OB Exam 3 Study Questions

What is the postpartum period?

Time period after birth to six weeks

What is involution?

Rapid reduction in size and conditions of the uterus to a non-pregnant state.

What are the factors that can speed up the process of involution?

Uncomplicated delivery

\
Breastfeeding

\
Getting up and moving

\
Complete expulsion of placenta.

What are the factors that can slow down the process of involution?

Complicated labor

\
Anesthesia depression

\
Bladder fullness

\
Infections

\
Overdistension of the uterus

What is the order of postpartum assessment?

The order of postpartum assessment is BUBBLE HE.

What does the first "B" in BUBBLE HE stand for?

The first "B" in BUBBLE HE stands for Breasts.

What should be assessed during the breasts portion of the postpartum assessment?

Ask if the mother is breastfeeding or bottle feeding

\
Engorgement

\
Tenderness

\
Redness or cracks in nipples

\
Mastitis

\
Palpable mass

What does the "U" in BUBBLE HE stand for?

The "U" in BUBBLE HE stands for Uterus.

What should be assessed during the uterus portion of the postpartum assessment?

Massage the fundus to ensure involution

\
Assess firmness and position (which should be midline and five cm below umbilicus)

\
Check for alterations such as a soft uterus or excessive bleeding

What does the second "B" in BUBBLE HE stand for?

The second "B" in BUBBLE HE stands for Bowels.

What should be assessed during the bowels portion of the postpartum assessment?

Assess for flatus and distension

\
Auscultate bowel sounds

\
Constipation from episiotomy

\
Fear of hemorrhoids

\
Peritrauma

What does the third "B" in BUBBLE HE stand for?

The third "B" in BUBBLE HE stands for Bladder.

What should be assessed during the bladder portion of the postpartum assessment?

Assess for voiding six to eight hours after delivery

\
UTI should be checked if catheterization is done

\
Frequency, burning, and urgency should also be assessed

What does the "L" in BUBBLE HE stand for?

The "L" in BUBBLE HE stands for Lochia

What should be assessed during the lochia portion of the postpartum assessment?

The type, quantity, amount, and color

\
Expected findings include red (1-3 days), serosa pink (3-10 days), and linea alba creamy white (10-21 days)

\
Unexpected findings include lots of clots, foul smelling, and subinvolution.

What does the first "E" in BUBBLE HE stand for?

The first "E" in BUBBLE HE stands for Episiotomy.

What should be assessed during the episiotomy portion of the postpartum assessment?

Redness

\
Edema

\
Ecchymosis

\
Discharge

\
Hemorrhoids should also be assessed and should be small and non-tender

What does the "H" in BUBBLE HE stand for?

The "H" in BUBBLE HE stands for Homan’s sign

What is Homan's sign and what does a positive sign indicate?

A test for pain in the calf with dorsiflexion of the foot. A positive sign indicates thrombophlebitis.

What does the second "E" in BUBBLE HE stand for?

The first "E" in BUBBLE HE stands for Edema

What should be assessed in relation to edema after delivery?

Pitting edema

\
Redness

\
Warmth

\
Pulse

What is postpartum hemorrhage?

Excessive bleeding after childbirth, which is the leading cause of maternal mortality in the US and a worldwide occurrence.

What are the risk factors for postpartum hemorrhage?

Having a large baby

\
Multiple gestations

\
Longer labor

\
Use of pitocin

\
Obesity

\
Having a full bladder

What are the causes of postpartum hemorrhage?

Trauma from forceps

\
Fast birth

\
C-section

\
Use of magnesium sulfate

\
Tissue issues such as accreta, increta, and percreta

What are the treatments for postpartum hemorrhage?

Uterine massage

\
Administration of duratonics

\
Rectal misoprostol

\
DNC (dilation and curettage) for tissue issues

\
Medications such as oxytocin, methagen, hemabate, and cytotec.

What are the contraindications for Methagen used to treat postpartum hemorrhage?

Contraindicated for those with high blood pressure

What are the contraindications for hemabate used to treat postpartum hemorrhage?

Contraindicated for those with a history of asthma

What does bright red blood during postpartum hemorrhage suggest?

Suggests lacerations

What does dark red blood during postpartum hemorrhage suggest?

Suggests bleeding from the posterior side of the uterus

What is mastitis?

Infection in the breast caused by staph or strep entering a break in the skin around the breas

What are the causes of mastitis?

Poor latch

\
Poor positioning

\
Poor fitting bra

\
Breast pumps

\
Traumatized tissue

\
Cracked nipple

\
Failure to wash hands before feeding

\
Poor drainage of breast milk

What are the signs and symptoms of mastitis?

Fever

\
Chills

\
Warm

\
Reddened area

\
Painful to touch

\
Flu-like symptoms.

What is the care for mastitis?

Emptying the breast

\
Massaging the breast

What are pelvic infections?

Infections in the pelvic area caused by bacteria spread from the vagina to the uterus, fallopian tubes, or ovaries.

What are the risk factors for pelvic infections?

