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Flashcards in OB - Exam Three Deck (49)
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First sign of hypovolemic shock

Increase heart and respiratory rate


What do you do for a boggy fundus that is deviated?

Massage uterus until firm

Have woman urinate or catheterize


What would the physician order if we could not get boggy fundus firm?



Discharge teaching for postpartum moms that delivered vaginally

a. Follow up appointments at week 2 and 6
b. Daily shower
c. Perineal care until lochia stops
d. No sex until episiotomy healed and lochia stops
e. Use protection
f. High fiber foods
g. Well-balanced diet
h. Moderate exercise
i. Continue prenatal for 6 weeks
j. Report the following
1. Fever higher than 100.4
2. Persistent lochia rubra or lochia with foul odor
3. Bright red bleeding, especially if lochia has changed from serosa or alba
4. Prolonged after pains, pelvic, abdominal pain, or constant backache
5. Signs of UTI
6. Pains, tenderness, redness in calf
7. Localized breast tenderness, or redness
8. Prolonged and pervasive feelings or depression and being let down, not enjoying life


Signs of late postpartum hemorrhage

a. Happens 24 hours to 6 weeks after childbirth
b. Causes= retention of placenta fragments and subinvolution of uterus
c. Persistent red bleeding
d. Return of red bleeding after it has changed to pinkish or white


Teaching for moms with mastitis

Heat promotes blood flow to the area

a. Wash hands thoroughly before breastfeeding
b. Maintain breast cleanliness with frequent breast pad changes
c. Expose nipples to air when possible
d. Ensure correct newborn latch and removal from breast
e. Enourage newborn to empty breast
f. Frequently breastfeed
g. Breastfeed from uninfected side first at each feeding to initiate let down in affected breast
h. Massage distended area as newborn nurses
i. Report redness and fever to healthcare provider
j. Apply ice packs or most heat to relieve discomfort


Postpartum complications if mom delivers a large baby vaginally

a. More at risk for uterine atony
b. More at risk for postpartum hemorrhage
c. May have a large episiotomy or laceration


What do we suspect if the uterus is firm but mom is still bleeding?

a. Blood clots retained
b. Infection


Where does a patient feel the pain with a positive Homan's sign?

Pain in calf when leg is dorsiflexed


Risk factors for postpartum shock

o Placental abruption. The early detachment of the placenta from the uterus.
o Placenta previa. ...
o Overdistended uterus. ...
o Multiple pregnancy.
o High blood pressure disorders of pregnancy.
o Having many previous births.
o Prolonged labor.
o Infection.


Signs and symptoms for mastitis

 Redness and heat in the breast
 Tenderness
 Edema and a heaviness in the breast
 Purulent drainage
 May have fever and chills


What would a nurse expect to assess if the peri-pad has no lochia on it shortly after delivery?

o Normal postpartum changes
 Lochia rubra should be bright red
 Amount during first few hours should be no more than on saturated perineal pad per hour
 A few small clots may appear but large clots are NOT normal

Check fundus - if it's not contracting, it can't get rid of blood


Interventions for hypovolemic shock

o Stop the blood loss
o Give IV fluids to maintain the circulating blood volume and to replace fluids
o Give blood transfusions to replace lost erythrocytes
o Give oxygen to increase the saturation of remaining blood cells
 Place pulse ox on patient
o Place an indwelling (Foley) catheter to assess urine output, which reflects kidney function



 Conforming of the fetal head to the size and shape of the birth canal


Caput succedeum

 Swelling of the soft tissues of the scalp
 (Glossary – pg 807) swelling or edema of the newborn scalp that crosses the suture lines



 Subperiosteal swelling containing blood, found on the head of some newborns
 The swelling does not cross the suture lines
• Often appears unilateral
 Usually disappears within a few weeks to 2 months without treatment


Moro reflex

 Sudden jarring causes extension and abduction (an embracing motion) of the extremities and spreading of the fingers, with the index finger and thumb forming a C shape
 If unilateral – could indicate a clavicle fracture
 Appears at birth; disappears around 3-6 months


Tonic neck reflex

 Turn infant’s head to one side and the arm and leg will extend on that side with a flexion of the opposite arm and leg
 Appears at birth; disappears around 5-7 months


Palmar grasp reflex

 Place object in the hand of the newborn, and the newborn will grasp it tightly
 Appears at birth; disappears around 4 months


Babinski reflex

 Stroke the side of the foot, the big toe will dorsiflexion and the toes will flare out
 Appears at birth; disappears before infant begins walking (variable)


Blinking response

 Infant blinks when hearing a loud noise
 Appears at birth; never disappears


Turning response

 Infant will turn its head towards the source of the noise
 Appears at birth; never disappears


Eye opening (Infant reflex)

 Holding the newborn infant upright, under the arms, and tipping the infant forward will induce eye opening
 Appears at birth; disappears at 3 months


Blinking to threat

 Bringing an object close to the eye at a fast pace will induce blinking
 Appears around 6-7 months; never disappears


Horizontal following

 Moving an object side to side within the infant’s visual field will elicit this response
 Appears around 4-6 weeks; never disappears


Vertical following

 Moving a colorful object up and down within the visual field of the infant will induce this response
 Appears around 2-3 months; never disappears


Rooting response

 Infant’s head turns in the direction of anything that touches the cheek in anticipation of food
 Appears at birth; disappears around 3-4 months


Sucking response

 Infant will suck on a finger or nipple placed in the mouth
 Appears at birth; disappears around 7-12 months


Stepping reflex/"dancing reflex"

 Hold infant upright above a table; the infant will life the foot up on contact with the firm surface of the table
 Appears at birth; disappears around 4-5 months


What should the fontanels feel like in a normal healthy newborn?

o Fontanelles are unossified spaces or soft spots on the cranium of a young infant. They protect the head during delivery by permitting the process of molding and allow for further brain growth during the next 1.5 years
o Anterior fontanelle is a diamond shape and located at the junction of the two parietal and two frontal bones
 Usually closes by age 12-18 months
o Posterior fontanelle is triangular and is located between the occipital and parietal bones
 Smaller than the anterior fontanelle
 Usually ossified by the end of the second month

Depressed = dehydration
Bulging = ICP
Should be soft