SIM Lab Quiz 4 Flashcards
(76 cards)
1
Q
early PPH
A
first 24 hrs after childbirth
loss of > 500mL
diagnosed when provider determines blood loss is greater than normal
2
Q
late PPH
A
after 24 hours post-birth
3
Q
% of women who will experience PPH
A
10%
4
Q
early PPH causes
A
uterine atony
lacerations
hematomas
5
Q
late PPH causes
A
hematomas
subinvolution
retained placental tissue
6
Q
PPH risk factors
A
macrosomia polyhydramnios operative vaginal delivery augmented labor ineffective contractions prolonged 1st/2nd stage precipitous labor/birth general anesthesia
7
Q
indications of possible early PPH
A
- 10% decrease in hematocrit post birth
- saturation of peripad w/in 15 min
- boggy fundus after massage
- tachycardia
- decrease in BP
8
Q
uterine atony
A
decreased tone of uterine muscle - primary cause of early PPH
9
Q
assessment findings of uterine atony
A
boggy fundus peripad saturation w/in 15 min slow/steady or sudden/massive bleeding blood clots pale, clammy skin anxiety, confusion tachycardia hypotension
10
Q
medical management of uterine atony
A
oxy, methergine, hemabate - uterine contractions
IV - hypovolemia
blood replacement - hemorrhagic shock
surgical interventions
11
Q
nursing actions for uterine atony
A
- review risk factors for PPH
- assess for displaced uterus (distended bladder)
- assess fundus firmness (massage)
- assess lochia (amount, clots)
- review lab tests (HgB, Hct)
- notify provider
- oxy, methergine, hemabate
- blood transfusion monitoring
- emotional support
12
Q
methergine
A
Indication: PPH s/t uterine atony or subinvolution
Action: stimulates contraction of uterine smooth muscle
Side effects: N/V/cramps
Route/dose: IM/IV, 200mcg every 2-4 hr
Caution: check BP - HTN contraindicated
13
Q
hemabate
A
Indication: PPH that is unresponsive to oxy or methergine
Action: uterine contraction
Side Effects: N/V/D/fever
Route/doe: IM, 250 mcg every 15-90 min (total
14
Q
lacerations
A
2nd most common cause of early PPH
15
Q
common sites for lacerations
A
cervix
vagina
labia
perineum
16
Q
laceration risk factors
A
fetal macrosomia
operative vaginal delivery
precipitous labor/birth
17
Q
laceration assessment findings
A
firm, midline uterus w/ heavy bleeding
steady bleeding w/o clots
tachycardia
hypotension
18
Q
medical management of lacerations
A
visual inspection
suturing
IV meds for pain
19
Q
nursing actions for lacerations
A
review risk factors vitals blood loss notify provider pain meds pelvic exam preparation emotional support
20
Q
hematoma
A
occurs when blood collects w.in connective tissue of vagina or peineal areas r/t vessel that ruptures and continues to bleed
hard to diagnose degree of blood loss
21
Q
hematoma risk factors
A
episiotomy
forceps
prolonged 2nd stage
22
Q
hematoma assessment findings
A
- severe pain in vagina/perineal area
- not managed w/ normal postpartum pain management
- tachy and hypotension
- heaviness/fullness of vagina or rectal pressure if in vagina
- in perineum - swelling, discoloration, tenderness
- hematomas of 200-500 ml can displace uterus and cause uteirne atony
23
Q
medical management of hematoma
A
evaluated and monitored if small
surgically excised if large
24
Q
nursing actions w/ hematoma
A
review risk factors ice for 24 hrs assess pain ask pt to verbalize pain, heaviness monitor for BP decrease monitor for HR increase pain meds review lab reports notify provider
25
subinvolution of uterus
uterus does not decrease in size nor descend into pelvis
usually later in postpartum period
26
uterine subinvolution risk factors
fibroids
endometritis
retained placental tissue
27
assessment findings of uterine subinvolution
soft, large uterus
lochia returns to rubra, heavy
back pain
28
medical management of uterine subinvolution
D&C for retained placental tissue
methergine for fibroids
antibiotic for endometritis
29
nursing actions for uterine subinvolution
```
risk factors
monitor pt
pt education
S/Sx: increased bleeding, clots, lochia change
reduce risk for infection
discharge meds
```
30
retained placental tissue
most common cause of LPH - when small portions of placenta (cotyledons) remain attached to uterus during 3rd stage
can interfere with involution of uterus and lead to endometritis
31
cotyledons
small portions of placenta still in uterus
32
risk factors for retained placental tissue
manual removal of placenta
33
assessment findings for retained placental tissue
```
sudden profuse bleeding after 1st wk
subinvolution of uterus
high temp
uterine tenderness
pale
tachy
hypotension
```
34
medical management of retained placental tissue
D&C to remove tissue
| IV antibiotic therapy (endometritis)
35
nursing actions for retained placental tissue
- risk factors
- monitor
- review labs
- patient education (bleeding)
- teach fundus assessment/massage
- assess fundus/lochia every hr for 4 hrs after hemorrhage
- oral/IV fluid intake
- prevent overdistended bladder
- assist w/ ambulation
- rest
- uninterrupted rest
- emotional support
