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PNC 102 lecture > chapter 13: postpartum complications > Flashcards

chapter 13: postpartum complications Flashcards

1
Q

care of the woman w/ postpartum hemorrhage

A
  • leading cause of maternal mortality
  • amount varies between vaginal delivery and cesarean
  • primary v secondary hemorrhage
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2
Q

risk factors for subinvolution postpartum hemorrhage

A
  • retained placenta
  • failure to progress during second stage of labor
  • placenta accreta
  • lacerations
  • LGA newborn
  • instrumental delivery
  • hypertension
  • induced labor
  • augmentation with oxytocin
  • overdistention of the uterus
  • bmi over 40
  • mnemonic 4 t’s: tone, tissue, trauma, thrombosis
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3
Q

signs and symptoms of postpartum hemorrhage

A
  • heavy vaginal bleeding
  • constant trickling or oozing
  • uterine atony
  • passing of blood clots larger than a quarter
  • return of lochia rubra
  • cool, clammy, pale skin
  • tachycardia and decreased bp
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4
Q

nursing care with postpartum hemorrhage

A
  • collaborative process of the healthcare team
  • identify excessive bleeding
  • notify rapid response
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5
Q

management of postpartum hemorrhage

A
  • fundal massage
  • support lower segment support, measure vitals, assess level of consciousness and amount of vaginal bleeding
  • notify physician or midwife
  • weigh peripads and linens to obtain accurate measurement
  • assess bladder
  • IV fluids
  • monitor oxygen
  • elevate legs
  • psychosocial support to pt and family
  • oxytocic drugs if ordered
  • bimanual massage
  • operating room
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6
Q

hematoma

A

collection of blood outside the blood vessel

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7
Q

common locations of hematoma in delivery

A

vaginal wall
vulvar area

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8
Q

risk factors of hematoma in delivery

A
  • episiotomy
  • lacerations to genital tract
  • instrumental delivery
  • nulliparity
  • difficult or prolonged second stage of labor
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9
Q

signs and symptoms of a hematoma during delivery

A
  • constant pain and pressure
  • discoloration and bulging of the tissue
  • tenderness of the tissue
  • a feeling of needing to defecate
  • inability to urinate
  • signs of shock depending on size
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10
Q

medical management of hematoma during delivery

A
  • observe perineal area for swelling and discoloration
  • report abnormal findings
  • apply ice for 20 mins for hematoma less than 3-5cm
  • observe perineal area for swelling and discoloration
  • report abnormal findings
  • size 3-5cm: apply ice for 20 min every 2 hours, warm sitz baths, pain medication
  • greater than 5cm: drained in OR
  • significant blood loss managed as postpartum hemorrhage
  • monitor vital signs
  • explain treatments and rational
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11
Q

endometritis risk factors

A
  • prolonged labor or prolonged rupture of membranes
  • internal monitoring
  • cesarean delivery
  • frequent vaginal infections
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12
Q

organisms that cause uterine infections

A
  • e.coli
  • group b streptococcus
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13
Q

signs and symptoms of uterine infection

A
  • temperature at or above 100.4F for 2 or more days
  • foul smelling lochia
  • lower abdominal tenderness
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14
Q

medical management of uterine infection

A
  • pelvic exam
  • cbc
  • blood cultures
  • pelvic ultrasound
  • administer IV fluids and antibiotics
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15
Q

nursing care of the woman with a uterine infection

A
  • administer IV fluids
  • administer pain medication and antipyretics
  • encourage fluid intake and foods
    explain treatment and rationale
  • support with bonding and breastfeeding
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16
Q

wound infection can occur in…

A

episiotomy incisions
perineal lacerations
cesarean incision

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17
Q

signs and symptoms of wound infection

A
  • redness
  • warmth
  • poor wound approximation
  • tenderness
  • pain
  • fever and malaise
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18
Q

medical management of wound infection

A

lab
antibiotics

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19
Q

nursing care of the woman with a wound infection

A
  • obtaining wound culture
  • administration of antibiotics
  • encourage adequate fluid intake andprotein intake
  • assess pain
  • teach patient proper hand washing
20
Q

