OB Exam 3
A 2-day postpartum client tells the nurse that she is experiencing abdominal cramps whenever she breastfeeds her baby. Which of the following is the most appropriate response from the nurse?
"Oxytocin is released when the baby sucks, which causes the uterus to contract."
While the nurse is assessing the fundus of a multiparous client who gave birth 24 hours ago, the client asks, "What can I do to get rid of these stretch marks?" Which response would be most appropriate?
"They usually fade to a silvery-white color over a period of time."
What is scant bleeding on a peripad?
1-2 inch; 10mL
when will the fundus no longer be palpable?
10 days
How often should the patient be assessed PP?
1H= Q15min 2H= Q30min 24H= Q4H after 24H= Q8H
What is the taking hold phase?
2-3 days PP; mother is ready to resume control over life, she is focused on baby and may need reassurance
when is a sitz bath indicate?
24 hours after birth; cold therapy should be used first
when can a mom get pregnant after a rubella or varicella immunization?
3 months after
when does engorgement occur?
3-5 days PP
how much urine can a mom lose in a day?
3000 mL
What is light bleeding?
4 inch; 10-25mL
How long does it take for milk to be produced after birth?
4-5 days
What is moderate bleeding?
4-6 inch; 25-50mL
How long does it take for the cervix to return to normal size?
6 weeks
when does menstruation restart for moms who are not breastfeeding?
7-9weeks; usually 3 months
when would rhogam be given PP?
72 hours after birth if baby is + and mom is -
how much should fluids be increased PP?
84 oz or 2500 mL
A nurse is caring for a woman who gave birth to her baby boy 2 hours ago. The nurse notes the woman's perineal pad contains some small clots and a moderate amount of lochia has accumulated under her buttocks. What is the first action the nurse should take at this time?
Check fundus for position and consistency.
What is the most common thromboembolitic condition that occurs in the foot to calf or thigh to pelvis?
DVT
What are s/s of mastitis?
Flu like symptoms, Inflammation, Breast engorgement, Tenderness, Warmth, Nipple discharge
What can cause subinvolution (not involuting)?
Full bladder (moves to right), not expelling full placenta, uterine atony
During a postpartum examination, the mother of a 2-week-old infant tearfully tells the nurse she feels very tired and thinks she is not a good mother to her baby. Which statement by the nurse would be best?
I am concerned about what you are experiencing. Tell me more about what you are thinking and feeling."
What should a mom use for perineal pain for at least the first 24 hours after birth?
Ice packs
What occurs at 3 months PP and puts the mom at risk for suicide and the baby at risk for infanticide?
PP psychosis
While assessing a primiparous client 8 hours after childbirth, the nurse inspects the episiotomy site, finding it edematous and slightly reddened. Which interpretation by the nurse is most appropriate?
The client needs application of an ice pack.
During the postpartum period, a nurse should assess for signs of normal involution. Which statement would indicate that a client is progressing normally?
The uterus is descending at the rate of one fingerbreadth per day.
how much is too much blood loss?
Vaginal = >500mL C-section = >1000mL
How do we treat mastitis?
antibiotics, pain meds, milk removal
what are moms at risk for after birth that deals with coagulation?
blood clots, DVTs, and PEs
what is a moms postpartum heart rate likely to be?
bradycardic and will return to baseline; 40-60bpm
what does a decrease in estrogen cause?
breast engorgement
what can the mom do to help release oxytocin?
breastfeed
How much should a moms diet increase?
by 500 calories
If a mom is breastfeeding she should consume at least 400 of what?
calcium
when does menstruation restart for breastfeeding moms?
can be between 2 and 18 months
what are causes of PPH associated with tissue?
clots, uterine inversion, subinvolution
What should a mom do if she has mastitis?
continue breastfeeding
what can cause hair loss during the first 3 months PP?
decreased estrogen
what characterizes mild shock? (20% blood loss)
diaphoresis, cool extremities, anxiety
if a mom has orthostatic HTN what should be done?
elevate HOB before ambulation; walk with patient; assess for s/s
What can a mom do to relieve pain from engorgement?
empty breasts frequently, warm showers/compresses before feeding. cold compresses between feeding
what hormones drop immediately after the placenta is delivered?
estrogen and progesterone
What happens to hormones after mom starts ovulating again?
estrogen decreases and progesterone increases
what can occur during the first 12 hours and up to the first week PP that effects the urinary system?
excessive diuresis from pitocin, epidural, etc.
what uterotonic drug is given IM for PPH and is contraindicated in patients with asthma?
