Exam 2 - Ch. 23 Flashcards
What conditions do the following S/S indicate?
Boggy uterus
Heavy bleeding
Saturated peripad within 15 to 30 minutes
Blood clots
Changes in skin color or turgor
Disoriented and anxious
Tachycardia
Hypotension
Uterine atony
The following are nursing intertentions for what condition?
Review prenatal and/or intrapartum records
Monitor vital signs
Establish intravenous access and draw labs
Perform fundal checks, assess bleeding, fundal massage
Assess and monitor patient more frequently
Administer and/or have uterotonics per orders and protocol
Reassure patient and provide explanation for nursing action/ interventions
Provide comfort measures
Uterine Atony
Risk factors for lacerations
Instrumented vaginal delivery
Malpresentation
Macrosomia
Episiotomy
Precipitous delivery
Shoulder dystocia
Clinical manifestations of lacerations
Steady stream of bleeding despite firm fundus
Absence of clots
Origin is often masked
Pain and hemodynamic instability are often
presenting symptoms
Tachycardia and hypotension
Prevention for lacerations
Minimal use of instrumentation
Limited use of an episiotomy
Offer operative delivery
What are the following nursing interventions for?
Review prenatal and intrapartum records
Monitor vital signs
Perform fundal checks and assess for bleeding
Monitor blood loss
Prepare patient for pending pelvic exam
Administer pain medication as prescribed
Provide comfort measures and emotional support
Lacerations
Risk factors for hematoma
Episiotomy
Instrumented vaginal delivery
Prolonged Second Stage
Clinical manifestations of hematoma
Severe pain in the vaginal or perineal areas
Pain often uncontrolled by standard analgesia
Swelling, discoloration, and tenderness
Vaginal bleeding may or may not be present
Prevention of hematomas
Avoid episiotomy and operative deliveries
Minimize second stage of labor
What condition are the following interventions used for?
Review prenatal and intrapartum records
Monitor vital signs
Apply ice to perineal area for first 24 hours postpartum
Assess pain
Administer pain meds as prescribed
Review lab results
Inform physician or APN as indicated
Hematoma
What conditions are the following interventions used on?
Call for help.
Fundal massage of a boggy uterus.
Assess for lacerations or hematoma if the fundus is firm.
Bladder catheterization for inability to void.
Establishing intravenous access.
Oxytocin administered as a first-line uterotonic medication.
Postpartum hemorrhage treatment
A family member of a postpartum patient comes out of the patient’s room to tell the nurse that the patient is pale, sweaty, and “isn’t acting right.” What should the nurse do first?
A. Notify the patient’s primary health care provider.
B. Evaluate the patient’s uterus and lochia.
C. Obtain a set of vital signs.
D. Reassure the family member that the patient is doing well.
B. Evaluate the patient’s uterus and lochia.
The patient may be experiencing excessive blood loss. The nurse should evaluate the patient’s fundus and lochia because uterine atony is a primary cause of postpartum hemorrhage. After assessing the uterus and lochia, the nurse might need to obtain a set of vital signs and notify the patient’s primary health care provider. The family should not be reassured that the patient is doing well at this time.
When is hypovolemic shock triggered?
When the volume of circulating blood decreases to a degree that the body’s organs do not have enough oxygen to function properly.
What condition is caused 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 the following S/S an indication of?
Hypotension
Tachycardia
Tachypnea
Oliguria
Mental status changes
Cool, pale, and clammy skin
Slowed capillary refill
Hypovolemic shock
What disease is caused by a venous thromboembolism (VTE) is a blood clot or multiple clots that form within a vein?
Thromboembolic disease
Factors that place a pregnant woman at risk for thromboembolic disease
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.
What is a pulmonary embolism?
VTEs may be limited to superficial veins or form in deeper veins of the lower extremities (a deep vein thrombosis [DVT]). A DVT can break off and travel to the pulmonary artery, which is known as a pulmonary embolism (PE).
Symptoms of a DVT
swelling, pain, localized redness, warmth, and tenderness.
How are DVTs diagnosed?
Ultrasound
What is the treatment of DVT?
Treatment of a DVT may include anticoagulation therapy or surgery.
What is more common, a DVT or a superficial vein thrombosis?
A superficial vein thrombosis is more common than a DVT.
What are the symptoms of a superficial vein thrombosis?
Symptoms include pain, tenderness, and redness along the length of the vein. The vein may feel cord-like.
In what condition does a vein feel cord-like?
A superficial vein thrombosis
How is a superficial vein thrombosis usually resolved?
A superficial vein thrombosis is often self-limiting.
Interventions with VTEs include:
Elevating affective leg
Warm or cold compresses for comfort
NSAIDs
Compression stockings
T/F: When a patient has a PE, you should watch and wait.
False. A PE is a medical emergency.
When should anticoagulant treatment for a PE should begin?
prior to confirmation of the diagnosis.
How long does anticoagulant therapy after a PE last?
6 months
T/F: Symptoms of PEs are often nonspecific.
