OB Exam 2 > Ch 16 > Flashcards

Ch 16 Flashcards

(62 cards)

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1
Q

When do Vaginal Deliveries discharge?

A

After 2 days

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2
Q

When do C-section Deliveries discharge?

A

After 3 days

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3
Q

NM Important things to check now that the baby has been Delivered:

A

Uterus and Signs of Bleeding

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4
Q

NM for Hour 1 PP

A
  • Recovery Period
  • VS every 15 minutes
  • Check the body for bleeding
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5
Q

NM for Hour 2 PP

A
  • Recovery Period
  • VS every 30 minutes
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6
Q

NM for Hour 3-24 PP

A
  • VS every 4 hours
  • C-Sections sometimes get a Third Hour of Recovery
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7
Q

NM for Hour 24-72 PP

A

VS every 8 hours (Shift)

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8
Q

Common problem at Immediate PP

A

Orthostatic Hypotension

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9
Q

A SOB could be indicative of what complication?

A

PE

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10
Q

PP Focused Assessment Mneomnic

A

BUBBLEPET

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11
Q

BUBBLEPET Acronyms

A

Breasts
Uterus
Bowel
Bladder
Lochia
Extremities
Perineum
Emotional Needs
Teaching

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12
Q

Preeclampsia Def

A

Preeclampsia = High BP and signs of Organ Damage

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13
Q

If patient states any vision changes what do we do?

A

Check the BP

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14
Q

If patient has a rapid HR what are we worried about?

A

Blood Loss

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15
Q

If the patient is feeling faint what are we worried about?

A

Blood loss or Hypotension

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16
Q

If the patient has calf pain what are we worried about

A

Is it a DVT?

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17
Q

What are some danger signs for the patient:

A

Fever over 100.4 or
Severe headaches which are indicative of epidural or spinal anesthesia or preeclampsia

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18
Q

What do we check in a Bubble Assessment: Breasts (2)

A
  • Check the size, shape and symmetry of the Breasts
  • Check for engorgement/distention
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19
Q

Bubble: Breasts Biggest Concern

A

If a baby has problems latching onto the nipples

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20
Q

Engorgement Tx

A

Have the mom empty the breasts by feeding the baby or pumping milk out

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21
Q

What do we expect to see in a Bubble Assessment: Uterus (3)

A
  • Fundus should be midline, firm
  • Uterus should be shrinking 1 finger a day
  • Check the pad and uterus at the same time, pressing on the uterus might cause blood to rush/gush out, which is normal
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22
Q

What would be the abnormal finding during a BUBBLE Assessment for the Uterus

A

It is not normal to have a continuous trickle of blood

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23
Q

What is the best way to check the uterus in the Bubble Assessment

A

Have them lay flat on their back

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24
Q

What could be the reason behind an abnormal BUBBLE assessment finding for the uterus

A

Abnormal/Variations could be due to deviations from a full bladder causing uterus to move to the side or a boggy fundus

