Part II Flashcards
(25 cards)
What are some Additional Causes (not uterine atony) of Postpartum Hemorrhage?
Causes of Postpartum Hemorrhage
· Genital tract lacerations
· Episiotomy
· Retained placenta fragments
· Vulvar or vaginal hematomas
· Uterine rupture or inversion
· Coagulation disorders
*Increased risk if previous hemorrhages
What are some signs of postpartum Hemorrhage?
Signs of Postpartum Hemorrhage
· Saturation of a pad an hour or more
· Boggy/Soft uterus-does not respond to massage.
· Abnormal clots (bigger than nickel is too big)
· High temperature
· Pelvic pain/backache
· Persistent bleeding with firm fundus
· Pulse up, BP down, decreased LOC
· High fundus
· Hematoma formation perineum
What are some ways to prevent Postpartum Hemorrhage?
· Assess every patient for risk factors
· Assess fundus, lochia, pulse, BP, incision, urine output/bladder placement, O2 sat., turgor, skin color per policy and as needed.
What are some Nursing Actions for Postpartum Hemorrhage?
· Yell for help-Initiate response team
· Massage fundus until firm if needed.
· Remember that the hemorrhage may not be because of uterineatony!!
· IV fluids (LR or normal saline)
· Administer prescribed uterotonic meds
.· Apply pulse oximeter & give O2 per protocol.
· Insert Foley· Maintain I & O
· Assess blood loss
· BP & pulse every 15 mins or more often.
· Assess for shock.
· Elevate legs 20-30 degrees.
· Draw CBC, type and crossmatch & coagulation studies.
· Notify blood bank.
Methergine, the medication used to treat severe bleeding after childbirth, is contraindicated in those with _______ disease
heart
What are some uterine stimulant medications used for postpartum hemorrhages?
· Oxytocin (Pitocin)-IV or IM
· Misoprostol (Cytotec)-rectally
· Dinoprostone (Prostin E2)-Vag or rectally
· Methylergonovine (Methergine)-IM
· Prostaglandin (Hemabate)-IM
What are some common postpartum infections?
Common Infection Sites
· Endometritis (infection of the endometrium)
· Wounds (genital/perineal), cesarean/uterine incision
· UTI
· Postpartum Mastitis
What are some Risk Factors for Endometritis?
· Cesarean delivery (endometritis 25x more common withcesarean)
· PROM (Premature rupture of membranes)
· Multiple vaginal exams during labor or manual removal of retained placental fragments after delivery.
· Compromised health status of the mother (Illicit drug use/alcohol, poor nutrition, anemia, smoking,obesity)
· Use of internal monitors, vacuum, or forceps
· OB trauma (lacerations/episiotomy)
· Preexisting bacterial vaginal/uterine infection or Chlamydia
· Diabetes
What are the Assessment Findings and Nursing Actions with a Uterine Infection?
· Foul-smelling lochia and/or excessive lochia
· Uterine/lower abdominal pain or pain
· Fever above 100.4; elevated WBCs
· Tachycardia, chills, nausea, fatigue
· Nursing Interventions: Teach/Practice preventative measures.
- Monitor for s/s infection in all PP women.
- Administer acetaminophen & contact care provider if symptoms of infection.
- Monitor characteristics of lochia-could be hemorrhage too!
- Monitor I & O, maintain IV.
Discuss Perineal Wound Infections and the nursing actions.
PERINEAL WOUND INFECTIONS
· Patient might present with classic infection signs in the wound.
Nursing Actions:
- Teach peri care/sitz bath use.
- Teach and practice good hand hygiene.
- Assess any wound for redness, edema, pain, heat, purulent drainage, approximation.
- Assess temperature.
- Assess labs if available; increase of WBC by 30% in 6 hours.
- Culture as ordered and watch for result.
- Report s/s to care provider, administer acetaminophen for fever, treat pain.
What are some Urinary Tract infection Risk Factors for postpartum moms?
- Excessive vaginal exams
- Urinary catheters
- Trauma during delivery
- PP Diuresis/Incomplete emptying/decreased sensitivity
What is the difference between Engorgement and Mastitis?
