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NURS 372 > Week 9 - Postpartum Complications > Flashcards

Week 9 - Postpartum Complications Flashcards

(75 cards)

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1
Q

Postpartum mood changes/”Baby blues”

A

within 3-5 days postpartum

tearfulness

agitation

mood swings

anxiety

sleep and appetite disturbances

overwhelmed

vigilance

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2
Q

How long do the postpartum mood changes/baby blues last for?

A

2 weeks

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3
Q

T or F: Postpartum mood changes/baby blues interfere with the client’s ability to care for themselves and baby.

A

FALSE

do not interfere

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4
Q

Perinatal Mood Disorders (PMD)

A

anxiety, depression, psychosis

requires TREATMENT

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5
Q

When do Perinatal Mood Disorders (PMD) occur?

A

during pregnancy to 1 year after birth

may not occur right away

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6
Q

When do Perinatal Mood Disorders (PMD) most commonly occur?

A

4 - 6 weeks following birth

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7
Q

Protective factor

A

positive birth experience

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8
Q

Risk factors

A

marginalized communities

discrimination, racism

family history

previous history of anxiety or depression

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9
Q

Signs of PMD (many)

A

lack of sleep

not keeping up with activities

crying

negative feelings, not loving being a mom

can lead to a crisis

hearing voices

losing touch with reality

wanting to hurt self or the baby

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10
Q

Treatment for Perinatal Mood Disorders (PMD)

A

medication

nutrition

exercise

therapy

support systems

awareness, knowing you’re not alone

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11
Q

Etiology of Perinatal Mood Disorders (PMD)

A

COMPLEX

biological, psychological, situational, or multifactorial

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12
Q

CFIM cognitive domain example

A

education on baby’s care and well being

what the health conditions are, how they’re treating it, hospital policies etc.

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13
Q

CFIM affective domain example

A

sharing in a birth circle

sharing experiences in the community - therapeutic to share experience, validate ur emotions

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14
Q

CFIM behavioural domain example

A

setting different roles on NICU visits

behaviours that would help with milk production

exercise, sleep - protective factors

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15
Q

Ontario Perinatal Record
Screening for Anxiety and Depression

A

validated across different cultures

validated when individual does it themselves

best for individual to do it**

lower score=better

score over 12 - refer

screening, not diagnosis

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16
Q

Ontario Perinatal Record
Screening for Anxiety and Depression - screening

A

GAD-2 - anxiety screening

PHQ-2 - depression screening

T-ACE Screening Tool (Alcohol)

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17
Q

What to use if patient scores high on the PHQ-2 for depression

A

Edinburgh Perinatal / Postnatal Depression Scale (EPDS)

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18
Q

Perinatal Depression

A

low mood

lack of interest in activities

mild to severe

intense, pervasive sadness and labile mood swings

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19
Q

How long do perinatal depression symptoms last for?

A

last longer than 2 weeks

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20
Q

Treatment for perinatal depression

A

psychotherapy

CBT

psychodynamic therapy

antidepressants

antianxiety medications

electroconvulsive therapy

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21
Q

Medication consideration

A

breastfeeding and what meds can be used

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22
Q

Examples of open-ended questions to ask clients regarding mental health

A

“Now that you’ve had your baby, how are things going for you?”

“How have things changed for you since you’ve had your baby.”

“Some people have thoughts of hurting themselves or their baby. Have you had any of these thoughts?”

