OB TEST 4
Card Set Information
OB TEST 4
6 weeks post-delivery
4th stage of labor
3 periods of postpartum and their time periods
: 1st 24hrs
: 1st week
: 2nd - 6th week
Goes back to prepregnancy state
Shrinking or returning to normal size of uterus, cervix and vagina
While giving a uterine massage what should you support?
Lower uterine segment
While giving a uterine fundus massage what position should the bed be in
When you are massaging the fundus what could be a possible complication if you don't have the pt .....
What things will delay uterine involution?
Any condition that over distends the uterus(multifetal pregnancies, hydramnios)
How are you VS going to differ from the normal person, immediately postpartum?
Temp slightly elevated within the first 24hrs
Slow pulse, 50 bpm, for the first week
BP should be normal
Most rapid changes pp occurs in what time frame?
1st 3-4 days
When dorsiflexing the foot the woman experiences pain
Positive Homan's Sign
Fundal Height Times
Immediately After Delivery:
1. Firm in the midline and 1/2 way between the umbilicus and symphysis pubis
One hour PP
uterus should be contracted firmly with the fundus at the level of the umbilicus
1 day after PP
1 fingerbreath (1 cm) below umbilicus
Anything after the first day
1 fingerbreath per day untill no longer papable
When should the fundus be no longer palpable
By the 10th day
What promotes involution
What factors inhibit involution
over distention of uterus
retainted placental fragments
When the uterus doens't contract effectivly what could this lead to
5 or more pregnancies
How is involution assessed?
Measuring fundal height
3 phases that occur in maternal adaptation
3 ways bleeding is controlled phsiologically immediately after delivery
1.Involution and contraction causes to open blood vessels and seal them off
2. Clotting cascade is initiated
3. Fibrinogen levels are raised
What are signs that the mother is not bonding with baby
Negative statements about baby
Refusing to name baby
Not caring for baby
Not wanting baby in room
Group of related symptoms
Spongy soft uterus not well contracted
When the uterus is not contracting effectively; blood and clots collect in uterus which could lead to what
Afterpains are most severe in ? because ?
Multipara because the uterus goes through periods of contraction and relaxation
When massaging the fudus what are we assesing?
If you over massage the fundus what could happen
Uterus becomes flaccid rather than helping it to contract
The blood, mucus, tissue and WBC's make up this
Describe Lochia Rubra
1st 3-4 days
Red in color
Small to Moderate Amount
Decribe Lochia Serosa
Decribe Lochia alba
After day 10
White, or Pale Yellow in Color
How long does lochia last?
2-3 weeks but could last up to 6 weeks
3 abnormal findings to watch for in lochia
1. Reverse in Pattern
2. Fall to decrease or Increases
3. Foul odor
Ovulation can occur as early as
3 weeks PP
Ovulation can occur in the absence of
A menstrual period can occur in the absence of
This suppresses ovulation but is NOT an effective form of birth control
A PP cervix may appear
Bruised and Torn
What appearance does a nulliparous cervix have
What appearance does a PP cervix have?
Slit-like doesn't ever go back to original shape
When does Rugae return to vaginal walls?
3 weeks PP
Breastfeeding can lead to dryness of the vaginal walls which leads to
Dyspareunia: painful intercourse
What 2 things can cause prolactin levels to rise
1. Delivery of placenta (estrogen and progesteron levels fall causing prolactin to rise)
When does milk usually come in?
What is the average amount of blood loss in a vag delivery
What is the average amount of blood loss in a c-section?
As PP blood volume returns to normal you can expect an increase in what?
High plasma fibrinogen levels at PP help bleeding stop but can cause what to occur?
PP Blood Loss
For every 250mL of blood loss the Hct & hgb do what
: Fall 2 points
: Fall 1 point
WBC's do what in PP
Immediate PP mom begins to shiver what do you do?
Assess for temp, if over 100.4 this means infection
If less than 100.4, give her a warm blanket or two
Abdominal wall seperates during pregnancy leaving part of abd wall without muscular support
Diastasis recti abdominis
4 risk factors for Diastasis recti abdominis
Over distended abdomen
Poor Muscle Tone
Diminished peristalsis, hemrrhoidal pain, perineal discomfort, and iron supplements can lead to what
PP bowel function should return to normal when?
End of the 1st week
When palpating the fundus if it deviates to the right it is because
Approximately how many pounds are lost with the expulsion of the fetus, placenta, and amniotic fluid
How many pounds is lost from fluid loss in early PP
The average woman returns to her prepregnancy wt when?
