Postpartum Complications and Care Quiz

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Questions and Answers

Which of the following interventions would be most appropriate for a postpartum patient experiencing a small vulvar hematoma?

  • Frequent assessment of blood pressure and pulse to monitor for hemorrhagic shock.
  • Administration of high-dose antibiotics to prevent infection.
  • Pain medications and ice packs to manage discomfort and reduce swelling. (correct)
  • Immediate surgical intervention to remove the hematoma.

A patient with a postpartum infection of the endometrium (endometritis) is most likely to present with which of the following signs or symptoms?

  • Pitting edema and calf tenderness in one leg.
  • Fever, uterine tenderness, and foul-smelling lochia. (correct)
  • Unilateral swelling and pain in the labia.
  • Hypotension, tachycardia, and dizziness.

Which of the following factors increase the risk of developing a postpartum laceration?

  • Maternal age over 35 years.
  • Vaginal birth after a previous cesarean section.
  • Macrosomia (large baby) and shoulder dystocia. (correct)
  • Use of epidural anesthesia during labor.

A postpartum patient experiencing a deep vein thrombosis (DVT) is MOST likely to present with which of the following clinical manifestations?

<p>Unilateral swelling, pitting edema, calf tenderness and skin redness. (A)</p> Signup and view all the answers

What is the MOST common cause of postpartum shock?

<p>Uterine atony, leading to excessive bleeding (postpartum hemorrhage). (D)</p> Signup and view all the answers

Which of these is NOT a suitable measure for preventing deep vein thrombosis (DVT) in postpartum patients?

<p>Wearing tight clothing such as leggings to support circulation. (C)</p> Signup and view all the answers

Which of the following interventions is MOST appropriate for a postpartum patient with a large vulvar hematoma causing significant pain?

<p>Immediate surgical intervention to drain the hematoma and control bleeding. (B)</p> Signup and view all the answers

Which of the following options is NOT a symptom of postpartum shock?

<p>Uterine tenderness and discomfort. (D)</p> Signup and view all the answers

When is a Pap test recommended for women aged 30-65 years old?

<p>Every 5 years, if combined with an HPV screening (A)</p> Signup and view all the answers

Which method of contraception requires the consistent use of a thermometer?

<p>Basal body temperature method (C)</p> Signup and view all the answers

Which barrier method of contraception is inserted 15 minutes before intercourse and lasts for approximately one hour?

<p>Spermicide (A)</p> Signup and view all the answers

What is the recommended timeframe for leaving a diaphragm in place?

<p>At least 6 hours but no longer than 24 hours (B)</p> Signup and view all the answers

Which of these methods is NOT considered a barrier method of contraception?

<p>Spermicide (A)</p> Signup and view all the answers

What is the primary purpose of a pelvic exam?

<p>To screen for cervical and ovarian cancer and STIs (C)</p> Signup and view all the answers

Which of the following methods of family planning is NOT based on identifying the fertile window?

<p>Coitus interruptus (B)</p> Signup and view all the answers

What is the most important factor to consider when choosing a method of contraception?

<p>The client's preference and needs (B)</p> Signup and view all the answers

Which of these scenarios would warrant a call to a newborn's primary care provider?

<p>The baby's umbilical cord is 2 weeks old and has a foul-smelling discharge. (B)</p> Signup and view all the answers

What is the main reason for waiting 24 hours before giving a newborn their first bath?

<p>To prevent the loss of the vernix caseosa, which protects the skin. (A)</p> Signup and view all the answers

Which of the following is NOT a risk factor for postpartum depression?

<p>Having a vaginal birth without complications. (A)</p> Signup and view all the answers

What is the optimal timeframe for the umbilical cord to fall off?

<p>Within 1-2 weeks. (A)</p> Signup and view all the answers

Why should babies be rear-facing in a car seat until they are at least 2 years old?

<p>It provides better support for their neck and head in case of an accident. (C)</p> Signup and view all the answers

What is the recommended frequency for bathing a newborn?

