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postpatum
| Question | Answer |
|---|---|
| The nurse is assessing a woman who saturated a perineal pad in 15 minutes. What is the priority intervention | Assess the uterine fundus. |
| With regard to afterbirth pains, nurses should be aware that these pains are: | More noticeable in births in which the uterus was overdistended |
| The cramping that causes _________ arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period | afterbirth pains |
| Why are afterbirth pains are more common in multiparous women | because first-time mothers have better uterine tone. |
| Lochia flow should approximate a heavy menstrual period for the first _______ and then steadily decrease | 2 hours |
| Less lochia usually is seen after | cesarean births |
| Lochia usually increases with | ambulation and breastfeeding |
| ___are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. | Rugae |
| Most episiotomies take _______to heal. | 2 to 3 weeks |
| Hemorrhoids can take _____to decrease in size | 6 weeks |
| A ______may result from overdistention of the bladder | urinary tract infection |
| _______ can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly | Excessive bleeding |
| Bladder distension may result from bladder wall atony. The most serious concern associated with bladder distention is excessive | uterine bleeding. |
| Fluid loss through perspiration and increased urinary output account for a weight loss of more than __ during the puerperium | 2 kg |
| Kidney function usually returns to normal in about | a month. |
| ______ is the separation of muscles in the abdominal wall | Diastasis recti abdominis |
| Bladder tone usually is restored ____to ___ days after childbirth | 5 to 7 |
| Breasts are essentially unchanged for the first ___ hours after birth. Colostrum is present and may leak from the nipples. | 24 |
| Leakage of milk occurs after the milk comes in ___to___ hours after birth | 72 to 96 |
| Engorgement of breasts occurs at day __or__ postpartum | 3 or 4 |
| 1. The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to | Palpate the uterus and massage it if it is boggy |
| The initial management of excessive postpartum bleeding is | firm massage of the uterine fundus. |
| Which PPH conditions are considered medical emergencies | Inversion of the uterus and hypovolemic shock |
| A _______uterus can be managed with massage and oxytocin. | hypotonic |
| _____is the most common postpartum infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. | Endometritis |
| _________is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. | Desmopressin |
| are oxytocic agents that promote uterine contraction | Blue cohosh, cotton root bark, motherwort and shepherds purse |
| is an expected finding related to circulatory changes after birth. | Postural hypotension |
| A boggy or soft fundus indicates that uterine atony is present. This is confirmed by ___________ The first action is to massage the fundus until firm | by the profuse lochia and passage of clots. |
| ________ can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage. | Methylergonovine(Methergine), 0.2 mg IM, |
| results in an elevation of the fundus above the umbilicus and deviation to the right or left of midline | Bladder distention |
| Uterine atony results in a | boggy fundus |
| Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of | hematoma formation |
| During _____ labor, contractions tend to be irregular and felt in the abdomen above the navel. Typically the contractions often stop with walking or a change of position | false |
| _____ contractions occur regularly, become stronger, last longer, and occur closer.They may become intense during walking and continue despite comfort measures. | True labor |
| Typically __labor contractions are felt in the lower back, radiating to the lower portion of the abdomen. | true |
| When accelerations of the fetal heart rate (FHR) are noted is a | positive sign |
| When the woman perceives perineal pressure or the urge to bear down is this an appropriate time to perform a vaginal examination. | yes |
| The nurse must be aware that there is an increased risk of _______ immediately after ROM | prolapsed cord |
| may mask the sensations and muscle control needed for the woman to push effectively. | The epidural |
| The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors which happen in what stage of labor | the second stage of labor |
| The ______ phase of the is the final phase in the second stage of labor; contractions are strong and painful | transition |
| The _____ phase of the second stage of labor is the lull, or "laboring down," period at the beginning of the second stage. It lasts 10 to 30 minutes on average | latent |
| In many instances a sterile speculum examination and a____ and ______ are performed to confirm that fluid seepage is indeed amniotic fluid | Nitrazine (pH) and fern test |
| The nurse performs Leopold maneuvers to identify fetal___, presenting part and attitude | lie |
| is the procedure of artificially rupturing membranes usually with a device known as an amnihook. | AROM |
| is indicated by a firmly contracting uterus, a change in the uterus from a discoid to a globular ovoid shape, a sudden gush of dark red blood from the introitus, an apparent lengthening of the umbilical cord, and a finding of vaginal fullness. | Placental separation |
| boggy uterus, bright red vaginal bleeding, alterations in vital signs, pallor, lightheadedness, restlessness, decreased urinary output, and alteration in the level of consciousness. | Signs of hemorrhage |
| If clots have formed in the upper uterine segment, the nurse would expect to find the uterus | boggy and displaced to the side. |
| begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina | Labor care |
| is the most commonly used opioid agonist analgesic for women in | Meperidine (Demerol) |
| overcomes inhibitory factors in labor and may even relax the cervix. Because tachycardia is a possible adverse reaction, is used cautiously in women with cardiac disease. | Meperidine (Demerol) |
| is are opioid agonist-antagonist analgesics | Butorphanol tartrate (Stadol),Nalbuphine (Nubain) |
| breathing techniques are usually helpful during contractions per the gate-control theory | Pant-blow (breaths and puffs) breathing techniques |
| is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain; however, it is unlikely to be effective for back labor. | Effleurage |
| _______ pain is greater for nulliparous women because their reproductive tract structures are less supple. | Sensory |
