T3 - Postpartum Complications (Josh) Flashcards Preview

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Flashcards in T3 - Postpartum Complications (Josh) Deck (37):
1

What constitutes a postpartum hemorrhage?

blood loss greater than 500 mL in 24 hrs

2

When is an early postpartum hemorrhage?

When is a late postpartum hemorrhage?

Early = within 24 hrs

Late = after 24 hrs

3

Common causes of Postpartum hemorrhage.

Uterine atony

Lacerations

Retained placenta (or fragments)

Disseminated Intravascular Coagulation (DIC)

Inversion of uterus

Subinvolution of uterus

4

What is the #1 cause of postpartum hemorrhage?

Uterine atony

5

What are predisposing factors to uterine atony?

Multiple pregs

Polyhydramnios

Macrosomic infant

6

What are clinical signs of uterine atony?

Boggy uterus

Excessive blood loss (hypotensive shock)

7

What are s/s of hypotensive shock?

Tachycardia

Tachypnea

Blood pressure decreasing

Skin changes (cool and clammy, pallor)

Restlessness and dyspnea

8

What is nursing actions for Uterine Atony?

Assess for bladder distention

Massage fundus and express clots

Accurate pad count (1 g of pad wt = 1 mL)

Maintain primary IV infusion

Type & Culture for blood

Meds

9

How much does 1 mL of blood way?

1 g

10

What are some drugs used in Postpartum Hemorrhage mgmt?

Pitocin

Methylergonovine (Methergine)

Prostin E2

Prostaglandins

11

How much pitocin would be used to treat postpartum hemorrhage?

10-40 U/1000 mL LR or NS

12

What should we be aware of when using Methylergonovine (Methergine) for treating postpartum hemorrhage?

BP

13

What are the prostaglandins used to treat postpartum hemorrhage?

Misoprostol (Cytotec) - SL, PO or per rectum

Carbopost or Hemabate - IM
- (C/Section intramyomtreially)

14

Clinical signs of postpartum hemorrhage r/t lacerations.

Continuous trickle of blood/ firm fundus*

Decreasing Hct

S/S of hypovolemic shock

15

Treatment for postpartum hemorrhage r/t lacerations.

Surgical repair If necessary

Encourage hygiene and Sitz baths

Nothing per rectum

16

What is the major clue that a postpartum hemorrhage r/t lacerations is happening?

continuous trickle of blood/firm fundus

17

Clinical signs of a postpartum hemorrhage r/t hematoma

Pressure (complaint of episiotomy pain)

VS or skin color changes

Hct lower without apparent blood loss

Bulging mass at introitus (may rapidly collect 250-500 mL blood)

Ice – reduce swelling
Heat – discomfort
Allowed to reabsorb/or evacuated and vessel ligated

18

Treatment for postpartum hemorrhage r/t hematoma

Ice – reduce swelling

Heat – discomfort

Allowed to reabsorb/or evacuated and vessel ligated

19

Would the nurse see symptoms of shock if the client develops a slow, continuous bleed (like a hematoma)?

Yes

20

Clinical signs of postpartum hemorrhage r/t placental fragments remaining in uterus.

DARK COLORED bleeding

Large clots

Boggy uterus (even past massage)

21

Treatment for postpartum hemorrhage r/t placental fragments remaining in uterus.

Oxytocin

Sonogrom (to rule out other causes)

Curretage and Antbiotics

22

What is a postpartum problem that can kill client?

DIC

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

23

What is the treatment for DIC?

correct the underlying problem

***FAST

***have blood available

24

Postpartum hemorrhage:

Soft boggy uterus =

Bright red bleeding =

Slow trickle of dark red blood =

Soft boggy uterus = UTERINE ATONY

Bright red bleeding = LACERATIONS

Slow trickle of dark red blood = RETAINED PLACENTA

25

What are objective signs of Hypovolemic Shock?

Peripad soaked within 15 minutes

Complaint of light-headed or dizzy

Appears anxious; air hunger

Skin cool and clammy; color pale

HR increased/BP decreased

26

Nursing interventions for postpartum hypovolemic shock?

Stay with client

Notify physician

Massage fundus/expel clots

LR or NS per primary line

Oxytoxic medication

Insert indwelling catheter

Prepare for possible surgery

27

What are the risk factors for a postpartum thromboembolism?

Maternal age > 35

Multiparity

Venous stasis r/t immobility (legs in stirrups long time)

Smoking

History of Cardiac Disease or Diabetes

28

How many types of Thrombosis are there?

Three

- Superficial
- PE (Pulmonary Embolism)
- DVT

29

What is a Puerperal Infection?

Elevated temp of 100.4 or higher on 2 successive days of the first 10 PP days

(NOT counting the first 24 hours)

30

Why do we disregard the elevated temp of first 24 hours post pregnancy?

thermoregulation may cause a temp of 100.4 unrelated to infection

31

What increases risk of postpartum infection?

ROM > 24 hours before delivery

Placental fragments retained (tissue necroses and serves as medium for bacterial growth)

Anemia – lowered defenses against infection

Difficult labor – many invasive procedures

Cesarean

32

Symptoms of a postpartum infection

Fever

Chills

Abdominal tenderness or strong afterpains

Lochia – increased OR scant --> dark brown in color

WBC’s elevated – more than the 20,000 or so normally elevated in PP

33

Treatment for a postpartum infection

Culture from vaginal vault (not pad)

Fluids and oxytoxic agent to encourage UC

Antibiotics

High Fowlers positioning to prevent pooling of secretions

34

Which organism is mastitis usually caused by?

staphylococcus

- from infants' nose and mouth
- from cracks in nipples
- from infected hand of mom or nurse

35

Symptoms of Mastitis

Fever to 103 or > with chills

Breast reddened, hard (Abscess)

Elevated WBC > >

36

Treatment for Mastitis

Antibiotics (Pen G X 48-72 hours) (Cephalexin for 10-14 days)

Warm compresses before feeding

Pump to empty breasts/continue breastfeeding

I&D of abscess

37

How long would you take Pen G for mastitis?

How long would you take Cephalexin for mastitis?

48-72 hrs

10-14 days

***PCN does cross breast milk but won't harm baby

***still pump and dump, though