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NRSG 206: OB > [Exam 2] Chapter 22 – Nursing Management of the Postpartum Woman at Risk > Flashcards

[Exam 2] Chapter 22 – Nursing Management of the Postpartum Woman at Risk Flashcards

1
Q

Postpartum Hemorrhage: What is this

A

Potentially life-threatening complication that can occur after both vaginal and cesarean births

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2
Q

Postpartum Hemorrhage: At what time do these post often occur?

A

Within 4 hours of childbirth

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3
Q

Postpartum Hemorrhage: What is this defined as?

A

Blood loss greater than 500 mL after vaginal birth, and more than 1000 mL loss after a cesarean birth

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4
Q

Postpartum Hemorrhage: Morbidity is severe, with what happening in body because of this?

A

Organ failure, shock, edema, thrombosis, acute respiratory distress, sepsis, anemia, and prolonged hospitalization

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5
Q

Postpartum Hemorrhage: Major obstetric hemorrhage is defined as

A

Blood loss of more than 1500 - 2500 mL or bleeding that requires more than 5 units of transfused blood

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6
Q

Postpartum Hemorrhage: What is primary postpartum hemorrhage?

A

Blood loss that occurs within 24 hours of birth

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7
Q

Postpartum Hemorrhage: What is delayed postpartum hemorrhage?

A

Blood loss that occurs 24 hours to 12 weeks after birth

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8
Q

Postpartum Hemorrhage Patho: Most common cause of this?

A

Uterine atony, the failure of the uterus to contract and retract after birth.

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9
Q

Postpartum Hemorrhage Patho: How must uterus remain after birth?

A

Contracted to control bleeding from the placental site

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10
Q

Postpartum Hemorrhage Patho: What makes up 20% of the reasons for this?

A

Obstetric lacerations, uterine inveresion, adn rupture compromise

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11
Q

Postpartum Hemorrhage Patho: What do the muscles of the uterus do during the third stage?

A

Contract downward, causing constriction of the blood vessels that pass through uterine wall, stopping flow of blood. Causes placenta to separate from uterine wall.

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12
Q

Postpartum Hemorrhage Patho: Absence of uterine contractions may result in what

A

excessive blood loss

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13
Q

Postpartum Hemorrhage Patho: What do Uterotonic medication spromote/

A

Uterine contractions to prevent atony and speed delivery of the placenta

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14
Q

Postpartum Hemorrhage Patho: Blood volume increases by how much during pregnancy?

A

50%, causing Hct and Hgb to fall. Provides reserve for blood loss during delivery.

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15
Q

Postpartum Hemorrhage Patho: Typical signs of hemorrhage do not appear until when?

A

2100 mL of blood has been lost.

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16
Q

Postpartum Hemorrhage Patho: Current evidence of postpartum volume replacement suggests what?

A

Packed red blood cells, fresh frozen plasma, platelets, and recombinant factor VIIa

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17
Q

Postpartum Hemorrhage Patho: Blood loss in mild shock?

A

20%

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18
Q

Postpartum Hemorrhage Patho: Signs in Mild Shock?

A

Diaphoresis, increased cap refill, cool extremities, maternal anxiety

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19
Q

Postpartum Hemorrhage Patho: Blood loss in moderate shock?

A

20-40%

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20
Q

Postpartum Hemorrhage Patho: Signs of modereate shock?

A

Tachycardia, Postural hypotension, and Oliguria

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21
Q

Postpartum Hemorrhage Patho: BLood loss in severe shock?

A

> 40%

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22
Q

Signs of severe shock?

A

Hypotension, Agitation/Confusion, Hemodynamic Instability

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23
Q

Postpartum Hemorrhage Patho: A helpful way to remember the causes of postpartum hemorrhage is by using the 4T which are?

A

Tone

Tissue

Trauma

Thrombin

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24
Q

Postpartum Hemorrhage Patho: What is included in Tone?

A

Uterine tony, Distended Bladder

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25
Q

Postpartum Hemorrhage Patho: What is included in Tissue?

A

Retained placenta and clots; uterine subinvolution

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26
Q

Postpartum Hemorrhage Patho: What is included in Trauma?

A

Lacerations, hematoma, inversion, rupture

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27
Q

Postpartum Hemorrhage Patho: what is included in Thrombin?

A

Coagulopathy (preexisting or acquired)

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28
Q

Postpartum Hemorrhage and Tone: What causes tone to change?

