Postpartum DVT/Preeclampsia

Question 1

List the risk factors for postpartum DVT (6)

Answer 1

• obesity
• sedentary habits post-delivery
• personal/family hx of DVT or abnormal clotting
• cesarean birth
• prolonged time in stirrups
• travel post-delivery

Question 2

why is obesity a risk factor for DVT?

Answer 2

it impairs venous flow, increasing risk of clot formation

Question 3

what is critical for prevention of DVT, especially after c-section?

Answer 3

walking

Question 4

when is pain relief necessary for DVT prevention?

Answer 4

if it is necessary to encourage movement

Question 5

stirrups are used less in vaginal deliveries today, except for what? (3)

Answer 5

Complicated perineal repairs.
D&C procedures.
Hematoma evacuation.

Question 6

what should be turned on when a pt is in stirrups to promote circulation?

Answer 6

sequential compression devices (SCVs)

Question 7

What is discouraged post-delivery?

Answer 7

airplane travel

Question 8

if a pt is traveling by car post-delivery, what should they do?

Answer 8

take frequent rest breaks to move around

Question 9

List the sx of DVT (7)

Answer 9

• unilateral leg swelling
• redness in affected leg
• warmth in affected leg
• pain in affected leg
• low-grade fever that may progress to higher
• palpable cord
• milk leg

Question 10

in postpartum women, what leg does DVT typically occur in?

Answer 10

left leg

Question 11

why might low-grade fever from DVT progress to higher temp?

Answer 11

due to inflammation

Question 12

what is a palpable cord?

Answer 12

hardened vein due to clot formation

Question 13

What is milk leg?

Answer 13

Spasm distal to the clot leads to:
- Pale, cold leg below the clot.
- Reduced circulation.

Question 14

What DVT test is unreliable? In how many cases is it positive?

Answer 14

homan’s sign

positive in only ~⅓ of DVT cases

Question 15

why is homan’s sign not used?

Answer 15

Sharply dorsiflexing the foot may dislodge the clot

Question 16

What is a safer method to use as opposed to homan’s sign?

Answer 16

Use gentle palpation with the back of the hand over the calf without pressing deeply.

Question 17

What is used to confirm clot and diagnose DVT?

Answer 17

doppler ultrasound

Question 18

what diagnostic finding is suspicious for DVT but not conclusive?

Answer 18

Elevated D-Dimer

Question 19

what must a pt with DVT strictly follow and why? (2)

Answer 19

STRICT BEDREST! Do NOT allow pt to walk → walking can dislodge the clot and cause a pulmonary embolism

Do NOT massage the clot → to prevent dislodging

Question 20

how is DVT treated? (3)

Answer 20

• heparin
• transition to warfarin (coumadin)
• long-term anticoagulant therapy

Question 21

Heparin is a ______ based ___ ______

Answer 21

weight based IV infusion

Question 22

what does heparin do?

Answer 22

Prevents clot progression & new clots from forming

Question 23

If a pt is on heparin, what is required?

Answer 23

frequent monitoring

Question 24

What overlaps with heparin and until when? what is crucial?

Answer 24

warfarin (coumadin) overlaps with Heparin until INR reaches 2-3

PT/INR monitoring is crucial

Question 25

what is the most common long-term anticoagulant agent despite newer agents?

Answer 25

warfarin (coumadin)

Question 26

A pt taking anticoagulants should be taught to monitor ________. what should they look for? (4)

Answer 26

bleeding look for: - Bleeding gums - Excessive bruising - Increased vaginal bleeding - Cuts that take too long to stop bleeding

Question 27

how can pts be taught to prevent bleeding? (2)

Answer 27

Avoid razors (use electric shaver or depilatory cream instead). Avoid activities that increase risk of cuts.

Question 28

what counteracts warfarin?

Answer 28

vitamin K

Question 29

pts should be taught to avoid sudden changes in ________ in their diet

Answer 29

vitamin K

Question 30

what foods decrease the effectiveness of warfarin?

Answer 30

foods high in vitamin K including green leafy vegetables such as spinach, broccoli and kale

Question 31

If there is over-anticoagulation, what will be too high?

Answer 31

INR

Question 32

what is the antidote if INR is too high?

Answer 32

vitamin K

Question 33

It is very important for the nurse to monitor for _________ _______ when a pt has DVT

Answer 33

pulmonary embolism

Question 34

when monitoring for pulmonary embolism, what should the nurse assess frequently?

Answer 34

respiratory status

Question 35

list the signs and sx of pulmonary embolism (5)

Answer 35

- Sudden shortness of breath. - Coughing. - Feeling of impending doom/severe anxiety. - Chest pain (pleuritic pain). - Tachypnea (rapid breathing)

Question 36

how long can postpartum preeclampsia last?

Answer 36

6 weeks

Question 37

postpartum preeclampsia can look similar to what?

Answer 37

preeclampsia in the antepartal period

Question 38

What signs of postpartum preeclampsia should the postpartum pt be taught to report? (4)

Answer 38

Severe headache Visual disturbances Epigastric pain Severe nausea and vomiting.

Question 39

If a postpartum pt had preeclampsia in pregnancy, what should she report regarding BP?

Answer 39

a systolic blood pressure of 160 or greater and/or diastolic pressure of 110 or greater.

Question 40

If a visiting nurse assessed the patient and found signs of severe preeclampsia, she should contact the provider and anticipate that the patient would have to go to the hospital for admission and administration of _________ ________

Answer 40

magnesium sulfate