6 mths PP
What does breastfeeding do to your body
Helps you loose wt faster
Reva Rubin identified 3 phases the PP woman goes through
Explain Taking In
When the woman is mostly concerned with her self
Explain Taking Hold
When the woman begins to focus her care on the newborn
Explain Letting Go
Woman begins to degine her role as a new parent
The enduring emotional bond that develops between a mother and her infant
Initial component of healthy attachment is the the process of
Face to Face Bonding
Approx 50-70% of all PP women experience a mild depression that lasts 2-3 days generally called
If a woman is goin to hemorrhage she is most likely to do so when
1st hour postpartum
What 13 do you assess in a PP assessment
Position and Firmness of Fundus
Amount and character of Lochia
Status of Perineum
Incision if C-sect
How ofter do you assess VS
1st hr q 15min
2nd q 30min
q 4hrs until 24hr mark
Add a head to toe assessment each shift
Check for what on Breasts
Who has more lochia?
Woman should be voiding what amout PP on a regular basis
What position do you check the perineum in?
We palpate the perineum with a gloved hand when checking for?
When you assess the calves what is the Norm?
Equal in size bilaterally
No red or painful areas when feet are dorsiflexed
What labs do you need to order?
When standing up lochia can alarm the woman because
Lochia can pool up while sitting down
Then once erect it may gush out and run down her legs
What nursing interventions should you take for a boggy uterus?
Bright Red Bleeding that occurs in a steady stream in the presence of a firm fundus is most likely to be caused by what?
Cervical Laceration that was not repaird
Unilateral pain and swelling sometimes with hard mass in the breast could indicate
What engorgement intervention should you provide for the breastfeeding mom
What nursing invention should you take for the mom who is feeding the infant formula
Why should we give analgesics 30-45 mins before mom breastfeeds?
Reduce feeling of afterpains from uterine contraction due to oxytocin release from suckling
What other nonpharm help with afterpains
Your pt complains of perineal pain...what is your next step?
First visualize the perineum to rule out hematoma and that the episiotomy is well approximated
Ice packs (20 min on/20 min off) 1st 24hrs
Sitz Bath After 24hrs
Mild analgesics with a narcotic
Nursing interventions for hemorrhoids
Witch Hazel Pads
Infection of the uterine lining
Instruct the PP to change her pad q
What is used to clean the perineum
First time mom is at risk for fainting the first time she showers because
Warm water causes peripheral blood vessels to dilate leading to hypotension resulting in fainting
3 reasons to do an In & Out cath
6 hours without void
Several voids less than 100mL
Anytime a narcotic is administered with a spinal or epidural what is a possible risk?
Report low RR when
Below 12 bpm
Report a low pulse ox when
Less than 95%
Abdominal surgeries such as c-sections cause gas to build up and manifests as pain where?
Common side effect of narcotics usually fixed with benadryl
How long is a cath left in with a c-sec birth
What should be available in the cse that hte meds cause RR of 12 or less
If the fundus is firm and the woman has no vaginal bleeding how often should you massage the fundus
How often should you asses lung status after a c-sec
q 4 hrs
How often should you TCDB
When the basal dose of analgesia doesn't control the pain adequately
Break through pain
Research has shown it is easier to control pain when
Before it starts
If pruritis becomes unberable what should your intervention be
Pain from flatus can be an issue after a c-sec so you need to teach your pt to avoid
Very Hot or very cold drinks
Drinking through a straw
Discharge day is focused on
Postpartum Danager Signs (12)
Fever greater than 100.4
Localized reddened, painful area on one breast
Frequency, Urgency, and Painful Urination
SOB or Chest pains
Severe unremitting abd or back pain
Foul Smelling Lochia
Increased in Heavy lochia or passage of clots
Lochia pattern reversal
Severe pain/reddness or swelling at epi site or incision
Swollen painful reddened area on calf
Prolonged or severe depression
Thoughts of harming self or baby
How many calories should the breastfeeding mom take in
500 more cal
How many calories should a formula feeding mom cut out of her diet
What does mag sulfate do?
Taken in toxic prevents seizures
Sedates the nervous system to control B/P
What can be done to help muscle tone
A falling in BP particularly in the presence of an increasing Pulse is suggestive of what
Is transient glycosuria, proteinura and ketouria normal in the 10th of PP
No just normal after immediate PP
Dilation of renal pelvis and uters
Is this common
Due to what
Due to hormonal influences
4 weeks after delivery
What is the nursing intervention for a Rh neg mom
RhoGAM injection withing 72hrs of delivery
If mom is not immune to rubella what would you do?
PT TEACHING No pregnant within 3 months of injection
Out put should be at what
30mL per hour
Difference between C-Sec and Vag
Longer to ambulate
Higher risk for gas pains
Higher risk for infection
Higher risk for Respiratory Disorders
Longer hospital stay
higer risk for hemorrhage
Higher risk for thrombus formation
Ausculatated more often
Uterus descends faster
More blood loss
Goes from rubra to serosa more quickly
: Epi/incision/ c-sec
: Ecchymosis (Brusing)