Exam 2 Review Concepts Flashcards
With vaginal delivery, what is the normal blood loss?
200-500 mL blood loss
What c section delivery, what is the normal blood loss?
500-1000 mL blood loss
What is the most common cause of post partum hemorrhage?
Uterine atony
What is uterine atony?
Failure of the uterine muscle to contract
What are the two most important interventions to prevent postpartum hemorrhage?
Maintaining good uterine tone
Preventing bladder distention
What is a potential cause of uterine atony?
Retained placental fragments
How can a nurse monitor for uterine bleeding?
Monitor lochia - color, consistency, amount
Fundus is firm and midline
What should a nurse do if she palpates the fundus postpartum and it is boggy?
Apply gentle massage
Express clots
Assess uterine response
What is postpartum hemorrhage described as?
cumulative blood loss ≥1000 mL or bleeding associated with signs/symptoms of hypovolemia within 24 hours of the birth process regardless of type of birth
Excessive bleeding that occurs during the period from the separation of the placenta to its expulsion or removal is commonly the result of…
incomplete placental separation, undue manipulation of the fundus, or excessive traction on the umbilical cord.
Persistent or excessive blood loss occurring after the expulsion or removal of the placenta is usually the result of…
uterine atony or prolapse of the uterus into the vagina
Risk factors for uterine atony
Overdistended uterus Large fetus Multiple fetuses Hydramnios Distention with clots
The greatest risk for early PPH is during the
1st hour of birth
What is the first intervention for a woman with a distended bladder?
Assist her to the bathroom or onto a bedpan if she is unable to void
What are some ways to stimulate voiding?
Having the woman listen to running water, placing her hands in warm water, or pouring water from a squeeze bottle over her perineum may stimulate voiding.
What if the non-pharmacologic methods do not work?
Possibly administer analgesia
In and out Cath
What are risk factors for bladder distention during pregnancy?
Epidural anesthesia, episiotomy, extensive vaginal or perineal lacerations, vacuum- or forceps-assisted birth, or prolonged labor.
How does a full bladder contribute to uterine atony?
A full bladder causes the uterus to be displaced above the umbilicus and well to one side of midline in the abdomen. It also prevents the uterus from contracting normally.
Who gets rhogam post partum?
Rh negative mothers who have not been sensitized, give standard dose within 72 h after birth if neonate is Rh-positive.
How is rhogam administered?
1 vial (300 mcg) IM in deltoid or gluteal muscle
When do you give microdose of rhogam?
Give microdose for first-trimester miscarriage or abortion, ectopic pregnancy, chorionic villus sampling.
What is the process for administering rhogam?
Provide explanation to the woman about the procedure, including the purpose, possible side effects, and effect on future pregnancies. Have the woman sign a consent form if required by agency. Verify correct dosage and confirm lot number and woman’s identity before giving injection (verify with another registered nurse or by other procedure per agency policy); document administration per agency policy. Observe client for at least 20 min after administration for allergic response.
What can the nurse give a postpartum patient before discharge?
Providing written materials on postpartum self-management, breastfeeding, and infant care that the woman can consult after discharge is helpful.
What is the goal before discharge?
maternal self-management and care of the newborn because the goal is for all women to be capable of providing basic care for themselves and their infants at the time of discharge
What is a safety concern to teach patients before discharge?
every woman must be taught to recognize physical and psychological signs and symptoms that might indicate problems and how to obtain advice and assistance quickly if these signs appear.
How can a nurse know what to focus on during postpartum discharge teaching?
Giving the woman a list of topics and asking her to indicate her learning needs help the nurse to maximize teaching efforts and can increase retention of information
What should you discuss during postpartum teaching?
Fatigue Nutrition Family adjustment Psychological status Family planning - no intercourse 6 weeks Approach intercourse slow, vaginal dryness Home visits/ follow up calls 3-4 days Return to work
