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Mgmt Test 3 - OB > postpartum complications/perinatal loss > Flashcards

postpartum complications/perinatal loss Flashcards

(64 cards)

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1
Q

postpartum hemorrhage can have an early and late onset t or f

A

true

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2
Q

risk fxr for postpartum hemorrhage

A 
c-section 
operative vaginal delivery (vacum, forceps)
precipitous labor (3 hrs start/finish)
atypically attached placenta
retained placenta fragments 
general anesthesia (uterus wont contract)
fetal demise
hx of postpartum hemorrhage
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3
Q

early postpartum hemorrhage occurs

A

within 1st hour after birth

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4
Q

the most common cause of early postpartum hemorrhage

A

***uterine atony (the uterus does not contract)

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5
Q

most likely cause of late postpartum hemorrhage

A

retained placenta fragments

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6
Q

other causes of early postpartum hemorrhage

A

lacerations (vagina, cervix, perineum)
hematomas (not necessarily outward)
uterine inversion
retained placenta fragments

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7
Q

risk fxrs for uterine atony

A

Over distension of the uterus from multiple gestations,
polyhydramnios, fetal macrosomia, or multiple fetuses
Uterine anomaly (fibroid tumors)
Poor uterine tone (long induction w/pitocin, receptors get tired; stops contracting like it should)

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8
Q

s/s of uterine atony

A

BOGGY fundus

excessive bleeding

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9
Q

mgmt for uterine atony

A

***massage the fundus, check often

medications (oxytocin, methergine, hemabate)

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10
Q

methergine - action

A

uterine stimulant

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11
Q

methergine - given

A

PO

IM

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12
Q

methergine s/e

A

very crampy - alot of pain

can raise BP

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13
Q

hemabate - action

A

uterine stimulant - usually used via c-section

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14
Q

methergine and hemabate are NEVER USED FOR INDUCTION t or f

A

true - only used during postpartum period to stop bleeding

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15
Q

hemabate is given

A

IM right into uterine muscle/fundus

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16
Q

misoprostil - action

A

controls post partum hemorrhage

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17
Q

misoprostil is given

A

PO

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18
Q

assessment findings for lacerations

A

excessive bleeding w/FIRM uterus

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19
Q

lacerations may be (4 types)

A

perineal
periurethral
vaginal
cervical

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20
Q

perineal lacerations are graded, how many degrees

A

four (4) (1, 2, 3, 4)

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21
Q

1st degree perineal laceration s/s

A

superficial; just subcutaneous tissue; may not need suture

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22
Q

2nd degree perineal laceration s/s

A

subcutaneous tissue & muscle (episiotomy) - needs suture

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23
Q

3rd degree perineal laceration s/s

A

extends into external anal sphincter

cold packs

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24
Q

4th degree perineal laceration s/s

A

extends into internal anal sphincter (local anesthesia)
take colace - no straining
cold packs

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25
mgmt of lacerations
nurse assist in repair inspect perineum, cervix, vagina monitor blood loss
26
retained placental fragments risk fxrs
mismanaging 3rd stage of labor - pulling on placenta/cord - hindering uterine contractions Placenta malformations - Abnormal placenta implantation
27
3 types of abnormal placenta implantation
acreta increta percreta
28
Acreta placenta implantation s/s
placenta starts to invade myometrium - difficult to detach -
29
increta placenta implantation s/s
invades the myometrium all together
30
percreta placenta implantation s/s
permeates the entire uterine wall
31
trt for increta and percreta
hysterectomy to stop bleeding
32
trt for acreta
manual detachment - likely leave behind pcs of placenta
33
retained placenta fragments assessment
``` subinvolution - uterus not contracting the way it should excessive bleeding boggy fundus Risk for DIC u/s detects this during pregnancy ```
34
mgmt of placental fragments
d&c and curettage to scrap uterus to ensure all pieces manually explore the uterus transfusion for lg amt of blood loss
35
a d/c procedure will not work w/abnormal placental implantation t or f
true
36
what level of H/H would require transfusion
7
37
hematoma assessment findings
usually not outward/visible bld'g; more into tissues mom complains of pain in perineal/vaginal area; feeling of fullness/pressure in vagina may see outline of hematoma
38
trt of hematoma
surgical drainage (severe cases) antibiotics analgesics blood products if excessive loss
39
late postpartum hemorrhage mgmt
``` control bleeding prevent hypovolemic shock d/c may require antibiotics massage fundus administer uterine stimulants ```
40
late postpartum hemorrhage occurs
sometimes without warning 1-6 weeks postpartum | delivery w/o issues then heavy bld'g
41
nursing implication for postpartum hemorrhage
assess quantity/quality of bld'g (hourly) assess level of consciousness monitor vitals large bore iv fluids (at least an 18 guage) administer oxygen, assess saturation assess urine output (hourly) - decreased administer/monitor fluids, blood products draw/monitor labs emotional support for family (extremely distressful) educate pt
42
s/s of hypovolemia
BP drops | HR increases
43
postpartum infection is also called
puerperal infection
44
what is postpartum infection
fever of 100.4 or greater occurring days 2-10, 2 days
45
what is endometritis
infection of uterine lining caused by various organisms including group B strep
46
s/s endometritis
foul smelling lochia sub-involution elevated wbc (after 1st 24hrs)
47
mgmt of endometritis
broad spectrum IV antibiotics (sometimes double/triple) | going home on PO antibiotics
48
nursing implications for endometritis
monitor for complications manage pain pt education f/u w/provider earlier than norm
49
what is mastitis
an infection of the breast (lactating); unilateral
50
mastitis vs engorgement
mastitis is unilateral | engorgement is bilateral
51
engorgement occurs
1st few days postpartum due to mom not emptying breast
52
s/s of mastitis
fever, chills
53
trt of mastitis
BREASTFEED - empty the breast; or pump | antibiotics (cont. to breastfeed)
54
what condition should mom not breast feed with
abscess - ruptures - if its in the duct it will pass to baby
55
thrombophlebitis where can it occur
in legs and pelvis (septic pelvic thromophlebitis due to c-sect and became infected)
56
what is thrombophlebitis
DVT - clot formation
57
thrombophlebitis s/s
redness/warmth in abdomen or calf
58
mgmt of thrombophlebitis
IV heparin (anti-coagulants) bedrest w/elevation of limb analgesics antibiotics w/septic pelvic thrombophlebitis
59
nursing implications of thrombophlebitis
may be started on warfarin before heparin is stopped continued for 6 weeks monitor symptoms lifestyle changes (do not wear stockings)
60
when does baby blues occur
first week to 10 days, mom needs TLC
61
baby blues caused by
hormonal imbalance feeling overwhelmed, worried sleep deprivation
62
postpartum depression onset; s/s
2 weeks or longer (2-4 weeks) affects ability to take care of self/baby suicidal ideation
63
trt for postpartum depression/psychosis
meds psychotherapy hospitalization
64
postpartum psychosis
``` early onset 2 days postpartum up to 8 weeks manic psychosis depressed mood suicidal ideations delusions (voices) ```

Mgmt Test 3 - OB (7 decks)

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