Postpartum OB Exam 3

What is uterine atony?

The inability of the uterus to contract adequately after birth, leading to postpartum hemorrhage.

List four risk factors for uterine atony related to uterine over-distention.

Multiparity, multiple gestations, polyhydramnios, and prolonged or precipitous labor.

How do operative deliveries affect the risk of uterine atony?

Forceps, vacuum-assisted, and Cesarean births increase the risk of uterine atony.

What are the primary assessment findings of a boggy uterus?

A boggy fundus, possible lateral displacement, and increased vaginal bleeding.

What vital sign changes indicate significant postpartum hemorrhage?

Tachycardia and hypotension.

What is the primary diagnostic tool for identifying retained placental pieces?

Bimanual compression or manual exploration of the uterine cavity.

Why must a nurse ensure the bladder is empty in a patient with uterine atony?

A full bladder can displace the uterus and prevent it from contracting effectively.

What is the critical safety rule when expressing clots from the uterus?

Only express clots after the uterus is firmly contracted to prevent uterine inversion.

What is the primary action of Oxytocin in postpartum care?

It acts as a uterine stimulant to contract the uterus.

What are the symptoms of water intoxication caused by Oxytocin?

Lightheadedness, nausea, vomiting, headache, and malaise.

What severe complications can arise from Oxytocin-induced water intoxication?

Cerebral edema, seizures, coma, and death.

How does Tranexamic acid (TXA) reduce postpartum bleeding?

By inhibiting the breakdown of blood clots.

What is a major contraindication for the administration of Methylergonovine (Methergine)?

Hypertension (HTN).

What are the common side effects of Methylergonovine (Methergine)?

Hypertension, nausea, vomiting, and headache.

Which medication used for postpartum hemorrhage is known to cause fever, chills, and diarrhea as side effects?

Carboprost tromethamine (Hemabate).

What is the role of Misoprostol (Cytotec) in postpartum hemorrhage?

It acts as a uterine stimulant to control bleeding.

What skin assessment findings are associated with postpartum hemorrhage?

Pallor of skin and mucous membranes, and cool, clammy skin.

What is the surgical management option for severe, unmanageable uterine atony?

Hysterectomy.

What is the nurse's priority action when detecting a boggy uterus?

Perform fundal massage.

Besides uterine stimulants, what is a necessary supportive nursing intervention for postpartum hemorrhage?

Maintain IV fluids and monitor vital signs.

What is subinvolution of the uterus?

A condition where the uterus remains enlarged with continuous lochia discharge, potentially causing postpartum hemorrhage.

What are the primary risk factors for uterine subinvolution?

Pelvic infection, endometritis, and retained placental fragments.

What physical assessment findings are characteristic of subinvolution?

Prolonged or excessive vaginal bleeding, a boggy uterus, and a fundus located high above the umbilicus.

Which laboratory tests are indicated for suspected subinvolution?

CBC and intracervical/intrauterine bacterial cultures to screen for infection.

What diagnostic procedure is used to treat retained placental fragments?

Dilation and curettage (D&C).

What should a nurse monitor in a patient with subinvolution?

Fundal position and consistency, lochia, and vital signs.

What patient behaviors should a nurse encourage to promote uterine involution?

Breastfeeding, early and frequent ambulation, and frequent voiding.

What hormone release is stimulated by breastfeeding?

Oxytocin

What is the psychological benefit of breastfeeding for the mother and infant?

It is important for maternal-fetal bonding.

Which pain medications are considered safe to administer while breastfeeding?

Hydrocodone/acetaminophen, ibuprofen, and PCA medications like morphine sulfate or fentanyl.

Are antidepressants safe to use during breastfeeding?

Yes, when clinically warranted.

What is the recommended intervention for breast engorgement?

Encourage a warm shower immediately after breastfeeding.

What is the correct technique for using a perineal pad after voiding or a bowel movement?

Remove the front part first, peeling it towards the back.

What is the recommended method for cleansing the perineal area after voiding?

Use a squeeze bottle filled with warm water and wipe from front to back.

What are the recommended comfort measures for the perineum in the first 24 hours versus after 24 hours?

Ice for the first 24 hours; sitz baths after 24 hours.

How long does it typically take for perineal stitches to dissolve?

1 to 2 weeks.

What symptoms should a patient monitor for to identify a potential perineal infection?

Fever, abdominal discharge, and foul-smelling discharge.

What is the purpose of monitoring for dehiscence in the context of perineal care?

To detect the separation or opening of the surgical repair site.

Is itching a normal symptom during the perineal healing process?