A

From overdistention of the uterus. Can be caused by multiple gestation, fetal macrosomia, hydramnios, and placenta previa . Could also be prolonged or rapid, forceful labor if stimulated by oxytocin

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29
Q

Postpartum Hemorrhage and Tone: Uterine atony can lead to what?

A

Hypovolemic shock.

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30
Q

Postpartum Hemorrhage and Tone: Distended bladder can cause what problem?

A

Can displace the uterus from the midline to either side, which impedes its ability to contract to reduce bleeding

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31
Q

Postpartum Hemorrhage and Tissue: What happens when the placenta fails to seprate?

A

Leads to retained fragments, which occupy space and prevent the uterus from contracting fully to clamp down on blood vessels. Clots can also occupy this space

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32
Q

Postpartum Hemorrhage and Tissue: Tears or fragments left inside the woman may indicate what?

A

Accessory lobe or placenta accreta(uncommon condition where chorionic villi adhere to the myometrium causing the placenta to adhere abnormally)

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33
Q

Postpartum Hemorrhage and Tissue: What does subinvolution refer to?

A

Incomplete involution of the uterus or failure to return to its normal size and condition after birth.

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34
Q

Postpartum Hemorrhage and Tissue - Subinvolution: What causes this to occur?

A

When the myometrial fibers of the uterus do not contract effectively and causes relaxation.

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35
Q

Postpartum Hemorrhage and Tissue - Subinvolution: Complictions of this?

A

Hemorrhage, pelvic peritonitis, salpingitis, and abscess formation

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36
Q

Postpartum Hemorrhage and Tissue - Subinvolution: Causes of this?

A

Retained placental fragments, distended bladder, excessive maternal activity, uterine myoma, and infection

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37
Q

Postpartum Hemorrhage and Tissue - Subinvolution: How does the fundus feel here and lochia?

A

Fundus higher than expected, and boggy.

Lochia fails to change colors from red to serosa to alba within a few weeks

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38
Q

Postpartum Hemorrhage and Tissue - Subinvolution: Treatment for this?

A

Stimulating the uterus to expel fragments with a uterine stimulant, and antibiotics given to prevent infection

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39
Q

Postpartum Hemorrhage and Trauma: What type of trauma would be included here?

A

Lacerations and hematomas.

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40
Q

Postpartum Hemorrhage and Trauma: What can hemoatomas present as?

A

Pain or as change in VS disproporionate to amount of blood loss. Associated with episiotomy, instrumental birht, or nulliparity.

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41
Q

Postpartum Hemorrhage and Trauma: When does uterine inversion happen?

A

When the top of the uterus collapses into inner cavity due to excessive fundal pressure or pulling on the umbilical cord when placenta still firmly attached to fundus

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42
Q

Postpartum Hemorrhage and Trauma: Tx for uterine inversion?

A

Giving uterine relaxants and immediate manual replacement by the health care provider

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43
Q

Postpartum Hemorrhage and Thrombin: Why is this a problem?

A

Disorders that interfere with clot formation which can lead to hemorrhage

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44
Q

Postpartum Hemorrhage and Thrombin: Abnormal results from coagulation studies typically include what?

A

decreased platelet and fibrinogen levels

Increased prothrombin time

Partial thromboplastin time

Fibrin degradation products

Prolonged bleeding times

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45
Q

Postpartum Hemorrhage and Thrombin and Idiopathic Trombocytopenia Purpura (ITP): What is this?

A

Autoimmune disorder of increased platelet destruction caused by antibodies, which can increase a womans risk of overhanging. Decrease in number of circulating platelets.

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46
Q

Postpartum Hemorrhage and Thrombin and Idiopathic Trombocytopenia Purpura (ITP): When is this most commmon?

A

Young women during childbearing age

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47
Q

Postpartum Hemorrhage and Thrombin and Idiopathic Trombocytopenia Purpura (ITP): Therapy for this?

A

Glucocorticoids and immune globulin

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48
Q

Postpartum Hemorrhage and Thrombin and Von Willebrand Disease (vWD): What is this?

A

Congenital bleeding disorder, autosomal dominant. Characterized by prolonged bleeding time, and impairment of platelet adhesion

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49
Q

Postpartum Hemorrhage and Thrombin and Von Willebrand Disease (vWD): Diagnosed in who most often?

A

Women due to menorrhagia.

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50
Q

Postpartum Hemorrhage and Thrombin and Von Willebrand Disease (vWD): Most common signs of this?

