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Flashcards in PostComplicationsAdap Deck (68)
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1
Q

How long does it the uterus and vagina to return to pre-pregnant size? How much does the uterus decease in size a day? When is the fungus no longer palpable?

A

Pre-pregnant size takes up to 6 weeks.
Decreases in size 1cm (1 finger breadth) a day
Fundus not palpable about 10 days after delivery

2
Q

When the uterus contracts after devilry. Often in response to breastfeeding.

A

Afterpains.

Complications in labor, delivery, or in the postpartum period can delay involution.

3
Q

Different stages of lochia?

A
Scant: less than 2 inches stain
Light: less than 4
Moderate: less than 6
Large: larger than 6 Tain and saturated in 2 hours 
Excessive: saturated within 1 hour
4
Q

Blood volume and cardiac output decreases postpartum are related to what? How long does it take to return to normal? What remains that increases the risks for DVTs and PE?

A

Related to blood loss at delivery. Takes about 6-8 weeks to return to normal.
Hypercoagulable state remains for 2-3 weeks.

5
Q

Blood plasma is further reduced due to diuresis. Explain hematocrit? Pulse?

A

Hematocrit stays stable or increases due to plasma reduction. Acute decrease in hematocrit is unexpected.
Pulse decrease is normal for a postpartum woman: 40-60 bpm.

6
Q

Why might postpartum women have difficulty voiding?

A

Anesthetic block inhibits neural functioning of the bladder. Oxytocin has an antidiuretic effect. Lacerations or swelling of the perineum. Hematomas.

7
Q

What can inhibit contractions of the uterus postpartum?

A

Displacement of the uterus with a full bladder.

8
Q

Diuresis of a postpartum woman within 12 hours?

A

Up to 3,000mL a day.
<150mL per void may indicate retention.
No void in 4-6 hours post delivery may require catheterization.

9
Q

There is no longer pressure on the abdominal organs after delivery, but explain constipation, appetite, and thirst?

A

Constipation can be caused by decreased peristalsis which causes decreased bowel tone. Fear of pain with bowel movement.
Hungry and thirsty because of energy expenditure and NPO status during labor.

10
Q

How does one assist a postpartum woman with elimination?

A

Privacy, get up as soon as possible. Pain management. Increasing fluids. Stool softener or laxatives, dietary changes.
For difficulty voiding use warm water on the perineum or hearing running tap water.

11
Q

Why are hip and joint pain increased? What happens to abdominal muscles?

A

Decreased progesterone and relaxin. Fatigue and exercise intolerance.
Joints eventually return to pre-pregnant state but there’s a permanent increase in shoe size.
The abdominal wall stretches which means loss of muscle tone requiring specific exercises.

12
Q

Explain the changes in the integumentary postpartum

A

Darkened pigment in the skin fades with decreased estrogen and progesterone. Temporary hair loss can occur within 3 months of delivery due to decreased estrogen. Diaphoresis can be profuse in early postpartum period as increased body fluids of pregnancy return to normal.

13
Q

RR postpartum? Diaphragm?q

A

16-24 bpm. Diaphragm returns to normal position. Pregnancy experienced SOB and rib pain resolve. Lung function changes of pregnancy return to normal quickly.

14
Q

Estrogen and progesterone levels drop quickly after delivery of the placenta. Breastfeeding?

A

Decreased estrogen causes breast engorgement. Breastfeeding keeps estrogen levels low. It’s dependent on the frequency of breast-feeding.

15
Q

Progesterone and prolactin after postpartum?

A

Progesterone levels begin to increase again with menstrual cycle. Prolactin remains elevated in women who are breastfeeding.

16
Q

Suckling on the breast stimulates hormone release. First secretions?

A

Prolactin stimulates milk production. Oxytocin causes the let down release of milk.
Colostrum, high in protein and carbs but not milk fat. Breast milk comes in at 4-5 days.

17
Q

When does the postpartum assessment happen? What’s involved?

A

Begins within an hour of delivery. Frequent vitals and fundal checks per protocol. Patient history, pregnancy, labor, delivery events, interventions.

