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CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) > PP COMP PART 1 (HEMORRHAGE - PUERPERAL INFECTION) > Flashcards

PP COMP PART 1 (HEMORRHAGE - PUERPERAL INFECTION) Flashcards

(52 cards)

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1
Q
  • any blood loss form the uterus > 500 ml, within 24 hr period
  • either ealry or late
A

postpartum hemorrhage

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2
Q

conditions that distend the uterus beyond capacity

A
  • multipe ges
  • hydramnios
  • macrosomia
  • uterine myomas
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3
Q

condition that could have caused cervical or uterine lacerations

A
  • operative birth
  • rapid birth
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4
Q

conditions with varied placental site or attachment

A
  • p. previa
  • p. accreta
  • premature separation of the placenta
  • retained placental fragments
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5
Q

conditions that lead to inadequate blood coagulation

A
  • fetal death
  • DIC
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6
Q

4 main causes of postpartum hemorrhage

A
  • uterine atony
  • lacerations
  • retained placental fragments
  • DIC
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7
Q
  • relaxation of the uterus
  • most frequent cause of postpartal hemorrhage
A

uterine atony

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8
Q

uterus must remain in a ___ after birth

A

contracted state

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9
Q

uterine atony s/sx

A
  • abrupt vaginal bleeding
  • shock (hypotension, tachycardia, weak pulse, pale clammy skin, anxiety)
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10
Q

management for uterine atony

A
  • fundal massage
  • bimanual massage
  • oxytocin and methergine
  • prostglandin
  • blood replacement
  • hysterectomy
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11
Q
  • performed by placing one hand in the vagina and pushing against the body of the uterus while the other hand compresses the fundus from above through the abdominal wall
A

bimanual massage

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12
Q

posteriori aspect of the uterus is massaged with the abdominal hand and the anterior aspect with the vaginal hand

A

bimanual massage

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13
Q

oxytocin administration

A
  • 10-40 U / 1 liter D5W
  • short duration of action (1 hr)
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14
Q
  • promotes strong, sustained uterine contractions
  • WOF nausea, diarrhea, tachycardia, and HTN
A

prostaglandin F

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15
Q
  • surgical removal of the uterus
  • last resort
  • provide comfort and support
  • open lines of communication
A

hysterectomy

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16
Q

in hemorrhage - adminster O2 at ___

A

4 lpm

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17
Q

lacerations occur most often due to

A
  • precipitate birth
  • primigravida
  • macrosomia
  • lithotomy position and instruments
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18
Q

suspect ___ is there is bleeding even if the uterus is firm

A

lacerations

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19
Q

degree of laceration: vaginal mucus membrane and skin of perineum to fourchette

A

1st degree

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20
Q

degree of laceration: vagina, perineal skin, fascia, levator ani muscle, and perineal body

A

second degree

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21
Q

degree of laceration: entire perineum and reches the external sphincter of the rectum

22
Q

degree of laceration: entire perineum, rectal sphincter, and some of the mucous membrane of the rectum

Study These Flashcards
A

fourth degree

23
Q

management of lacerations

Study These Flashcards
A
  • suturing
  • high fluid diet
  • stool softener
24
Q

what to avoid after laceration

Study These Flashcards
A
  • enema or rectal suppository
  • rectal thermometer
25
- incomplete delivery of placenta - fragments separate and are left behind
retained placental fragments
26
retained placenta happens with ___ and ___
succenturiate placenta placenta accreta
27
a serum sample that contains ___ reveals that aprt of placenta is still present
hCG
28
if retained fragment is ___, bleeding will be appraent in the immediate postpartal period
large
29
if fragment is small, bleeding may not be detected until postpartum day ___, the woman willnotice abrupt discharge and a large amount of blood
day 6-10
30
management for retained placenta
- D&C - methotrexate - client should know how to observe lochia
31
- incomplete return of uterus to its prepregnant size and shape - at 4-5 week postpartal visit uterus still enlarged and soft - lochia is still present
subinvolution
32
management for subinvolution
- methergine 0.2 mg PO - oral antibiotic for possible endometritis - WOF bleeding
33
- collection of blood in the SQ layer of perineum - may be caused by injury to perineal blood vessels - usually represent minor bleeding
perineal hematoma
34
perineal hematoma is most likely to occur after
- rapid births - women with perineal varicosiies - episiotomy or laceration repair
35
if the hematoma continues to increase in size, site may be incised and the ____ is ___ under local anesthesia.
bleeding vessel is ligated
36
if an episiotomy incision is opened to drain a hematoma, it may be ___ rather than sutured
left open and packed with gauze
37
packed episiotomy incision after reopening is removed within ___
24-48 hours
38
- infection of the reporductive tract associated with childbirth that occurs any time up to 6 weeks postpartum
puerperal infection
39
conditions that increase a woman’s risk for postpartal infection
- ROM > 24 hours before birth - retained placental fragments - postpartal hemorrhage - preexisting anemia
40
conditions that increase a woman’s risk for postpartal infection
- prolonged and difficult labor - instrument births - internal fetal heart monitoring - local vagina infection during birth - uterine exploration after birth
41
management for postpartal infection
- BCS - antibiotics
42
common microbes postpartally
- group B strep - aerobic gram-negative bacilli (e.coli)
43
staph infections are common that can cause ___
toxic shock syndrome
44
- bacteria gain access to the uterus through the vagina and ente the uterus either at the time of birth or during the postpartal period
endometritis
45
may occur with any birth, but is associated with chorioamnionitis and CS birth
endometritis
46
endometritis - the WBC is increased to ___
20,000 to 30,000 cells/mm3
47
signs of abdominal wound infection
- erythema - warmth - skin discoloration - tenderness - fever, pain - malodorous lochia - abd distention
48
after drainage of abcess, the cavity may be packed with ___ to promote drainage and facilitate healing
iodoform gauze
49
the woman with ___ is acutely ill and may require care in an ICU
severe systemic infection
50
supportive therapy after drainage
- adequate IV hydration - analgesic - continuous nasogastric suctioning if paralytic ileus develops
51
endometriosis - inspect woman’s perineum every ___ for signs of early infection
8-12 hours
52
endometriosis - immediately report any degree of ___ to clinician
induration (hardening)

CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) (77 decks)

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