A

Bleeding gums, easy bruising, menorrhagia, blood in urine and stools, nosebleeds and hematomas. PRolonged bleeding from trivial wounds and oral cavity bleeding common.

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51
Q

Postpartum Hemorrhage and Thrombin and Disseminated Intravascular Coagulation (DIC): What is this?

A

Life-threatening, acquired coagulopathy in which the clotting system abnormally activated, resulting in widespread clot formation in small vessels throughout body, which leads to depletion of platelets and coagulation factors.

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52
Q

Postpartum Hemorrhage and Thrombin and Disseminated Intravascular Coagulation (DIC): Secondary diagnosis , that occurs as a complication of what?

A

abruptio placentae, amniotic fluid embolism, intrauterine fetal death and severe preeclampsia

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53
Q

Postpartum Hemorrhage and Thrombin and Disseminated Intravascular Coagulation (DIC): Clinical features of this?

A

Petechiae, ecchymoses, bleeding gums, fevere, hypotension, hematomas, tachycardia and uncontrolled bleeding during birth

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54
Q

Postpartum Hemorrhage and Thrombin and Disseminated Intravascular Coagulation (DIC): Treatment goals?

A

Maintain tissue perfussion through aggressive administratio of fluid, oxygen, heparin, and blood products

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55
Q

Postpartum Hemorrhage and Therapeutic Mx: Management focuses on what?

A

Underlying cuase of hemorrhage.

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56
Q

Postpartum Hemorrhage and Therapeutic Mx: What is done to treat uterine atony?

A

Uterine massage

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57
Q

Postpartum Hemorrhage and Therapeutic Mx: What may be given for ITP?

A

Glucocorticoids and intravenous immunoglobulin, IV anti-RhoD, and platelet transfusions

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58
Q

Postpartum Hemorrhage and Therapeutic Mx: What are the therapies for vWD?

A

Desmopressin and plasma concentrates that contain von Willebrand factor

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59
Q

Postpartum Hemorrhage and Nursing Assessment: What should you review at first?

A

Mothers history, including labor hx.

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60
Q

Postpartum Hemorrhage and Nursing Assessment: Most common cause of this?

A

Uterine atony (failure of the uterus to contract properly after birth)

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61
Q

Postpartum Hemorrhage and Nursing Assessment: What is the Signaling a Postpartum hemorrhage Emergency (SAPHE) mat?

A

Mat was constructed so that each square on mat would absorb up to 50 mL of blood. Blood then calculated by multiplying the squares.

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62
Q

Postpartum Hemorrhage and Nursing Assessment: If bleeding continues without evidence of lacerations, suspect what?

A

placental fragments

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63
Q

Postpartum Hemorrhage and Nursing Assessment: How would uterus/hematoma appear with hematoma?

A

Uterus would be firm, wight bright red bleeding.

Hematoma will appear as localized bluish bulging area just under skin surface of perineal area. Provider will incise the skin bulge

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64
Q

Postpartum Hemorrhage and Nursing Management: When excessive bleeding present, initial steps are aimed at improving uterine tone by doing

A

fundal massage, IV fluid resuscitation, and administration of uterotonic meds

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65
Q

Postpartum Hemorrhage and Nursing Management: First line of treatment?

A

Manual massage and pharmacologic therapies.

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66
Q

Postpartum Hemorrhage and Nursing Management: Second line of tx/

A

Intrauterine balloon (or gauze) tamponade and uterine compression sutures.

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67
Q

Postpartum Hemorrhage and Nursing Management: THird line of tx?

A

Radiologic embolization, pelvic devascularization or hysterectomy

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68
Q

Postpartum Hemorrhage and Nursing Management: Last resort for tx?

A

Peripartum hysterectomy and carries higher mortality rate.

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69
Q

Postpartum Hemorrhage and Nursing Management - Massage the Uterus: When would this be done?

A

If uterine atony present

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70
Q

Postpartum Hemorrhage and Nursing Management - Massage the Uterus: Why would the boggy uterus be massaged?

A

To stimulate contractions and expression of any accumulated blood clots wjile supporting the lower uterine segment

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71
Q

Postpartum Hemorrhage and Nursing Management - Administer a Uterotonic Drug: When would this be administered?

A

If repeated fundal massage and expression of clot fails.

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72
Q

Postpartum Hemorrhage and Nursing Management - Administer a Uterotonic Drug: What drugs are administered after labor to prevent PPH?