- food high in iron
36
chronic hypertension
HTN before conception or before 20th wk of gestation
high risk of preeclampsia
37
preeclampsia-eclampsia
pre: HTN w/ proteinuria after 20th wk
eclampsia: convulsive stage of disease
38
preeclampsia superimposed on chronic HTN
new-onset proteinuria
proteinuria before 20th wk
sudden uncontrolled HTN
39
gestational hypertension
high BP for first time mid-pregnancy w/o proteinuria
diagnosis is made postpartum and is relatively benign w/o underlying physiological changes
40
arteries in normotensive pregnancies
spiral arteries of uterus are remodeled by invasion of endovascular trophoblast cells of placenta, which allows them to widen to accommodate 10-fold increase in blood flow
41
arteries in hypertensive pregnancies
remodeling of spiral arteries of uterus is incomplete
arteries remain thick-walled, resulting in suboptimal placental perfusion
42
uteroplacental perfusion
can be diminished 50% before onset of preeclamptic symptoms
43
ischemia of uteroplacental tissue
results in endothelial cell dysfxn, resulting in multiorgan endothelial cell damage and dysfxn
triggers vasospasm w/ poor tissue perfusion to all organs
increased peripheral resistance and elevated BP
44
liver in preeclampsia
fat deposits - epigastric pain
HELLP
45
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelets
46
hepatic involvement in preeclampsia
periportal hemorrhagic necrosis of liver
subcapsular hematoma
47
GFR in preeclampsia
glomerular endothelial damage
fibrin deposition
resulting ischemia
reduce GFR - protein excreted
48
coagulation system in preeclampsia
activated - thrombocytopenia
49
endothelial damage in preeclampsia
damage to brain
| fibrin deposition, edema, hemorrhage
50
retinal arterial spasms in preeclampsia
blurring, double vision
| photophobia, scotoma
51
leakage of serum protein in preeclampsia
decreased serum albumin
| tissue edema
52
pulmonary edema in preeclampsia
volume overload r/t to left ventricular failure s/t high vascular resistance
53
preeclampsia risk fx
```
nulliparity
younger than 19; older than 35
obesity
multiple gestation
family hx
preexisting htn or renal disease
previous preeclampsia or eclampsia
DM
```
54
preeclampsia risks for mother
```
cerebral edema/hemorrhage/stroke
disseminated intravascular coagulation
pulmonary edema
congestive HF
hepatic failure
renal failure
abruptio placenta
```
55
preeclampsia risk for newborn
```
prematurity
IUGR
LBW
stillbirth
fetal intolerance r/t decreased placental perfusion
```
56
preeclampsia assessment findings
```
HTN
proteinuria
elevated liver fxn
diminished kidney fxn
altered coagulopathies
```
57
first-line drugs for preeclampsia
hydralazine (vasodilator)
methyldopa (mechanism unknown)
labetalol (beta blocker)
58
second-line drug for preeclampsia
nifedapine (Ca channel blocker)
59
mag loading dose
4-6 g in 100ml IV fluid over 15-20 min
60
mag continuous infusion
2g/hr in 100 ml IV fluid for maintenance
61
mag lab eval
measure serum magnesium level at 4-6 hrs
maintain 4-7 mEq/L
62
mag duration
IV should continue 24 hrs post delivery
63
mag antidote
calcium gluconate or calcium chloride 5-10 mEq IV over 5-10 min
64
eclampsia
occurrence of seizure activity in presence of preeclampsia
65
eclampsia triggers
```
cerebral:
vasospasm
hemorrhage
ischemia
edema
```
66
eclampsia warning signs
```
persistent headaches
epigastric pain
N/V
hyperreflexia w/ clonus
restlessness
```
67
care during eclampsia seizure
```
stay with pt
call for help
As and Bs
anticipate suction
prevent injury
record time, length, type
notify provider
```
68
maternal side effects on mag
```
nausea
flushing
diaphoresis
blurred vision
lethargy
hypocalcemia
depressed reflexes
respiratory distress/arrest
cardiac dysrhythmias
decreased platelet aggregation
circulatory collapse
```
69
fetal side effects on mag
```
decreased variability in FHR
respiratory depression
hypotonia
decreased suck reflex
magnesium toxicity
```
70
nursing actions for patient on mag
vital signs before infusion and every 5-15 min during loading dose, then 30-60 min until stable
assess DTRs every 2 hrs
monitor I/Os strictly
monitor mag levels
monitor for mag toxicity
seizure/resuscitation precautions
cardiac monitoring
FHR monitor - continuous
neonatal team
71
post-seizure assessment
```
maternal and fetal status
assess airway
supplemental oxygen
IV access
mag sulfate
quiet environment
```
72
HELLP risks for woman
abruptio placenta
renal failure
liver hematoma/rupture
death
73
HELLP risk for fetus
preterm
| death
74
HELLP assessment findings
general malaise, nausea, RUQ pain
unexplained bruising, mucosal bleeding, petechiae, bleeding from injection/IV sites
altered lab tests
75
HELLP medical management
immediate delivery of fetus and placenta
resolution generally 48 hrs postpartum
platelet replacement
76
HELLP nursing actions
```
assessment r/t preeclampsia
lab tests
notify physician
platelet replacement
education
emotional support
```
