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Maternity > Chapter 22 > Flashcards

Chapter 22 Flashcards

1
Q

Define postpartum hemorrhage

A

blood loss greater than 500 for vaginal birth and/or blood loss greater than 1000 for cesarean birth

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2
Q

blood loss of more than 1,500 mL to 2,500 mL or bleeding that requires more than 5 units of transfused blood

A

major Obstetric hemorrhage

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3
Q

primary vs delayed postpartum hemorrhage

A

<24 hours blood loss, 24 hours to 12 weeks blood loss

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4
Q

failure of uterus to contract and retract after birth

A

uterine atony

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5
Q

mild shock signs and symptoms

A
  • diaphoresis
  • increased capillary refill
  • cool extremities
  • anxiety
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6
Q

moderate shock signs and symptoms

A
  • tachycardia
  • postural hypotension
  • oliguria
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7
Q

Severe shock signs and symptoms

A
  • hypotension
  • agitation/confusion
  • hemodynamic instability
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8
Q

4 Ts that show cause of PPH

A

Tone (uterinatoney)
Tissue (retained placenta)
Trauma (Lacerations, inversions, rupture)
Thrombin (DIC, coagulopathy)

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9
Q

refers to incomplete involution of the uterus or failure to return to its normal size and condition after birth.

A

Subinvolution

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10
Q

Causes subinvolution

A

myometrial fibers do not contract effectively and cause relaxation, placental fragments

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11
Q
  1. ) an autoimmune disorder of increased platelet destruction caused by autoantibodies
  2. )congenital bleeding disorder that is inherited as an autosomal dominant trait
  3. ) clotting system is abnormally activated, resulting in widespread clot formation in the small vessels throughout the body, which leads to the depletion of platelets and coagulation factors.
A
  1. ) Idiopathic thrombocytopenia
  2. ) von Willebrand disease
  3. )DIC (treat through fluids and plasma, heparin)
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12
Q

how to treat uterine atony

A

-massage uterus (fundus)

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13
Q

Therapeutic management for obstetric Hemorrhaging

A
  • focus on underlying condition
  • uterine massage
  • removal of retained fragments
  • antibiotics
  • repair laceration
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14
Q

Risk for Tone obstetric hemorrhage

A
  • overdistention of uterus (polyhydramnios, Multifetal gestation, macrosomia)
  • uterine exhaustion (Rapid Labor or prolonged labor, oxytocin over use)
  • uterine Infection
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15
Q

Risk for tissue obstetric bleeding

A

Incomplete placental birth

uterine subinvolution

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16
Q

Risk for trauma obstetric bleeding

A

lacerations
uterine inversion
rupture

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17
Q

Nursing assessment in obstetric hemorrhage

A
  • assess the amount of bleeding (counting peripad, SAPHE pads collect 50 ml each square)
  • assess placenta for intactness
  • assess for hematoma (needs surgical intervention)
  • assess for coagulopathy (petechia and echymosis)
  • tachycardia, decease LOC
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18
Q

How to assess for hematoma

A
  • asses perineal area for bluish bulging discoloration
  • severe perineal or pelvic pain with difficulty voiding
  • shock may be present
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19
Q

Nursing management for obstetric hemorrhage

A
  1. ) initial measures include massage, IV fluid, and utertonic medications
  2. ) if that don’t work, we do bimanual compression, internal uterine packing , and /or balloon tamponade
  3. ) if 2nd line still don’t work, then do : undergo radiologic embolization, pelvic devascularization, or hysterectomy.
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20
Q

once estimated bleeding exceeds 1500

A

transfuse blood

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21
Q

Uterine Massage procedure

A
  • gloved hand over symphysis pubis
  • other gloved hand on fundus
  • massage fundus in circular manner9 do not over massage)
  • if firm, apply gentle firm pressure downward toward vagina to express any clots( do not try to express if not firm)
  • perineal care and add perineal pad
22
Q

Uterotonic drugs

A
  1. ) oxytocin(Pitocin) - first line therapy, stimulates uterus contraction
  2. ) Misoprostol (Cytotec) - causes uterine contraction, not approved by FDA
  3. ) Dinoprostone (Prostin E2
  4. ) Methegrine
  5. ) Prostaglandin (Hemabate)
23
Q

Contraindications of Utertonic drugs

A
  1. ) Pitocine - never give undiluted
  2. )Cytotec - allergy, CVD, pulmonary or hepatic disease
  3. ) Prostin E2 - Cardiac, hepatic, pulmonary, or rena diseases
  4. )Methergine - hypertension
  5. )Hemabate - not for asthma
24
Q

Assessing for hypovolemic shock

A
  • anxiety

- hypotension, tachyardia, slow capillary refil, decrease LOC, and low Urine output