A

Oxytocin (Pitocin)

Misoprostol/Dinoprostone

Methylergonovine Maleate (Methergine)

Carboprost

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73
Q

Postpartum Hemorrhage and Nursing Management - Administer a Uterotonic Drug: What contraindiction to know for Pitocin?

A

Never give undiluted as a bolus injection intravenously

74
Q

Postpartum Hemorrhage and Nursing Management - Administer a Uterotonic Drug: What contraindication to know about Cytotec?

A

Allergy, active cardiovascular disease, pulmonary or hepatic disease

75
Q

Postpartum Hemorrhage and Nursing Management - Administer a Uterotonic Drug: What contraindication to oknow for Prostin E2?

A

Active cardiac, pulmonary, renal, or heaptic disease

76
Q

Postpartum Hemorrhage and Nursing Management - Administer a Uterotonic Drug: What contraindication to know for Methergine?

A

If woman hypertensive, do not administer

77
Q

Postpartum Hemorrhage and Nursing Management - Administer a Uterotonic Drug: What contraindication to know for Hemabate?

A

Contraindicated with asthma due to risk of bronchial spasm

78
Q

Postpartum Hemorrhage and Nursing Management - Checking VSs: How often should you check this?

A

Every 15-30 minutes.

79
Q

Postpartum Hemorrhage and Nursing Management - Checking VSs: Why would you assess the womans LOC?

A

To determine changes that may result from inadequate cerebral perfusion

80
Q

Postpartum Hemorrhage and Nursing Management - Checking VSs: Why is catheter placed?

A

To keep bladder empty to avoid displacement of uterus. Fundus deviated laterally iindicates full bladder

81
Q

Postpartum Hemorrhage and Nursing Management - Prepare Woman for Removal of Retained Placental Fragments: What to know here?

A

Be sure health care provider remains long after birth to assess bleeding status. Suture any lacerations to control hemorrhage.

82
Q

Postpartum Hemorrhage and Nursing Management - Continually Assess for S+S of Hemorrhagic Shock: With this, a catabolic state develops at the same time, which leads to what?

A

Inflammation, endothelial dysfunction, and disruption of metabolic process. Once established, process of shock irreversible.

83
Q

Postpartum Hemorrhage and Nursing Management - Continually Assess for S+S of Hemorrhagic Shock: Main goals of treatment for this?

A

Fluid resuscitation, correction of imbalance betwen oxygen delievery and consumption and treating DIC

84
Q

Postpartum Hemorrhage and Nursing Management - Continually Assess for S+S of Hemorrhagic Shock: What VS will you monitor?

A

BP, Pulse, Cap Refill, Mental Status, and Urinary Output

85
Q

Postpartum Hemorrhage and Nursing Management - Continually Assess for S+S of Hemorrhagic Shock: Interventions in hemorrhagic shock focus on what

A

Controlling sourse of blood loss, restoring adequate oxygen capacity, and maintaining adequate tissue perfusion

86
Q

Postpartum Hemorrhage and Nursing Management - Continually Assess for S+S of Hemorrhagic Shock: What to give for someone with ITP?

A

Administer glucocorticoids, IV immunoglobulin, IV Rhogam, and platelet transfusions

87
Q

Postpartum Hemorrhage and Nursing Management - Emergency Measures for DIC: What to do if this develops?

A

Emergency measures to control bleeding and impending shock and prepare to transfer to ICU

88
Q

Postpartum Hemorrhage and Nursing Management - Emergency Measures for DIC: What interventions will you do here?

A

Replace fluid volume, administer blood component therapy, and optimize mothers oxygenation and perfusion status

89
Q

Postpartum Hemorrhage and Nursing Management - Emergency Measures for DIC: What should you monitor for?

A

VS’s closely, and changes tht increase in bleeding or impending shock

90
Q

Postpartum Hemorrhage and Nursing Management - Emergency Measures for DIC: Observe for early signs of what?

A

ecchymosis, including spontaneous bleeding from gums or nose, petechiae, excessive bleeding from IV site, hematuria, and blood in stool

91
Q

Postpartum Hemorrhage and Nursing Management - What are the five causes of postpartum hemorrhage?

A

Urine Atony

Retained Placental Tissue

Lacerations or Hematoma

Thrombin

Uterine Inversion

92
Q

Venous Thromboembolic Conditions: What is a thrombosis?

A

Blood clot within a blood vessel

93
Q

Venous Thromboembolic Conditions: What is thrombophlebitis?

A

Inflammation of the blood vessel lining

94
Q

Venous Thromboembolic Conditions: What is thromboembolism?