Yes, itching is normal as the skin heals.

What is lochia?

Vaginal discharge after childbirth consisting of blood, mucus, and uterine tissue.

How does a C-section affect the amount of lochia?

It typically results in less lochia because the provider cleans the uterus during surgery.

What are the characteristics of Lochia Rubra?

Bright red, fleshy odor, small clots, lasts 1-3 days; increases with breastfeeding or standing.

What are the characteristics of Lochia Serosa?

Pinkish-brown, contains small clots and leukocytes, lasts from day 4 to day 10.

What are the characteristics of Lochia Alba?

Yellowish-white creamy color, contains mucus and leukocytes, lasts from day 10 to 8 weeks postpartum.

What is the definition of 'heavy' lochia?

One pad saturated in 2 hours.

What constitutes excessive blood loss (hemorrhage) in the postpartum period?

One pad saturated in 15 minutes or less, or pooling of blood under the buttocks.

What is the recommended frequency for assessing lochia in the first hour after delivery?

Every 15 minutes.

What four factors should be assessed when evaluating lochia?

Odor, color, amount, and consistency (clots).

What does a foul odor in lochia indicate?

Infection.

What are the signs of a cervical or vaginal tear?

Bright red blood that is spurting from the vagina.

What is the primary patient teaching regarding tampon use postpartum?

Do not use tampons due to an increased risk of infection.

What hygiene practices should be taught to postpartum patients regarding pad changes?

Change pads frequently and wash hands after each change.

How is lochia amount measured if visual estimation is insufficient?

Soiled pads can be weighed.

What is the typical duration of the entire lochia discharge period?

Four to eight weeks after childbirth.

What is the typical prevalence of postpartum blues among patients?

50% to 60% of patients

What is the typical onset period for postpartum blues?

1 to 10 days postpartum

What are the primary contributing factors to postpartum blues?

Fatigue, hormonal changes, role changes, family tension, and financial concerns

What are common signs and symptoms of postpartum blues?

Feelings of sadness, inadequacy, anxiety, or anger; crying easily; lack of appetite; sleep disturbances; restlessness; and headaches

What nursing interventions are recommended for patients experiencing postpartum blues?

Patient teaching regarding the need for sleep, exercise, and adequate nutrition, as well as encouraging the patient to seek support for newborn care and utilize community resources

What are the primary contributing factors to postpartum depression?

History of depression, poverty, unwanted pregnancy, lack of a support system, and newborn health problems.

What percentage of patients experience postpartum depression?

10 to 15%.

What is the typical onset and duration of postpartum depression?

It can occur up to 1 year after delivery and may persist for years.

What are the common signs and symptoms of postpartum depression?

Persistent depression, feelings of being overwhelmed, anxiety, hopelessness, inability to care for self or infant, and thoughts of suicide.

What are the key nursing interventions for a patient with postpartum depression?

Using depression screening tools, teaching the patient to recognize symptoms, encouraging them to seek assistance, and ensuring rapid intervention.

What are the primary signs and symptoms of postpartum psychosis?

Pronounced sadness, disorientation, confusion, and paranoia.

What specific assessment findings indicate a risk of harm in postpartum psychosis?

Behaviors indicating hallucinations or delusional thoughts of self-harm or harming the infant.

What is the nurse's role regarding the mother-newborn relationship in postpartum depression?

Monitor interactions and encourage bonding activities.

What should a nurse reinforce to a mother experiencing postpartum depression regarding her feelings?

That feeling down is normal and self-limiting, but she should notify her provider if the condition persists.

What critical safety question must a nurse ask a mother with postpartum depression?

Ask if she has thoughts of self-harm, suicide, or harming the infant.

What is the nurse's responsibility regarding medication adherence in postpartum depression?

Reinforce the importance of taking prescribed medications exactly as prescribed.

What lifestyle advice should a nurse provide to a mother with postpartum depression?

Get plenty of rest, nap when the baby naps, and take time out for herself.

What support systems should a nurse facilitate for a mother with postpartum depression?

Contacting community resources and seeking counseling.

Which vaccines are recommended for pregnant individuals?

Flu, pneumonia, and Tdap.

Why is the Tdap vaccine recommended for adults?

To prevent pertussis.

What is the recommendation regarding Tdap vaccination for those around the baby?

Friends and family who will be around the baby should also get vaccinated.

When is the Varicella vaccine administered to a mother?

If the mother does not have immunity.

What is the required waiting period to avoid pregnancy after receiving the Varicella vaccine?

One month.

When is the second dose of the Varicella vaccine administered?

At 4-8 weeks postpartum.