<p>2-3 times per week. (D)</p> Signup and view all the answers

Which of these is a common sign of baby blues?

<p>Feeling emotional and tearful for brief periods. (B)</p> Signup and view all the answers

Which of these actions can help siblings adjust to a new baby?

<p>Encouraging the siblings to help with the baby's care, such as fetching diapers or toys. (C), Giving the siblings extra attention and making time for them individually. (D)</p> Signup and view all the answers

What is the maximum duration for which a cervical cap can be left in place?

<p>24 hours (D)</p> Signup and view all the answers

What is a potential consequence of leaving the contraceptive sponge in for too long?

<p>Toxic Shock Syndrome (TSS) (D)</p> Signup and view all the answers

Which of the following conditions is contraindicated for the use of combined oral contraceptives?

<p>Thromboembolic disorders (B)</p> Signup and view all the answers

What is the action of progestin-only pills compared to combined oral contraceptives?

<p>Decrease chances of fertilization and implantation (C)</p> Signup and view all the answers

What should be done if a patient misses two doses of combined oral contraceptives?

<p>Look for directions for specific action and use alternative contraception (C)</p> Signup and view all the answers

Which side effect is commonly associated with the use of combined oral contraceptives?

<p>Breakthrough bleeding (C)</p> Signup and view all the answers

What should patients using combined oral contraceptives report immediately?

<p>Chest pain or shortness of breath (B)</p> Signup and view all the answers

How often do cervical caps need to be replaced under typical circumstances?

<p>Every 2 years (D)</p> Signup and view all the answers

Which statement about hormonal contraceptives is true?

<p>They can regulate the menstrual cycle. (B)</p> Signup and view all the answers

What is a therapeutic effect of combined oral contraceptives?

<p>Regulation of menstrual cycles (D)</p> Signup and view all the answers

Which of these is NOT a neurological reflex present in newborns?

<p>Caput succedaneum (C)</p> Signup and view all the answers

A newborn with a heart rate of 95 beats per minute and weak, irregular breathing would score which of the following on the Apgar scale?

<p>3 (D)</p> Signup and view all the answers

A newborn who has blue hands and feet, but a pink body, would score which of the following on the Apgar scale for appearance?

<p>1 (A)</p> Signup and view all the answers

Which of the following is a concern that should be carefully monitored in a newborn with Cephalohematoma?

<p>The swelling could potentially increase in size. (A)</p> Signup and view all the answers

Which of the following is a physical characteristic seen in newborns as a result of the pressure exerted during delivery?

<p>Caput succedaneum (D)</p> Signup and view all the answers

Which of these reflexes is crucial for the newborn's ability to obtain nourishment?

<p>Rooting reflex (A)</p> Signup and view all the answers

Which of the following is a potential issue related to the newborn's oral anatomy?

<p>A short lingual frenulum preventing a good latch. (D)</p> Signup and view all the answers

Why is it essential for the newborn's skull sutures to be unfused?

<p>It allows the skull to expand faster after birth, accommodating brain growth. (D)</p> Signup and view all the answers

A newborn has a bilirubin level of 10 mg/dL at 18 hours of age. Which of the following nursing actions is MOST appropriate?

<p>Closely monitor the infant's bilirubin levels and feeding. (C)</p> Signup and view all the answers

A mother asks why her newborn is receiving phototherapy. Which of the following responses by the nurse is MOST accurate?

<p>The phototherapy helps convert bilirubin to a form that can be excreted in the stool. (C)</p> Signup and view all the answers

A newborn with hyperbilirubinemia is exhibiting lethargy, poor feeding, and a high-pitched cry. Which of the following nursing actions is PRIORITY?

<p>Assess for signs of infection. (A)</p> Signup and view all the answers

A mother is concerned about her newborn's jaundice. Which of the following explanations by the nurse is MOST accurate?

<p>Jaundice is a common occurrence in newborns and usually resolves on its own. (D)</p> Signup and view all the answers

Which of the following factors is MOST likely to contribute to delayed bonding between a mother and her newborn?