A

Obstruction of a blood vessel by a blood clot carried by the circulation from the site of origin

95
Q

Venous Thromboembolic Conditions: Where does this usually occur?

A

Involvles the saphenous venous system and confined to lower leg

96
Q

Venous Thromboembolic Conditions: Superficial Thrombophlebitis may be caused by?

A

Use of the lithotomy position during birth

97
Q

Venous Thromboembolic Conditions: DVT can involve what?

A

Deep veins from the foot to the calf, to the thights, or pelvis. Thrombi can dislodge and migrate to the lungs, causing pulmonary embolism

98
Q

Venous Thromboembolic Conditions: DVT can lead to pulmonary emboli, which leads to what?

A

Chest pain, breathlessenss, and sudden death

99
Q

Venous Thromboembolic Conditions: DVT may present with what signs?

A

Calf pain, edema, and venous distention

100
Q

Venous Thromboembolic Conditions: What are the most common ones that occur?

A

Superficial venous thrombsis, DVT, and PE.

101
Q

Venous Thromboembolic Conditions: Risk for this is highest when?

A

During the first three weeks after childbirth

102
Q

Venous Thromboembolic Conditions Patho: Thrombus (blood clot) formation typically results from what

A

venous stasis , injury to innermost layer of blood vessel, and hypercoagulation

103
Q

Venous Thromboembolic Conditions Patho: If clot dislodges and travels to pulmonary circulation, what can occur?

A

Pe can occur. Fatal when the pulmonary artery is blocked

104
Q

Venous Thromboembolic Conditions Patho: When clot is large enough to block one or more pulmonary vessels, it results in what?

A

It results in sudden death

105
Q

Venous Thromboembolic Conditions Patho: Takes how long for this to usually occur??

A

3 Weeks postpartum

106
Q

Venous Thromboembolic Conditions Nursing Assessment: RF’s for this is what?

A

Hx or oral contraceptive use before pregnancy, smoking, employment that necessitates prolonged standing, and history of thrombosis

107
Q

Venous Thromboembolic Conditions Nursing Assessment: What questions should we ask the woman?

A

if she has pain or tenderness in the lower extremities. Ask if theres increased pain in affected leg when she ambulates.

Area appears reddened along the vein

108
Q

Venous Thromboembolic Conditions Nursing Assessment: What is Homans sign?

A

Pain in the uper calf upon dorsiflexion

109
Q

Venous Thromboembolic Conditions Nursing Assessment: Be alert for signs of pulmonary embolism, which include what?

A

Unexplained sudden onset of SOB and severe chest pain

110
Q

Venous Thromboembolic Conditions Nursing Assessment: Additional manifestations of this may include what?

A

tachypnea, tachycardia, hypotension, distention of the jugular vein, and decreased O2 sat

111
Q

Venous Thromboembolic Conditions Nursing Management: This focuses on what?

A

preventing thrombotic conditions, promoting adequate circulation if thrombosis occurs, and educating about preventive measures

112
Q

Venous Thromboembolic Conditions Nursing Assessment - Preventing Thrombotic Conditions: This can be achieved with what simple measures?

A

Developing public awareness about risk factors , symptoms , preventive measures

Preventing venous stasis by moving

Dorsi/plantar flexion of feet

Use intermittent sequential compression devices to produce passive leg muscle contractions

Elevate womans legs above heart

Stop smoking

113
Q

Venous Thromboembolic Conditions Nursing Assessment - Preventing Thrombotic Conditions: What could be applied on woman?

A

Compression stockings that decreases distal calf vein thrombosis by decreasing venous stasis and augmenting venous return

114
Q

Venous Thromboembolic Conditions Nursing Assessment - Preventing Thrombotic Conditions: What to do if someone has a high risk for thromboembolic disease?

A

May be placed on prophylactic anticoagulation therapy during pregnancy

115
Q

Venous Thromboembolic Conditions Nursing Assessment - Preventing Thrombotic Conditions: What medications can be prescribed?

A

Heparin like enoxaparin (Lovenox) or Rivaroxaban (Xarelto), Apixaban (Eliquis) or Dabigatran etexilate (Pradaxa)

116
Q

Venous Thromboembolic Conditions Nursing Assessment - Promoting Adequate Circulation: For woman with superficial venous thrombosis, administer what?

A

NSAIDS for analgesia, provide bed rest, and elevation of the affected leg, apply wwarm compresses to the affected area to promote healing

117
Q

Venous Thromboembolic Conditions Nursing Assessment - Promoting Adequate Circulation: Movement actions for someone with DVT?

