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NURS 414: OB > Chapter 23: Conditions Occurring After Delivery > Flashcards

Chapter 23: Conditions Occurring After Delivery Flashcards

Exam 2

1
Q

Postpartum Early Warning Criteria:

Criteria used to help nurses serving postpartum patients include (having to do with mood):

A

Maternal agitation, confusion or unresponsiveness

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2
Q

Postpartum Early Warning Criteria:

Criteria used to help nurses serving postpartum patients include (having to do how they are feeling):

A

Report of headache or SOB by patient with preeclampsia

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3
Q

Postpartum Early Warning Criteria:

Criteria used to help nurses serving postpartum patients include (having to do vital signs):

A

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

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4
Q

Postpartum Hemorrhage:

What is typical blood loss after a vaginal birth?

A

Typical blood loss after vaginal birth is 500 mL

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5
Q

Postpartum Hemorrhage:

What is typical blood loss after c-section?

A

1,000 mL after a cesarean birth.

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6
Q

Postpartum Hemorrhage:

What is postpartum hemorrhage?

A

A postpartum hemorrhage (PPH) is bleeding of more than 1,000 mL despite uterine massage and first-line uterotonics (such as oxytocin [Pitocin]).

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7
Q

Postpartum Hemorrhage:

What is classified as major postpartum hemorrhage? What is classified as severe?

A

Blood loss over 1,000 mL may be classified as major; over 2,000 mL is severe.

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8
Q

Postpartum Hemorrhage:

When does primary or early PPH occur?

A

Primary or early PPH occurs within 24 hours of birth.

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9
Q

Postpartum Hemorrhage:

When does delayed or secondary PPH occur?

A

Delayed or secondary PPH may occur 24 hours to 12 weeks after birth.

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10
Q

Postpartum Hemorrhage:

After birth, what does the uterus do to prevent PPH?

A

After birth the uterus normally maintains hemostasis and prevents PPH by clotting and contraction of the myometrium of the uterus.

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11
Q

Postpartum Hemorrhage:

What is PPH often caused by?

A

PPH is often caused by uterine atony, blood coagulopathies, or trauma.

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12
Q

Postpartum Hemorrhage Risk Factors:

A
  1. Atony
  2. Trauma
  3. Coagulopathy
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13
Q

Slide 4 and 5 read

A
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14
Q

Postpartum Hemorrhage Treatment includes:

What should you do with the fundus?

A

Fundal massage of a boggy uterus.

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15
Q

Postpartum Hemorrhage Treatment includes:

What should you assess for if fundus is firm?

A

Assess for lacerations or hematoma if the fundus is firm

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16
Q

Postpartum hemorrhage treatment includes:

What should be done if there is an inability to void?

A

Bladder catheterization for inability to void.

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17
Q

Postpartum Hemorrhage Treatment:

What should be established?

A

Establishing intravenous access.

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18
Q

Postpartum Hemorrhage Treatment includes:

What should be administered?

A

Oxytocin (Pitocin) administered as a first-line uterotonic medication.

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19
Q

Hypovolemic Shock:

When is it triggered?

A

Triggered when the volume of circulating blood decreases to a degree that the body’s organs do not have enough oxygen to function properly.

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20
Q

Hypovolemic Shock:

What are symptoms of hypovolemic shock?

A

Hypotension

Tachycardia

Tachypnea

Oliguria

Mental status changes

Cool, pale, and clammy skin

Slowed capillary refill

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21
Q

Hypovolemic Shock Treatment:

What needs to be done with blood volume?

A

Restoration of circulating blood volume (usually normal saline or lactated Ringer’s)

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22
Q

Hypovolemic Shock Treatment:

What needs to be established?

A

Establish 2 large-bore IV lines

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23
Q

Hypovolemic Shock Treatment:

What should be monitored?

A

Monitor urine output using a Foley catheter.

Monitor vital signs.

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23
Q

Hypovolemic Shock Treatment:

What should labs be drawn up for?

A

Draw labwork as ordered to evaluate red blood cell count and assess for disseminated intravascular coagulation (DIC).

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24
Q

Hypovolemic Shock Treatment:

What should be administered?

A

Administer blood transfusions as ordered.

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25
Q

Thromboembolic Disease:

What is a VTE?

A

A venous thromboembolism (VTE) is a blood clot or multiple clots that form within a vein.

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26
Q

Thromboembolic Disease :

What are factors that place a pregnant patient at risk for thromboembolic disease?

A

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.

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27
Q

Thromboembolic Disease:

Where are VTEs formed?

A

VTEs may be limited to superficial veins or form in deeper veins of the lower extremities (a deep vein thrombosis [DVT]).

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28
Q

Thromboembolic Disease :

How does a PE form?

