MCCN OB test 3 Test Questions with Complete Solutions, A+

involution of the uterus -Correct Answer the uterus returns to its normal nonpregnant size 24hrs post pregnancy- @ or below umbilicus 48 hrs post pregnancy- @ or below 1 finger-breath below umbilicus uterine contractions/afterpains -Correct Answer Multips feel afterpains more often Use ibuprofen for pain b/c it acts on prostiglandin Lochia -Correct Answer rubra- red, immediately postpartum until day 3-4 serosa- light red/pink, day 3-10 alba- white/clear, day 10-21 report if return to rubra (sign of infection) Lochia in C/section -Correct Answer progress directly to serosa, if see rubra call provider Uterine Health Promotion -Correct Answer frequent voiding, breastfeeding, kangaroo care, frequent pericare assess: uterine firmness, height, position in relation to midline, pain, lochia Uterine Atony Clinical Signs -Correct Answer Soft/high fundus, heavy lochia, bladder distension, possible s/s of hypervolemic shock (increased HR, decreased BP) Uterine atony contributing factors -Correct Answer bladder distension, prolonged or rapid labor, overdistended gravid uterus, medications, mutiparity Uterine Atony prevention and anticipation -Correct Answer review patient history, prevent bladder distension, promote breastfeeding and kangaroo care, teach and promote fundal massage, maintain IV access, fundal exam retained placental fragments contributing factors -Correct Answer Partial separation of normal placenta, abnormal adherence of all or part of placenta to uterine wall, mismanagement of third stage retained placental fragments clinical signs -Correct Answer Acute: possible profuse bleeding After discharge: foul smelling lochia, tender abdomen Hemmorrhage -Correct Answer Goal: restore blood volume and treat cause of hemmorhage Prepare and Anticipate: transfusion, iron replacemant, mother's need for assistance with newborn Assessment: fundus, lochia, bladder, perineum, vital signs, skin, cap. refill Interventions: uterine massage, medication, IV access, O2, catheter, elevate legs Methergine -Correct Answer 0.2 mg IM Q2-4hr (up to 5 doses) Sustained smooth muscle contractions, Monitor cardiac symptoms Assess BP before giving, do not give if 140/90 know it is working when uterus in firm Contraindicated: HTN, cardiac disease Pitocin -Correct Answer 10-40 u/l diluted in LR (we use LR because it's isotonic) 125-200 miliu/hr IV Prostiglandin F2a -Correct Answer 0.25mg IM or intrauterine Q15-90 min (up to 8 doses) Contraindication: asthma Misoprostol (Cytotec) -Correct Answer 800-1000mcg rectal 1x dose (provider must insert if tear/epeis is 3 or 4) Hemorrhage discharge teaching -Correct Answer involve family, fundal massage, Fe supplementation, S/S of worsening condition, hand hygine, breastfeeding, kangaroo care endometritis -Correct Answer predisposing factors: placenta fragment, frequent cervical exams Assessment findings: heavy/foul smelling lochia, tender/enlarged uterus, fever (100.4) after first 24 hrs Interventions: full fowlers, manage pain, possible delay of discharge If this is seen at home, PO antibiotics no need for admittance