Module 6

Question 1

First Degree Perineal Laceration

Answer 1

• Superficial vaginal mucosa or perineal skin

Question 2

Second Degree Perineal Laceration

Answer 2

• Involves vaginal mucosa, perineal skin and deeper tissues of the perineum

Question 3

Third Degree Perineal Laceration

Answer 3

• Same as second degree but involves the sphincter

Question 4

Fourth Degree Perineal Laceration

Answer 4

• Extends through the anal sphincter into the rectal mucosa.

Question 5

Treatment for Perineal Lacerations

Answer 5

-Usually suturing

Question 6

Episiotomy

Answer 6

-Controlled surgical enlargement of the vaginal opening during birth

Question 7

Indications for an Episiotomy

Answer 7

• Control over how much and where the vaginal opening is enlarged
• Clean edged opening

Question 8

What is an alternative to an episiotomy ?

Answer 8

Perineal massage and stretching before labor

Question 9

Midline Episiotomy

Answer 9

Directly down to the sphincter

Question 10

Mediolateral Episiotomy

Answer 10

Directly down and then to the side of the sphincter

Question 11

Nursing Care after episiotomy

Answer 11

• Cold packs for first 12 hours
• Hot packs sitze baths after 12-24 hours
• Oral analgesics as ordered
• No suppositories or enemas for 3-4 degree tears
• High fibre diets and fluids
• Stool softeners

Question 12

4 types of Shock

Answer 12

• Hypovolemic
• Septic
• Cardiogenic
• Anaphylactic

Question 13

HypoVolemic Shock

Answer 13

• Volume of blood is depleted and cannot fill circulatory system
• Caused by Postpartum Hemorrhage or blood clotting disorders

Question 14

Body Response to Hypovolemia

Answer 14

• Increased heart and respiratory rate
• Increase o2 content of red blood cells
• speed up circulation of blood in system
• BP shows narrow pulse pressure
• Blood flow to nonessential organs gradually stops
• Skin and mucosa membranes become pale, cold and clammy

Question 15

Narrow pulse pressure

Answer 15

Falling systolic

Rising Diastolic readings

Question 16

Immediate Medical and Nursing interventions to Correct HypoVolemia

Answer 16

• Give IV fluids to maintain circulating volume and replace fluids
• Blood Transfusions to replace lost erythrocytes
• Give O2 to increase saturation in blood cells
• Indwelling foley catheter to assess urine output

Question 17

Medication intervention to correct hypovolemia

Answer 17

• Oxytocin
• Ergot Alkaloids
• Misoprostol

Question 18

Nursing Care for Hypovolemia

Answer 18

• VS often
• O2 saturations
• Assess Lochia ( for clots )
• Assess Fundus
• Measurements of intake and output
• Monitor for signs of Anemia
• Emotional support to woman

Question 19

Postpartum Hemorrhage

Answer 19

• Blood loss greater then 500mL for vaginal birth or 1000mL for section.

Question 20

Postpartum hemorrhage early and late

Answer 20

Early within 24 hrs postpartum

Late between 24 hrs- 6 weeks postpartum

Question 21

What is the major risk of Hemorrhage

Answer 21

Hypovolemic shock

Question 22

Signs and Symptoms of a hemorrhage

Answer 22

• Tachycardia
• Active bleeding
• Narrow pulse pressure
• Pale, Cold, Clammy Skine
• Mental status changes
• Decreased urinary output.

Question 23

Causes of Early(Primary) Postpartum hemorrage

Answer 23

• Uterine atony
• lacerations or tears of the reproductive tract
• Retained products

Question 24

Uterine Atony

Answer 24

• Collection of blood in Uterus

Question 25

Medications used to Treat PPH

Answer 25

- Oxytocin : stimulate upper muscles of uterus - Carbetocin ( long acting oxytocin) - Ergonovine ( Ergot Alkaloids): Stimulates the myometrium and upper/lower uterine segments - Misoprstol: Vasoconstrict and enhance contractility.

Question 26

Late PPH causes

Answer 26

- Retention of placenta - Subinvolution - Preparation for IV medication - Prepare for possible surgical intervention

Question 27

Nursing care for late PPH

Answer 27

- Teach to report persistent bright red bleeding | - return of red bleeding after it has changed to pink or white

Question 28

Puerperal Sepsis

Answer 28

Infection after child birth fever 38 after first 24hr lasts 2days for first 10 dats postpartum

Question 29

Risks of Puerperal Sepsis

Answer 29

- Cracked Nipples - Surgical incision - tissue trauma during labor - Open wound at placental insertion site - retained placenta or blood clots - increased pH of the vagina after birth - Endometritis ( inflammation of the uterus lining)

Question 30

Nursing care for Infection

Answer 30

- teach hygienic measures - promote adeqüei rest and nutrition - teach and observe for signs of infection - teach how to correctly apply perineal pads - teach the woman to take all antimicrobial medications as prescribed.

Question 31

Thromboembolic Disorders

Answer 31

- Venous thrombosis blood clots

Question 32

Types of thromboembolic Disorders

Answer 32

Superficial Vein Thrombosis - Deep Vein thrombosis Pulmonary embolism

Question 33

Anticoagulant teachings

Answer 33

- Prolonged bleeding from minor injuries - Nosebleeds - Unexplained bruising - stress importance of completing follow up blood tests

Question 34

Rh incompatability medication

Answer 34

- Rh0 immunoglobulin is administered at 28 weeks and within 72 hours after delivery

Question 35

ABO blood incompatibility

Answer 35

Mothers blood type is O and babies is A or B this is life threatening