A

A DVT can break off and travel to the pulmonary artery, which is known as a pulmonary embolism (PE).

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29
Q

Thromboembolic Disease :

What amount of maternal deaths does PEs account for in the US?

A

Pulmonary embolisms account for 9.2% of maternal deaths in the United States.

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30
Q

Thromboembolic Disease:

What are symptoms of DVT?

A

Symptoms of a DVT include swelling, pain, localized redness, warmth, and tenderness.

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31
Q

Thromboembolic Disease:

How are DVTs diagnosed?

A

DVTs are often diagnosed with ultrasound imaging.

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32
Q

Thromboembolic Disease :

What does treatment of DVTs include?

A

Treatment of a DVT may include anticoagulation therapy or surgery.

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33
Q

Thromboembolic Disease :

What is more common than a DVT?

A

A superficial vein thrombosis is more common than a DVT.

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34
Q

Thromboembolic Disease:

What are symptoms of a superficial vein thrombosis?

A

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.

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35
Q

Thromboembolic Disease :

How does a superficial vein thrombosis progress?

A

A superficial vein thrombosis is often self-limiting.

36
Q

Thromboembolic Disease:

SUPPORTIVE MEASURES for the care of patients with superficial, uncomplicated VTEs include:

A

Elevating affective leg

Warm or cold compresses for comfort

NSAIDs

Compression stockings

37
Q

Thromboembolic Disease :

Treatment for symptomatic VTEs include:

A

Anticoagulation possibly as long as 3 months

37
Q

Thromboembolic Disease:

What is considered a medical emergency?

A

A PE is a medical emergency.

37
Q

Thromboembolic Disease:

What treatment should begin prior to confirmation of PE/Thromboembolic disease?

A

Anticoagulant treatment should begin prior to confirmation of the diagnosis.

38
Q

Thromboembolic Disease :

How long does anticoagulation therapy continue for?

A

Anticoagulant therapy continues for approximately 6 months.

38
Q

Thromboembolic Disease :

How are symptoms of PE?

A

Symptoms of PEs are often nonspecific and include dyspnea, cough, sweating, and pleuritic chest pain.

38
Q

Thromboembolic Disease :

How is diagnosis of PE made?

A

Diagnosis of a PE is accomplished by a ventilation/perfusion (V/Q) scan

and computer tomographic pulmonary angiography.

38
Q

Postpartum Infections:

What can they be related to?

A

Postpartum infections can be related to:

perineal or cesarean wounds,

septic thrombophlebitis,

endometritis,

mastitis,

breast abscess,

and urinary tract infections.

39
Q

Postpartum Infections:

Symptoms of postpartum infection can be how?

A

Symptoms of a postpartum infection can be nonspecific.

40
Q

Postpartum Infections:

General symptoms of a postpartum infection include:

A

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.

41
Q

What kind of symptoms may a women feel for a short time which is normal?

A

Women may feel chills or shivers after birth for a short time which is normal

42
Q

Postpartum Infections: Perineal Wounds:

What is it associated with?

A

Associated with third- and fourth-degree lacerations.

43
Q

Postpartum Infections: Perineal Wounds:

Risks factors include:

A

Operative vaginal birth

Prolonged second stage of labor

Third- or fourth-degree lacerations

Mediolateral episiotomy

Maternal smoking

Meconium-stained fluid

44
Q

Postpartum Infections: Perineal Wounds:

What are assessment findings?

A

Assessment findings include tenderness, redness, and swelling, as well as purulent, yellow, and stringy exudate.

45
Q

Postpartum Infections: Perineal Wounds:

What does treatment include?

A

Treatment requires removal of sutures and opening of the wound.

46
Q

Postpartum Infections: Perineal Wounds:

What circumstances are antibiotics used and not used?

A

Antibiotics are not necessary unless there is evidence of cellulitis.

47
Q

Postpartum Infections: Cesarean Wounds:

What percent of c-section wounds are there infections?

A

Occurs in 1% to 28% of cesarean births.

48
Q

Postpartum Infections: Cesarean Wounds

When are infections usually diagnosed after a c-section?

A

Often diagnosed after discharge, from day 4 to 7 postpartum.

49
Q

Postpartum Infections: Cesarean Wounds

What do signs and symptoms of infection of C-section wounds include?

A

Induration, redness, warmth

Pain at the incision site

Wound edges may separate

Purulent discharge and fever may be noted

50
Q

Postpartum Infections: Cesarean Wounds

How do Obs treat postpartum infections of C-sections?

How are wounds left?

A

Obstetric providers treat by opening and draining the wound.

Wounds are left open but kept moist and covered.

51
Q

Postpartum Infections: Endometritis

What is endometritis?

