Chapter 23: Conditions Occurring After Delivery Flashcards
Exam 2
Postpartum Early Warning Criteria:
Criteria used to help nurses serving postpartum patients include (having to do with mood):
Maternal agitation, confusion or unresponsiveness
Postpartum Early Warning Criteria:
Criteria used to help nurses serving postpartum patients include (having to do how they are feeling):
Report of headache or SOB by patient with preeclampsia
Postpartum Early Warning Criteria:
Criteria used to help nurses serving postpartum patients include (having to do vital signs):
Systolic bp <90 or >160 mmHg
Diastolic bp >100 mmHg
HR < 50 or > 120 bpm
RR < 10 or > 30 breaths/min
O2 Sat on room air < 95%
Oliguria for 2 or more hours <35mL/hr
Postpartum Hemorrhage:
What is typical blood loss after a vaginal birth?
Typical blood loss after vaginal birth is 500 mL
Postpartum Hemorrhage:
What is typical blood loss after c-section?
1,000 mL after a cesarean birth.
Postpartum Hemorrhage:
What is postpartum hemorrhage?
A postpartum hemorrhage (PPH) is bleeding of more than 1,000 mL despite uterine massage and first-line uterotonics (such as oxytocin [Pitocin]).
Postpartum Hemorrhage:
What is classified as major postpartum hemorrhage? What is classified as severe?
Blood loss over 1,000 mL may be classified as major; over 2,000 mL is severe.
Postpartum Hemorrhage:
When does primary or early PPH occur?
Primary or early PPH occurs within 24 hours of birth.
Postpartum Hemorrhage:
When does delayed or secondary PPH occur?
Delayed or secondary PPH may occur 24 hours to 12 weeks after birth.
Postpartum Hemorrhage:
After birth, what does the uterus do to prevent PPH?
After birth the uterus normally maintains hemostasis and prevents PPH by clotting and contraction of the myometrium of the uterus.
Postpartum Hemorrhage:
What is PPH often caused by?
PPH is often caused by uterine atony, blood coagulopathies, or trauma.
Postpartum Hemorrhage Risk Factors:
- Atony
- Trauma
- Coagulopathy
Slide 4 and 5 read
Postpartum Hemorrhage Treatment includes:
What should you do with the fundus?
Fundal massage of a boggy uterus.
Postpartum Hemorrhage Treatment includes:
What should you assess for if fundus is firm?
Assess for lacerations or hematoma if the fundus is firm
Postpartum hemorrhage treatment includes:
What should be done if there is an inability to void?
Bladder catheterization for inability to void.
Postpartum Hemorrhage Treatment:
What should be established?
Establishing intravenous access.
Postpartum Hemorrhage Treatment includes:
What should be administered?
Oxytocin (Pitocin) administered as a first-line uterotonic medication.
Hypovolemic Shock:
When is it triggered?
Triggered when the volume of circulating blood decreases to a degree that the body’s organs do not have enough oxygen to function properly.
Hypovolemic Shock:
What are symptoms of hypovolemic shock?
Hypotension
Tachycardia
Tachypnea
Oliguria
Mental status changes
Cool, pale, and clammy skin
Slowed capillary refill
Hypovolemic Shock Treatment:
What needs to be done with blood volume?
Restoration of circulating blood volume (usually normal saline or lactated Ringer’s)
Hypovolemic Shock Treatment:
What needs to be established?
Establish 2 large-bore IV lines
Hypovolemic Shock Treatment:
What should be monitored?
Monitor urine output using a Foley catheter.
Monitor vital signs.
Hypovolemic Shock Treatment:
What should labs be drawn up for?
Draw labwork as ordered to evaluate red blood cell count and assess for disseminated intravascular coagulation (DIC).
Hypovolemic Shock Treatment:
What should be administered?
Administer blood transfusions as ordered.
Thromboembolic Disease:
What is a VTE?
A venous thromboembolism (VTE) is a blood clot or multiple clots that form within a vein.
Thromboembolic Disease :
What are factors that place a pregnant patient at risk for thromboembolic disease?
Factors that place a patient who is pregnant at risk for thromboembolic disease include:
dilated veins leading to slower blood flow and pooling,
endothelial injury related to surgical intervention or placental detachment,
and the increase of coagulation factors in pregnancy to decrease the risk of hemorrhage.
Thromboembolic Disease:
Where are VTEs formed?
VTEs may be limited to superficial veins or form in deeper veins of the lower extremities (a deep vein thrombosis [DVT]).
Thromboembolic Disease :
How does a PE form?
A DVT can break off and travel to the pulmonary artery, which is known as a pulmonary embolism (PE).
Thromboembolic Disease :
What amount of maternal deaths does PEs account for in the US?
Pulmonary embolisms account for 9.2% of maternal deaths in the United States.
Thromboembolic Disease:
What are symptoms of DVT?
Symptoms of a DVT include swelling, pain, localized redness, warmth, and tenderness.
Thromboembolic Disease:
How are DVTs diagnosed?
DVTs are often diagnosed with ultrasound imaging.
