ch. 33: postpartum complications Flashcards
What is UTERINE ATONY?
inadequate uterine ctx, uterus is flaccid & rapid blood loss can follow
What is the treatment for UTERINE ATONY?
-massage fundus until firm
-empty bladder
-IV oxytocic meds
What are PLACENTAL COMPLICATIONS?
-retained placenta: placenta NOT expelled within 30 mins after birth
-fragments of placenta remain in uterus
What is the treatment of PLACENTAL COMPLICATIONS?
manual separation and removal by nurse-midwife or physician
What are LACERATIONS?
-tear that causes bleeding despite contracted fundus: slow trickle, oozing, hemorrhage
-can also cause hematomas
What is the treatment of LACERATIONS?
-usually Id and sutured immediately: position changes, warm/cold application, increase fiber and fluid, stool softener
-hematomas are surgically evacuated
What is INVERSION OF THE UTERUS?
uterus turns inside out
-s/s: hemorrhage, shock, pain
What is the treatment of INVERSION OF THE UTERUS?
-maternal fluid resuscitation
-replacement fo uterus within pelvic cavity
-correction of associated clinical conditions
What is SUBINVOLUTION OF THE UTERUS?
delayed return of enlarged uterus to non-pregnant size and function
-s/s: prolonged lochia, irregular excessive bleeding
What is the treatment of SUBINVOLUTION OF THE UTERUS?
-depends on cause
-Ergonovine or Methylergonovine (methergine) 0.2 mg every 3-4 hr for 24-48 hr
What are the side effects of OXYTOCIN?
-water intoxication
-n/v
What are the contraindications for OXYTOCIN?
none for PPH
What is the dosage/route of OXYTOCIN?
10-20 units/L up to 80 units/L diluted in LR or NS at 125-200 microunits/min
OR
10-20 units IM
What are nursing considerations for OXYTOCIN, MISOPROSTOL, CARBOPROST, & DINOPROSTONE?
continue to monitor bleeding and uterine tone
What are the side effects of MISOPROSTOL?
-HA
-n/v
-diarrhea
-fever
-chills
What are the contraindications for MISOPROSTOL?
none
What is the dosage/route of MISOPROSTOL?
600-1000 mcg rectally ONCE
OR
400 mcg SL or PO ONCE
What are the side effects of METHYLERONOVINE?
-HTN
-hypotension
-n/v
-HA
What are the contraindications for METHYLERONOVINE?
-HTN
-PREECLAMPSIA
-CARDIAC DISEASE
What is the dosage/route of METHYLERONOVINE?
0.2 mg IM q 2-4 hr up to 5 DOSES
-can also be given intrauterine or orally
What are the nursing considerations for METHYLERONOVINE?
-check BP before admin
-DO NOT GIVE if BP > 140/90
-continue monitoring vag bleeding and uterine tone
What are the side effects of CARBOPROST?
-HA
-n/v
-diarrhea
-fever
-chills
-TACHYCARDIA
-HTN
What are the contraindications for CARBOPROST?
AVOID giving to pts w/ ASTHMA or HTN
What is the dosage/route of CARBOPROST?
250 mcg IM
OR
intrauterine inj q 15-90 min UP TO 8 DOSES
What are the side effects of DINOPROSTONE?
-HA
-n/v
-diarrhea
-fever
-chills
What are the contraindications for DINOPROSTONE?
use w/ caution on pts w/ hx of ASTHMA, HTN, HYPOTENSION
What is the dosage/route of DINOPROSTONE?
20 mg vaginal or rectal suppository q 2 hr
What are risk factors for developing a DVT/PE?
-obesity
-immobility
-malignancy
-chronic medical condition
-smoking
-multiparity
What are clinical manifestations of DVT?
-unilateral extremity edema, erythema, warmth, pain, + Homan’s sign
What are clinical manifestations of PE?
-chest pain
-coughing
-dyspnea
-tahcypnea
-crackles
What teaching would you provide to pts discharged home after a DVT/PE?
-explain treatment schedule and possible SE of oral anticoagulants
-pts on anticoagulants should AVOID BREASTFEEDING or use alternative (warfarin)
What is the management/nursing interventions for puerperal infection?
-IV broad spectrum axb (cephalosporins, penicillins, clindamycin, gentamycin)
-supportive care: hydration, rest pain relief