18
Q

Vitals for a postpartum woman?

A

Temp as high as 100.4 normal for first 24hrs. Bradycardia can be normal for the first week. BP can vary with position but should stay similar to labor.

19
Q

What should be looked for with persistent perineal pain?

A

Hematoma. Pre-medicate postpartum women for pain

20
Q

BUBBLE EEP

A
Breasts and nipples
Uterus
Bladder
Bowels
Lochia
Episiotomy
Extremities (lower)
Emotions (bonding)
Pain
21
Q

Explain what three things cause a predisposition to DVT postpartum?

A

Stasis of blood: compression of large veins by gravid slows blood flow back to the heart.
Altered coagulation due to pregnant state.
Localized vascular damage in any vessel, not just the legs during the birthing process.

22
Q

What are some subtle signs of DVT?

A

Lower extremity tightness or aching relieved by rest, feels like compression possibly. Edema in the affected leg, usually the left. Warmth, tenderness, redness in the affected calf. Low-grade fever.

23
Q

This lasts from immediately after birth until about 24-48 hours.

A

Taking-in. Mother depends on others to help meet her needs and relives the birth process.

24
Q

This begins 3 days post partum and lasts for several weeks.

A

Taking-hold. Mother is more self-sufficient but still needs reassurance. Preoccupied with the present.

25
Q

Explain letting-go?

A

Reestablishes relationships with others. Adapts to parenthood. More confident in ability to care for the newborn.

26
Q

The emotional attraction in the first 30-60 minutes to a few hours after birth.
The strong affection between the infant and mother or significant other.

A

Bonding. Continuation of the relationship that began during pregnancy. During this time, the infant is quiet, alert, and looks at the mother.
Attachment

27
Q

Monitor the mother’s interest in the newborn. Further emotions/bonding monitoring?

A

Is she feeding and caring for it? Is she interested or disinterested? Does she want the baby in the nursery all the time?
Use a standard postpartum screening tool on all post natal women. PPD is the most common complication of pregnancy

28
Q

What must the mother fill out herself, answering all questions?

A

Edinburgh postnatal depression scale. Often done when she has already gone home. Questions are asked about her feelings for the last 7 days, not just the day she does it. If she has a borderline high score, it should be repeated at the end of the second week.

29
Q

Transient emotional disturbances that involve anxiety, irritability, insomnia, and sadness.

A

Postpartum blues. Begin at 3-4 days and last up to 2 weeks. Typically resolves once mother gets better sleep. No formal treatment other than reassurance.

30
Q

Factors that affect the attachment of the parents and their children?

A

Background of the parents, the infant, care practices. Occurs most readily when parent’s expectations have been met. Temperament, gender, health, and appearance.

31
Q

What should be initiated within 30-60 minutes of birth?

A

breastfeeding. Exclusively breastfeed on demand, at least every 2-3 hours. Encourage “rooming in.”
Increase maternal calories by 500/day and fluid intake to 2 quarts/day.

32
Q

What is involved in care of the breasts when breastfeeding?

A

Wear well-fitting, supportive bra 24 hours/day. Ice packs for soreness. Air dry after feeding instead of covering when wet which causes chafing. Lanolin cream once dry.

33
Q

What should be remembered when bottle feeding?

A

No stimulation or heat to excess milk. Cabbage leaves may help to dry milk.

34
Q

What are some high risk postpartum conditions?

A

Postpartum hemorrhage, thromboembolitic conditions, postpartum infection, postpartum affective disorders

35
Q

How much blood is lost after birth to be considered postpartum hemorrhage (PPH)? Timing?

A

> 500mL after vaginal birth. >1000 after c/s.

Early if within 24 hours after birth. Late when 24 hours to 12 weeks after birth.

36
Q

Common causes of PPH (hemorrhage)? Shock?

A
Uterine atony (early)
Lacerations/trauma (early)
Subinvolution of the uterus (late) 
Clotting disorders (early or late)
Hypovolemic shock is a late symptom (increased blood volume during pregnancy)
37
Q

4T’s, causes of PPH?