True.
What condition presents with dyspnea, cough, sweating, and pleuritic chest pain?
Pulmonary embolism
How is a PE diagnosed?
Ventilation/perfusion (V/Q) scan and computer tomographic pulmonary angiography.
What can the following problems be related to: perineal wounds, cesarean wounds, endometritis, mastitis, and urinary tract infections.
Postpartum infections
What condition do the following symptoms indicate?
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.
Risk factors for a perineum postpartum infection are…
Operative vaginal delivery
Prolonged second stage of labor
Third- or fourth-degree laceration
Meconium-stained fluid
What condition manifests as the following?
Assessment findings include tenderness, redness, and swelling, as well as purulent discharge.
Postpartum Infections: Perineal Wounds
In a perineal wound, antibiotics are not necessary unless there is evidence of what?
Cellulitis
T/F: Treatment of an infected perineal wound doesn’t require removal of sutures and opening of the wound.
False, removal of sutures to open the wound is required.
What is edometriosis?
Endometritis is an infection of the lining of the uterus.
Is the rate of endometriosis higher in vaginal or cesarian births?
Cesarians at about 30%, vaginal only 1-3%
What are the following risk factors of?
Risk factors include chorioamnionitis, prolonged labor, and prolonged rupture of membranes.
Endometriosis
T/F: Infection may cause the uterus to become soft and subinvoluted
True
What condition can predispose the woman to hemorrhage?
Infection
S/S of endometriosis
Fever
Uterine tenderness
Flu-like symptoms
Tachycardia
How is endometriosis treated?
Typically treated with intravenous infusion of a broad-spectrum antibiotic.
What is mastitis?
Inflammation of the breast tissue often associated with infection.
What condition do the following factors indicate?
Delayed breast emptying, poor drainage of one or more ducts, inconsistent pressure on breasts (like poorly fitting bra), oversupply of milk, or nipple trauma.
Mastitis
Mastitis is common in what period after birth?
First 3 months
Mastitis presents how?
tender, red area of breast, malaise, or a high fever
What is the treatment for mastitis?
Cold compresses
NSAIDs
Regular and complete emptying of the breast
Antibiotics
What factors contribute to UTIs in postpartum women?
Bladder catheterization and genital procedures.
What are the symptoms of a UTI
Symptoms include urinary urgency and pain with urination.
What is Pyelonephritis
Pyelonephritis is a UTI of the upper urinary tract
What are the symptoms of pyelonephritis?
Symptoms include flank pain, nausea and vomiting, and fever.
What is the treatment for a UTI
antibiotics
Is the following statement true or false?
A patient who had a spontaneous vaginal delivery 12 hours ago and is found to have a low-grade fever and slightly elevated white blood cell count probably has an infection that should be treated.
False.
It is normal for women to have a low-grade fever and elevated white blood cell counts for 24 hours after delivery. If her temperature does not decrease after 24 hours or if her white blood cell counts continue to increase, she might have an infection that should be evaluated by her health care provider.
Is it normal for women to have a low-grade fever and elevated white blood cell counts for 24 hours after delivery.
Yes
When should maternal elevated white count and low grade fever resolve after birth?
24 hours
What is postpartum blues?
Postpartum blues is a transient, self-limiting mood disorder that starts 2 or 3 days after delivery and resolves within 2 weeks.
What is postpartum depression?
Postpartum depression is major depression with an onset during pregnancy or in the first 4 weeks after birth.
What is postpartum psychosis?
Postpartum psychosis is a rare disorder that affects a woman’s sense of reality.
To be diagnosed with postpartum depression, a woman must meet at how many of nine diagnostic criteria for major depressive disorder
Five of nine during a 2-week period with at least one of the symptoms being a depressed mood or diminished pleasure in all or most activities
What are these S/S an indication of?
Low mood for at least 2 weeks
Negative attitude toward the infant
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
Postpartum depression
What is the treatment for postpartum depression?
Treatment includes medication and therapy.
Disturbance of a woman’s perception of reality as evidenced by hallucinations, thought disorganization, disorganized behavior, and delusions is called what?
Postpartum psychosis
A home health nurse notices the patient, who delivered 6 weeks ago, appears disheveled, the house is dirty, and the infant appears to be well-fed but is wearing a dirty onesie. What should the nurse do first?
A. Notify the patients primary health care provider.
B. Interview the patient using open-ended questions.
C. Call child protective services due to the risk of postpartum psychosis.
D. Realize the patient has a new baby and is likely sleep deprived.
B. Interview the patient using open-ended questions.
The nurse should interview the patient using open-ended questions to find out what is going on and what the patient is thinking. The patient may be experiencing symptoms of postpartum depression and is having difficulty caring for herself or her infant or she may be sleep-deprived and having a rough day. After talking with the patient, the nurse may need to notify her primary health care provider. If the patient expresses thoughts about harming herself or her infant, has disorganized thoughts, or hallucinations, she may be experiencing postpartum psychosis and requires care immediately.