A

Endometritis is an infection of the lining of the uterus.

52
Q

Postpartum Infections: Endometritis

In what percent of c-section births and vaginal births does this occur in?

A

Occurs in up to 19% of cesarean births and 1% to 3% of vaginal births.

53
Q

Postpartum Infections: Endometritis

What are risk factors to developing Endometritis?

A

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.

54
Q

Postpartum Infections: Endometritis

What may endometritis do to the uterus?

A

Infection may cause the uterus to become soft and subinvoluted, which predisposes the patient to hemorrhage.

55
Q

Postpartum Infections: Endometritis

Signs and symptoms include:

A

Fever (generally postpartum days 2 to 10) in absence of other cause

Uterine tenderness

Tachycardia

Purulent discharge

Flu-like symptoms

56
Q

Postpartum Infections: Endometritis

How is it treated?

A

Typically treated with intravenous infusion of a broad-spectrum antibiotic.

57
Q

Postpartum Infections: Lactational Mastitis

What is it?

A

Inflammation of the breast tissue often associated with infection.

58
Q

Postpartum Infections: Lactational Mastitis

What are contributing factors?

A

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.

59
Q

Postpartum Infections: Lactational Mastitis

When is it most common?

A

Most common in the first 3 months of breastfeeding.

60
Q

Postpartum Infections: Lactational Mastitis

What are symptoms?

A

Symptoms include tender, red area of breast, malaise, or a high fever.

61
Q

Postpartum Infections: Lactational Mastitis

Treatment may include:

A

Cold compresses
NSAIDs
Regular and complete emptying of the breast
Antibiotics

62
Q

Postpartum Infections: Urinary Tract Infection (UTI)

When are patients prone to UTIs? Why?

A

Patients in the postpartum period are prone to UTIs because of the frequency of bladder catheterization and genital procedures.

63
Q

Postpartum Infections: Urinary Tract Infection (UTI):

What are symptoms of UTIs?

A

Symptoms include

urinary urgency and pain with urination, hematuria,
and lower abdominal discomfort.

64
Q

Postpartum Infections: Urinary Tract Infection (UTI)

What is pyelonephritis?

A

Pyelonephritis is a UTI of the upper urinary tract.

65
Q

Postpartum Infections: Urinary Tract Infection (UTI)

What are symptoms of pyelonephritis?

A

Symptoms include flank pain, nausea and vomiting, and fever above 100.4°F (38°C).

66
Q

Postpartum Infections: Urinary Tract Infection (UTI):

What is treatment?

A

Treatment is generally antibiotics.

67
Q

Postpartum Mood Disorders

What is Postpartum blues? When does it start and resolve?

A

Postpartum blues is a transient, self-limiting mood disorder that starts 2 or 3 days after birth and resolves within 2 weeks.

68
Q

Postpartum Mood Disorders

What is postpartum depression? When is onset?

A

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.

69
Q

Postpartum Mood Disorders:

What is Postpartum psychosis?

A

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.

70
Q

Postpartum Mood Disorders:

What is Postpartum psychosis considered?

A

It is a medical emergency.

71
Q

Postpartum Depression #1:

What percent of patients experience postpartum depression?

A

Estimated 10% to 16% of patients experience postpartum depression.

There is more stuff like risk factors on slide 21

72
Q

Postpartum Depression:

How to be diagnosed with postpartum depression?

A

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.

73
Q

Postpartum Depression : What is treatment?

A

Treatment includes medication and therapy.

74
Q

Postpartum Depression :

What are warning signs of postpartum depression?

A

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

75
Q

Postpartum Depression : Factors affecting PPD?

A

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

76
Q

Postpartum Depression :

PPD Sequelae

A

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

77
Q

Postpartum Psychosis:

What is it?

A

Disturbance of a patient’s perception of reality postpartum as evidenced by hallucinations, thought disorganization, disorganized behavior, and delusions

78
Q

Postpartum Psychosis:

What patients is it most common in?

A

Most common in patients with bipolar disorder or who suffer from depression with schizophrenia, schizoaffective disorder, or psychosis

79
Q

Postpartum Psychosis:

When does postpartum psychosis occur?

A

Condition may occur within 48 hours of birth and almost always develops within the first few weeks after the birth

80
Q

Postpartum Psychosis: How does it manifest itself?

A

Psychosis manifests as bizarre behavior, confusion, hallucinations, delusions, and/or the appearance of delirium.

81
Q

Postpartum Psychosis: What is the priority of care for a patient with postpartum psychosis?

A

The priority of care is the safety of the patient and the safety of the infant.

82
Q

Postpartum Psychosis:

What does treatment require?

A

Treatment often requires inpatient psychiatric care.

NURS 414: OB (15 decks)

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