OB 5

41 question 2 sets of matching

  1. If the women is Rh-negative and newborn is RH-Positive: women needs Rho(D) (immune globbin) ; must receive in 72 hours of delivery to be most effective

  2. Twins , large baby( macrosomia) , excess amniotic fluid can cause over extension

  3. Indwelling chest pain with hypovolemic shock

prevent infection:

  • wash your hands throughly

  • wipe back to front

  • rinse with perineum with peri bottle

  • remove soil sanity front ti back ‘

  • advise women to not touch pad in the middle only outer of pad when inserting

  • wash hands

  • front to back (directions )

Treatment for uterine atony

  • fundal palpation and massage

  • medication: oxytocin, ergonovine, methylergonovine, carboprost, misoprostol


Inspect perineum : closely for evidence and amount of bleeding.

  • monitor perineal pad count to help determine the amount of blood lost

  • 1 gram of blood = 1 mL anything over 1000 ml indicate hemorrhage including s/s : fever 100.4 greater, chills, or foul smelling lochia, lochia increased in amount or reversal of the pattern of lochia (serosa back to rubera)

  • do not throw away before counting pads


Matching what are the characterized for

  • Hemorrhage caused by uterine atony: fundus might be hard to palpate ; during palpation is soft(boggy) , replaced amd located above the level of umbilicus , if the women has distended bladder this interferes with uterine contraction. vagial bleeding lochia is moderate to heavy and numerous large clots (heavy bleeding, large clots)

  • Lacerations: fundus is firm on palpation , bleeding continues in steady trickle characteristics; bleeding is bright red no clots present

  • Hematoma: may not be apparent , blood vessel ruptures and leaks to surrounding tissue causes pressure, pain, swelling, and dark red pr purple discoloration. commonly on one side of perineum. may feel soft but as leakage continues becomes firm to touch , area is tender (pain and pressure in rectum)


Diastasis Recti: condition in which the abdominal muscles separate during pregnancy leaving part of the abdominal wall without muscular support

  • abdominal muscles are separated you are able to feel the gap between the muscles


Involution: is the process through which the uterus, cervix, and vagina return to the non pregnant size and function.

Each postpartum day should drop one cm (one finger) ex; Day 3 should be 3 fingerbreadth below umbilicus

  • if abnormal massage and check lochia & ask pt if they experienced any bleeding increase


Perineum : assist patient in sims position to asses the perineum check; redness , edema and ecchymosis. should be intact with minimal swelling.

  • Perineal pain/lacerations/hematomas: within first 24 hours include ice packs to the perineum helps swelling and ease painful sensation on for 10-20 minutes off for 10-20 minutes


DVT preventions: ambulations (peripheral circulation) , apply compression stockings, elevate affected extremities to promote venous return. , inspect for color, temperature and size and palpate pedal pulses . Measure circumference of each lower extremities compare bilaterally. use stocking for 8-12 hours.

  • pt 2 day c-section what interventions with swelling and tenderness: compare pulse, check color, do full assessment and notify RN or provider

  • Not right answers: hangar test , exercise, Not check temp

  • to prevent peripheral circulation

  • NOTE: women with DVT; edema, warmth, redness and calf pain or tenderness in affected leg in extreme cases where the edmea compromises circulation and the arterial blood flow , leg may appear visibly pale or white with diminished pedal pulse


Ice packs will decrease swelling and pain responses in perineal discomfort in 24 hours.


Differences of postpartum disorders

  • postpartum depression: strong feeling of sadness, irritability and anxiety, frequently tearful, lack of interests of surrounding, inability to sleep, lack of interest , loss of libido and inability to concentrate

  • Postpartum blues: temporary condition that usually begins about the third day after delivery last for 2-3 days resolved by 2 week postpartum. Reports of: sadness, tearfulness for reason, irritability , anxiety , difficulty sleeping eating, decreased concentration.

