Postpartum Nursing Practice Exam Flashcards

150 VOCABULARY flashcards focused on Postpartum Nursing assessment, physiological adaptations, hemorrhage management, and psychological complications based on the lecture transcript.

BUBBLE-HE

The systematic acronym for postpartum nursing assessment: Breasts, Uterus, Bowels, Bladder, Lochia, Episiotomy, Hemorrhoids, and Emotional Status.

Breasts (Assessment)

Assessment focusing on size, shape, engorgement (soft or filling), and nipple status (no cracking or bleeding) while noting colostrum presence.

Uterus (Assessment)

Involves checking the fundus for firmness (firm or boggy) and position (midline, at or below the umbilicus).

Bowels (Assessment)

Focused on whether the abdomen is soft and nondistended, checking for normal bowel sounds and the passage of flatus.

Bladder (Assessment)

Observing for tenderness or distention; essential to ensure frequent emptying to prevent uterine displacement.

Lochia (Assessment)

Assessment of uterine discharge based on amount, odor, color, and the presence of clots.

Episiotomy (Assessment)

Inspection of location, stitches, edema, and redness; ensuring the laceration or incision is intact and well approximated.

Hemorrhoids (Assessment)

Observing the rectum to determine if hemorrhoids are present, flesh-colored, small, and non-tender.

Emotional Status (Assessment)

Observing for adequate maternal/newborn bonding, attachment behaviors, and verbalization of proper newborn care.

Normal Postpartum Temperature

May increase up to $100.4^{\circ}F$ ($38^{\circ}C$) for the first $24\,hr$ due to exertion and dehydration.

Postpartum Fever

Defined as a temperature equal to or greater than $100.5^{\circ}F$ ($38.1^{\circ}C$).

Postpartum Heart Rate (Normal)

Slightly bradycardic ($50-70$ bpm) in the first $6-10$ days due to decreased cardiac effort and increased stroke volume.

Postpartum Tachycardia

A heart rate greater than $100$ bpm; requires assessment for hypovolemia, infection, anxiety, or pain.

Transient rise in Blood Pressure

A temporary increase in BP that usually returns to pre-pregnant baseline within a few days postpartum.

Low Blood Pressure (Postpartum Warning)

Can be a sign of decreased intrapelvic pressure or postpartum hemorrhage related to hypovolemia.

High Blood Pressure (Postpartum Warning)

May indicate excessive use of oxytocin, vasopressors, or the development of postpartum pre-eclampsia.

Respiratory Rate (Significance)

Increase may suggest anxiety or respiratory compromise; decrease may suggest the use of opioid pain medications.

HCG Level (Postpartum)

Decreases to zero by the end of the first week postpartum following the expulsion of the placenta.

Prolactin

Hormone produced by the pituitary gland for milk production; levels peak with suckling or pumping.

Oxytocin (Lactation)

Produced in response to breastfeeding; signals the milk ejection reflex to release milk from mammary lobe alveoli.

Postpartum Diuresis

The renal system eliminates excess fluid; the client can urinate up to $3,000\,mL$ a day for the first few days.

White Blood Cells (Postpartum)

Levels can be elevated due to the stress of labor, but should trend down during the postpartum period.

Mild Proteinuria

Expected finding in the renal system on day $1$ or $2$ postpartum; may last up to $6$ weeks.

OASIS

Acronym for Obstetric Anal Sphincter Injury, which may cause anal incontinence following vaginal birth.

Cervical External Os (Post-birth)

After vaginal birth, this opening permanently becomes a larger transverse slit rather than a round opening.

Lactational Amenorrhea

The suppression of ovulation and menstruation that can occur during breastfeeding.

Vaginal Wall Rugae

These folds return to the vaginal canal within $3$ weeks postpartum.

Colostrum

The initial milk produced during the first few days postpartum before transitional milk arrives.

Hyperlactation

Production of too much milk due to excess mammary glandular tissue, hormonal signaling, or overstimulation.

Hypolactation

Production of too little milk; associated with maternal health conditions like diabetes, PCOS, or smoking.

Local Control of Milk

The shift within a few months postpartum where milk synthesis moves from hormonal control to control at the breast.