25
Q

Nursing interventions in the event of DIC

A
  • transfer patient to ICU
  • replace fluid and give plasma
  • asses for signs of bleed (gums, petechia, echymosis, blood in stool)
26
Q

three most common venous thromboembolic conditions occurring during the postpartum period

A

DVT, PE, superficial venous thrombosis

27
Q

Thrombus paathophisiology

A
  • Venous stasis
  • injury to inner most layer of blood vessel
  • hypercoagulation
28
Q

Risk factors for thrombophlebitis

A
  • oral contraceptive use
  • smoking
  • prolonged sitting or standing or bed rest
  • history of thrombosis
  • obesity, diabetes
  • varicose veins
  • advanced age
29
Q

Signs and symptoms to assess for thrombophlebitis

A
  • lower extremity pain
  • reddened and warm lower extremities
  • pain with movement of extremity
  • positive homan’s sign
30
Q

signs and symptoms of pulmonary embolism

A
  • SOB
  • severe chest pain
  • diaphoresis
  • tachypnea and tachycardia
31
Q

Prevention of thrombotic conditions

A
  • encourage activity
  • dorsi and plantar flexion
  • intermitent sequential compressive device or compression stockings
  • elevate legs, no pillows under knees
  • no smoking and avoid use of oral contraceptives
  • anticoagulant therapy, aspirin
32
Q
  1. ) Collection of blood factors on a vessel wall
  2. )Vessel wall develops an inflammatory response to thrombus
  3. )A mass composed of thrombus
A
  1. ) Thrombus
  2. )Thrombophlebitis
  3. )Embolus
33
Q

environment encourages the growth of bacteria.

A

Alkaline environment

34
Q

an infectious condition that involves the endometrium, decidua, and adjacent myometrium of the uterus

A

Metritis

35
Q

Metritis that extends to broad ligament, ovaries, and fallopian tubes

A

Parametritis

36
Q

common bacteria that cause pelvic infections

A

E.coli, Klebsiella pneumonia, G. vaginalis

37
Q

Therapeutic technique for Metritis

A

Prophylactic antibiotic

38
Q

cause for surgical site infection

A
  • any break in the skin
39
Q

Causes for UTI

A
  • frequent vaginal examination
  • genital trauma
  • catheterization
  • epidural
40
Q

Inflammation of mammary gland

A

Mastitis (occur withing 2 days to 2 weeks

41
Q

Risk factors for mastitis

A
  • stasis of milk

- S. aureus, Staph albus, E. coli

42
Q

Therapeutic techniques:

  1. ) Metritis
  2. )Surgical site infection
  3. )UTi
  4. )Mastitis
A
  1. ) broad spectrum antibiotics, restore fluid electrolyte balance ( resolved at 48 to 72 hours after starting therapy)
  2. )open wound to allow drainage, clean wounds with aseptic technique, hydration and ambulation and antibiotics and analgesics
  3. ) prevent by timely removal of catheter, fluids, antibiotics, vitamin C and cranberry juice
  4. )emptying the breasts by feeding or manual expulsion and controlling the infection via antibiotics
43
Q

Factors that increase the risk of PPI

A
  • Prolonged membrane rupture >18-24 hrs and prolonged labor
  • incisional procedures and instrument assisted child birth and frequent vaginal exams
  • catheterization
  • regional anesthesia or epidurals
  • anemia, obesity, diabetes, smoking, drug use, poor nutrition
  • placental fragments
  • trauma
44
Q

S&S of Metritis

A
  • Lower Abdominal pain
  • fever, foul smelling lochia
  • nausea, fatigue, lethargy
45
Q

S&S of wound infection

A
  • serosanguineous or purulent drainage
  • unapproximated wound edges
  • edema or erythema
  • fever
46
Q

UTI S&S

A
  • Urgency
  • frequency
  • Dysuria
  • Cloudy urine and positive for nitrates
47
Q

Mastitis S&S

A
  • Flue like symptoms
  • tender warm, red area on one breast (inflammation)
  • nipple crack skin
48
Q

used for assessing a woman’s perineum status

A 
Redness
Edema
Ecchymosis
Discharge
Approximation of skin edges
(score of 0 to 3 each, the higher the score, the higher the trauma)
49
Q

how long does baby blues usually last

A

10 days, no more than 2 weeks

50
Q

difference between baby blues and PPD

A

PPD does not go away on its own and gets worse over time. Lasts longer than 6 weeks

51
Q

an emergency psychiatric condition, can result in a significant increased risk for suicide and infanticide.

A

Postpartum Psychosis

52
Q

S&S of Postpartum Psychosis

A
  • mood lability, delusional beliefs, hallucinations, and disorganized thinkin, anger towards self and infant
  • surfaces within 3 months
  • sleep disturbance
  • fatigue
  • depressions

Maternity (4 decks)

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