hemabate
What are the s/s of metritis? (infection of the endometrium, decidua, and myometrium)
high temp, fatigue, lethargy, nausea, anorexia, lower abd pain
what bowel sounds would you anticipate PP?
hypoactive that eventually return to normal
what characterizes severe shock? (>40% blood loss)
hypotension, agitation, confusion, hemodynamic instability, possible death
What is the taking in phase?
immediately after birth; mom is dependent on nurse
What should a patient do PP to help decrease constipation and promote GI motility?
increase fluid intake; high fiber diet; ambulate; possible stool softener
what can a decreased BP be indicative of during postpartum?
infection or uterine hemorrhage
What is thrombophlebitis?
inflammation of a vein with clot formation
what can a mom do to improve her pelvic floor tone?
kegel exercises
What are the s/s of shock?
low BP, high HR, low output, change in LOC
What is the first thing you do if the mom has excessive bleeding?
massage the fundus
What uterotonic drug is used in PPH but, cannot be used in patients with HTN?
methergine
what characterizes the baby blues?
mildly depressed, fatigue, anxiety, irritable; peak = 4-5 days; resolves by day 10
what uterotonic drug stimulates contractions and controls bleeding during PPH; should not be given as a bolus?
misoprostol
How far down should the fundus move each day postpartum?
one finger breadth; @12 hours should be at umbilicus; (1cm/day)
what can still occur without menstruation? (be careful during sex)
ovulation
What hormone contributes to after pains that is secreted from the pituitary gland?
oxytocin
what is lochia serosa?
pink/clear discharge; made from leukocytes; usually occurs after day 3; can last from 3-10 days
what is given directly after birth to help with after pains?
pitocin
what can a high BP be indicative of during postpartum?
pre-e; can alst 24-48 hours; s/s: headache, calf pain, blurry vision
BUBBLE -EET Breast Assessment
problems with breasts?; palpate for masses, warmth, etc.
what hormone decreases if the mom doesnt breastfeed?
prolactin
What happens in von wildebrand's disease that causes PPH?
prolonged bleeding time; congenital; platelets dont stick; common to have nosebleeds
what is the leading cause of pregnancy related deaths in the US?
pulmonary embolism
what is lochia rubra?
red discharge; lasts until day 2-3; can occur for the first 3-4 days after birth
What is the letting go phase?
redefines her new role as mother, extends and continues into the child's growing years; BAM= becoming a mom
What is postpartum depression?
requires treatment; more severe
What is a sign of hemorrhage associated with peri-pads?
saturating a pad within 1 hour
What does oxytocin do for breastfeeding?
stimulates milk let down
what does prolactin do for the mom?
stimulates milk production and inhibits ovulation
What position should mom be in when assessing the uterus?
supine with empty bladder
what is the first sign of hemorrhage?
tachycardia
what characterizes moderate shock? (20-40% blood loss)
tachycardia, postural hypotension, oliguria
what are some PP danger signs?
temp >100.4 , foul lochia, calf pain, SOB, pre- e history, dysuria
Uterine involution
the process of the uterus returning to normal size
What happens to PT and PTT times during PPH?
they are prolonged
if a mom is breastfeeding what happens to her estrogen levels?
they remain low until breastfeeding decreases or stops; then will increase
what are the five Ts of PPH?
tone, tissue, trauma, traction and thrombin
what erikson stage is associated with PP?
trust vs mistrust
When assessing an 18-year-old primipara who gave birth to a viable neonate under epidural anesthesia 24 hours ago, the nurse determines that the fundus is firm but to the right of midline. Based on this finding, the nurse should further assesses for:
urinary retention
What is superficial venous thrombosis?
usually occurs in the saphenous vein of the lowe leg
During the first hour after a precipitous birth, the nurse should monitor a multiparous client for signs and symptoms of which complication?
uterine atony
a boggy uterus is a sign of what?
uterine atony
what is the most common cause of pp hemorrhage?
uterine atony
what can happen if the umbilical cord is pulled that causes PPH?
uterine inversion; life-threatening hemorrhage and hypotension; S/s: pain, bleeding, shock
Do vaginal births or c-section births have more lochia postpartum?
vaginal
What should a mom use if shes experiencing dyspareunia after birth?
water soluble lubricants
What should mom do if she does not want to breastfeed?
wear supportive bra; ice during engorgement; no stimulation; analgesics for pain
What is lochia alba?
white discharge; from day 10-14 can last 3-6 weeks