Uterine Weight (Post-Birth)

Approximately $1,000\,g$ ($2.2\,lb$) immediately after birth.

Uterine Weight ($6$ weeks)

Decreases to approximately $100\,g$ ($0.22\,lb$) or less by the end of the postpartum period.

Involution

The process by which the uterus rapidly decreases in size to return to its pre-pregnancy state.

Placental Site Healing

The process where the area of placental attachment heals specifically by exfoliation.

Fundus at $12$ Hours

The uterine fundus is typically at the level of the umbilicus at this time.

Fundal Descent per Day

The fundus descends at a rate of approximately $1\,cm$ per day.

Fundus at Day $10$

The uterus has typically descended into the pelvis and is no longer palpable.

Fundal Palpation (Support)

One hand must support the lower uterine segment above the symphysis pubis to prevent uterine inversion.

Boggy Uterus (Risk)

A soft, non-contracted fundus that carries a high risk for increased bleeding and hemorrhage.

Lochia Rubra

Bright red uterine discharge appearing for the first $2-3$ days postpartum; has a fleshy odor.

Lochia Serosa

Pinkish-brown uterine discharge typically appearing from days $3$ to $10$ postpartum.

Lochia Alba

White or creamy uterine discharge that continues from day $10$ until the cervix is closed.

Scant Lochia

Defined as a blood stain on a peripad measuring less than $2.5\,cm$ ($1\,inch$).

Light Lochia

Defined as a blood stain on a peripad measuring between $2.5\,cm$ and $10\,cm$ ($1-4\,inches$).

Moderate Lochia

Defined as a blood stain on a peripad measuring between $10\,cm$ and $15\,cm$ ($4-6\,inches$).

Heavy Lochia

Defined as a peripad that is saturated within $1\,hour$.

Normal Vaginal Blood Loss

Expected range is between $200\,mL$ and $500\,mL$ for a vaginal delivery.

Normal Cesarean Blood Loss

Expected range is between $700\,mL$ and $1,000\,mL$ for a C-section delivery.

Hematocrit Change (PPH Rule)

A drop in hematocrit of $10\%$ or more from pre-delivery values indicates postpartum hemorrhage.

Weight to Volume Ratio (Blood)

In quantification of blood loss, $1\,g$ of pad weight is equal to $1\,mL$ of blood.

Obstetric Hemorrhage (ACOG)

Defined as blood loss over $1,000\,mL$ or loss with signs of hypovolemia within $24\,hr$ of birth.

Joint Hypermobility Resolution

Joints should return to pre-pregnancy stability levels by $8$ weeks postpartum.

Chloasma (Melasma)

The 'mask of pregnancy' hyperpigmentation that lightens during the first few months postpartum.

Linea Nigra

The dark line on the abdomen that fades as hormones return to pre-pregnancy levels, though it may never fully vanish.

Striae Gravidarum

Stretch marks that become less prominent over time but may never completely disappear.

Postpartum Hair Loss

Temporary thinning of hair where growth typically returns to pre-pregnancy thickness by $6-15$ months.

Perineal Ice Packs

Recommended treatment for the first $12-24\,hr$ to reduce pain and swelling.

Peri-bottle

Used to spray warm water over the perineum during toileting; the patient should pat dry and not wipe.

Front to Back Cleaning

The essential direction for perineal hygiene to prevent the introduction of bacteria into the birth canal.

Diastasis Recti Abdominis

A separation of the rectus abdominis muscles, appearing as a tent-like protrusion on the abdominal wall.

Abdominal Wall Recovery

Wall appears loose/flabby after birth but typically responds to exercise within $2-3$ months.

Rubella Vaccine

A live vaccine administered postpartum if the mother is non-immune; avoiding pregnancy for a month is required.

Rho(D) Immune Globulin

Administered within $72\,hr$ of delivery to Rh-negative mothers who give birth to Rh-positive infants.

TDAP Vaccine

Administered to protect the infant from Pertussis, as infants do not receive their first dose until $2\,months$ of age.

