Exam 3 Essays

Question 1

patho of pulmonary embolism

Answer 1

• complication of DVT occurring when 1 part of blood clot dislodges and is carried to the pulmonary artery
• occludes the vessel and obstructs blood flow to the lungs
• more common in postpartum period

Question 2

estrogen influence of pulmonary embolism

Answer 2

• plasma fibrinogen (coagulation/clots) increase during pregnancy
• plasminogen (lysis of cells) does NOT increase

Question 3

assessment of pulmonary embolism

Answer 3

• check resp. status and auscultate for crackles
• echocardiogram abnormalities may be seen
• pulmonary arteriogram used for diagnosis

Question 4

treatment of pulmonary embolism

Answer 4

• anticoagulant therapy
• continuous heparin therapy until symptoms have resolved
• intermittent subcut heparin or oral anticoagulant therapy for up to 6 mos

Question 5

s/s of pulmonary embolism

Answer 5

dyspnea, chest pain, cough, hemoptysis

Question 6

physical signs of pulmonary embolism

Answer 6

tachypnea (RR >16), rales, tachycardia, fever, diaphoresis

Question 7

what are the acute respiratory consequences of pulmonary emobolism

Answer 7

• increased alveolar dead space (diminished breath sounds)
• hypoxemia (decreased O2 sat)
• hyperventilation (decreased O2 and paresthesia)

Question 8

who should pulmonary embolisms be actively sought in

Answer 8

pts with respiratory symptoms that are unexplained by an alternate diagnosis (high index of suspicion d/t nonspecific symptoms)

Question 9

diagnostic features of pulmonary embolism

Answer 9

acute chest pain, syncope, abdominal pain, fever, productive sputum cough, wheezing, decreased level of consciousness

Question 10

patho of deep vein thrombosis

Answer 10

• occurs in lower extremities, involvement varies but can extend from the foot to the iliofemoral region
• DVT occurs most often during pregnancy

Question 11

estrogen influence of DVT

Answer 11

plasma fibrinogen (clotting) increased during pregnancy
plasminogen (lysis) does not increase

Question 12

s/s of DVT

Answer 12

unilateral leg pain, calf tenderness and swelling

redness and warmth

Question 13

assessment of DVT

Answer 13

• inspect/palpate affected area, palpate peripheral pulse, check homan’s sign, measure/compare leg circumference
• assess for unusual bleeding, increased lochia, petechiae, hematuria, oozing from venipuncture

Question 14

what is the status of homan’s in r/t DVT

Answer 14

positive homan’s needs more diagnostic testing, NOT performed because it can dislodge clot and cause PE

Question 15

treatment of DVT

Answer 15

• anticoagulant therapy and continuous IV heparin, bed rest, affected side elevated and analgesic
• fitted with compression sock when allowed to ambulate
• IV heparin continued 3-5 days or until ss resolve
• oral anticoagulant therapy (warfarin/coumadin) continued 3 mos
• prothrombin time monitored at least monthly

Question 16

assessment for BOTH DVT and PE

Answer 16

venous ultrasound

labs-prothrombin time

Question 17

patho for BOTH DVT and PE

Answer 17

venous stasis and hypercoagulation

Question 18

estrogen influence for BOTH DVT and PE

Answer 18

SAME
increased fibrinogen
decreased plasminogen/fibrinolytic activity

Question 19

barrier methods for B/C

Answer 19

condom and diaphragm

Question 20

describe BC for breastfeeding mothers

Answer 20

• start progesterone only BC methods after 3 wks of breastfeeding
• *progesterone only BC

Question 21

types of BC allowed for breastfeeding mothers

Answer 21

minipill (Micronor), Depo-provera (lasts 3 mos), Nexplanonon (arm, last 3 yrs), Mirena (IUD, lasts 5 yrs), Skyla (smaller mirena, lasts 3 yrs)

Question 22

describe BC for nonbreastfeeding mothers

Answer 22

• start on low dose hormonal BC containing estrogens and progesterone OR just progesterone AFTER 6 wk mark
• wait 6 wks d/t risk of developing DVT/PE after delivery

Question 23

what to watch for in estrogen containing BC

Answer 23

*ACHES
Abdominal pain
Chest pain
Headaches
Eye pain
Severe leg pain

Question 24

what are you at an increased risk for developing with estrogen containing BC

Answer 24

blood clot or stroke

Question 25

what to watch for with IUB BC

Answer 25

``` *PAINS Period late/pelvic pain Abdominal pain Infection Not feeling well Strings missing (dislodged IUD=ineffective) ```

Question 26

what is postpartum blues

Answer 26

a let down of feeling, accompanied by irritability and anxiety usually begins 2-3 days after birth and disappears within a week or two

Question 27

how do mothers feel with postpartum blues

Answer 27

- emotionally liable and often cry easily for no apparent reason - overwhelmed and in vulnerable state from giving birth

Question 28

what is postpartum depression

Answer 28

a major depressive episode with an onset of pregnancy or within 2 wks of childbirth with symptoms lasting up to a year

Question 29

what is a risk factor for postpartum depression

Answer 29

hx of anxiety or depression

Question 30

symptoms of postpartum depression

Answer 30

depressed mood, fatigue, irritability, loss of appetite, sleep disturbance, loss of libido

Question 31

treatment for postpartum blues

Answer 31

no treatment, educate, resolves on own

Question 32

treatment of postpartum depression

Answer 32

ranges with severity antidepressants (ssri) psychotherapy

Question 33

when should pt contact HCP when depressed

Answer 33

change in appetite, feelings of guilt, lack of interest in baby/friends, thoughts of harming baby or self