Term
| Your patient delivered 24 hours ago. She shows little interest in the baby but talks at length about the birth. Should you be concerned? |
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Definition
| No. Women commonly focus on the 'birth story' before they bond to their baby. You should begin to worry if she is not interacting with the infant on day 2. |
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Term
PP assessment of Reproductive changes
PRIMARY
CLIPP |
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Definition
Cervix: open for 2 weeks, risk of infection
Lochia: rubra, serosa, alba, diminishing quantity
Involution: fundal height and tone
Perineum: edema, hematoma, lacerations
Placental site: evaluate by lochia |
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Term
| How many cm of involution occur each day postpartum? |
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Definition
| Uterus should shrink 1 cm/day |
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Term
1. At 20 weeks, where should the fundus be?
2. Why would it be less than 18 cm?
3. Why would it be greater than 20cm?
4. When will diabetes effect fetus? |
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Definition
1. Even with the umbilicus + or - 2
2. IUGR, smoking, HTN, poor nutrition, drug use, stress, anemia
3. Polyhydramnios, multifetal pregnancy
4. Third trimester |
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Term
| The patient is 4 weeks postpartum and complains of a milky discharge. What will you tell her? |
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Definition
| The patient is experiencing Lochia Alba, a normal part of postpartum recovery. She should call her MD if she has odor, bleeding, an increase in discharge, or if she continues to experience PP symptoms after 6 weeks. |
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Term
How does the placental site heal differently than an integumentary wound?
Why does it heal differently? |
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Definition
Temporary clots are formed on the site. As the uterus contracts, the clots are sloughed off.
If the clot sealed the wound, scar tissue might form on the uterus. |
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Term
When should you expect the following?
1. Rubra
2. Serosa
3. Alba |
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Definition
1. 3-4 days PP
2. 10 days post rubra
4. Alba 2-4 weeks post serosa |
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Term
What percentage of circulating volume is lost during labor?
What does this equate to in ml? |
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Definition
40-45%
500 for vaginal, 1000 for c-section |
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Term
PP assessment of Cardiovascular changes
SECONDARY
Very Bad Dogs Have Less Cookies |
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Definition
V: Varicocities
B: Blood Loss
D: Diuresis: Increases Cardiac Output, other VS remain stable
H: H&H - May not change due to lost volume
L: Leukocytosis
C: Coagulation: increased coagulation factors |
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Term
Which is the best indicator of hypovolemia in the pp patient?
1. Low BP
2. Tachycardia
3. MAP |
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Definition
1. No- BP may remain stable until late stages of hypotension
2. No- Tachycardia may be present, but it is not the best indicator
3. Yes- MAP represents blood volume better than any other indicator. Lower map = hypotension |
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Term
Risk factor:
1. Increased Coagulation
2. Leukocytosis
3. Varicosities |
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Definition
1. PP patients are at risk for DVT; pt should get up and walk
2. Increased WBC count masks infection; assess fever, tachycardia, respiratory rate
3. Risk for DVT, hemorrhoids; pt may c/o one sided swelling and pain |
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Term
PP assessment of Respiratory changes
1. When should respiratory rate return to WNL?
2. Dyspnea
3. Residual volume, TV
4. ABG levels |
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Definition
1. Soon after birth, due to reduction of pressure and increased space
2. Should be relieved. If not, suspect Asthma or respiratory infection
3. Values should increase
4. Normalize in 3-4 weeks |
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Term
| Patient is 4 weeks PP. She complains of a white discharge, hemorrhoid pain, terrible headache, and nipple tenderness. What is your priority intervention and why? |
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Definition
| Assess HR, BP, peripheral edema and MAP. Check for h/o nausea, decreased urination, dizziness or sudden weight gain. Patient is at risk for pre-eclampsia. |
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Term
| Pt gave birth 32 hours ago. She is on a foley catheter. Her urine is amber colored. What do you suspect? |
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Definition
| Pt is not properly diuresing and may have edema somewhere. Check lungs for pulmonary edema (moist cough.) |
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Term
| Pitocin can cause what unwanted occurrence? |
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Definition
| Pulmonary edema/water intoxication |
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Term
| What are 5 primary GI interventions for a pp mother? |
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Definition
1. Stool softeners or laxatives
2. Fiber and Fluids
3. Ambulation
4. NSAIDs
5. Pain relief/compassion for episiotomy or hemorrhoid patients |
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Term
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Definition
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