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25
What are we looking for in a Bubble Assessment: Bowel/Bladder (4)
* Is there a UTI? * Does she have Urinary Retention * Are there no bowel movements? * It is normal to have constipation and sluggish bowel sounds right after delivery
26
What are we checking for in a Bubble Assessment: Lochia (4)
* Check for Lochial bleeding from the Uterus * Estimate QBL * Check the amount, composition, smell, quality * Assess the color, odor, of the bleeding and if there are any clots?
27
How big of a clot is too big?
If bigger than a golf ball
28
Why are we estimating the amount of blood loss in lochial discharge?
We want to estimate blood loss bc we are worried about PP hemorrhage
29
What are two Indications of the Mom hemorrhaging?
* If mom has > 500 mL blood loss and vaginal discharge → Mom is hemorrhaging * If mom has > 1000 mL blood loss and c-section → Mom is hemorrhaging * 1 gram = 1 mL when measuring blood loss
30
Lochial Bleeding Intervention Order
First EMPTY the bladder THEN use uterotonics
31
If the uterus is the cause of bleeding it will be ____ if the uterus is not the cause of bleeding it will be ____
Uterus cause --> Boggy fundus Not Uterus cause --> Firm Fundus
32
What are we checking for in a Bubble Assessment - Extremities
Check legs for DVT Check for Edema
33
What are we checking for in a Bubble Assessment - Perineum
Are there lacerations? Lacerations are common
34
What is a WNL Perineum Assessment Finding
Edematous, Slightly Bruised and Painful
35
Different Laceration Kinds:
* 1st degree is just the first layer of tissue and superficial * 2nd degree is a tear through the muscle * 3rd degree tear has torn through the anal sphincter * 4th degree tear has torn through the rectum
36
What is a normal laceration?
1st and 2nd degree tear is Normal
37
What are we worried about with 3rd and 4th degree lacerations? (2)
* 3rd and 4th degree is very painful and need extra anesthesia for repair * With 3rd and 4th degree tear we are not worried about pain, but also a potential hematoma
38
What do we check in a Bubble Assessment - Emotional Status (2)
Are parents engaging with baby? Check bonding/attachment and mood
39
What do we do in a Bubble assessment - Teaching
Educate the parents
40
Bonding Def
Happens the 30-60 minutes after birth, it is unidirectional
41
Bonding NM (2)
* This bonding golden hour is protected for the mom and the baby * No extra family should visit and no extra assessments should be done
42
How can the bonding be disrupted and what happens if Bonding if it is disrupted
* This bonding process can be disrupted if the baby has complications * This being disrupted can cause PP depression and anxiety
43
Attachment Def
A reciprocal or two way interaction, when the baby reciprocates to the mom’s bonding
44
What is indicative of Attachment recurring
The En Face position is a sign that attachment is recurring, a sign that strong affection between the baby and the mom is developing
45
When do we give opioids?
Only for C-section deliveries and if they are in severe pain We do not give for vaginal deliveries unless they have 3rd or 4th degree tear
46
What is a Peri Bottle
Lukewarm bottle, everytime the pt goes to the bathroom, they should be taught to squirt their perineum area with the Peri Bottle
47
What is a Sitz Bath
Basin in toilet that is filled with lukewarm bottle that is attached to IV bag filled with lukewarm bottle, they sit in the toilet and soak their bottom, the idea is that warm water will cause vasodilation and promote blood flow and healing
48
What does a Dermoplast do?
Numbs perineum and relieves itching
49
Nonpharmacologic interventions for pain PP (3)
* Ice for the first 24 hours after injury for immediate relief * After 24 hours, no ice, but regular pads as we want to promote blood flow * Teach correct latch position for the baby on the mom or offer nipple cream to prevent nipple soreness
50
Stress Incontinence Def
Involuntary Leakage of Urine due to Pelvic Floor Weakening
51
First Line Tx for Stress Incontinence
Kegel Exercises
52
When can PP patients have intercourse?
After 6 weeks
53
When should patients have their next delivery?
Wait at least a year between deliveries for the delivery to be safe
54
Calorie intake for lactating patients
Inc calorie intake by at least 400
55
When is Hand Expression Technique Used
If the breasts get engorged/distended, we want them to stand in warm shower and use their hands to express the milk out
56
3 Contraindications for Breastfeeding
Pts who are HIV Positive Patients who take certain drugs Baby with problems
57
3 NM for Bottle Feeding
* Babies need to be burped more because they are taking in more air * Formula should be warm, but never microwaved due to hot spots * Never let the baby go to bed with the bottle in their mouth as it can cause tooth decay
58
How long is breastfeeding recommended?
Recommended for baby's first 6 months
59
Postpartum Blues Def
Normal Transient Feelings of sadness that are self-limiting aka meaning it resolves in a few days, present a week after delivery, this is due to hormonal changes, if it persists for >2 weeks PP then we worry about it being PP depression
60
Who should get Tdap Vaccine?
Anyone regularly near the baby, including grandparents should get an updated Tdap Vaccine
61
For adolescent parents what is important NM
Social support is IMPORTANT!!!!!!!!!!!!
62
For Midlife Parents what NM is important?
Realistic Expectations are IMPORTANT!!!!!
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