A

Bed rest or limited ambulation. Reduces interstitial swelling and promotes venous return form that leg

118
Q

Venous Thromboembolic Conditions Nursing Assessment - Promoting Adequate Circulation: What to know for Anticoagulant therapy?

A

Heparin along with Vit-K antagonsist usually initiated to prolong clotting time .

119
Q

Venous Thromboembolic Conditions Nursing Assessment - Promoting Adequate Circulation: Therapeutic aPTT ranges from?

A

35-45 seconds.

120
Q

Venous Thromboembolic Conditions Nursing Assessment - Promoting Adequate Circulation: What to do after several days of heparin infusion?

A

Expect to begin oral anticoagulant therapy as ordered.

121
Q

Venous Thromboembolic Conditions Nursing Assessment - Promoting Adequate Circulation: What to give if woman has pulmonary embolism?

A

Oxygen via mask and initiate heparin therapy titrated according to results of coagulation.

Maintain on best rest and administer analgesics for pain relief.

122
Q

Venous Thromboembolic Conditions Nursing Assessment - Promoting Adequate Circulation: What thrombolytic agent is prescribed for someone with PE?

A

Alteplase (tPA), which might be used to dissolve pulmonary emboli and the source of thrombus in pelvis or deep leg veins

123
Q

Postpartum Infection: What is this defined as?

A

Fever of 100.4 or higher after the first 24 hours after childbirth, occuring on the first 10 days after birth

124
Q

Postpartum Infection: Risk factors for this?

A

Surgical birth, prolonged rupture of membranes, long labor with multiple vaginal exams, and inadequate hand hygiene

125
Q

Postpartum Infection: What physiologic changes occur after childbirth that increase the risk of infection?

A

By decreasing the vaginal acidity due to the presence of amniotic fluid, blood, and lochia.

126
Q

Postpartum Infection: What bacteria usually cause infection?

A

S. Aureus, E. Coli. Klebsiella, Gardnerella Vaginalis, Gonococci, Colofirm bacteria

127
Q

Postpartum Infection - Metritis: What is this?

A

Infectious condition that involves the endometrium, decidua, and adjacent myometrium of the uterus.

128
Q

Postpartum Infection - Metritis: Extension of the metritis can result in parametritis, which involves what?

A

The broad ligament and possibly the ovaries and fallopian tubes, or septic pelvic thrombophlebitis, which results when the infection spreads along the venous routes

129
Q

Postpartum Infection - Metritis: When does this occur?

A

Within the first two days postpartum or as late as two to six weeks postpartum

130
Q

Postpartum Infection - Metritis: The bacteria that normally cause infection include what?

A

Those that normally reside in the bowel, vagina and perineum

E. Coli, Klebsiella Pneumoniae, or G. Vaginalis

131
Q

Postpartum Infection - Metritis: What kind of birth makes this worse?

A

C-SEction

132
Q

Postpartum Infection - Metritis: What has been recommended to use one hour before any cesarean section?

A

One dose of prophylactic antibody therapy

133
Q

Postpartum Infection - Surgical Site Infections: Womens do not show up here until when?

A

Until 24-48 hours afterbirth

134
Q

Postpartum Infection - UTIs: Most commonly caused by what bacteria?

A

E. Coli, Klebsiella, Proteus, and Enterobacter species

135
Q

Postpartum Infection - Mastitis: What is this?

A

Defined as inflammation of the mammary gland, may occur within first 2 days to 2 weeks postpartum

136
Q

Postpartum Infection - Mastitis: Risk factors associated with this?

A

Stasis of milk due to infrequent, inconsistent breastfeeding and nipplel trauma.

137
Q

Postpartum Infection - Mastitis: This can result from any event that creates milk stasis, which is what?

A

Insuffienct drainage of breast, rapid weaning, oversupply of milk, pressure on the breast from poorly fitting bra, a blocked duct, and missed feedings

138
Q

Postpartum Infection - Mastitis: Most commonn infecting organism?

A

S. Aureus, comes from breast-feeding infant’s mouth or throat

139
Q

Postpartum Infection - Mastitis: What may develop if this is not treated adequately?

A

A breast abscess

140
Q

Postpartum Infection - Mastitis: First symptoms experienced by mother?

A

Flu-Like symptoms. Breasts are red, tender, and hot to the touch. Upper, outer quadrant of breast is most common site because breast tissue is located there

141
Q

Postpartum Infection, Therapeutic Mx - Mastitis: What is used to treat?

