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NUR514: Maternity Exam 2 > Postpartum at risk > Flashcards

Postpartum at risk Flashcards

(76 cards)

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1
Q

List 9 risk factors of PP hemorrhage

A

1) Hx of PPH
2) Uterine overdistention
3) Prolonged dysfunctional labor
4) Grand multiparity
5) Preeclampsia
6) Meds that relax smooth muscle
7) Obesity
8) Asian/ Latina heritage
9) Birth procedures

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2
Q

What does a mother with a Hx of PPH require?

A

Doubled risk
Requires alerting blood bank, ensuring cross-matched blood is available

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3
Q

When could we see uterine overdistention Hint: 3

A

1) Multiple gestation
2) Macrosomia (Baby > 9 lbs)
3) Polyhydramnios

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4
Q

How can Prolonged/ dysfunctional labor put mom at risk for PPH? Hint: 2

A

1) Uterine muscle exhaustion
2) Lactic acid buildup

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5
Q

How can grand multiparity put mom at risk for PPH?

A

5+ pregnancies
Uterus may struggle to maintain tone

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6
Q

How does preeclampsia put mom at risk for PPH?

A

1) Low platelets (HELLP syndrome)
2) Tx w/ uterine relaxants (mag sulfate, nifedipine)

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7
Q

List 3 meds that relax smooth muscle & can increase risk of PPH

A

1) Anesthesia
2) Magnesium sulfate
3) Nifedipine

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8
Q

How does obesity put mom at risk for PPH?

A

1) Hormonal changes reduce oxytocin response
2) Higher likelihood of macrosomia

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9
Q

List 3 birth procedures that can put mom at risk for PPH

A

1) Induction or augmentation w/ oxytocin (esp. prolonged use)
2) Operative vaginal deliveries (forceps, vacuum)
3) C-section

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10
Q

What is the FIRST nursing intervention for PPH?

A

Fundal massage

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11
Q

What are 3 things the nurse should know about hidden bleeding?

A

1) Blood clots in uterus prevent contraction & mask blood loss
2) Extra blood volume in preg can delay detection
3) VS may remain stable until blood loss exceeds 1000-1500 mL

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12
Q

Pre-existing _____ increases danger of PPH

A

Pre-existing anemia (Hgb < 11 & Hct < 33)

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13
Q

Low ____ can also increase risk of PPH
List 2 disorders we can see this in

A

Low plts → Preeclampsia & thrombocytopenia

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14
Q

List 7 ways to prevent complications from PPH

A

1) Identify high-risk pts
2) Frequent PP assessments (every 15 min in first 1-2 hrs)
3) Avoid invasive birth procedures if possible
4) Active management of 3rd stage of labor
5) Administer oxytocin immediately after delivery
6) Skin-to-skin contact stimulates endogenous oxytocin
7) Early intervention in heavy bleeding is critical

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15
Q

What should be included in active management of 3rd stage labor? Hint: 3

A

1) Admin oxytocin before placenta delivery
2) Gentle traction on placenta to promote detachment
3) Rapid placenta delivery prevents excessive BF

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16
Q

How should oxytocin be administered if you cannot get IV access?

A

Give 10 units IM

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17
Q

How does giving oxytocin immediately after delivery help prevent PPH complications?

A

Floods oxytocin receptors to contract uterus effectively

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18
Q

What is the #1 cause of 50% of all PPH?

A

Tone → uterine atony

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19
Q

List the causes of PPH Hint: 4 T’s

A

1) Tone
2) Tissue
3) Trauma
4) Thrombin

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20
Q

What is tone (uterine atony)? Hint: 4

A

1) Failure to contract
2) Overdistended uterus
3) Full bladder preventing contraction
4) Clots inside the uterus

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21
Q

What does tissue pertain to?