A

Tone: abnormalities of uterine contractions
Tissue: retained POC in uterus
Trauma: to the genital tract
Thrombin: preexisting coagulopathies
Maybe traction: forceful pulling of the placenta

38
Q

Tone. Overdistention of the uterus, most common cause of PPH. Causes?

A

Overdistention: multifetal gestation, fetal macrosomia or abnormality, hydramnios, placental fragments.
Tone: prolonged, forceful or rapid labor. Bacterial toxins, infection. Use of anesthesia/magnesium sulfate. Distended bladder.

39
Q

Failure of the uterus to contracted retract. Causes and treatment?

A

Uterine atony. Causes are distended uterus in pregnancy, distended bladder postpartum, other risk factors.
Treatment: massage funds and assess loch. Increase IV fluids. Administer uterine stimulant medications.

40
Q

Uterine stimulant medications?

A

oxytocin, misoprostil, dinoprostone, methylergonovine, prostaglandin PGF2a

41
Q

Tissue. Retained placental fragments which may lead to what?

A

Uterine inversion, fundal prolapse to or through the cervix. Subinvolution, incomplete involution of the uterus or failure to return to normal state after birth. Placenta previa, placental abruption

42
Q

Causes and clinical signs of subinvolution?

A

Causes: retained placental fragments (RPOC), distended bladder, infection or uterine myoma.
Signs: PP fundal height higher than expected, boggy uterus, loch progression abnormal.

43
Q

Treatment of subinvolution?

A

Often identified at 4-6 week exam. Uterine stimulant. Antibiotic prophylaxis.

44
Q

Trauma. Damage to the genital tract. What does it involve?

A

Lacerations: continuous trickling of bight red blood with contracted uterus, pushing too soon, fetal presentation or forceps delivery.
Uterine inversion, uterine rupture (previous c/s, surgery), prolonged or vigorous labor (uterine stimulants), manipulation of fetus or instrumentation, hematoma.

45
Q

Can be vaginal or perineal. Visible as swelling. Pain may be severe. Change in VS disproportionate to blood loss. Treatment?

A

Hematoma.

Ice packs, decreased pressure when sitting, pain meds, monitor closely for rupture.

46
Q

Thrombin. Disorders that interfere with clot formation: coagulopathies. Suspected when PPH persists without cause.
Risk? Common abnormal results?

A

Risk determined during pregnancy. Family history, history of mennorhagia, clotting disorders.
Results: decreased platelet and fibrinogen levels, increased PT and PTT, prolonged bleeding time.

47
Q

Platelet destruction by autoantibodies.

A

Idiopathic thrombocytopenia purpura. ITP.

Treatment is glucocorticoids and immune globulin (IVIG)

48
Q

Congenital disorder (autumnal dominant). Deficiency of this factor. Prolonged bleeding time. Impaired platelet function.

A

von Willebrand disease. vWD. Factor increases during pregnancy. Common symptoms include nosebleeds, menorrhagia, hematomas.

49
Q

Clotting system is abnormally activated. Clotting and bleeding occur at the same time. Life threatening and emergent.

A

Disseminated intravascular coagulation. DIC.
Always a secondary diagnosis. Symptoms include bleeding form multiple sites, petechiae. Abnormal lab values and vitals.
Treatment is correcting the underlying cause, maintaining tissue perfusion (aggressive fluids, blood products)

50
Q

Excessive force on umbilical cord during the 3rd stage of labor to hasten the stage.

A

Traction. Lack of uterine separation from the placenta during the placental delivery. Can result in uterine inversion.

51
Q

Prolapse of the uterine fundus through the cervix. Uterus turns inside out. Occurs in 1 in 6000 births.

A

Uterine inversion. Prompt recognition and treatment are essential.
Treatment includes gentle replacement of the uterus (anesthesia). Oxytocin and antibiotics.
Prevent by avoiding pulling on the umbilical cord.

52
Q

Nursing management of PPH?

A

Correct underlying cause, assess uterine tone, immediate massage if atony, administer uterotonic drug, IV fluid resuscitation, monitor vitals q 15-30 mins, assess/estimate blood loss. Assist client to void, prepare for removal of retained parts, assess for hemorrhagic shock, institute emergency measures for DIC

53
Q

What are the common types of thromboembolic conditions during the PP period? Causes?

