Postpartum at risk pt. 2

Question 1

How long can postpartum preeclampsia last?

Answer 1

Can last 6 weeks & looks similar to preeclampsia

Question 2

Important teaching point for PP pt to report as signs of PP preeclampsia Hint: 5

Answer 2

1) Severe H/A
2) Visual disturbances
3) Epigastric pain
4) Severe N/V
5) Systolic BP 160 or > or diastolic BP of 110 or > if she had preeclampsia in pregnancy

Question 3

If a nurse assessed a pt and found signs of severe preeclampsia what should she anticipate?

Answer 3

The pt should go to the hospital & receive magnesium sulfate

Question 4

Women with bipolar disorder have 100 times the incidence of what?

Answer 4

Postpartum psychosis

Question 5

List 4 S/S of postpartum psychosis

Answer 5

1) Delusions/ hallucinations
2) Depersonalization
3) bizarre & disorganized behavior
4) Neglect of self/ infant

Question 6

PP Psychosis:

What can the delusions/ hallucinations involve?

Answer 6

Belief that baby is possessed, evil, or an alien → often involves harming the baby

Question 7

Management of PP psychosis Hint: 3

Answer 7

1) Usually responsive to Tx
2) Woman usually fears “losing her mind”
3) Safety of woman & infant

Question 8

PP Psychosis:

How can we help keep both mom & baby safe? Hint: 4

Answer 8

1) Hospitalization/ separation from infant
2) Stabilization on anti-psychotics
3) Agents may be incompatible w/ BF
4) Support groups for woman & family

Question 9

List 4 risk factors for UTI postpartum

Answer 9

1) Urinary catheterization
2) Urinary stasis
3) Trauma to urinary structures during birth
4) Improper hygiene

Question 10

List 4 teaching points for proper hygiene

Answer 10

1) Wipe front to back
2) Use peri bottle instead of rubbing w/ toilet paper
3) Change pads every 2-3 hrs
4) Pat dry to prevent toilet paper from remaining in area & causing infection

Question 11

List 6 ways to manage urinary retention

Answer 11

1) Manage pain
2) pour warm water over perineal area
3) have woman lean forward on toilet
4) Run water
5) Have woman blow bubbles through straw
6) Peppermint oil

Question 12

List 4 S/S of urinary retention

Answer 12

1) Burning
2) Urgency
3) Frequency
4) Nocturia

Question 13

What can UTI progress to?

Answer 13

Pyelonephritis

Question 14

List 3 S/S that would suspect pyelonephritis

Answer 14

1) Fever (up to 104°F)
2) Chills, flank pain, N/V
3) CVA tenderness

Question 15

How do we Dx UTI in PP patients?

Answer 15

“Clean catch” specimen

Question 16

List 4 first line Abx used to Tx UTIs

Answer 16

1) Bactrim
2) Cephalosporins
3) Nitrofurantoin
4) Augmentin

Question 17

List 3 meds that are used to Tx pyelonephritis

Answer 17

1) IV Abx (i.e. vanco, Clindamycin)
2) Antipyretics (Acetaminophen, Ibuprofen)
3) Antispasmodics (Pyridium) for pain relief

Question 18

What is the most likely culprit of wound infections?

Answer 18

Staph aureus (i.e. MRSA)

Question 19

Why can obesity increase risk of wound infection?

Answer 19

Increased warmth & moisture in incision area

Question 20

How can C-section staples increase risk of wound infection?

Answer 20

Multiple portals of entry for bacteria

Question 21

List 3 compromised health statuses that increase risk of wound infection

Answer 21

1) Anemia
2) Diabetes
3) Postpartum hemorrhage

Question 22

List 5 S/S of wound infection

Answer 22

1) Redness at incision
2) Foul-smelling discharge
3) Edema
4) Induration (hardness)
5) Pain → severe, beyond normal post-op pain

Question 23

What should be performed to ensure proper Tx for wound infection?

