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Flashcards in Final Deck (37):
1

What is primary PPH?

Within the first 24 hrs

2

What is secondary PPH?

24hrs--12 wks

3

What are some interventions for uterine atony?

Assess for bleeding/fundal height/ fundal massage
Encourage voiding
Oxytocin (Pitocin)
Contact physician
Methylergonovine (Methergine)
IV fluid and/or transfusion
Bimanual compression of uterus
Ligation of uterine vessels or hysterectomy

4

What are the 3 types of puerperal infections?

Metritis, perineal, cesarian infections

5

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
Prexisting infection
Compromised health status

6

What are the assessments for metritis?

Abd/Uterine pain
Foul smelling vaginal discharge
Fever 101-104 F
Chills
Malaise
30% increase in WBC

7

What are the interventions for metritis?

CBC
Cultures
Hygiene
Abscess is drained
IV antibiotics
Antipyretics
ICU hospitalization

8

What is metritis?

inflammation of the uterus

9

When do Superficial thrombophlebitis occur?

3rd to 4th day after delivery

10

When do Deep vein thrombosis occur?

10-20 days after delivery

11

What assessment findings would you want to look out for, for a pulmonary embolism?

Dyspnea >> Chest pain
Cough >> Hemoptysis
Cyanosis >> Hypotension
Tachypnea >> Tachycardia

12

What are the two biggest signs of pyelonepritis?

flank pain and high fever

13

What are the assessment findings of pyelonephritis?

UTI signs >> High fever
Chills >> Flank pain
N&V >> Acutely ill

14

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

15

What is the definition for preeclampsia?

Vasospastic disease with reduced organ perfusion
Protein in urine
CNS irritability
Hypertension

16

When does preeclampsia develop?

after 20 weeks gestation

17

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
Diabetes/Obesity
RH incapability

18

What are some theories of why women get preeclampsia?

Vasoconstrictor tone
Abnormal prostaglandin action
Endothelial cell dysfunction
Coagulation abnormalities
Abnormal trophoblastic invasion
Dietary deficiencies or excesses

19

When giving magnesium for preeclampsia, what are some important things to remember?

NPO
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

20

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

21

How long post-partum does the mother have to have high BP for it to be considered chronic?

12 weeks

22

What is the HELLP syndrome?

Checks hepatic disfunction with preeclampsia with:
H: hemolysis
EL: elevated liver enzymes
LP: low platelets

23

What are some risk factors for hemorrhage ?

prolonged/augmented labor
HX of it in the past
Overdistended/ ruptured uterus
Operative delivery
Unrepaired lacerations of the birth canal
*Placenta Previa
*Mag admin during labor
Coagulation disorders

24

What is true PPH?

Bleeding after the placenta is delivered

25

What is the #1 cause of secondary/ delayed hemorrhage?

uterine subvolution, retained products.tissue

26

What are the steps to stopping hemorrhage?

1- Fundal massage- get help
2- Pit
3-other hemorrhage drugs
4-Vitals Q5mins
5- Empty bladder
(O2)

27

When do "baby blues" normally start?
When do they end?

around day 3
after 10 days

28

how common are baby blues?

80% of women

29

What are the signs of baby blues?

General irritability
*Weepiness
*Feeling down

30

How common is postpartum depression?

15-20% women
10% partners

31

What are the signs of PPD and how many have to be present to be classified?

4 present
Depressed mood
Agitation
Fatigue/ Insomnia/ Lack of interest
Poor concentration and decision making
Poor appetite
Feelings of failure as a mother
Guilt
Unusual worry over infant's health
Suicidal thoughts

32

What are some coping treatments for PPD?

Sleep
Nutrition
Exercise
Social support system
Counseling with a therapist specializing in perinatal mental health

33

Which drug is the first line for breastfeeding mothers who have PPD?

Zoloft

34

What are the signs of postpartum psycosis?

Bizarre behavior
Disorganization of thought
Hallucinations/ Delusions(strange beliefs)
Irritation
Hyperactive/ Decreased need for sleep
Significant mood changes with poor decision making

35

What are some contraindications to using nexplanon?

Known or suspected pregnancy
*Active DVT
*Sever Hepatic Disease
*Personal hx of Breast Cancer
*Undiagnosed vaginal bleeding
*inability to tolerate irregular menses,
bleeding and spotting

36

What are LARCS?

Long ascting reversible contraceptives

37

What are examples of LARCS?

IUDs or Nexplanon