Early Postpartum Hemorrhage

Primary hemorrhage occurring within the first $24\,hr$ after delivery; the most common type.

Late Postpartum Hemorrhage

Secondary hemorrhage occurring from $24\,hr$ up to $6$ weeks after delivery, often due to sub-involution.

The 4 T's of PPH

The major causes of postpartum hemorrhage: Tone (Atony), Trauma, Tissue (Retained), and Thrombin (Coagulopathy).

Uterine Atony

A failure of the uterus to contract; it is the leading cause of postpartum hemorrhage.

Oxytocin (Treatment)

First-line medication used to stimulate uterine contractions and manage atony during PPH.

Methergine

A medication used for PPH to sustain uterine contractions; contraindicated in patients with high blood pressure.

Hemabate

A prostaglandin used for PPH; common side effect is significant diarrhea; contraindicated in patients with asthma.

Cytotec (Misoprostol)

A medication often administered rectally or orally to treat uterine atony and hemorrhage.

Uterus Inversion

A rare surgical emergency where the uterus turns inside out; treated with tocolytics and manual replacement.

Bakri Balloon

A medical device inserted into the uterus and inflated with fluid to apply pressure and stop hemorrhage.

B-Lynch Suture

A surgical technique used to compress the uterus to stop life-threatening hemorrhage.

Subinvolution

The failure of the uterus to return to its normal non-pregnant size at the expected rate.

Retained Placenta

When the placenta is not expelled within $30\,minutes$ of birth; a major cause of secondary PPH.

Placenta Accreta

A condition where the placenta attaches too deeply into the uterine wall.

Placenta Percreta

The most severe form of adherent placenta where tissue grows through the uterine wall, often requiring hysterectomy.

Pelvic Rest

Postpartum instruction to avoid tampons, douching, or intercourse for $6$ weeks to allow healing.

Perineal Hematoma

A collection of blood in the perineal tissue; an emergency if greater than $10\,cm$.

Shock Index ($SI$)

The ratio of heart rate divided by systolic blood pressure; a value greater than $1.1$ indicates increased risk of shock.

Deep Vein Thrombosis (DVT)

Higher risk postpartum (especially after C-section); symptoms include unilateral leg pitting edema and calf tenderness.

DVT Prophylaxis

Includes early ambulation, use of SCDs after epidurals, and low molecular weight heparin for high-risk clients.

Staphylococcus aureus

The most common pathogen associated with wound infections (C-section) and mastitis.

Endometritis

Infection of the decidua (pregnancy endometrium); characterized by pelvic pain, tachycardia, and purulent discharge.

Endometritis Treatment

Broad-spectrum IV antibiotics administered until the woman is afebrile for $48\,hr$.

Lactational Mastitis

Infection usually caused by traumatized tissue (sore/cracked nipples) or blocked milk ducts.

Mastitis (Breastfeeding Guidance)

The mother can and should continue breastfeeding from the affected breast as the milk is not contaminated.

Postpartum Sepsis

An impaired maternal immune response to infection; causes $14.3\%$ of pregnancy-related deaths in the U.S.

Gestational Thrombocytopenia

A mild condition of low platelets that typically resolves after delivery without significant bleeding risk.

Von Willebrand Disease (VWD)

The most common inherited bleeding disorder; can lead to iron deficiency anemia during pregnancy.

Postpartum Diaphoresis

Increased perspiration, often at night, used by the body to eliminate fluid and waste products.

After Pains

Uterine contractions occurring after birth while the uterus shrinks; more common in multiparous and breastfeeding patients.

Breastfeeding Nutrition

Requires an increase of $500\,kcal$ per day total ($200\,kcal$ above the pregnancy intake).

Non-Breastfeeding Nutrition

Intake should decrease by $300\,kcal$ to return to pre-pregnancy caloric levels.

Nipple Soreness Prevention

Position the infant so the mouth covers a large portion of the areola; use breast milk on the nipple after feeding.

Breast Engorgement

Tight, tender, warm breasts caused by lymphatic circulation, milk production, and temporary vein congestion.

Engorgement Treatment

Frequent nursing, warm showers to stimulate letdown, and cool compresses between feedings.