Flashcards in Final Deck (37):
What is primary PPH?
Within the first 24 hrs
What is secondary PPH?
What are some interventions for uterine atony?
Assess for bleeding/fundal height/ fundal massage
IV fluid and/or transfusion
Bimanual compression of uterus
Ligation of uterine vessels or hysterectomy
What are the 3 types of puerperal infections?
Metritis, perineal, cesarian infections
What are the causes of metritis?
Cesarean - Prolonged labor
PROM - Multiple vaginal exams
Scalp electrodes - Internal uterine monitor
OB trauma - Instrument assisted birth
Manual removal of placenta
Compromised health status
What are the assessments for metritis?
Foul smelling vaginal discharge
Fever 101-104 F
30% increase in WBC
What are the interventions for metritis?
Abscess is drained
What is metritis?
inflammation of the uterus
When do Superficial thrombophlebitis occur?
3rd to 4th day after delivery
When do Deep vein thrombosis occur?
10-20 days after delivery
What assessment findings would you want to look out for, for a pulmonary embolism?
Dyspnea >> Chest pain
Cough >> Hemoptysis
Cyanosis >> Hypotension
Tachypnea >> Tachycardia
What are the two biggest signs of pyelonepritis?
flank pain and high fever
What are the assessment findings of pyelonephritis?
UTI signs >> High fever
Chills >> Flank pain
N&V >> Acutely ill
What are the values for
Urine protein: > 300 mg. of protein in 24 hours
Blood Pressure: > 140/90 in two readings 4 hours apart after 20 weeks
Platelets: < 100,000
Serum createnine . 1.1 mg.
Liver function: double the normal values
What is the definition for preeclampsia?
Vasospastic disease with reduced organ perfusion
Protein in urine
When does preeclampsia develop?
after 20 weeks gestation
What are some risk factors for preeclampia?
Chronic renal disease/ hypertension
Family hx of preeclampsia
Multiple gestations/first baby
First baby with a new partner
Younger than 19 or greater than 40 years of age
What are some theories of why women get preeclampsia?
Abnormal prostaglandin action
Endothelial cell dysfunction
Abnormal trophoblastic invasion
Dietary deficiencies or excesses
When giving magnesium for preeclampsia, what are some important things to remember?
Have antidote: Calcium gluconate
Vitals and urine output Q1Hr
Keep it quiet
Education of the magnesium: metallic taste, muscle weakness, feels very hot internally
Monitor fetal response (usually has flat variability on the fetal monitor)
Labs: mag levels/ liver damage
What is one thing to be very aware about post delivery when giving mag?
Will probably bleed a lot more than normal, so be ready
How long post-partum does the mother have to have high BP for it to be considered chronic?
What is the HELLP syndrome?
Checks hepatic disfunction with preeclampsia with:
EL: elevated liver enzymes
LP: low platelets
What are some risk factors for hemorrhage ?
HX of it in the past
Overdistended/ ruptured uterus
Unrepaired lacerations of the birth canal
*Mag admin during labor
What is true PPH?
Bleeding after the placenta is delivered
What is the #1 cause of secondary/ delayed hemorrhage?
uterine subvolution, retained products.tissue
What are the steps to stopping hemorrhage?
1- Fundal massage- get help
3-other hemorrhage drugs
5- Empty bladder
When do "baby blues" normally start?
When do they end?
around day 3
after 10 days
how common are baby blues?
80% of women
What are the signs of baby blues?
How common is postpartum depression?
What are the signs of PPD and how many have to be present to be classified?
Fatigue/ Insomnia/ Lack of interest
Poor concentration and decision making
Feelings of failure as a mother
Unusual worry over infant's health
What are some coping treatments for PPD?
Social support system
Counseling with a therapist specializing in perinatal mental health
Which drug is the first line for breastfeeding mothers who have PPD?
What are the signs of postpartum psycosis?
Disorganization of thought
Hallucinations/ Delusions(strange beliefs)
Hyperactive/ Decreased need for sleep
Significant mood changes with poor decision making
What are some contraindications to using nexplanon?
Known or suspected pregnancy
*Sever Hepatic Disease
*Personal hx of Breast Cancer
*Undiagnosed vaginal bleeding
*inability to tolerate irregular menses,
bleeding and spotting
What are LARCS?
Long ascting reversible contraceptives