A

Retained placenta fragments
1) Body continues perfusing placenta site, inhibits contraction
Placental inspection post-delivery is critical

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22
Q

What do traumas include? Hint: 2

A

1) Unrepaired lacerations → cervical, vaginal, perineal
2) Perineal hematomas → collection of blood under tissue; can hold 250-500 mL

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23
Q

What does thrombin pertain to? Hint: 2

A

1) Coagulation disorders (low plts, vWD, DIC)
2) PP hemorrhage may be first sign of undiagnosed clotting disorder

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24
Q

Explain how fundal massage can help manage tone (uterine atony)

A

Supports uterus at pubic symphysis to prevent inversion

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25
List 3 other ways to manage tone (uterine atony)
1) Empty bladder → straight cath if uterus is displaced 2) Uterotonic meds 3) Prepare for OR if less invasive methods fail
26
List 6 invasive procedures that can be performed to manage tone (uterine atony)
1) exploration of uterus for retained placenta (remove if found) 2) Dilation & Curettage (D&C) 3) Bakri balloon 4) B-Lynch suture 5) Ligation of uterine arteries 6) Hysterectomy (last resort)
27
List 3 ways to manage retained placental fragments in PPH
1) Provider should inspect placenta, membranes after delivery 2) Manual removal at bedside by provider 3) D & C in OR if fragments persist
28
What is management for small hematoma?
Apply ice/ pressure
29
What is management for large hematomas?
Incision/ drainage, vaginal packing
30
List 2 other management options for unrepaired lacerations/ hematomas
1) monitor for hypovolemic shock 2) Laceration tears may require surgery
31
List 6 management options for thrombins
1) Minimize invasive procedures 2) Identify hemorrhage early 3) Replace clotting factors (FFP; plts) 4) Monitor for fluid overload 5) Tranexamic acid (TXA) 6) Avoid NSAID use until stable
32
How can we replace fluid volume & support hemodynamic stability? **Hint: 7**
1) 2nd IV site → pref. 18 gauge 2) Crystalloid fluids → LR or NSS 3) Frequent monitoring of VS 4) Admin O2 if needed 5) Elevate legs 30° 6) Foley cath → monitor output 7) Transfusion if indicated, massive transfusion protocol (MTP) may be needed
33
What will assessment findings look like in uterine atony?
Uterus will be boggy, "high" above umbilicus
34
Assessment findings for retained placental fragments
May have "trailing membranes"
35
Assessment findings of unrepaired lacerations/ hematomas (trauma) **Hint: 3**
1) Pt will complain of sudden, excruciating pain 2) Continuous trickle w/ firm fundus at umbilicus, OR s/s perineal hematoma 3) Monitor for localized swelling at site - discoloration, fluctuant mass
36
Assessment findings for thrombins **Hint: 3**
1) Lab values abnormal (i.e. plts) 2) Hx of PPH, heavy periods, etc 3) Coagulopathy may be secondary to primary cause
37
List 5 medications used for PPH
1) Oxytocin (Pitocin) 2) Methylergonovine (Methergine) 3) Misoprostol (Cytotec) 4) Tranexamic acid (TXA) 5) Carboprost (Hemabate)
38
What 3 meds are used to increase uterine tone?
1) Oxytocin 2) Methergine 3) Prostaglandins (Cytotec/ Carboprost)
39
What should the nurse anticipate if the patient is already on Oxytocin post delivery?
Anticipate the need for a bolus
40
What medication is the first line agent for PPH Tx?
Oxytocin (Pitocin)
41
What med is known as a potent uterotonic & vasoconstrictor?
Methylergonovine (Methergine)
42
What must be checked prior to administering Methergine?
Blood pressure
43
Why must BP be checked prior to administration of Methergine?
Used for uterine contractions but can cause hypertension & potential risk of stroke, seizure, or hypertensive crisis
44
How is Methergine typically given?
IM injection (0.2 mg or 200 mcg) into large muscle (i.e. thigh or ventrogluteal) **Can be given SL, rectally, or orally**
45
What is given with misoprostol (cytotec) to manage temperature spikes?
Acetaminophen **Ibuprofen can be given if no clotting issues present**
46
How does TXA help Tx PPH?
It inhibit fibrinolysis & promotes normal clotting
47
How is TXA administered?