A

Broad-spectrum antibiotics to treat the infection.

Also restore and promote fluid and electrolyte balance, provide analgesia, and provivde emotional support

142
Q

Postpartum Infection, Therapeutic Mx - Mastitis: How long for fever to go away?

A

Within 48-72 hours after start of antibiotic therapy

143
Q

Postpartum Infection, Therapeutic Mx - Surgical-Site Infections: What is done to treat this?

A

Opening wound to allow drainage.

144
Q

Postpartum Infection, Therapeutic Mx - Surgical-Site Infections: Main treatment?

A

Parenteral antibiotics. Along with Analgesics

145
Q

Postpartum Infection, Therapeutic Mx - UTIs: What is done here for treatment?

A

Fluids for dehydration. Take large doses of Vitamin C or regular intake of cranberry juice . It inhibits growth of E. Coli

146
Q

Postpartum Infection, Therapeutic Mx - Mastitis: Treatment focuses on what two parts?

A

Emptying the breasts and controlling the infection.

147
Q

Postpartum Infection, Therapeutic Mx - Mastitis: Control of infection achieved how?

A

With antibiotics. Ice or warm packs and analgesics may be needed

148
Q

Postpartum Infection, Therapeutic Mx - Mastitis: Regardless of the etiology of mastitis, the focus is on what?

A

Reversing milk stasis, maintaining milk supply, and continuing breast-feeding, along with providing maternal comfort

149
Q

Postpartum Infection, Nursing Assessment: What should a nurse do assessment wise?

A

Review clients hx and physical exam and labor and birth record. Then complete assessment , BUBBLE-EE method.

150
Q

Postpartum Infection, Nursing Assessment: Other generalized signs of postpartum infection include what?

A

Chills, foul-smelling vaginal discharge, headache, malaise, restlessness, anxiety, and tachycardia

151
Q

Postpartum Infection, Nursing Assessment: What acronym is used when assessing a womens perineum statis?

A

REEDA

152
Q

Postpartum Infection, Nursing Assessment: What does REEDA stand for?

A

Redness - May feel warm to touch

Edema - Infection/Hematoma

Ecchymosis - Indicate vaginal trauma

Discharge - Should follow expected lochia pattern

Approximation of skin edges- should be well aligned without gaps

153
Q

Postpartum Infection, Nursing Assessment: Scoring for REEDA?

A

Each assessed from 0 to 3 points, with score ranging from 0 to 15

154
Q

Postpartum Infection, Nursing Mx: This focuses on what?

A

Preventing postpartum infections

155
Q

Postpartum Affective Disorders: What hormones contribute to mood disorders?

A

Plummenting levels of estrogen and progesterone immediately afater birth

156
Q

Postpartum Affective Disorders - Postpartum Blues: What do women experience?

A

Rapid cycling mood symptoms during the first postpartum week typically.

Exhibit mild depressive symptoms of anxiety, irritability, mood swings, tearfullness, increased sensitivity, and felings of being overwhelmed.

157
Q

Postpartum Affective Disorders - Postpartum Blues: Most prominent symptom seen?

A

Emotional lability.

158
Q

Postpartum Affective Disorders - Postpartum Blues: When do the blues peak?

A

On postpartum days 4 and 5 and usually resolve by day 10

159
Q

Postpartum Affective Disorders - Postpartum Blues: Treatment for this?

A

Just reassurance and validation of the womans experience, as well as assistance in caring for herself and newborn

160
Q

Postpartum Affective Disorders - Postpartum Depression: What is this?

A

They feel worse over time, and changes in mood and behavior do not go away on their own. Persist for minimum of six months if untreated.

161
Q

Postpartum Affective Disorders - Postpartum Depression: Some signs of this include?

A

Restless, worthless, guilty, hopeless, moody, sad, and overwhelmed

162
Q

Postpartum Affective Disorders - Postpartum Depression: A new mother may also do what?

A

Cry a lot, be unable to make decisions, lose her memory, lack of pleasure, lack of interest in baby

163
Q

Postpartum Affective Disorders - Postpartum Depression: Based on history of prior depression what may be prescribed?

A

Prophhylactic antidepressant therapy may be used during third trimester

164
Q

Postpartum Affective Disorders - Postpartum Depression: Highest rates of depression by fathers reported between what months?