Improper pericare

\
Laceration or episiotomy

\
Sexually transmitted diseases.

What are the signs and symptoms of pelvic infections?

Redness

\
Swelling

\
Pain

\
Abnormal amounts of discharge or color of discharge

\
Pain

\
Burning sensation

\
HNS and odor

What is the care for pelvic infections?

Hygiene

\
Antibiotics

\
Increased food intake

\
Fluids.

What are UTIs?

Infections in the urinary tract caused by bacteria

What are the risk factors for UTIs?

Urinary catheters

\
Improper hygiene

\
Dehydration

\
Urinary retention

\
Frequent vaginal exams during labor

What are the signs and symptoms of UTIs?

Hematuria

\
Polyuria

\
Odor

\
Film over urine

\
Suprapubic pain

\
Dysuria

\
Flank pain

\
Fever

\
Nausea

\
Vomiting

\
Back pain

\
Dizziness

What is the care for UTIs?

Hygiene

\
Antibiotics

\
Fluids

What is postpartum thromboembolism?

A blood clot that can occur in postpartum women

What are the risk factors for postpartum thromboembolism?

Preterm labor

\
Eclampsia

\
C-section

\
Smoking

\
Increased maternal age

\
Obesity

What are the signs and symptoms of thromboembolism?

Pain, heat, and swelling in the affected area

\
Abnormal circumference

\
Pain in the lower leg or abdomen

What are the types of thromboembolism?

Superficial thrombophlebitis and deep vein thrombosis.

What is superficial thrombophlebitis?

Type of thromboembolism that occurs around the third or fourth day postpartum and is signified by tenderness in the end portion of vein, local heat, and redness.

What is deep vein thrombosis?

Type of thromboembolism that is characterized by edema of the ankle and leg, pain in the lower leg or abdomen due to calf pressure, and peripheral pulses may be decrease

What are postpartum psychiatric disorders?

Mental health conditions that occur after childbirth

What are the symptoms of postpartum psychosis?

Agitation

\
Hyperactivity

\
Insomnia

\
Confusion

\
Irritation

\
Irrational thoughts

\
Poor judgment

\
Delusions (hearing or seeing things that aren't there)

What are the risk factors for postpartum psychosis?

Previous history of disorder

\
Bipolar disorder

\
Prenatal stressors

\
Family history of mood disorder

What are the symptoms of postpartum depression?

Sadness

\
Frequent crying

\
Insomnia

\
Appetite changes

\
Inability to concentrate or make decisions

\
Lack of interest in usual activities

\
Obsessive thoughts of being inadequate

\
Hostility towards the baby

What are the risk factors for postpartum depression?

First-time mothers

\
Lack of social support

\
Lack of a stable relationship with parents or partner

\
Concerns about body image.

What are the symptoms of baby blues?

Overwhelmed feelings

\
Lack of coping skills

\
Fatigue

\
Anxiety

\
Irritability

\
Oversensitivity

When do baby blues typically occur?

Typically occur within the first few days after the infant's birth

What causes baby blues?

Rapid alterations in estrogen, progesterone, and prolactin level

How long does baby blues typically last?

Self-limiting and last up to 10 days

How do children's views of death depend on their age?

Siblings aged 6 and below may view death as temporary and reversible.

\
Siblings aged 6-12 view death as inevitable and irreversible.

\
Siblings aged 12 and above have normal thoughts about death.

What effects might fathers experience when coping with grief?

Fathers may have a different expression of grief and may experience guilt or self-blame.

What are some helpful actions a nurse can take to support grieving families?

Call the child by name

\
Cry with the family if needed

\
Attend the funeral if possible

\
Remember the family on the child's due date

\
Birthday, or death anniversary

\
Provide photographs, lock of hair, footprints, and the baby ID band and clothes

What are some unhelpful actions a nurse should avoid when supporting grieving families?

Not acknowledging pregnancy or loss

\
Isolating from the client's room

\
Making insensitive comments like "at least it wasn't older" or "you can have other children."

How can nurses support parents who have experienced the loss of an infant?

Provide a quiet, private setting for parents to say hello and goodbye to their infant

\
Inform parents of their child's appearance before they decide to see and touch the child

\
Encourage parents to spend as much time as they want with their infant

\
Dress the infant in a diaper and t-shirt and wrap them in a baby blanket

\
Offer pictures of the infant dressed in baby clothes and without clothes

\
Obtain a lock of hair, baby ID bracelets, handprints, and footprints for the parents to keep

How can remembrances such as pictures help parents cope with the loss of an infant?

Pictures can help parents accept their child's death and move forward in their grieving process

What is the normal range for blood pressure in newborns?

Normal range is 50-70 over 30-45 mmHg.

\
Mean pressure should not be greater than 60 mmHg.

What is the normal range for temperature in newborns?

Normal range is 97-99 degrees Fahrenheit (axillary)

What does a low temperature in a newborn indicate?

Infection

What does a high temperature in a newborn indicate?