Thromboembolic Disease :
What does treatment of DVTs include?
Treatment of a DVT may include anticoagulation therapy or surgery.
Thromboembolic Disease :
What is more common than a DVT?
A superficial vein thrombosis is more common than a DVT.
Thromboembolic Disease:
What are symptoms of a superficial vein thrombosis?
Symptoms include:
pain,
tenderness,
induration (hardening),
and erythema (redness) along the length of the vein and sometimes a low-grade fever.
The vein may feel cord-like.
Thromboembolic Disease :
How does a superficial vein thrombosis progress?
A superficial vein thrombosis is often self-limiting.
Thromboembolic Disease:
SUPPORTIVE MEASURES for the care of patients with superficial, uncomplicated VTEs include:
Elevating affective leg
Warm or cold compresses for comfort
NSAIDs
Compression stockings
Thromboembolic Disease :
Treatment for symptomatic VTEs include:
Anticoagulation possibly as long as 3 months
Thromboembolic Disease:
What is considered a medical emergency?
A PE is a medical emergency.
Thromboembolic Disease:
What treatment should begin prior to confirmation of PE/Thromboembolic disease?
Anticoagulant treatment should begin prior to confirmation of the diagnosis.
Thromboembolic Disease :
How long does anticoagulation therapy continue for?
Anticoagulant therapy continues for approximately 6 months.
Thromboembolic Disease :
How are symptoms of PE?
Symptoms of PEs are often nonspecific and include dyspnea, cough, sweating, and pleuritic chest pain.
Thromboembolic Disease :
How is diagnosis of PE made?
Diagnosis of a PE is accomplished by a ventilation/perfusion (V/Q) scan
and computer tomographic pulmonary angiography.
Postpartum Infections:
What can they be related to?
Postpartum infections can be related to:
perineal or cesarean wounds,
septic thrombophlebitis,
endometritis,
mastitis,
breast abscess,
and urinary tract infections.
Postpartum Infections:
Symptoms of postpartum infection can be how?
Symptoms of a postpartum infection can be nonspecific.
Postpartum Infections:
General symptoms of a postpartum infection include:
A fever that persists beyond the initial 24 hours after birth.
A fever that begins 2 to 10 days after birth.
Elevated white blood cell count that continues to rise rather than fall.
What kind of symptoms may a women feel for a short time which is normal?
Women may feel chills or shivers after birth for a short time which is normal
Postpartum Infections: Perineal Wounds:
What is it associated with?
Associated with third- and fourth-degree lacerations.
Postpartum Infections: Perineal Wounds:
Risks factors include:
Operative vaginal birth
Prolonged second stage of labor
Third- or fourth-degree lacerations
Mediolateral episiotomy
Maternal smoking
Meconium-stained fluid
Postpartum Infections: Perineal Wounds:
What are assessment findings?
Assessment findings include tenderness, redness, and swelling, as well as purulent, yellow, and stringy exudate.
Postpartum Infections: Perineal Wounds:
What does treatment include?
Treatment requires removal of sutures and opening of the wound.
Postpartum Infections: Perineal Wounds:
What circumstances are antibiotics used and not used?
Antibiotics are not necessary unless there is evidence of cellulitis.
Postpartum Infections: Cesarean Wounds:
What percent of c-section wounds are there infections?
Occurs in 1% to 28% of cesarean births.
Postpartum Infections: Cesarean Wounds
When are infections usually diagnosed after a c-section?
Often diagnosed after discharge, from day 4 to 7 postpartum.
Postpartum Infections: Cesarean Wounds
What do signs and symptoms of infection of C-section wounds include?
Induration, redness, warmth
Pain at the incision site
Wound edges may separate
Purulent discharge and fever may be noted
Postpartum Infections: Cesarean Wounds
How do Obs treat postpartum infections of C-sections?
How are wounds left?
Obstetric providers treat by opening and draining the wound.
Wounds are left open but kept moist and covered.
Postpartum Infections: Endometritis
What is endometritis?
Endometritis is an infection of the lining of the uterus.
Postpartum Infections: Endometritis
In what percent of c-section births and vaginal births does this occur in?
Occurs in up to 19% of cesarean births and 1% to 3% of vaginal births.
Postpartum Infections: Endometritis
What are risk factors to developing Endometritis?
Risk factors include:
chorioamnionitis,
prolonged labor,
and prolonged rupture of membranes, multiple cervical examinations during labor,
internal monitoring during labor, meconium-stained fluid,
retained placenta with manual removal, low socioeconomic status,
maternal diabetes or anemia,
preterm birth,
operative vaginal birth,
postterm pregnancy,
maternal human immunodeficiency virus infection,
bacterial vaginosis in pregnancy,
and group B Streptococcus colonization.
Postpartum Infections: Endometritis
What may endometritis do to the uterus?
Infection may cause the uterus to become soft and subinvoluted, which predisposes the patient to hemorrhage.