<p>A traumatic birth experience. (B)</p> Signup and view all the answers

A mother is in the "taking hold" stage of maternal role attainment. Which of the following behaviors is she MOST likely to demonstrate?

<p>She seeks information and support from healthcare providers and family. (A)</p> Signup and view all the answers

A newborn has ABO incompatibility. Which of the following diagnostic tests would be MOST helpful in determining the severity of the condition?

<p>Serum bilirubin (C)</p> Signup and view all the answers

Which of the following nursing interventions is MOST appropriate for a newborn with hyperbilirubinemia who is exhibiting lethargy and decreased output?

<p>Encourage the mother to breastfeed more frequently. (D)</p> Signup and view all the answers

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Flashcards

Lanugo

Fine hair on newborns that helps keep them warm in utero.

Sutures

Not fused skull bones that allow for delivery and brain growth.

APGAR score

Assessment tool for newborns evaluating 5 criteria: Appearance, Pulse, Grimace, Activity, Respirations.

Appearance in APGAR

Evaluates skin color: 0=blue, 1=pink body with blue extremities, 2=fully pink.

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Moro reflex

Startle reflex in newborns where arms extend and grasp.

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Cephalohematoma

Bleeding underneath the skull that doesn't cross suture lines.

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Cleft palate

A condition checked by examining the mouth for a gap.

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Lingual frenulum

Tissue under the tongue; a tight frenulum may hinder latching.

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Secondary PPH

Postpartum hemorrhage occurring after the first 24 hours, often due to retained tissue or infection.

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Enlarged, boggy uterus

A uterus that feels soft and larger than expected, often associated with postpartum bleeding.

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Laceration risks

Factors such as macrosomia, malpresentation, and use of instruments that increase the likelihood of tearing during delivery.

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Hematomas

Localized collections of blood outside blood vessels, causing swelling and pain.

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Postpartum Shock

A life-threatening condition often due to PPH, characterized by rapid heart rate and low blood pressure.

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Deep vein thrombosis (DVT)

Blood clots in deep veins, commonly seen after cesarean sections or prolonged bed rest.

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Endometritis

Infection of the uterine lining, presenting with fever and foul-smelling discharge.

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Patient education for DVT

Guidelines to prevent DVT, such as avoiding long sitting and elevating legs.

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Letting go stage

The process a mother undergoes to integrate new family roles, taking months to adjust.

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Baby blues

Temporary emotional instability in the first two weeks after giving birth.

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Postpartum depression

Severe emotional changes post-birth, including anxiety, sadness, and bonding issues.

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Risk factors for postpartum depression

Conditions that increase chance of postpartum depression, like prior anxiety or stress.

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Newborn bathing guidelines

Wait 24 hours for the first bath, sponge bath until the cord falls off.

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Umbilical cord care

Keep diapers rolled below the cord until it falls off within 1-2 weeks.

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Car seat safety

Children should be rear-facing until at least 2 years old for maximum safety.

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Signs to call PCP for a newborn

Fever over 100.4°F, jaundice, lethargy, or difficulty breathing requires immediate care.

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ABO & Rh Incompatibility

A condition where the mother's blood type is incompatible with the baby's, leading to the creation of antibodies.

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Clinical Manifestations of Rh Incompatibility

Symptoms caused by Rh incompatibility include anemia, jaundice, lethargy, and more.

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Direct Coombs Test

A test that checks for the presence of antibodies in the fetus' blood.

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Hyperbilirubinemia

A condition where bilirubin levels exceed 12 mg/dL in newborns under 24 hours, indicating jaundice risk.

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Signs of Delayed Bonding

Indicators that bonding between parent and newborn is not occurring, like traumatic birth effects.

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Phototherapy Management

Nursing intervention that uses light to treat jaundice in newborns; requires eye protection.

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Maternal Role Attainment - Stage 1

The initial stage post-birth where the mother focuses on her own recovery and the birthing experience.

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Maternal Role Attainment - Stage 2

Stage that occurs weeks after birth as the mother learns to care for her newborn.

