T3 - Postpartum Complications (Josh)

Question 1

What constitutes a postpartum hemorrhage?

Answer 1

blood loss greater than 500 mL in 24 hrs

Question 2

When is an early postpartum hemorrhage?

When is a late postpartum hemorrhage?

Answer 2

Early = within 24 hrs

Late = after 24 hrs

Question 3

Common causes of Postpartum hemorrhage.

Answer 3

Uterine atony

Lacerations

Retained placenta (or fragments)

Disseminated Intravascular Coagulation (DIC)

Inversion of uterus

Subinvolution of uterus

Question 4

What is the #1 cause of postpartum hemorrhage?

Answer 4

Uterine atony

Question 5

What are predisposing factors to uterine atony?

Answer 5

Multiple pregs

Polyhydramnios

Macrosomic infant

Question 6

What are clinical signs of uterine atony?

Answer 6

Boggy uterus

Excessive blood loss (hypotensive shock)

Question 7

What are s/s of hypotensive shock?

Answer 7

Tachycardia

Tachypnea

Blood pressure decreasing

Skin changes (cool and clammy, pallor)

Restlessness and dyspnea

Question 8

What is nursing actions for Uterine Atony?

Answer 8

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

Question 9

How much does 1 mL of blood way?

Answer 9

1 g

Question 10

What are some drugs used in Postpartum Hemorrhage mgmt?

Answer 10

Pitocin

Methylergonovine (Methergine)

Prostin E2

Prostaglandins

Question 11

How much pitocin would be used to treat postpartum hemorrhage?

Answer 11

10-40 U/1000 mL LR or NS

Question 12

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

Answer 12

BP

Question 13

What are the prostaglandins used to treat postpartum hemorrhage?

Answer 13

Misoprostol (Cytotec) - SL, PO or per rectum

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

Question 14

Clinical signs of postpartum hemorrhage r/t lacerations.

Answer 14

Continuous trickle of blood/ firm fundus*

Decreasing Hct

S/S of hypovolemic shock

Question 15

Treatment for postpartum hemorrhage r/t lacerations.

Answer 15

Surgical repair If necessary

Encourage hygiene and Sitz baths

Nothing per rectum

Question 16

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

Answer 16

continuous trickle of blood/firm fundus

Question 17

Clinical signs of a postpartum hemorrhage r/t hematoma

Answer 17

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

Question 18

Treatment for postpartum hemorrhage r/t hematoma

Answer 18

Ice – reduce swelling

Heat – discomfort

Allowed to reabsorb/or evacuated and vessel ligated

Question 19

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

Answer 19

Yes

Question 20

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

Answer 20

DARK COLORED bleeding

Large clots

Boggy uterus (even past massage)

Question 21

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

Answer 21

Oxytocin

Sonogrom (to rule out other causes)

Curretage and Antbiotics

Question 22

What is a postpartum problem that can kill client?

Answer 22

DIC

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

Question 23

What is the treatment for DIC?

Answer 23

correct the underlying problem

***FAST

***have blood available

Question 24

Postpartum hemorrhage:

Soft boggy uterus =

Bright red bleeding =

Slow trickle of dark red blood =

Answer 24

Soft boggy uterus = UTERINE ATONY

Bright red bleeding = LACERATIONS

Slow trickle of dark red blood = RETAINED PLACENTA

Question 25

What are objective signs of Hypovolemic Shock?

Answer 25

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

Question 26

Nursing interventions for postpartum hypovolemic shock?

Answer 26

Stay with client Notify physician Massage fundus/expel clots LR or NS per primary line Oxytoxic medication Insert indwelling catheter Prepare for possible surgery

Question 27

What are the risk factors for a postpartum thromboembolism?

Answer 27

Maternal age > 35 Multiparity Venous stasis r/t immobility (legs in stirrups long time) Smoking History of Cardiac Disease or Diabetes

Question 28

How many types of Thrombosis are there?

Answer 28

Three - Superficial - PE (Pulmonary Embolism) - DVT

Question 29

What is a Puerperal Infection?

Answer 29

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

Question 30

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

Answer 30

thermoregulation may cause a temp of 100.4 unrelated to infection

Question 31

What increases risk of postpartum infection?

Answer 31

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

Question 32

Symptoms of a postpartum infection

Answer 32

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

Question 33

Treatment for a postpartum infection

Answer 33

Culture from vaginal vault (not pad) Fluids and oxytoxic agent to encourage UC Antibiotics High Fowlers positioning to prevent pooling of secretions

Question 34

Which organism is mastitis usually caused by?

Answer 34

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

Question 35

Symptoms of Mastitis

Answer 35

Fever to 103 or > with chills Breast reddened, hard (Abscess) Elevated WBC > >

Question 36

Treatment for Mastitis

Answer 36

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

Question 37

How long would you take Pen G for mastitis? How long would you take Cephalexin for mastitis?

Answer 37

48-72 hrs 10-14 days ***PCN does cross breast milk but won't harm baby ***still pump and dump, though