Postpartum Infections: Endometritis
Signs and symptoms include:
Fever (generally postpartum days 2 to 10) in absence of other cause
Uterine tenderness
Tachycardia
Purulent discharge
Flu-like symptoms
Postpartum Infections: Endometritis
How is it treated?
Typically treated with intravenous infusion of a broad-spectrum antibiotic.
Postpartum Infections: Lactational Mastitis
What is it?
Inflammation of the breast tissue often associated with infection.
Postpartum Infections: Lactational Mastitis
What are contributing factors?
Factors contributing to mastitis include delayed breast emptying, poor drainage of one or more ducts, inconsistent pressure on breasts (like poorly fitting bra), infrequent feedings, rapid weaning, oversupply of milk, or nipple trauma.
Postpartum Infections: Lactational Mastitis
When is it most common?
Most common in the first 3 months of breastfeeding.
Postpartum Infections: Lactational Mastitis
What are symptoms?
Symptoms include tender, red area of breast, malaise, or a high fever.
Postpartum Infections: Lactational Mastitis
Treatment may include:
Cold compresses
NSAIDs
Regular and complete emptying of the breast
Antibiotics
Postpartum Infections: Urinary Tract Infection (UTI)
When are patients prone to UTIs? Why?
Patients in the postpartum period are prone to UTIs because of the frequency of bladder catheterization and genital procedures.
Postpartum Infections: Urinary Tract Infection (UTI):
What are symptoms of UTIs?
Symptoms include
urinary urgency and pain with urination, hematuria,
and lower abdominal discomfort.
Postpartum Infections: Urinary Tract Infection (UTI)
What is pyelonephritis?
Pyelonephritis is a UTI of the upper urinary tract.
Postpartum Infections: Urinary Tract Infection (UTI)
What are symptoms of pyelonephritis?
Symptoms include flank pain, nausea and vomiting, and fever above 100.4°F (38°C).
Postpartum Infections: Urinary Tract Infection (UTI):
What is treatment?
Treatment is generally antibiotics.
Postpartum Mood Disorders
What is Postpartum blues? When does it start and resolve?
Postpartum blues is a transient, self-limiting mood disorder that starts 2 or 3 days after birth and resolves within 2 weeks.
Postpartum Mood Disorders
What is postpartum depression? When is onset?
Postpartum depression as defined by the American Psychiatric Association (APA) is major depression with an onset during pregnancy or in the first 4 weeks after birth. Onset may be as late as 6 weeks to a year after birth.
Postpartum Mood Disorders:
What is Postpartum psychosis?
Postpartum psychosis, a rare disorder, is the disturbance of a patient’s perception of reality postpartum as evidenced by hallucinations, thought disorganization, disorganized behavior, and delusions.
Postpartum Mood Disorders:
What is Postpartum psychosis considered?
It is a medical emergency.
Postpartum Depression #1:
What percent of patients experience postpartum depression?
Estimated 10% to 16% of patients experience postpartum depression.
There is more stuff like risk factors on slide 21
Postpartum Depression:
How to be diagnosed with postpartum depression?
To be diagnosed with postpartum depression, a patient must meet at least five of the nine diagnostic criteria for major depressive disorder identified by the APA during a 2-week period with at least one of the symptoms being a depressed mood or diminished pleasure in all or most activities.
Postpartum Depression : What is treatment?
Treatment includes medication and therapy.
Postpartum Depression :
What are warning signs of postpartum depression?
Low mood for at least 2 weeks
Negative attitude toward the infant
Little interest in the infant or infant activities
Anxiety about the health of the infant
Concern about the ability to care for the infant
Use of alcohol, street drugs, drugs prescribed to others, or tobacco
Nonadherence to recommended care
Frequent off-schedule calls and/or visits to the healthcare provider
Postpartum Depression : Factors affecting PPD?
History of prenatal depression
Hormonal dyregulation
Inadequate social support; unmarried or socially isolated
Pregnancy not planned
Obstetric complications
Difficult infant temperament or behavior
Low socioeconomic status
Postpartum Depression :
PPD Sequelae
Unsuccessful or no breastfeeding
Poor maternal responsiveness/low bonding with infant
Harsh parenting; Low use of child safety practices
Poor infant attachment
Child behavior problems
Postpartum Psychosis:
What is it?
Disturbance of a patient’s perception of reality postpartum as evidenced by hallucinations, thought disorganization, disorganized behavior, and delusions
Postpartum Psychosis:
What patients is it most common in?
Most common in patients with bipolar disorder or who suffer from depression with schizophrenia, schizoaffective disorder, or psychosis
Postpartum Psychosis:
When does postpartum psychosis occur?
Condition may occur within 48 hours of birth and almost always develops within the first few weeks after the birth
Postpartum Psychosis: How does it manifest itself?
Psychosis manifests as bizarre behavior, confusion, hallucinations, delusions, and/or the appearance of delirium.
Postpartum Psychosis: What is the priority of care for a patient with postpartum psychosis?
The priority of care is the safety of the patient and the safety of the infant.
Postpartum Psychosis:
What does treatment require?
Treatment often requires inpatient psychiatric care.