UTIs are common due to ______ of childbirth

A

trauma

21
Q

other risk factors in UTI during delivery

A

foley catheter
prolonged labor

22
Q

organisms that cause UTIs

A

e.coli and klebsiella, proteus and enterobacter

23
Q

signs and symptoms of UTI

A
  • urgency
  • dysuria
  • increased frequency
  • urination of small amounts
  • fever
  • flank pain
  • hematuria
24
Q

medical management of UTI

A
  • largely based on symptoms
  • urine specimen
  • oral antibiotics
25
Q

nursing care of UTI

A
  • administer antibiotics
  • encourage fluid intake
  • teach pt to clean the perineum and use peri-bottle
26
Q

mastitis

A

infection of the breast tissue, blocked mi lk ducts

27
Q

organisms that cause mastitis

A

staphylococcus aureus

28
Q

mastitis transmitted from

A

infant’s mouth or woman’s hands through cracked nipples

29
Q

signs and symptoms of mastitis

A
  • sudden onset
  • red swollen area or mass on breast
  • fever 100.4F or higher
  • pain or burning sensation
  • malaise
30
Q

medical management

A

breast examination, rule out breast abscess, antibiotics, and pain relievers

31
Q

nursing care of mastitis

A
  • teaching mother to wash hands before feeding
  • observing latch-on and teach correct method
  • lactation specialist
  • encourage regular feedings
  • administer antibiotics
  • assess pain and administer medication
  • reassurance
  • apply warmth to breast
  • teaching signs of mastitis
32
Q

thromboembolism

A

blood vessel becomes inflamed and thrombus develops
- pregnancy increases the risk 4-6 times
- highest risk in first 12 weeks

33
Q

major causes of postpartum thromboembolic disease

A
  • venous stasis
  • hypercoagulable blood
  • injury to endothelial surface of blood vessel
  • 1 in 1,000 pregnancies and deliveries have complications like DVT or PE
34
Q

risk factors of postpartum thromboembolic disease

A
  • obesity
  • prolonged bed rest
  • advanced maternal age
  • still birth
  • premature birth
  • gestational diabetes
  • cesarean delivery
  • multiparity
  • varicose veins
  • smoking
35
Q

prevention of postpartum thromboembolic disease

A
  • encourage postpartum pts to ambulate frequently
  • carefully assess legs
  • identify women at high risk
36
Q

signs and symptoms of postpartum thromboembolic disease

A
  • swelling
  • pain or tenderness
  • erythema
  • pain on ambulation
  • stiffness of the leg
  • large, hard, cordlike vein
37
Q

diagnosis of postpartum thromboembolic disease

A
  • doppler ultrasound
  • MRI
38
Q

medical management of postpartum thromboembolic disease

A
  • IV heparin therapy
  • low molecular weight heparin
  • compression stockings
  • bed rest
  • analgesics
  • moist heat
39
Q

nursing care of postpartum thromboembolic disease

A
  • administer heparin
  • monitor INR and PT
  • apply compression stockings correctly
  • maintain bed rest
  • measure calf
  • administer analgesics
  • apply moist heat
  • monitor for complications such as pulmonary emboli
40
Q

postpartum depression

A
  • more serious and incapacitating than postpartum blues
  • interfere w/ self care and care of newborn
  • usually develops during first 4 months
  • high risk: personal history of depression, lack of social support, stressful events, unintended pregnancy, financial factors
41
Q

signs and symptoms of postpartum depression

A
  • intense sadness with crying, feeling overwhelmed
  • feeling moody and irritable
  • anxiety or worrying
  • feelings of guild or inadequacy
  • ambivalence
  • lack of motivation for self care or infant care
  • anhedonia
  • appetite disturbances
  • insomnia
  • fatigue
  • thoughts of hurting baby
  • suicidal thoughts
42
Q

medical management of postpartum depression

A
  • counseling
  • antidepressant medications
43
Q

nursing care of postpartum depression

A
  • monitor for signs of suicidal thoughts or thoughts of harming baby
  • encourage compliance w/ antidepressants
  • encourage follow up appts
  • encourage pt to seek counseling
  • encourage rest and naps when baby sleeps
  • seek out community groups
  • encourage partner to locate help and support
  • encourage verbalization of feelings
44
Q

postpartum psychosis

A

most severe form of postpartum psychiatric illness

45
Q

high risk for postpartum psychosis

A

those with history of bipolar or previous postpartum psychosis episode
- occurs within 48-72 hours

46
Q

signs and symptoms of postpartum psychosis

A
  • incoherent
  • rapidly shifting mood from depression to elation
  • delusional beliefs
  • hallucinations
  • medical emergency requiring hospitalization
47
Q

nursing care of postpartum psychosis

A
  • immediate reporting
  • reorienting pt with surroundings
  • provide safety
  • arrange for admission to psychiatric facility
  • provide emotional support

PNC 102 lecture (38 decks)

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