A

Between months 3-6

165
Q

Postpartum Affective Disorders - Postpartum Depression: Factors that increase risk of paternal PPD include waht

A

personal history of depression/anxiety, low level of marital satisfaction, excessive financial stressors, and a lack of significant other or partners parental leave

166
Q

Postpartum Affective Disorders - Postpartum Depression: What screens have been used to assess this?

A

Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Depression Predictor Scale (PDSS)

167
Q

Postpartum Affective Disorders - Postpartum Depression: What is the EPDS?

A

Self-report, quick, adn easy screening tool for PPD that uses 10 questions with four possible responses. Scores from 0 to 3, creating score of 30. Cutoff score is 9 oor 10

168
Q

Postpartum Affective Disorders - Postpartum Depression:What is the PDSS?

A

Self-report, 35 item likert type response scale divided into seven domains. Scores range from 35-75

169
Q

Postpartum Affective Disorders - Postpartum Depression:What are the seven domains of the PDSS?

A 
Anxiety
Sleep
Emotional Liability
Loss of Self-Esteem
guilt
Cognitive Impairment
Suicidal Thoughts
170
Q

Postpartum Affective Disorders - Postpartum Psychosis:What is this?

A

Emergency psychiatric psychosis, such as mood lability, delusional beliefs, hallucinations, and disorganized thinking, which can be frightening for the women who are affected

171
Q

Postpartum Affective Disorders - Postpartum Psychosis: When does this normally surface?

A

Within 3 months of giving birth

172
Q

Postpartum Affective Disorders - Postpartum Psychosis: How will mother be here?

A

Tearful, confused, and preoccupied with feelings of guilt and worthlessenss

173
Q

Postpartum Affective Disorders - Postpartum Psychosis: Early symptoms resemble those of depression, but thye escalate to what?

A

Deliriu, hallucinations, extreme disorganization of thought, anger toward herself, and bizarre behavior

174
Q

Postpartum Affective Disorders - Postpartum Psychosis and Nursing Assessment: Begin assessment by reviewing history to idetnify general risk factors that could predispose woman to depression is what

A

Poor coping skills

First pregnancy

Low self-esteem

Numerous life stressors

History of abuse

175
Q

A postpartum mother appears very pale and states she is bleeding heavily. The nurse should first:

Call the client’s health care provider immediately.
Immediately set up an intravenous infusion of magnesium sulfate.
Assess the fundus and ask her about her voiding status.
Reassure the mother that this is a normal finding after childbirth.
A

Assess the fundus and ask her about her voiding status.

176
Q

A postpartum woman reports hearing voices and says, “The voices are telling me to do bad things to my baby.” The clinic nurse interprets these findings as suggesting postpartum

psychosis.
anxiety disorder.
depression.
blues.
A

Psychosis

177
Q

When implementing the plan of care for a multigravida postpartum woman who gave birth just a few hours ago, the nurse vigilantly monitors the client for which complication?

Deep venous thrombosis
Postpartum psychosis
Uterine infection
Postpartum hemorrhage
A

Postpartum Hemorrhage

178
Q

Which of the following would the nurse expect to include in the plan of care for a woman with mastitis who is receiving antibiotic therapy?

Stop breast-feeding and apply lanolin.
Administer analgesics and bind both breasts.
Apply warm or cold compresses and administer analgesics.
Remove the nursing bra and expose the breast to fresh air.
A

Apply warm or cold compresses and administer analgesics.

179
Q

While assessing a postpartum multiparous woman, the nurse detects a boggy uterus midline 2 cm above the umbilicus. Which intervention would be the priority?

Assessing vital signs immediately
Measuring her next urinary output
Massaging her fundus
Notifying the woman’s obstetrician
A

Massaging her fundus

180
Q

Methergine has been ordered for a postpartum woman because of excessive bleeding. The nurse should question this order if which of the following is present?

Mild abdominal cramping
Tender inflamed breasts
Pulse rate of 68 beats per minute
Blood pressure of 158/96 mmHg
A

blood pressure of 158/96

181
Q

Which of the following findings would lead the nurse to suspect that a woman is developing a postpartum complication?

Moderate lochia rubra for the first 24 hours
Clear lung sounds upon auscultation
Temperature of 100 degrees F
Chest pain experienced when ambulating
A

Chest pain experienced when ambulating

182
Q

Which of the following factors in a postpartum woman’s history would lead the nurse to monitor the woman closely for an infection?

Hemoglobin of 12 mg/dL
Manually extracted placenta
Labor of 10 hours length
Multiparity of 5 pregnancies
A

Manually extraced placenta

NRSG 206: OB (42 decks)

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