A

Superficial venous thrombosis, deep venous thrombosis, pulmonary embolism (leading cause of PP death).
Venous stasis, hyper coagulation, injury to blood vessel

54
Q

Pre-pregnancy and pregnancy related risk factors for TE conditions?

A

Pre: use of OCP, smoking, prolonged sntading, history of TE disease or endometriosis, current varicosities
Preg: bedrest, maternal DM, obesity, anemia, AMA, multiparty, c/s

55
Q

Symptoms of PE?

A

Sudden onset SOB/chest pain. Diaphoresis, anxiety. Change in vital signs: increased RR, increased HR, decreased BP, decreased O2. Change in mental status.

56
Q

Prevention of TE conditions?

A

Encourage ROM (active or passive). Use compression stockings/devices. Elevate legs. Avoid smoking, OC, trauma, prolonged standing.

57
Q

Promoting adequate circulation during treatment of TE?

A

Promote adequate circulation during treatment with analgesia, rest, elevate affected leg. Antiembolism stockings, warm compresses, anticoagulant therapy.

58
Q

Fever of 100.4F or higher. Occurs after the first 24hrs post birth. Occurs on at least 2 days in the first 10 days. Risks?

A

Postpartum infection.
Surgical birth, prolonged ROM, prolonged labor with multiple vaginal checks, extremes of client age, low socioeconomic status, anemia.

59
Q

Uterine infection, sometimes referred to as endometritis. Within 6 weeks of birth. Symptoms?

A

Metrits. Sterile environment until rupture of the sac. Increased risk after c/s.
Symptoms include pain, backache, foul-smelling lochia, increased WBC.
Maintain upright position

60
Q

Wound infections? Symptoms?

A

Surgical incisions, episiotomy, lacerations. 24-48 hours post-delivery.
Redness, warmth, swelling, tenderness, foul drainage, odor, pain

61
Q

UTI’s and symptoms?

A

Urinary catheterization, manipulation, trauma. 2-7 days post-delivery.
Dysuria, frequency, urgency, low-grade fever, hematuria (difficult to assess)

62
Q

Caused by milk stasis within the first two weeks PP. Usually unilateral. Most commonly caused by s aureus.

A

Mastitis.

Flu-like symptoms (chills, fever, malaise). Red, warm, very painful breast

63
Q

Nursing management of PP infection?

A

Administer appropriate antibiotics. Provide analgesia, emotional support, fluid and electrolyte balance. Assess perineum status with REEDA (ecchymoses). Assess wounds frequently. Vitals, esp temp.

64
Q

Includes baby blues, postpartum depression, postpartum psychosis.

A

Postpartum affective disorders. Extraordinary changes in the life of the pt. Varied reactions. Decreased estrogen and progesterone.

65
Q

Involves mild depression symptoms, common, 50-90% of mothers. Peaks on day 4-5 and resolves by day 10.

A

Baby blues. Self-limiting. No formal treatment. Follow up is needed.

66
Q

A form of clinical depression that affects up to 20%. Feelings worsen over time, requires treatment. Symptoms last longer and are more severe than BB.

A

Postpartum depression, PPD.
Feels restless, worthless, hopeless, moody. Exhibits crying, low energy, body Ain, memory loss, negativity, detachment, suicidal.
Treatment includes antidepressants, anti anxiety meds. Psychotherapy. Marital counseling, assess the partner.

67
Q

Emergency psychiatric condition. Onset within 3 months of delivery, Should not be alone with the infant.

A

Postpartum psychosis.
Sleep disturbances, depression, delusional thinking, hallucinations, mood lability. Escalates to thoughts of suicide or infanticide.
Treatment includes hospitalization, psychotropic meds, psychotherapy, group therapy.

68
Q

Risk factors for PP affective disorders? Observation?

A

Poor coping skills, low self-esteem, numerous life stressors, previous psychological problems, family history, substance abuse, limited social support network.
Can see poor personal hygiene, weight loss, not responding to infant’s cues