Engorgement - excessive amount of milk (not infected)… breast is hot, swollen, sore so the milk needs to come out (or ice if not)
Mastitis - flu-like symptoms, pain, fever, etc.
Explain Mastitis.
MASTITIS
· Infection of the interlobular connective tissue of the breast that occurs primarily in lactating women.
Commonly occurs between 2 days and 2weeks postpartum; · Commonly S. Aureus from baby’s mouth.
- Incidence is as high as 10% in breastfeeding women.
· Red, hot area on breast with flu-like symptoms, fever, and pain.
How is Mastitis treated?
Goals:
- controlling infection and keeping breasts empty.
- Antibiotics (10-14 days),
- NSAIDS, heat & ice for comfort, bedrest,
- keep breast feeding on affected breast!!
true or false - should a breastfeeding mother continue to feed her baby on a breast with Mastitis?
YES! - keep breast feeding on affected breast!!
Explain Thromboembolic Disease?
THROMBOEMBOLIC DISEASE
· All pregnant women are at higher risk because of hypercoagulability & venous stasis.
· Iliac vein common site
· Can be Antepartum or Postpartum but almost always a PP issue (clot risk elevated for 12 weeks postpartum but highest the first 3 weeks postpartum)
· Can be superficial (saphenous vein) or deep vein… Superficial rarely results in PE or need for anticoagulant therapy.
How are DVTs treated?
- Treated with extremely elevation, heat, analgesics, bedrest and support hose.
*DO NOT MASSAGE! NEVER apply COLD (dont want vasoconstriction)
What are Risk Factors for Thrombophlebitis?
· Cesarean birth
· Prolonged immobility
· Obesity
· Smoking
· Previous clots/strong family hx
.· Oral Contraceptive Use
· Varicose veins
· Diabetes or anemia
· Advanced maternal age
· Multiparity
What are the Treatments/Nursing Actions for Thrombophlebitis?
· IV Heparin or low molecular weight heparin
· warfarin sodium (Coumadin) 4-6 weeks to follow
· Strict bedrest
· Elevation of the affected limb
· Analgesics as ordered
· Heat to area
· Support hose after several days of anticoagulant therapy
· Nurse must teach s/s bleeding, importance of labs and what to report.
*Monitor aPTT (activated partial thromboplastin time) therapeutic at 35-45 seconds
· Might monitor Anti-factor Xa-therapeutic level typically 0.6-1.0units/mL.
What are some s/s of Pulmonary Embolism?
Signs/Symptoms:
o Dyspnea, chest pain, cough, cyanosis, tachypnea, tachycardia, panic, syncope, or sudden hypotension
· High mortality rate
· Most fatalities happen in 30-60 minutes.
What are Nursing Actions for Pulmonary Embolism?
Nursing Actions for Pulmonary Embolism
· Alert rapid response team & care provider
· Elevate HOB
· Oxygen at 8-10 Liters
· Narcotics for pain and anxiety
· Several imaging tests for diagnosis
· Immediate anticoagulants
· alteplase (tPA) to dissolve clot(s)
· ICU for close CV and respiratory monitoring
What is the difference between Baby Blues and Postpartum Depression?
Postpartum Blues (Baby Blues)-Occurs in up to 80% of PP women.
*Able to still function but very emotions (no treatment needed)
*Postpartum Depression - needs to be treated clinically
Explain Postpartum Blues (Baby Blues).
Postpartum Blues (Baby Blues)
- Occurs in up to 80% of PP women.
- Usually peaks 4-5 days after delivery.
- Usually resolves by postpartum day 14.
- Emotional hypersensitivity but still functioning - no treatment needed.
Explain Postpartum Depression.
Postpartum Depression
- clinical depression
- 1 in 9 women experience symptoms of PPD
- Can occur anytime the first year-Gradual onset but usually evident by 6 weeks postpartum.
- PPD may persist a minimum of 6 months without treatment.
- Often suicidal, thoughts of harming baby, guilt, detachment
- Combination of therapy and antidepressants best
