Ch 31 + 33 postpartum complications

Question 1

definition of early PPH

Answer 1

-cumulative blood loss >1000 mL
-blood loss w/ S+S of hypovolemia
-within 24 hrs after birth (includes blood loss during birth)

Question 2

causes early PPH (4 Ts)

Answer 2

-tone: uterine atony
-trauma: lacerations
-tissue: retained placenta
-thrombin: clotting abnormalities

Question 3

risk factors uterine atony

Answer 3

-high parity
-labor dystocia/trauma during L&D
-rapid/prolonged labor
-use of oxytocin during labor
-anesthesia and analgesia
-over-distended uterus
-previous history
-magnesium sulfate admin
-chorio
-placenta previa/abruption

Question 4

what part of hand do you use to massage fundus during uterine atony

Answer 4

palm of hand

Question 5

Tx uterine atony

Answer 5

-massage fundus
—-if doesn’t work——:
-bimanual exploration and massage
-uterine tonics

Question 6

anticipatory prep nursing interventions for uterine atony

Answer 6

-IV access with large bore catheter
-blood in lab
-uterine tonics readily available
-keep bladder empty

Question 7

nursing interventions uterine atony

Answer 7

-call for immediate help
-empty bladder if distended
-massage fundus
-IV fluids
-administer oxytocin, uterine tonics
-position and O2 (if hypovolemic)
-administer blood prn

Question 8

1st drug of choice for PPH

Answer 8

oxytocin

Question 9

adverse effects of oxytocin admin

Answer 9

-HTN
-severe uterine Cxs

Question 10

adverse effects of misoprostol (cytotec) - causes uterine contractions

Answer 10

-headache
-N/V/D
-fever
-chills

Question 11

meds for PPH (uterine stimulant meds)

Answer 11

-oxytocin/pitocin
-cytotec
-methergine
-hemabate/carboprost

Question 12

adverse reaction to methergine

Answer 12

HTN

Question 13

contraindications to methergine

Answer 13

-HTN
-preeclampsia
-cardiac disease

Question 14

when would you not be able to admin methergine for PPH

Answer 14

if BP >140/90

Question 15

side effects all uterine stimulant meds (prostaglandins)

Answer 15

-headache
-N/V/D
-fever
-chills

Question 16

contraindications to admin of hemabate/carboprost

Answer 16

asthma
HTN

Question 17

what VS to check with hemabate/carboprost

Answer 17

temp q1-2h
breath sounds

Question 18

what pts should dinoprostone (prostin) be used with caution with

Answer 18

-asthma
-HTN/hypoTN

Question 19

purpose of tranexamic acid (TXA)

Answer 19

interferes with break down of clots

Question 20

what pts would use of tranexamic acid (TXA) be contraindicated with

Answer 20

-known thromboembolic event during pregnancy
-h/o coagulopathy

Question 21

risk factors lacerations

Answer 21

-operative birth
-precipitate labor (fast)
-congenital abnormalities
-contracted pelvis/pelvic dystocias
-abnormal fetal characteristics
-previous scarring
-variscocities

Question 22

S+S lacerations

Answer 22

-firm, contracted fundus
-continued bleeding

Question 23

S+S pelvic hematomas

Answer 23

-pain/pressure unrelieved by analgesics
-pressure
-shock

Question 24

PPH after 24 hrs of birth

Answer 24

late PPH

Question 25

most common cause late PPH

Answer 25

uterine subinvolution

Question 26

2 causes uterine subinvolution

Answer 26

-infection -retained placental fragments

Question 27

S+S late PPH

Answer 27

-vaginal bleeding (usually slow, oozing -low, persistent backache -abdominal pain/tenderness -fatigue

Question 28

Tx late PPH

Answer 28

-oral methergine -oral Abx -re-evaluate in 2 wks -if frank hemorrhage without response to uterine tonics: D&C

Question 29

risk factors PP (puerperal) infections

Answer 29

-ROM >24 hrs -lacerations/incisions -hemorrhage, hematomas -anemia/poor physical health before birth -intrauterine manipulation during labor/birth/pp

Question 30

S+S puerperal infections

Answer 30

-fever (after 1st 24 hrs) -site specific S+S

Question 31

S+S perineal infection

Answer 31

-red, swollen, very tender -purulent drainage -wound dehiscence

Question 32

infection of uterus PP

Answer 32

endometritis

Question 33

S+S endometritis

Answer 33

-fever -N/V -malaise, anorexia -foul smelling discharge -abdominal distention -uterine distention -decreased bowel sounds -lochia return from serosa to rubra

Question 34

causes endometritis

Answer 34

-birth -prolonged ROM -vaginal exams -poor hygiene

Question 35

Tx endometritis

Answer 35

-IV Abx -fowlers/semifowlers position -palpate fundus q8h

Question 36

prevention of mastitis

Answer 36

-frequent feeds -good latch -teach early S+S -warm line (phone # for PP nurse/hospital) -2 week PP visit

Question 37

risk factors thromboembolic disease

Answer 37

-venous stasis -immobility -endothelial damage (stirrup use) -increased clotting of pregnancy -wound infection -obesity -previous history -heart disease -varicosities

Question 38

S+S thromboembolic disease

Answer 38

-abrupt onset -sever leg pain -edema

Question 39

Tx thromboembolic disease

Answer 39

-consultation -anticoag therapy

Question 40

S+S superficial thrombophlebitis

Answer 40

-day 3-4 PP -tenderness -heat -redness -low grade fever -elevated pulse

Question 41

Tx superficial thrombophlebitis

Answer 41

-heat -elevate -analgesia -bedrest -support hose -anticoags

Question 42

prevention of DVT

Answer 42

-good hydration -early ambulation -avoid long use stirrups -minimize blood loss -avoid estrogen until 2 weeks PP (or done breastfeeding)

Question 43

S+S pulmonary embolism

Answer 43

-dyspnea, SOB -cough, hemoptysis -tachycardia -chest pain

Question 44

nursing interventions pulmonary embolism

Answer 44

-O2 -IV access -raise hob -notify hcp

Question 45

S+S baby blues

Answer 45

-should go away in about 10 days -sad, anxious, overwhelmed -crying spells -loss of appetite -difficulty sleeping

Question 46

S+S PP depression

Answer 46

-same as baby blues but last longer and more severe -thoughts of harming self/baby -uninterested in baby

Question 47

screening tools for PP depression (3)

Answer 47

-EPDS: edinburgh postnatal depression screen (gold standard) -PDSS: postpartum depression screening scale -two item screen

Question 48

red flags for PP depression (identified during antenatal period)

Answer 48

-lack of acceptance of pregnancy -excessive mood swings -withdrawal -preoccupation with appearance -excessive physical complaints -failure to prepare for baby

Question 49

red flags for PP depression (during PP period)

Answer 49

-excessive fatigue -marked depression -preoccupation with physical status -low self esteem