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23
Q

Things to promote with clients

A

exercise

sharing their feelings

sleep

seeking support

ask for hel

don’t overcommit

realistic expectations

flexibility in the day

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24
Q

Risk factors for perinatal mood disorders in partners

A

previous history

partner with postpartum depression

financial and work stress

poor social and relational support

difference with parenting expectations vs. reality

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25
Symptoms of perinatal mood disorders in partners
fatigue frustration anger irritability
26
Nursing interventions for perinatal mood disorders in partners
include partners in health teaching regarding PMD universal screening with validated tools advocating for strong healthcare team relationships
27
Postpartum psychosis overview
SEVERE rare typical onset: within 2 weeks
28
Postpartum psychosis symptoms
RAPID onset unusual behaviour hallucinations paranoid disorientation high levels of impulsivity increase risk for suicide or infanticide
29
Collaborative care for postpartum psychosis
inpatient psychiatric care antipsychotics mood stabilizers benzodiazepines electroshock therapy
30
Leading cause of maternal death
postpartum hemorrhage
31
Postpartum hemorrhage definition
any blood loss that has the potential to cause hemodynamic instability also blood loss that doesn't meet traditional cut-offs, BUT creates hemodynamic instability life-threatening, will little warning
32
Postpartum hemorrhage blood loss amount after vaginal birth
500 mL
33
Postpartum hemorrhage blood loss amount after C-section
1,000 mL
34
T or F: Postpartum hemorrhage is largely preventable
TRUE problem: not recognizing or recognizing late need early intervention
35
Primary postpartum hemorrhage
within first 24 hours after birth
36
When do primary postpartum hemorrhages most commonly occur?
within 4 hours***
37
Secondary postpartum hemorrhage
after 24 hours but less than 6 weeks
38
Best way to measure postpartum bleeding amount
direct measurement weigh blood soaked items (wet weight - dry weight) sponge counts pad counts use containers
39
T or F: Practitioners underestimate blood loss.
TRUE
40
Preventing postpartum hemorrhage
active management in the 3rd stage of labour oxytocin after delivery of anterior shoulder gentle cord traction (no pulling) immediate fundal assessment after birth
41
Oxytocin administration
usually 10 unit push IV or IM IM - vastus lateralis
42
Risk of PPH increases six-fold if the 3rd stage of labour takes longer than....
30 minutes placenta may be retained
43
4 Ts of Postpartum Hemorrhage
Tone - uterine attony* Trauma - perineum, cervix Tissue - retained placenta Thrombin - ability to clot
44
Risk factors for uterine attony (many)
overdistended uterus (macrosomia, multiples, polyhydramnios) high parity prolonged labour oxytocin-induced labour (cells oversaturated, less response) MgSo4 administration chorioamnionitis (affects ability to contract)
45
Examples of trauma
lacerations of birth canal uterine rupture (previous C-section and trialing vaginal birth) uterine inversion hematomas (on perineum - medical emergency)
46
Risk factors for trauma
operative birth precipitous birth
47
When to suspect bleeding from lacerations
bleeding despite a firm uterus faster signs of shock
48
Examples of tissue
detained placental fragments placenta previa placenta accreta (mild invasion) placenta increta (deeper invasion) placenta percreta (completely through the uterus)
49
What is done for retained tissue
manual removal by OB provider Dilation and curettage (D&C) may be required
50
Considerations for manual removal of tissue
painful! ensure adequate management consult anesthesia
51
Thrombin risk factors and causes
Idiopathic thrombocytopenic purpura (ITP) von Willebrand’s disease Disseminated intravascular coagulation (DIC)
52
Disseminated intravascular coagulation (DIC)
pathological clotting very bad! shock, SOB prolonged PTT low platelets low fibrinogen correction of underlying cause
53
Signs of hemorrhagic shock (many)
tachypnea and shallow respirations tachycardia, weak and irregular HR hypotension (late sign) cool, pale, clammy skin urinary output decreasing LOC - lethargic anxious
54
What is one of the first signs of shock?
anxiety!
55
T or F: Classic signs of shock may not appear until a significant amount of blood is lost.
TRUE until 30-40% of blood is lost blood volume increases during pregnancy - protective
56
Management of a PPH (many)
early recognitive MASSAGE THE FUNDUS watch blood clots as you're massaging eliminate bladder distention meds IV fluids - bolus blood transfusion oxygen administration bimanual compression by OB manual exploration of the uterus for retained placenta uterine tamponade (packing or balloon) ligation of arteries uterine compression suturing hysterectomy
57
Max amount of time that a balloon can be left in for
24 hours
58
What to do if fundus is firm and patient is still bleeding
assess for source of bleeding (trauma, thrombin)
59
Drugs for postpartum bleeding (5)
1) oxytocin* 2) misoprostol 3) carboprost thromethamine (Hemabate) 4) methylergonovine; ergonovine 5) tranexamic Acid
60
Oxytocin
contracts uterus decreases bleeding no contraindication for PPH monitor bleeding and tone
61
Misoprostol
contracts uterus don't give if allergic to prostaglandins monitor bleeding and tone
62
Carboprost thromethamine (Hemabate)
contracts uterus contraindications: avoid with severe asthma or hypertension monitor bleeding and tone
63
Methylergonovine; Ergonovine
contracts uterus contraindication: HTN, PET, cardiac disease check BP before giving do not give if greater than 140/90****
64
Postpartum infections
puerperal infection endometriosis wound infections UTIs mastitis
65
Puerperal infection
any infection of genital canal within 28 days after abortion or birth
66
Signs of a puerperal infection
fever foul smelling lochia lethargy severe abdominal pain subinvolution of the uterus tachycardia in mom (> mom) and baby (>160)
67
Most common infectious agents (2)
1) streptococci 2) anaerobes
68
Intrapartum risk factors for infection (many)
episiotomy or lacerations C-section prolonged rupture of membranes chorioamnionitis prolonged labour frequent bladder catheterization internal FHR monitor or IUPC multiple vaginal exams after ROM epidural retained placental fragments PPH
69
Infection prevention measures
limits vag exams to every 4 hours/as necessary using squirt bottle after going to the bathroom good hand hygeien nothing in the vagina prophylactic antibiotics in some cases
70
Venous Thromboembolic (VTE) Disorders
blood clot(s) inside a blood vessel due to venous stasis and hypercoagulation occurs during pregnancy or postpartum (up to 3 weeks)
71
What increases risk for embolus? a) vaginal birth b) C-section
b) C-section less ambulation
72
Priority for prevention VTE
early ambulation!
73
VTE risk factors
C-section operative vaginal delivery history of VTE, PE or varicosities obesity maternal age greater than 35 years multiparity smoking
74
Clinical manifestations of venous thromboembolism
pain and tenderness in lower extremities warmth redness enlargement and hardened vein
75
Clinical manifestations of PE
dyspnea & tachypnea tachycardia chest pain cough & hemoptysis elevated temperature

NURS 372 (12 decks)

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