Administered as a loading dose followed by a slower dose over 4-8 hrs
48
When is TXA used?
Used for significant bleeding to help control the hemorrhage caused by clotting issues (i.e. thrombin)
49
How does carboprost work?
It's a prostaglandin that promotes strong uterine contractions
50
What side effect can Carboprost (Hemabate) cause?
Severe diarrhea
51
Why are CUS words used during PPH?
To be assertive in PPH situations
52
What do CUS words stand for & how would you use them?
C → concerned; "I'm concerned that my pt is deteriorating" U → uncomfortable; "I'm uncomfortable waiting this long for appropriate care/ surgeon to see her" S → safety; "I don't feel safe managing this situation w/o appropriate escalation"
53
What do you do if the CUS words do not work?
Move up the chain of command → charge nurse → nursing supervisor → Chief of obstetrics; Medical director; Director of radiology
54
Perineal assessment
Inspect labia & perineum for hemorrhoids & swelling
55
What should hemorrhoids look like?
Soft & flat; if swollen, hard, or painful, comfort measures should be provided
56
What will pt complain of if theres a perineal hematoma?
Sudden, excruciating pain; intense pain & pressure assess for possible mass
57
Obesity as a risk factor of DVT
Impairs venous flow, increasing risk of clot formation
58
How to prevent DVT from sedentary habits post-delivery **Hint: 2**
1) walking is critical for prevention, esp after C-section 2) Pain relief should be used to encourage movement
59
C-section as a risk factor of DVT
Increased immobility & surgical trauma
60
When are stirrups used? **Hint: 3**
1) Complicated perineal repairs 2) D&C procedures 3) Hematoma evacuation
61
What should be turned on to promote circulation for a pt having prolonged time in sitrrups?
Sequential compression devices
62
Guidelines for travel post-delivery to prevent DVT
1) Airplane travel is discouraged 2) If driving, patients should take frequent rest breaks to move around
63
True or false: Hx of DVT or abnormal clotting increases risk of DVT post-delivery
TRUE
64
List 5 S/S of DVT post-delivery
1) Unilateral leg swelling (left leg) 2) Redness, warmth, pain 3) Low-grade fever (may progress to higher) 4) Palpable cord (hardened vein) 5) Milk leg
65
What is milk leg?
Spasm distal to the clot leads to: → Pale, cold leg below the clot → Reduced circulation
66
Explain Homan's sign
**Not reliable** 1) Sharply dorsiflexing foot may dislodge clot 2) Safer method: Use gentle palpation with the back of hand over the calf w/o pressing deeply
67
Diagnosis of DVT **Hint: 2**
1) Doppler u/s to confirm 2) Elevated D-dimer suspicious but not conclusive
68
Management of DVT **Hint: 2**
1) STRICT bed rest → walking can dislodge & cause PE 2) Do NOT massage clot
69
Discuss Tx plan of DVT **Hint: 3**
1) Heparin drip 2) Transition to warfarin (coumadin) 3) Long-term anticoagulant therapy
70
Tx plan of DVT: Heparin drip
**Weight based IV infusion** 1) Adjusted based on lab values (aPTT levels) 2) Prevents clot progression & new clots from forming 3) Requires frequent monitoring
71
Tx plan of DVT: Transition to Warfarin (Coumadin)
1) Overlaps with heparin until INR reaches 2-3 2) PT/INR monitoring is crucial
72
Patient education regarding anticoagulants **Hint: 3**
1) Monitor for bleeding 2) Bleeding prevention 3) Dietary considerations (for warfarin)
73
What kind of bleeding should patients monitor for? **Hint: 3**
1) bleeding gums, excessive bruising 2) Increased vaginal bleeding 3) Cuts that take too long to stop bleeding
74
What are the dietary considerations for Warfarin? **Hint: 3**
1) Vitamin K counteracts Warfarin 2) Avoid sudden changes in Vit K intake: → green leafy vegetables decrease warfarin effectiveness 3) Vit K is antidote if INR is too high
75
List 5 S/S of PE that has occurred due to DVT
1) Sudden SOB 2) Coughing 3) Feeling of impending doom/ severe anxiety 4) Chest pain (pleuritic pain) 5) Tachypnea (rapid breathing)
76
Prevention & monitoring for PE **Hint: 3**
1) Frequent resp assessments for early detection 2) Pt education on warning signs 3) Seek emergency care if experiencing any PE Sx

NUR514: Maternity Exam 2 (7 decks)

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