Ch 14 High Risk PP(10-15) Flashcards
Risk factors for PPH
15
- maccrosomia
- placenta previa
- multiple gestation
- previous c/s, uterine surgery
- polyhydramnios
- high parity
- prior PPH
- operative vag delivery
- preeclampsia
- augmented/induced labor
- ineffective uterine contractions
- Triple I
- Obesity
- Coagulation defects
-lacerations/episiotomy
Involution vs subinvolution
involution= uterus returning to normal size
subinvolution= not returning to normal size
PPH definition
- vag: > 500ml
- c/s: >1000ml
- 10% decrease in Hgb/Hct
Primary vs Secondary PPH
Primary: within first 24 hours
Secondary: 24 hrs- 6-12 wks postdelivery
What are the 4 T’s
- Tone
- Trauma
- Tissue
- Thrombin
Which 2 are usually primary?
Which 2 usually secondary?
- Primary: tone, trauma
- Secondary: tissue, thrombin
Assessment findings in uterine atony (decreased tone)
9
- soft boggy uterus
- saturation of peripad in 15 min
- slow steady bleeding
- sudden massive bleeding
- presence of blood clots
- tachycardia
- pale & clammy
- anxiety/confusion
- hypotension
Nursing care for uterine atony
5- in order
- assess uterus (if displaced go pee or cath)
- reassess fundus and lochia
- review labs
- notify physician
- emotional support
Medical Management for uterine atony
3
- Meds: uterotonics
- Bimanual compression of uterus by provider
- IV therapy (fluids, blood, platelets, fresh frozen plasma)
Oxytocin
class, moa, maternal SE, contra, nursing
- Class: uterotonic
- MOA: uterine contraction
- SE: N/V, water intoxication
- Contra: fetal distress, and when vag delivery isn’t advised
- Nursing: monitor, d/c for fetal distress, monitor I&O
Methylergonovine(Methergine)
class, moa, maternal SE, contra, nursing
- Class: uterotonic
- MOA: smooth muscle stimulation (shortens stage 3, reduces bloos loss)
- SE: N/V, abd pain, headache, dizziness
- contra: HTN, sepsis, liver/kidney disease, CAD, DM, obesity
- Nursing: monitor BP, HR, uterine response, vaginal bleeding, contractions
Carboprost (Hemabate)
class, moa, maternal SE, contra, nursing
- Class: uterotonic
- MOA: strong uterine contractions
- SE: N/V, diarrhea
- Contra: PID, carciac, pulm, kidney, or liver disease
- Nursing: strict dosing, given IM, pretreat w/antiemetics
Misoprostol (Cytotec)
class, moa, maternal SE, contra, nursing
- Class: uterotonic
- MOA: uterine contractions
- SE: diarrhea, abd cramps
- Conta: CV diease, allergy to prostaglandins
- Nursing: should not be taken prior to labor, used for scheduled abortion for premature birth, uterine rupture, or defects
Tranexamic acid (TXA)
class, moa, maternal SE, contra, nursing
- Class: antifibrinolytic
- MOA: prevents clot breakdown
- SE: N/V, diarrhea
- Contra: DVT or other clots
- Nursing: assess for DVTs, educate on DVT
Trauma causes
2
- Lacerations
- Hematomas
Trauma laceration findings
2
- uterus firm, midline, heavier than normal bleeding
- Bleeding usually steady w/o clots
Hematoma assessment findings
3 vagina vs perineal
- severe pain uncontrolled by standard pain management
- Vagina: heaviness, rectal pressure
- Perineal: swelling, discoloration, tenderness, pressure/pain
Trauma medical management
2
- Laceration: visual inspection, possible repair
- Hematoma: excision to litigate vessel
Trauma Nursing Actions
4
- assess risk factors
- ICE for swelling
- monitor VS, treat pain
- notify physician
Tissue Assessment Findings
8
- profuse bleeding after first postpartum week
- lochia returns to rubra
- presence of large clots
- elevated temp, uterine tenderness with endometritis
- tachycardia
- hypotension
- confusion
- pale/clammy
Tissue nursing care
Pt education!!
Tissue Medical management
3
- US to identify tissue
- D&C to remove
- IV abx
Thrombin disorders
3
- DIC: Disseminated Intravascular Coagulation
- Anaphylactoid Syndrome of Pregnancy
- Venous Thromboembolic Disease (DVT, PE)
PP Infection Nursing Care
5
- assess s/sx of infection
- infection prevention measures (hygeine)
- encourage frequent urination
- hydration
- wound care
