CHAP 25 - POSTPARTUM COMP Flashcards

1
Q

Assessing the Postpartum Patient with Complications

EFPTP
DRUAP
PLPP

A

 Elevated temperature
 Feeling of extreme sadness or unreality
 Pallor
 Thready, rapid, weak pulse
 Pain and swelling
 Decreased blood pressure
 Relaxed uterus
 Uterine hemorrhage
 Abdominal pain
 Pain of symphysis pubis on walking
 Perineal pain
 Lochia with foul odor
 Pain and tenderness in calf of leg
 Positive Homans sign

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2
Q

Expected outcomes for discharge include:

A

 Lochia is free of foul odor.
 Fundus remains firm and midline with progressive
descent.
 Patient maintains a urinary output greater than 30 mL/h
 Lochia discharge amount is 6 in or less on a perineal pad
1 hour.
 Patient maintains vital signs and oxygen saturation
within defined normal limits.
 Patient identifies signs and symptoms that should be
reported.
 Patient demonstrates attachment behaviors with infant
despite separation or activity restriction.

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3
Q

HEMORRHAGE

A

one of the primary causes of mortality associated with childbearing,

is a major treat during
pregnancy, throughout labor, and continuing into the postpartum period.

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4
Q

4 Main Reasons for Postpartum Hemorrhage

A

1) Tone - uterine atony
2) Trauma - lacerations, hematomas, uterine inversion, or
uterine rupture
3) Tissue - retained placental fragments
4) Thrombin - development of disseminated intravascular
coagulation (DIC)

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5
Q

TONE

A

UTERINE ATONY

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6
Q

TRAUMA

A

lacerations, hematomas, uterine inversion, or
uterine rupture

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7
Q

TISSUE

A

retained placental fragments

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8
Q

THROMBIN

A

development of disseminated intravascular
coagulation (DIC)

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9
Q

or relaxation of the uterus, is the most
frequent cause of postpartum hemorrhage; it tends to occur
most often in Asian, Hispanic, and Black patients.

A

UTERINE ATONY

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10
Q

UTERINE ATONY

A

or relaxation of the uterus, is the most
frequent cause of postpartum hemorrhage; it tends to occur
most often in Asian, Hispanic, and Black patients.

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11
Q

S/sx of Uterine Atony

A

1) Abrupt gush of blood
2) Hypovolemic shock
3) Falling BP
4) Rapid, weak, o rthready pulse
5) Increased and shallow respirations
6) Clammy skin with hypopigmented mucocutaneous
surfaces
7) Increasing anxiety

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12
Q

Conditions that Distend the Uterus Beyond Average
Capacity

A

1) Multiple gestation
2) Polyhydramnios (excessive amount of amniotic fluid)
3) Large baby (greater than 9 lb)
4) Presence of uterine myomas (fibroid tumors)

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13
Q

Conditions that Could Have Caused Cervical or Uterine
Lacerations

A

1) Operative birth
2) Rapid birth

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14
Q

Conditions With Varied Placental Site or Attachment

A

1) Placenta previa
a) Low lying placenta
b) Marginal placenta
c) Partial previa
d) Complete previa

2) Placenta accreta
a) Accreta
b) Increta
c) Percreta

3) Premature separation of the placenta

4) Retained placental fragments

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15
Q

Conditions that Leave the Uterus Unable to Contract Readily

A

1) Deep anesthesia or analgesia
2) Labor initiated or assisted with an oxytocin agent
3) High parity or age over 35 years of age
4) Previous uterine surgery
5) Chorioamnionitis or endometritis
6) Secondary illness such as anemia
7) Prior history of postpartum hemorrhage
8) Prolonged use of magnesium sulfate or other tocolytic
therapy

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16
Q

Conditions that Lead to Inadequate Blood Coagulation

A

1) Fetal death
2) Disseminated intravascular coagulation

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17
Q

Additional Measures That Can Be Helpful To Combat
Uterine Atony Include:

A

 Elevate the patient’s lower extremities to improve
circulation to essential organs.
 Offer a bedpan or assist the pt to the bathroom at least
every 4 hours to be certain their bladder is emptying
because a fulll bladder predisposes a patient to uterine
atony.
 Administer oxygen by face mask at a rate of about 10-12
L/min.
 Obtain vital signs.

18
Q

other therapeutic management of uterine atony

A

1) Bimanual Compression
2) Blood Replacement
3) Hysterectomy or Suturing

18
Q

Therapeutic Management for Uterine Atony

A

1) Oxytocin bolus/infusion
2) Tranexamic acid for bleeding
3) Carbopost thomethamine
4) Misoprostol (cytotec)
5) Prostaglandin F2a derivative
6) Methylergonovine maleate (Methergin)

19
Q

HOW MANY DEGREE OF SEPERATION

20
Q

GRADE 2

A

VAGINAL BLEEDING, UTERINE CONTRACTIONS, NO SIGNS OF MATERNAL SHOCK, SIGNS OF FETAL DISTRESS PRESENT

20
Q

PPC

A

 Partial abruption concealed hemorrhage
 Partial abruption apparent hemorrhage
 Complete abruption, concealed hemorrhage

20
Q

is a prolapse of the fundus of the uterus
through the cervix so that the uterus turns inside out.

A

UTERINE INVERSION

21
Q

GRADE 0

A

ASYMPTOMATIC, SMALL RETROPLACENTA CLOT DETECTED

21
GRADE 1
VAGINAL BLEEDING, UTERINE IRRITABLITY, AND TEDNERNESS PRESENT; NO SIGN OF MATERNAL OR FETAL DISTRESS
22
GRADE 3
SEVERE BLEEDING PRESENT OR CONCEALED UTERINE HYPERTONOUS WOODEN HARD UTERUS PERSISTENT ABDOMINAL PAIN MATERNAL SHOCK OFTEN COAGULOPATHY FETAL DISTRESS OR DEATH
23
a placenta does not detach in its entirely; fragments of it separate and are left still attached to the uterus.
RETAINED PLACENTAL FRAGMENTS
23
a placenta that fuses with the myometrium because of an abnormal decidua basalis layer, may also be retained.
PLACENTA ACCRETA
23
LACERATION
They occur most often:  With difficult or precipitate births  In primigravidas  With the birth of a large infant (heavier than 9 lb)  With the use of a lithotomy position and instruments (e.g., focep, vacuum extraction)
24
a placenta with an accessory lobe, it can happen in any instance.
SUCCENTURIATA PLACENTA
24
3 KINDS OF LACERATION
CERVICAL VAGINAL PERINEAL
24
If a pt has a suture line on the perineum from an episiotomy or a laceration repair, a ready portal of entry exists for bacterial invasion.
INFECTION OF THE PERINEUM
25
4 CLASSIFICATION OF PERINEAL LACERATION
FIRST SECOND THIRD FOURTH DEGREE
25
is inflammation with the formation of blood clots.
THROMBOPHLEBITIS
25
is a defficiency in clotting ability caused by vascular injury.
DIC
25
is the incomplete return of the uterus to its pre-pregnant size and shape.
SUBINVOLUTION
26
or infection of the peritoneal cavity, usually occur as an extension of endometritis.
PERITONITIS
26
is an infection of the endometrium, the lining of the uterus.
ENDOMETRITIS
26
is a collection of blood below the epidermis of the vulva.
VULVAR HEMATOMAS
27
PHLEBITIS
is inflammation of the lining of a blood vessel.