T3-Post-Partum Complications

Question 1

What is PPH?

Answer 1

Blood loss greater than 500 mL in 24 hours

Question 2

What is early PPH?

Answer 2

Within 24 hours of delivery

Question 3

What is late PPH?

Answer 3

After first 24 hours of delivery

Question 4

What are some common causes of PPH? (6)

Answer 4

• Uterine atony
• Lacerations
• Retained placenta (or fragments)
• DIC
• Inversion of uterus
• Subinvolution of uterus

Question 5

What is the number one cause of PPH?

Answer 5

Uterine atony

Question 6

What is uterine atony?

Answer 6

Failure of muscles to contract effectively could be due to overstretched muscle from multiple preg, polyhydraminos, or macrocosmic infant

Question 7

What are some clinical signs of uterine atony? (3)

Answer 7

• Hypotonic uterus (boggy)
• Excessive blood loss
• Hypotensive shock

Question 8

What are s/s of hypotensive shock?

Answer 8

• Tachycardia and tachypnea
• BP decreasing
• Skin changes (cool, clammy, pallor)
• Restlessness and dyspnea

Question 9

What are some drugs used for PPH?

Answer 9

• Pitocin
• Methergine
• Prostin E2 (mom may throw up with this one)
• Prostaglandin

Question 10

PPH r/t lacerations What are the clinical signs?

Answer 10

• Continuous trickle of blood; firm fundus (this is the big clue…if she is saturating pads but her fundus is firm, check for laceration!)
• Decreasing Hct
• S/s of hypovolemic shock

Question 11

PPH r/t lacerations…What is treatment?

Answer 11

• Surgical repair if necessary
• Hygiene and sit baths
• Nothing PR

Question 12

PPH r/t hematoma

What are clinical signs?

Answer 12

• Pressure
• VS or skin color changes
• Hct lower w/o apparent blood loss
• Bulging mass

Question 13

PPH r/t retained fragments of placenta

What are signs?

Answer 13

• Dark colored bleeding
• Large clots
• Boggy uterus (even past massage)

Question 14

PPH r/t retained fragments of placenta

What is treatment?

Answer 14

• Control bleeding with drugs (oxytocin)
• Sonogram
• Curretage and antibiotics

Question 15

Coagulation problem with bleeding and increased clotting occurring at the same time

Answer 15

DIC

Question 16

What is treatment of DIC?

Answer 16

Correct underlying problem

Question 17

Uterus soft and boggy causing bladder to be distended and displaced= ?

Answer 17

Uterine atony

Question 18

A cut above causing bright red bleeding in spite of contracted uterus= ?

Answer 18

Laceration(s)

Question 19

Left behind so a soft/non-contracted uterus with slow trickle of dark red blood= ?

Answer 19

Retained placenta

Question 20

If uterine atony, lacerations, and retained placenta have all been ruled out, what may be the problem?

Answer 20

Coagulation problems

Question 21

What are some objective symptoms of hypovolemic shock? (6)

Answer 21

• Peripad soaked w/in 15 min
• Complaint of light-headed or dizzy
• Appears anxious; air hunger
• Skin cool and clammy; pale
• HR increased
• BP decreased

Question 22

What are some interventions for PP Hypovolemic shock?

Answer 22

• Stay with client
• Notify physician
• Massage fundus/expel clots
• *LR or NS per primary line
• Oxytoxic med
• Indwelling catheter
• Prep for possible surgery

Question 23

Collection of platelets and fibrin on a vessel wall

Answer 23

Thrombus

Question 24

Confined to lower leg involving superficial veins

Answer 24

Superficial thrombosis

Question 25

Clot dislodges and settles in the pulmonary artery

Answer 25

PE

Question 26

Veins from lower leg to femoral region

Answer 26

DVT

Question 27

What is the definition of puerperal infection?

Answer 27

Elevated temp of 100.4 or higher or 2 successive days of the first 10 PP days (not counting first 24 hours)

Question 28

What are risk factors for PP infection?

Answer 28

- ROM more than 24 hours before delivery - Placental fragments retained (growth medium for bacteria) - Anemia - Difficult labor (suction or forceps) - C-section

Question 29

Symptoms of PP infection?

Answer 29

- Fever - Chills - Abdominal tenderness; strong afterpains - Lochia (increased or scant; dk brown in color) - WBC elevated

Question 30

Is it ok to obtain a culture from a peripad?

Answer 30

No; culture vagina

Question 31

Treatment of PP infection: What do we do/give to encourage UC?

Answer 31

Encourage fluids; give oxytoxic agent

Question 32

Treatment of PP infection: What positioning to do put client in to prevent pooling of secretions?

Answer 32

High fowlers

Question 33

Breast infection r/t staph

Answer 33

Mastitis

Question 34

Symptoms of mastitis?

Answer 34

- Fever to 103 or greater and with chills - Breast reddened, hard (abscess) - Elevated WBC

Question 35

What is treatment for mastitis?

Answer 35

- Antibiotics (Pen G 48-72 hours; cephalexin for 10-14 days) - Warm compresses before feeding - Pump to empty breasts - I&D of abscess *some physicians recommend breastfeeding be discontinued temp--pen does cross into milk but wouldn't harm baby