  • Postpartum psychosis: severe dustition in her view of reality , accompanied by hallucination and delusion


Breastfeeding releases oxytocin stimulates uterus to contract for afterpain ; breastfeeding most will experience stronger afterpain

(breastfeeding causes oxytocin increase the duration and intensity of afterpains for both the primipara and multipara)


patient coming for 2 week postpartum appt. Abnormal;

  • fundus should not be upped the umbilicus


LOCHIA: know all 3 times

  • for 2 days postpartum : rubia


If mom has trauma to urethra what will we see; swelling (edema): urethral edema


Postpartum discharge signs for patients when to call

  • do not call for starting period, exercise with periods of bleeding but stops


Kegel exercise : for stress incontinence



The urinary system. must handle an increase load in early postpartum period as the body excretes excess plasma volume.

  • Trauma certain medication and anesthesia given during labor can lead to loss of bladder sensation. Prolonged pushing can cause the perineum to become edematous can cause pressure around the urethra preventing the women being able to adequately vvoid leads to urinary retention (Diuresis)

  • Diuresis if patient is early postpartum because the body excretes excess plasma volume


What is abnormal blood loss for vaginal and c-section?

  • blood loss of greater than 1000ml


What is the acronym of REEDA for wound or incision assessment?

  • Redness

  • Erythema

  • Edema

  • Drainage

  • Approximation



Endometritis : infection of the uterine lining


Postpartum blues: resolved by 2 weeks


How can you estimate blood loss on postpartum patient? length of time of pads changes

whats the time to give Rho(D)? 72 hours


Lochia characteristics normal and abnormal when to report

  • foul smell report



Matching complication and signs and symptoms

  • subinvolution of the uterus 406: volution is delayed and slow s/s; expect to see prolonged bleeding

  • Mood disorders:

  • postpartum infection 410: dark lochia ; foul smell, fevver,

  • hypovolemic shock : rapid pulse tachycardia, hypotension , cool clammy

  • hemorange for c section: over 1000 ml blood loss

  • pulmonary embolism : appedant doom , onset dyspnea, hypotension , fast HR


Fundal palpation and massage :

  • place non dominant hand just above the symphysis pubis to gently support the base of uterus


Breast

  • engorgement : breast is full causing discomfort


If mom is not breastfeeding : support with tight fitting bras, ice packs '


Lochia the uterus shed its lining that helped nourish the pregnancy , blood, mucus , tissues and white blood cells composed the uterine discharge (should never contain large clots)

color:

  • rubia: occurs in first 3-4 days small moderate amount; composed if mostly blood dark red ; fleshy odor

  • Serosa : occurs 4-10 days ; decreases to small amount ; brownish or pinkish color

  • Alba: after 10 days; white or pale yellow discharge bleeding has stopped discharged composed mostly of white blood cells .

  • should not have a foul smell , without large clots.


If patient risk for hemorrhage risk factors

fundus might be hard to palpate ; during palpation is soft(boggy) , replaced amd located above the level of umbilicus , if the women has distended bladder this interferes with uterine contraction. vagial bleeding lochia is moderate to heavy and numerous large clots

  • uterine atony : distended bladder , laceration , hematoma, retained placenta fragments



Postpartum danger signs

  • fever of 100.4

  • localized redness, painful area to one breast

  • frequency urgency and painful urination '

  • sob, /chest pain

  • severe unremitting abdominal or back pain is relieved by normal pain measures

  • foul smelling lochia ‘(A)

  • increased or heavy lochia with heavy clots(A)

  • return to rubia after its been serosa or alba (A)

  • severe redness or swelling in episiotomy or c section

  • swollen reddened are on calf

  • prolonged or severe symptoms of depression

  • thoughts of harming infant or self



Hypovolemic shock: weak, thready, rapid pulse; drop in bp ; cool clammy skin, a decrease urine output less 30ml/hr changes in level of consciousness

Postpartum infection: fever of 100.4 , uterine tenderness, tachycardia that increases and midline lower abdominal pain, s/s of endometriosis lochia is dark increase amount, purulent and foul smelling


Pulmonary embolism signs/ symptoms: women may be tachypneic, tachycardic, and hypotensive and cause cough with blood sputum ( hemoptysis)

Fundal Measurement: 2 week postpartum check if its above umbilical its an abnormal finding

Discharge teaching when to call

  • NOT ( discomfort in peri area, period before 6 weeks, if up and active bleeding occurs but stops)