OB final - Post Partum

Question 1

PP vitals

Answer 1

• temp below 100.4
• slight elevation in BP
• bradycardia for 6-10 days

Question 2

causes of the elevated BP postpartum

Answer 2

• Preeclampsia
• hypertension
• renal disease
• anxiety

Question 3

causes of low BP postpartum

Answer 3

• uterine hemorrhage
• hematoma

Question 4

causes of tachycardia postpartum

Answer 4

• difficult labor & birth
• hemorrhage

Question 5

causes of marked tachypnea postpartum

Answer 5

• respiratory disease
• pulmonary edema

Question 6

how to treat elevated BP postpartum

Answer 6

• procardia 30 XL, labetalol, aldomet
• Mag Sulfate IV

Question 7

cardiovascular postpartum

Answer 7

• CO declines by 30% in the first 2 weeks & normalizes by 6-12 weeks
• diuresis assists to decrease extracellular fluid & wt loss
• failure to eliminate fluid can lead to pulmonary edema & cardiac problems

Question 8

what is the most common side effect postpartum

Answer 8

headache - may result from

• a fluid shifts in the first week after birth

or

• a leakage of CSF d/t epidural, HTN, PreE, stress & fatigue

Question 9

postpartum nutrition

Answer 9

• high iron foods
• continue prenatal vitamin esp if BF
• BF mother increase 300kcal per day
• non BF mother decrease intake by 200kcal

Question 10

postpartum changes in labs

Answer 10

• non pathologic leukocytosis during 1st wk (wbc 25000-30000)
• 2 to 3 % drop in hct = blood loss of 500ml
• plasma levels reach pre pregnant state by wks 4-6
• platelets return to normal by week 6

Question 11

ovulation/menstruation for non breastfeeding mothers

Answer 11

• menstruation usually occurs in 7-12 weeks
• ovulation usually occurs within 70 to 75 days

Question 12

ovulation/menstruation for breastfeeding mothers

Answer 12

• menstruation may be delayed 3 months or longer
  Not reliable form of BC

Question 13

BUBBLE HE

Answer 13

BUBBLE

• Breast
• Uterus
• Bowel
• Bladder
• Lochia
• Episiotomy/incision

HE

• Homan’s/hemorrhoids
• Emotions

Question 14

breast assessment

Answer 14

• size & shape
• abnormalities, reddened areas or engorgment
• presence of breast fullness d/t milk
• assess nipples for cracks, fissures, soreness or inversion

Question 15

suppression of lactation

Answer 15

• well fitting bra or wraps
• cold compression or cabbage leaves
• anti inflammatory medications
• no warm water on breasts
• no stimulation

Question 16

lactation education

Answer 16

• feed every 1.5-3 hrs
• 10 to 20 mins on 1st breast, whatever baby wants on 2nd
• breast may feel heavy but not hard, sore or reddened
• do not consume alcohol 2hr before nursing & limit it

Question 17

signs of a poor latch

Answer 17

baby making smacking sounds -> unlatch & retry

Question 18

fluid intake for breast feeding mom

Answer 18

2L/day

Question 19

mastitis s/s

Answer 19

• sudden onset
• chills & fevers
• reddened, painful swollen areas
• possible discharge

Question 20

treatment for mastitis

Answer 20

• abx
• supportive bra w/o under wiring
• good hand washing
• warm compress

Question 21

difference between engorgement & mastitis

Answer 21

gradual, bilateral hardness & not associated with fever

Question 22

benefits of slow method weaning

Answer 22

• prevents breast engorgement
• allows infants to alter their eating methods at their rates
• provides time of psychological adjustment

Question 23

diastasis recti abdominis

Answer 23

when the abdominal muscles have separated due to allowing room for the enlarged uterus

Question 24

after pains

Answer 24

• intermittent uterine contractions associated with uterine involution
• resting prone w/ pillow under abdomen helps keep uterus contracted
• motrin 600 mg po q8 as needed for cramping

Question 25

motrin contraindications

Answer 25

- do not give if platelets <70,000 - careful using for pt w/ preE

Question 26

endometritis (PP uterine infection)

Answer 26

involves the lining of the uterus causing: tenderness, temp spikes, chills, foul smelling lochia

Question 27

endometritis treatment

Answer 27

broad spectrum antibiotics like clindamycin & gentamycin until culture & sensitivity results are available, continue until afebrile for 24-48 hrs

Question 28

when will the fundus be at level with the umbilicus

Answer 28

6-12 hours after delivery

Question 29

when does the fundus get back into the true pelvis

Answer 29

on the 10th day, descends 1cm per day until then

Question 30

uterine atony

Answer 30

**boggy uterus** increased risk of bleeding caused by high levels of oxytocin, multipara, multiples, LGA and red haired women **if bladder is full, pt needs to void**