| _______ cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier | Systemic analgesics |
| A high incidence of postbirth headache is seen with | spinal blocks;An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for a spinal headache. |
| ________blocks limit the womans ability to move freely. | Epidural |
| __________pain is that which predominates the first stage of labor | Visceral |
| This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia | Visceral |
| As labor progresses the woman often experiences _________pain. | referred |
| This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. | Referred |
| ________pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. | Somatic |
| Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor | Afterpain |
| The ______powers are responsible for dilation and effacement; | primary |
| ______powers are concerned with expulsion of the fetus. | secondary |
| Scarring of the cervix may slow | dilation |
| After _________a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. | lightening |
| Blood pressure ________during contractions but remains somewhat elevated between them. | increases |
| Use of the ______maneuver is discouraged during second stage labor | Valsalva |
| During the descent phase of the second stage of labor, the woman may experience an increase in the | urge to bear down. |
| Many women may have an urge to bear down when the presenting part is | below the level of the ischial spines |
| Although the amount of time varies with each woman, a normal uncomplicated labor is usually completed within __hours. | 18 |
| The ____ phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours | latent |
| The ______ phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours | active |
| The ________ phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes. | transition |
| _____ moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet. | Kneeling or squatting |
| The placenta cannot detach itself from a _______ uterus | flaccid (relaxed) |
| The _____ stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. | third |
| The major risk for women during the third stage of labor is | postpartum hemorrhage |
| Fetal bradycardia can be considered a later sign of fetal | hypoxia |
| _________ can result from placental transfer of drugs, viral infections such as cytomegalovirus (CMV), maternal hypothermia, and maternal hypothermia. | Bradycardia |
| Tocolytic treatment using ritodrine will most likely result in fetal ________ . | tachycardia |
| Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal _________. | well-being |
| ___________ results in variable decelerations in the FHR. | Umbilical cord compression |
| __________insufficiency would result in late decelerations in the FHR. | Uteroplacental |
| ___________ flow results in early decelerations in the FHR. | Altered fetal cerebral blood |
| Fetal _______is evidenced by tachycardia initially and then bradycardia. A persistent decrease or loss of FHR variability may be seen. | hypoxemia |
| A temporary decrease in variability can occur when the fetus is in | a sleep state. These sleep states do not usually last longer than 30 minutes. |
| If the FHR were to continue in an abnormal or nonreassuring pattern, a _______ may be warranted | cesarean section |
| To relieve an FHR deceleration the nurse can | reposition the mother, |
| To relieve an FHR deceleration the nurse can | discontinued oxytocin |
| The assessment is done by | palpation; duration, frequency, intensity, and resting tone must be assessed |
| The duration of contractions is measured in ____; the frequency is measured in ___. | seconds minutes |
| The intensity of contractions usually is described as | mild, moderate, or strong. |
| The resting tone usually is characterized as | soft or relaxed |
| Maternal ingestion of narcotics may be the cause of _____ variability. | decreased |
| The use of barbiturates may also result in a significant _______in variability as these are known to cross the placental barrier. | decrease |
| The use of illicit drugs such as cocaine or methamphetamines might cause _______variability. | increased |
| Uterine contractions are described in terms of ___________(the strength of the contraction at its peak). | intensity |
| Uterine contractions are described in terms of _________or how often the contractions occur | frequency |
| Uterine contractions are described in terms of ________ (the tension in the uterine muscle). | resting tone |
| __________ are described in terms of frequency, intensity, duration, and resting tone. | Uterine contractions |
| _____________ syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. | Maternal supine hypotension |
| Oxytocin, Regional anesthesia, Intravenous analgesic may _________maternal cardiac output | reduce |
| FHR patterns are characterized by an FHR baseline in the range of ________ beats/min with no periodic changes | 110 to 160 |
| Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a _______category I tracing. | normal |
| Late PPH may be the result of this of the uterus and include retained placental fragments and pelvic infection | subinvolution |
| clinical infection of the genital canal that occurs w/in 28 days after miscarriage, induced abortion, or childbirth. the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth. | Postpartum or puerperal infection |
| Placenta ____is a recognized degree of attachment that results in deep penetration of the myometrium. | increta |
| Placenta ____is a recognized degree of attachment. With placenta accreta there is slight penetration of the trophoblast into the myometrium | accreta |
| Placenta ______is premature separation of the placenta as opposed to partial or complete adherence. This occurs between the twentieth week of gestation and delivery in the area of the decidua basalis. Symptoms include localized pain and bleeding | abruptio |
| Placenta _____is the most severe degree of placental penetration that results in deep penetration of the myometrium. | percreta |
| Bleeding with complete placental attachment occurs only when separation of the placenta is attempted after delivery. Treatment includes blood component therapy and in extreme cases, hysterectomy may be necessary. | Placenta percreta |
| are medications used to manage PPH. | Oxytocin, methergine, and hemabate |
| Terbutaline and magnesium sulfate are | tocolytics |
| localized infection at the placental site | Endometritis |
Created by:
troop27