCs to be slightly elevated... | 15000-20000mL...but can get up to 30000mL
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| what can occur directly after deliver and is most likely due to hormonal and physiologic changes and isn't harmful...and can be taken care of with warm blankets? | shaking pp chills
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| if the woman experiencing shaking pp chills also has a fever of 110.4F or higher...what might you assume is going on? | infection
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| if your patient has VS: slightly raised temp; BP at the woman's baselie; and the HR is mostly slow within the first week after delivery you would assume? | all is WNL
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| your patient's VS: temp of 100.4F or higher; BP that is elevating or falling BP accompanied with steadily rising HR; tachycardia-what would you start accessing for? | temp(infection); BP(preeclampsia) or (hemorrhage); tachycardia (hemorrhage/diff. labor/delivery)
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| while palpating the fundus, you find it above the umbilicus, deviated to the right side and boggy what do you know to most likely be the cause and how do you treat this? | full bladder///help her to the bathroom so that she can fully eliminate..and then palpate fundus again-once bladder is empty.
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| dilation of the renal pelves and ureters, is a normal change that occurs during pregnancy because of hormones and can persist up to 4 weeks pp; however, also predisposes the woman for UTI. | Hydronephrosis
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| immediately after delivery, your assessment of the woman finds a soft and saggy abdomen; she c/o extremely being hungry and thirsty and might feel constipated; along with her urinary output being greater than her intake...you will find these to be? | WNL
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| you are told that your patient has transient glycosuria, proteinuria, and ketonuria immediately after delivery-these findings are? | WNL
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| because of intra-abdominal pressure that decreases rapidly after childbirth and peristalsis being diminished...these 2 factors slow down feces traveling down the GI tract, predisposing the pp woman to what condition? | constipation
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| this occurs in the first few days because of excess water and waste via the skin; she will notice perspiration mostly at night; possibly wake up drenched...this is normal..what's it called | copious diaphoresis
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| If the woman gained the recommended WNL weight gain during her pregnancy...what is the average length it will take her to lose that weight and return to prepregnant weight? | 6 months
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| immediately after the expulsion of the fetus, placenta, and amniotic fluid, how much weight will she lose? | 12-14 pounds
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| how much weight will she lose in addition to the immediate 12-14 pounds, due to sweat and urinary output> | 5-15 pounds
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| what can you tell your pt, that is concerned about her weight because of the high caloric demands after delivery? | breast-feeding woman tend to lose weight faster than those who do not breast-feed,
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| enduring emotional bond that develops between the parent and infant even though this process doen't happen automatically. | attachment
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| the initial component of healthy attachment; this is the way the new mom and dad become aquainted with their newborn. | bonding
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| this is the initial start of bonding that has the new mom exploring her newborn's extremities, counting his fingers and toes. | fingertip touching
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| this is where the mom interacts face to face with the newborn, placing the baby's face within her direct line of vision and makes full eye contact with the newborn | en face position
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| list the normal progression of interaction that occurs during the initial boning experience between a new parent and the newborn. | fingertip touching...exploring extremeties...touching with palm of hands...more of the baby's body surface is now touched and caressed...cuddled close to the parent...en face positioning with talking and cooing to newborn
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| in the first hour pp how often would you check on VS, bladder distention, fundus, perineum, lochia, and incision sites? | every 15 minutes
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| in the first hour, when is it appropriate to check the breasts? | check the breasts immediately upon receiving pt one time, and then once more right before transferring to pp unit.
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| check vs, perineum, lochia, bladder distention, fundus, and incision sites how often in the 2cd hour after delivery | every 30 minutes
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| how often do you make checks on your patient within the first 24 hours, after the first 2 hr? | every 4 hours
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| what is the most likely cause of bright red bleeding that occurs in a steady stream in the presence of a firm fundus? | vaginal or cervical lacerations that were not repaired...report this immediately to your RN
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| this woman would find breast engorgement more comforting if allowed a warm compress or warm shower to run over her breasts; or to express milk before doing this. | the breast-feeding mother
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| engorged breasts for this mom apply ice packs, wear support bra 24 hrs a day. | non-breast feeding mom
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| perineum ice packs...on for how long..off for how long | 20 min on 10-20 off
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| can you give a warm sitz bath after the first 24 hours to help with perineum pain | yes
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| how many kcal need to be added to the lactating woman's diet per day...giving her a total of how many kcals a day? | she needs to add 200 kcal, giving her a total of 500 kcals a day
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| non-breast-feeding woman needs to decrease her kcals per day by how many? | 300 kcal
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| your patient is RhO- and has had a RhO+ baby...what must be done and when? | mom needs to be given RoGAM within 72 hours of delivery
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| mom's rubella titer reads less than 1:8...what two things need to be done? | she needs to receive the rubella vaccine and informed that she need to not attempt getting pregnant for 3 months after the vaccine
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| your patient is scared about taking medicine because she is lactating | explain to her that the meds given will not hurt her baby and that it is important that she take her meds to prevent pain from affecting her breast-feeding to occur
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| ibuprofen is best given for what pain | cramping
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| analgesic-narcotic combinations are best for what pain | controlling episiotomy or incisional pains
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| your patient has a PCA-pump, she asks you to push the button for her, what she you do? | explain that because of what is referred to as analgesia by proxy...you cannot.
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| the lochia flow stops and there is no discomfort when two fingers are placed inside the vaginal opening...this indicates what | healing is indicated
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| the C-section mom is at higher risk with complications of what 3 things | respiratory complications, infection and hemorrhage
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