A high temperature in a newborn can indicate dehydration.

What is the normal range for respiration rate in newborns?

The normal range for respiration rate in newborns is 30-60 breaths per minute.

When should a newborn not be fed due to their respiration rate?

A newborn should not be fed if their respiration rate is 80 or greater due to the risk.

What is the normal range for heart rate in newborns?

The normal range for heart rate in newborns is 120-160 bpm.

What is the range for heart rate in a newborn while crying?

The heart rate in a newborn can go up to 180 bpm while crying.

What is the range for heart rate in a sleeping newborn?

The heart rate in a sleeping newborn can go down to 100-110 bpm

What should you listen for when assessing newborn vital signs and measurements related to the heart?

Abnormal sounds such as a slush or slur sound, which could indicate a congenital heart defect.

What pulses should you check when assessing newborn vital signs and measurements?

You should check for the brachial pulse, femoral pulse, and pedal pulse.

What is the normal weight range for a newborn?

The normal weight range for a newborn is 2500-4000 grams (5 pounds 8 ounces to 8 pounds 13 ounces).

Is weight loss in the first few days after birth normal for newborns?

Yes, weight loss of 5-10% in the first few days is normal.

What is the normal range for the length of a newborn?

The normal range for the length of a newborn is 48-52 centimeters (18-22 inches).

Should the head circumference be larger than the chest in the first few months?

Yes, the head circumference should be larger than the chest in the first few months due to cephalocaudal growth.

When measuring head circumference in a newborn, is it important to use the same method consistently?

Yes, always measure consistently using the same method.

What is the shape of the anterior fontanelle in a newborn?

The anterior fontanelle is diamond-shaped.

What is the shape of the posterior fontanelle in a newborn?

The posterior fontanelle is triangular-shaped.

What is cephalohematoma?

Cephalohematoma is a collection of blood from ruptured capillaries that does not cross suture lines and increases the risk for hyperbilirubinemia.

What is caput succedaneum?

Caput succedaneum is edema of tissues that does cross suture lines

What is jaundice and how does it present on a newborn's skin?

Jaundice is a yellowing of the skin and eyes caused by excess bilirubin. It can present first on the face and then spread down the body.

What is acrocyanosis and when does it occur in newborns?

Acrocyanosis is normal and presents as blue hands and feet 2-6 hours after birth.

What are milia and where do they occur on a newborn's skin?

Milia are small white spots that occur on the face of a newborn.

What is vernix caseosa?

Vernix caseosa is a cheese-like substance that covers a newborn's skin at birth.

What should be evaluated if forceps or vacuum marks are present on a newborn's skin?

Forceps or vacuum marks should be evaluated for drooping or lacerations.

What are stork bites and where do they typically occur on a newborn's skin?

Stork bites are pale pink or red spots that occur on the eyelids or neck of a newborn and fade by 2 years.

What are Mongolian spots and where do they typically occur on a newborn's skin?

Mongolian spots are blueish-blackish pigmentation that occur on the dorsal area or butt of a newborn and should be documented.

What is a nevus flammeus or port-wine stain and where do they typically occur on a newborn's skin?

A nevus flammeus or port-wine stain is a capillary malformation that presents as a pink or red patch on a newborn's skin, frequently on the face.

What is an infantile hemangioma?

An infantile hemangioma is a type of birthmark that happens when a tangled group of blood vessels grows in or under a baby's skin.

What should be assessed when checking a newborn's eyes?

When checking a newborn's eyes, you should assess for open eyes with no discharge or hemorrhages and check for the red reflex to ensure there are no cataracts.

What should be checked when assessing a newborn's nose and mouth?

When assessing a newborn's nose and mouth, you should check for patent nasal passages, assess the mouth for symmetry and hard palate intact, and check for rooting and sucking reflexes.

What are Epstein's pearls and thrush?

Epstein's pearls are white specks on gums, and thrush is white patches on mucus membrane

What should you check for regarding the frenulum in newborns?

You should check for tongue-tie and refer for evaluation if needed. It's important to monitor feeding and only clip if symptomatic.

What should you check for in a newborn's ears?

You should check for normal appearance, and keep in mind that ear abnormalities can indicate problems in other body systems. You should also assess maturity level by checking for ear recoil.

What should you look for in a newborn's neck and clavicles?

You should look for masses and webbing in the neck, check range of motion and intact clavicles, and note if the tonic neck reflex indicates a healthy nervous system.

What should you assess for in a newborn's chest and breathing?

You should assess for symmetry, engorgement, and nipple retraction. Check cry strength and pitch, observe for abdominal movements, and listen for bowel sounds. Look for signs of respiratory distress such as nasal flaring or retractions.

What should you check for in a newborn's umbilical cord and inguinal areas?

You should check for a white umbilical cord with two arteries and one vein. Ensure equal femoral pulses, and watch out for bulges in inguinal area

What should be checked for in male genitalia?

The scrotum should have testes descended into it and the penis should have a urinary meatus at the tip of the glands on the ventral surface of the penile shaft.