Answer 23

Culture the wound

Question 24

Tx of wound infection Hint: 3

Answer 24

1) Pain relief
2) Abx to specific organisms (while waiting use agents that target S. Aureus)
3) Wound vac

Question 25

How should we Tx an abscess if it presents in wound? **Hint: 3**

Answer 25

1) Provider may reopen wound & pack it 2) Wet-to-damp dressings 3) Wound care education for home

Question 26

What is mastitis?

Answer 26

Infection of the breast

Question 27

What type of mothers is mastitis common in?

Answer 27

Nursing mothers

Question 28

List 4 risk factors for mastitis

Answer 28

1) Cracked nipples 2) Compromised health status 3) Abx therapy 4) Milk stasis → not emptying breast fully

Question 29

List 5 S/S of mastitis

Answer 29

1) Plugged duct 2) Fever, chills, flu-like Sx 3) Severe breast pain 4) Yeast infections of breast 5) Abscess

Question 30

What finding would tell us there is a plugged duct?

Answer 30

Superficial red lump in breast (not infected yet)

Question 31

What findings would tell us there is a yeast infection of the breast? **Hint: 2**

Answer 31

1) Bright pink nipples 2) Sharp pain while nursing

Question 32

How do we prevent reinfection of yeast infection of the breast?

Answer 32

Tx both mom and baby

Question 33

What findings tell us there is an abscess? **Hint: 2**

Answer 33

1) Black/ blue discoloration 2) Collection of pus → needs I&D

Question 34

If mother is experiencing mastitis what should she be told about nursing?

Answer 34

DO NOT stop nursing **Pump if nursing is too painful**

Question 35

Tx of mastitis

Answer 35

1) Heat & massage to encourage milk expression 2) Abx/ Anti-candidal → cephalosporin (keflex) → Diflucan for yeast → I&D for abscess

Question 36

What is endometritis?

Answer 36

Infection of the uterine cavity

Question 37

When is endometritis most commonly seen?

Answer 37

Post-cesarean

Question 38

Incidences of endometritis **Hint: 3**

Answer 38

1) With pre-op Abx: infection rate ≤10% 2) W/o prophylactic Abx: infection rate ~35% 3) Most women recieve pre-op Abx (i.e. Ancef) within 1 hr of first incision

Question 39

List 6 risk factors of endometritis

Answer 39

1) C-section 2) PROM 3) Multiple vaginal exams in labor 4) Compromised health status 5) Low socioeconomic status 6) Instrumental deliveries

Question 40

List 3 compromised health statuses that increase risk of endometritis

Answer 40

1) Anemia 2) Diabetes 3) Malnutrition

Question 41

Why is low socioeconomic status a risk factor for endometritis **Hint: 2**

Answer 41

1) Potential hygiene barriers 2) Lack of access to pads

Question 42

List 2 examples of instrumental deliveries & why they increase risk of endometritis

Answer 42

**Forceps; vacuum** More trauma + insertion of foreign objects

Question 43

List 7 S/S of endometritis

Answer 43

1) Foul smelling lochia 2) Temp 100.4 or > 3) Tachycardia 4) Chills 5) Body aches 6) Lower abd pain 7) Uterine tenderness

Question 44

Management of endometritis is dependent on what?

Answer 44

Dependent on causative organism

Question 45

What diagnostic test should be done to determine what Abx to Tx endometritis?

Answer 45

Culture/ sensitivity → may take 2-3 days

Question 46

What type of Abx do we give before C&S comes back for endometritis?

Answer 46

Empiric IV Abx → Cephalosporins/ penicillins unless allergic

Question 47

How long are IV Abx given for to Tx endometritis?

Answer 47

Continued until fever free for 24 hrs

Question 48

List 2 examples of severe cases of endometritis

Answer 48

1) Parametritis 2) Peritonitis

Question 49

Severe cases of endometritis require stronger Abx such as **Hint: 3**

Answer 49

1) Vancomycin 2) Gentimicin 3) Clindamycin

Question 50

What is rare but possible in women who experience endometritis?

Answer 50

Long term complications (sequelae) although most women recover quickly