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Pap test

A test to detect cervical cancer by examining cervical cells.

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Cervical mucus ovulation

The observable changes in cervical mucus indicating ovulation.

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Barrier methods

Contraceptive methods that block sperm from entering the uterus.

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Natural family planning

A method of tracking fertility cycles to prevent pregnancy.

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Lactation amenorrhea method

A contraceptive method that relies on breastfeeding to prevent ovulation.

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Coitus interruptus

The pull-out method used to prevent sperm from entering the vagina.

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Spermicide

A chemical that kills sperm before they enter the cervix.

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Diaphragm

A barrier contraceptive that is inserted into the vagina to block sperm.

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Cervical Cap

A contraceptive device inserted into the vagina used with spermicide. It comes in 3 sizes and needs replacement every 2 years.

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Contraceptive Sponge

A barrier method that acts physically and chemically to prevent pregnancy. Should be left in for at least 6 hours but no longer than 30 hours.

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Toxic Shock Syndrome (TSS)

A potentially fatal condition linked to leaving menstrual products in too long, including sponges and caps.

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Hormonal Contraceptives

Birth control methods that use hormones (like estrogen and progestin) to prevent ovulation and alter the uterine lining.

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Combined Oral Contraceptives (COCs)

Pills containing both estrogen and progestin that suppress ovulation and can help with menstrual issues.

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Minipill

Progestin-only pill that also prevents ovulation and implantation but needs to be taken consistently without missing doses.

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Patient Education for COCs

Instructions regarding missed doses, side effects, and when to seek medical advice for combined oral contraceptives.

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Contraindications of COCs

Conditions where COCs should not be used, including thromboembolic disorders, uncontrolled hypertension, and certain cancers.

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Side Effects of COCs

Common issues like headaches, nausea, and breakthrough bleeding that may occur when taking combined oral contraceptives.

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Progestin-only Pill Consistency

For minipills, taking at the same time every day is crucial for effectiveness, as they don't include estrogen.

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Study Notes

Postpartum Hemorrhage

  • Cumulative blood loss greater than 500 mL (vaginal delivery) or 1000 mL (C-section)
  • Early PPH: within 24 hours of birth
  • Secondary PPH: 24 hours to 6 weeks after birth

Clinical Manifestations

  • Boggy uterus, possibly deviated to the right
  • Bladder full
  • Heavy vaginal bleeding with clots

PPH Causes and Interventions

  • Tone: Uterine atony (lack of muscle tone)
    • Intervention: Fundal massage, oxytocin
  • Trauma: Lacerations
    • Intervention: Repair via suturing
  • Tissue: Retained products of conception (e.g., placenta)
    • Intervention: Surgical removal (e.g., D&C)
  • Thrombin: Coagulation issues
    • Intervention: Fundal massage, oxytocin

PPH Treatment

  • Massage the fundus to contract the uterus and push down vessels
  • Bimanual exam (provider inserts fingers into vagina to apply pressure to fundus)
  • Medications:
    • Oxytocin
    • Misoprostol
    • Methylergonovine
    • Tranexamic acid (inhibits clotting factor breakdown)

Other Postpartum Issues

  • Retained Placenta: Placenta not delivered within 30 minutes
    • Manual removal may be needed
  • Subinvolution: Uterus fails to contract down
  • Lacerations: Tears in the reproductive tract
    • Perineal lacerations
  • Hematoma: collection of blood outside blood vessels
  • Diagnosis and Treatment of bleeding:
    • Use of blood products as needed
    • Follow up care

Postpartum Complications

  • Blood Products: Transfused as required based on patient's condition.
  • Fluids: Monitor and appropriately administer
  • Surgical Interventions: Balloon tamponade
  • Retained placenta: Removal of placenta as required
  • Subinvolution of uterus: Lack of contraction.
  • Lacerations: Repair of tears.
  • Hematoma: Monitor closely for increase in size.
  • Postpartum Shock: Low blood pressure, rapid pulse, dizziness, or confusion.

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