Alterations Of Postpartum Flashcards
What are the 4 postpartum complications
Hemorrhage
Infection
Thromboembolic disease
Postpartum affective disorder
Why is Depression screening hard to do on postpartum women
Most of the questions that are asked she will say yes to, not because of the depression but because the changes asked come with bringing a baby I to the world
What is classified as postpartum hemorrhage
Any amount of bleeding that places the mother in hemodynamic jeopardy
What are the signs and symptoms of <20% blood loss
Mild degree of shock
Diaphoresis, increased capillary refilling, cool extremities, maternal anxiety
What are signs and symptoms of 20-40% blood loss
Moderate degree of shock
Tachycardia, postural hypotension, oliguria
Signs and symptoms of >40% blood loss
Severe degree of shock
Hypotension, agitation/ confusion, hemodynamic instability
There are multiple causes to postpartum hemorrhage, what are they
Uterine atony Lacerations/episiotomy Retained placental fragments Uterine inversion Coagulation disorders Hematomas Hemorrhage history after delivery
During the birth of the placenta, should the doctor help by pulling or let it fall out naturally
Let it fall out naturally
Pulling on placenta could cause uterine inversion
5 T’s of postpartum hemorrhage
Tone: uterine atony; distended bladder Tissue: retained placenta and clots Trauma: vaginal, cervical, uterine injury Thrombin: coagulopathy Traction: causing uterine inversion
When should you use Tylenol and when should you use Ibuprofen during/after pregnancy
During pregnancy only use Tylenol
After pregnancy use either but ibuprofen is reccomended because of its anti inflammatory properties
Management for postpartum hemorrhage
Focus on underlying cause Uterine massage Removal of retained placental fragments Antibiotics for infection Repair of lacerations
Postpartum hemorrhage is most commonly due to what
Uterine atony
What is subinvolution
The uterus not contracting the way it should
Causes of subinvolution
Retained placental fragments
Distended bladder
Uterine myoma
Infection
Complications of subinvolution
Hemorrhage
Pelvic peritonitis (inflammation of everything)
Salpingitis (inflammation of Fallopian tubes)
Abscess formation
Why is treatment of salpingitis so important
Your Fallopian tubes are as hollow as a single hair
In this infection if it is bit treated they could close up or scar tissue could build up causing future infertility
Thromboembolic conditions
Inflammation of blood vessel lining
Two most common types of thromboembolic conditions
Superficial and deep vein
What is different about superficial and deep vein thrombosis
Superficial you can see by looking at lower extremities
Deep vein you can only see with a Doppler ultrasound
What should you be careful about when looking at thromboembolic conditions
Superficial and deep vein can occur at the same time. Always look for deep vein because although you can’t see it it can be there. Both can be very painful
When testing for thromboembolic conditions do we worrying about unilateral pain or bilateral pain
Unilateral
What drug would a nurse expect to administer to a postpartum woman with deep vein thrombosis
Heparin
What does a fever have to be over after first 24 hours to indicate a infection
100.4 degrees F
What are the four postpartum infections
Metritis
Wound infections
UTI
Mastitis
What is metritis
Infection of endometrium, decidua, and adjacent myometrium
What is mastitis
Inflammation of the breast
Therapeutic management of metritis
Broad-spectrum antibiotics
Therapeutic management of wound infection
Recognition of infection and opening of wound to promote drainage, aseptic technique, analgesics if needed
Therapeutic management of UTI
Fluids and antibiotics
Therapeutic management of mastitis
Breast emptying and antibiotics
If a woman has mastitis how often should you try to get her to empty her breast?
Every 2 hours
Is vagina a sterile environment
No
Does tear or episiotomy heal better
Tear
What are ways to prevent postpartum infections
Aseptic technique, hand washing, perineal hygiene, screening of visitors
What does REEDA stand for? What is it used for?
Perineal healing assessment Redness Edema Ecchymosis Discharge Approximation
Do you see Lochia Rubra more in vaginal delivery or C/S? Why?
More in vaginal delivery because they vacuum the uterus out during C/S so you Exocet to see less blood
What is the most severe form of postpartum affective disorder?
Postpartum psychosis
What is the treatment of postpartum psychosis
Hospitalization
Signs of postpartum psychosis
Not knowing right from wrong, clear disconnect from reality, manic behaviors
Signs is postpartum depression
Major depressive episode associated with childbirth, symptoms lasting beyond 6 weeks and worsening
Signs of “Baby Blues”
Onset quicker but resolves, mood swings, irritability, insomnia, typically resolves within 2 weeks, usually self limiting
