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OB > Ch 31 + 33 postpartum complications > Flashcards

Ch 31 + 33 postpartum complications Flashcards

1
Q

definition of early PPH

A

-cumulative blood loss >1000 mL
-blood loss w/ S+S of hypovolemia
-within 24 hrs after birth (includes blood loss during birth)

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2
Q

causes early PPH (4 Ts)

A

-tone: uterine atony
-trauma: lacerations
-tissue: retained placenta
-thrombin: clotting abnormalities

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3
Q

risk factors uterine atony

A

-high parity
-labor dystocia/trauma during L&D
-rapid/prolonged labor
-use of oxytocin during labor
-anesthesia and analgesia
-over-distended uterus
-previous history
-magnesium sulfate admin
-chorio
-placenta previa/abruption

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4
Q

what part of hand do you use to massage fundus during uterine atony

A

palm of hand

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5
Q

Tx uterine atony

A

-massage fundus
—-if doesn’t work——:
-bimanual exploration and massage
-uterine tonics

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6
Q

anticipatory prep nursing interventions for uterine atony

A

-IV access with large bore catheter
-blood in lab
-uterine tonics readily available
-keep bladder empty

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7
Q

nursing interventions uterine atony

A

-call for immediate help
-empty bladder if distended
-massage fundus
-IV fluids
-administer oxytocin, uterine tonics
-position and O2 (if hypovolemic)
-administer blood prn

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8
Q

1st drug of choice for PPH

A

oxytocin

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9
Q

adverse effects of oxytocin admin

A

-HTN
-severe uterine Cxs

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10
Q

adverse effects of misoprostol (cytotec) - causes uterine contractions

A

-headache
-N/V/D
-fever
-chills

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11
Q

meds for PPH (uterine stimulant meds)

A

-oxytocin/pitocin
-cytotec
-methergine
-hemabate/carboprost

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12
Q

adverse reaction to methergine

A

HTN

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13
Q

contraindications to methergine

A

-HTN
-preeclampsia
-cardiac disease

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14
Q

when would you not be able to admin methergine for PPH

A

if BP >140/90

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15
Q

side effects all uterine stimulant meds (prostaglandins)

A

-headache
-N/V/D
-fever
-chills

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16
Q

contraindications to admin of hemabate/carboprost

A

asthma
HTN

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17
Q

what VS to check with hemabate/carboprost

A

temp q1-2h
breath sounds

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18
Q

what pts should dinoprostone (prostin) be used with caution with

A

-asthma
-HTN/hypoTN

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19
Q

purpose of tranexamic acid (TXA)

A

interferes with break down of clots

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20
Q

what pts would use of tranexamic acid (TXA) be contraindicated with

A

-known thromboembolic event during pregnancy
-h/o coagulopathy

21
Q

risk factors lacerations

A

-operative birth
-precipitate labor (fast)
-congenital abnormalities
-contracted pelvis/pelvic dystocias
-abnormal fetal characteristics
-previous scarring
-variscocities

22
Q

S+S lacerations

A

-firm, contracted fundus
-continued bleeding

23
Q

S+S pelvic hematomas

A

-pain/pressure unrelieved by analgesics
-pressure
-shock

24
Q

PPH after 24 hrs of birth

A

late PPH

25
Q

most common cause late PPH

A

uterine subinvolution

26
Q

2 causes uterine subinvolution

A

-infection
-retained placental fragments

27
Q

S+S late PPH

A

-vaginal bleeding (usually slow, oozing
-low, persistent backache
-abdominal pain/tenderness
-fatigue

28
Q

Tx late PPH

A

-oral methergine
-oral Abx
-re-evaluate in 2 wks

-if frank hemorrhage without response to uterine tonics: D&C

29
Q

risk factors PP (puerperal) infections

A

-ROM >24 hrs
-lacerations/incisions
-hemorrhage, hematomas
-anemia/poor physical health before birth
-intrauterine manipulation during labor/birth/pp

30
Q

S+S puerperal infections

A

-fever (after 1st 24 hrs)
-site specific S+S

31
Q

S+S perineal infection

A

-red, swollen, very tender
-purulent drainage
-wound dehiscence

32
Q

infection of uterus PP

A

endometritis

33
Q

S+S endometritis

A

-fever
-N/V
-malaise, anorexia
-foul smelling discharge
-abdominal distention
-uterine distention
-decreased bowel sounds
-lochia return from serosa to rubra

34
Q

causes endometritis

A

-birth
-prolonged ROM
-vaginal exams
-poor hygiene

35
Q

Tx endometritis

A

-IV Abx
-fowlers/semifowlers position
-palpate fundus q8h

36
Q

prevention of mastitis

A

-frequent feeds
-good latch
-teach early S+S
-warm line (phone # for PP nurse/hospital)
-2 week PP visit

37
Q

risk factors thromboembolic disease

A

-venous stasis
-immobility
-endothelial damage (stirrup use)
-increased clotting of pregnancy
-wound infection
-obesity
-previous history
-heart disease
-varicosities

38
Q

S+S thromboembolic disease

A

-abrupt onset
-sever leg pain
-edema

39
Q

Tx thromboembolic disease

A

-consultation
-anticoag therapy

40
Q

S+S superficial thrombophlebitis

A

-day 3-4 PP
-tenderness
-heat
-redness
-low grade fever
-elevated pulse

41
Q

Tx superficial thrombophlebitis

A

-heat
-elevate
-analgesia
-bedrest
-support hose
-anticoags

42
Q

prevention of DVT

A

-good hydration
-early ambulation
-avoid long use stirrups
-minimize blood loss
-avoid estrogen until 2 weeks PP (or done breastfeeding)

43
Q

S+S pulmonary embolism

A

-dyspnea, SOB
-cough, hemoptysis
-tachycardia
-chest pain

44
Q

nursing interventions pulmonary embolism

A

-O2
-IV access
-raise hob
-notify hcp

45
Q

S+S baby blues

A

-should go away in about 10 days
-sad, anxious, overwhelmed
-crying spells
-loss of appetite
-difficulty sleeping

46
Q

S+S PP depression

A

-same as baby blues but last longer and more severe
-thoughts of harming self/baby
-uninterested in baby

47
Q

screening tools for PP depression (3)

A

-EPDS: edinburgh postnatal depression screen (gold standard)
-PDSS: postpartum depression screening scale
-two item screen

48
Q

red flags for PP depression (identified during antenatal period)

A

-lack of acceptance of pregnancy
-excessive mood swings
-withdrawal
-preoccupation with appearance
-excessive physical complaints
-failure to prepare for baby

49
Q

red flags for PP depression (during PP period)

A

-excessive fatigue
-marked depression
-preoccupation with physical status
-low self esteem

OB (21 decks)

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