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Repro exam 2 > Exam 2 Saffian content > Flashcards

Exam 2 Saffian content Flashcards

1
Q

What is the leading cause of pregnancy-related death worldwide?

A

Postpartum hemorrhage

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2
Q

What is early pp hemorrhage?

A

Within 24 hours of childbirth

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3
Q

What is late pp hemorrhage?

A

Occurs 24hrs to 6wks after birth.

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4
Q

What volume of blood loss qualifies as pp hemorrhage?

A

After vaginal delivery = 500mL

After c/s = 1000mL

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5
Q

What are the 3 ways that pp hemorrhage can be diagnosed?

A
  • Volume loss (500mL after vaginal delivery, 1000mL after c/s)
  • Percentage (Hct drop of >/=10% from pre-pregnancy baseline)
  • Loss of ptnt stability (bleeding that causes hemodynamic instability and need for transfusion)
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6
Q

How quickly can a woman die after the onset of pp hemorrhage?

A

8-10min

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7
Q

What are the s/s of pp hemorrhage?

A
  • Hypotension
  • Tachycardia
  • Increased pulse
  • Thirst
  • Restlessness
  • Decreased UO
  • Widening pulse pressure
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8
Q

What is the most common cause of early pp hemorrhage?

A

Uterine atony

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9
Q

What risk factors increase the likelihood of early pp hemorrhage?

A
  • Multigravida
  • Uterine atony
  • Placental fragmentation
  • Macrosomia
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10
Q

What could a firm fundus and bright red bleeding indicate?

A

Laceration of the genital tract

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11
Q

What are 2 possible causes of late pp hemorrhage?

A
  • Subinvolution

- Retention

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12
Q

What is subinvolution?

A

When the uterus fails to fully contract back to baseline and lochia fails to progress from rubra –> serosa –> alba

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13
Q

During d/c teaching, what education should be provided to a patient about s/s of pp hemorrhage?

A
  • Normal vs. irregular amount of blod
  • Progression and timing of shift from rubra –> serosa –> alba
  • Clots (big vs. little)
  • Infections (s/s)
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14
Q

What is the most common infection r/t pregnancy and childbirth?

A

Endometritis

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15
Q

What are the s/s of endometritis?

A
  • Pp fever
  • Foul smelling lochia
  • Lower abd pain
  • Tachycardia
  • Chills
  • Uterine pain/tenderness
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16
Q

What is a risk of untreated endometritis?

A

Can progress to peritonitis (whole peritoneal cavity infection)

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17
Q

When are pp infections r/t the genital tract typically experienced?

A

W/in first 6 weeks pp

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18
Q

What are the risk factors for endometritis?

A
  • C/S
  • PROM
  • Prolonged labor
  • Compromised health status
  • Obstetric trauma (episiotomy, etc.)
  • Chorioamnionitis
  • Manual removal of placenta
  • Diabetes
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19
Q

What is the assessment tool for would infections?

A

REEDA (red, ecchymosis, edema, discharge, approximation)

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20
Q

When is mastitis typically detected?

A

2-8wks pp

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21
Q

What are the s/s of mastitis?

A
  • Fever
  • Chills
  • HA
  • Flu-like muscle aches
  • Malaise
  • Red area of breast
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22
Q

What are 2 common causes of mastitis?

A

Thrush and staph

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23
Q

How is mastitis tx?

A
  • Antibiotics
  • Rest
  • Frequent emptying of breasts
  • Increased fluid intake
  • Local application of heat
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24
Q

Should a woman stop breastfeeding if she suspects mastitis?

A

No- breast feeding is even more important if mastitis occurs

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25
Q

What are the 3 subclasses of pp psychiatric disorders?

A 
1 = adjustment rxn with depressed mood
2 = pp mood episode w/ psychotic features
3 = peripartum major mood episode
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26
Q

What are pp blues?

A
  • Mild condition
  • Mood lability w/ emotional hypersensitivity
  • Occurs 2-4 days after birth
  • More severe in primiparas
  • R/t hormone changes pp
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27
Q

When do pp blues typically manifest?

A

2-4 days after delivery

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28
Q

How long do pp blues last?

A

About 14 days

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29
Q

What percentage of pp women are dx with pp depression?

A

10-20%

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30
Q

What are risk factors for pp depression?

A
  • Hx of major depression
  • Hx of pp depression
  • Stressful life events
  • Lack of social support
  • Labor complications
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31
Q

During the pp period, when is the greatest risk for pp depression onset?

A

4th week pp

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32
Q

When is the risk of suicide highest with a woman dx with pp depression?

A

At start of s/s and recovery period (more energy to follow through on a plan for self-harm)

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33
Q

What is done within the pp period to screen for pp depression?

A

Telephone follow-up and early pp visit (before 6 weeks)

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34
Q

How is pp depression treated?

A

Combination of psychotherapy and antidepressants (SSRIs and TCAs are safe with breastfeeding)

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35
Q

What type of antidepressants are ok for breastfeeding?

A

TCAs and SSRIs

36
Q

When does pp psychosis manifest during the pp period?

A

Within first few days pp

37
Q

What are the s/s of pp psychosis?

A
  • Sleep disturbance
  • Woman is distanced/dazed/zoning out
  • Disorganized thinking
  • Mood swings
  • Delusions
  • Hallucinations
38
Q

What are risk factors of pp psychosis?

A
  • Hx of pp psychosis
  • Hx of bipolar disorder
  • Family hx of pp psychosis
39
Q

What pp mood disorder is considered a medical emergency?

A

Pp psychosis

40
Q

What is the difference between pp blues and pp depression?

A
  • Timing
  • Level of severity
  • Whether or not s/s affect all aspects of life
  • Whether or not s/s or constant or wax and wane
41
Q

What are the goals of pp care?

A
  • Physiologic recovery of mom and infant
  • Psychological well-being
  • Ability of mom to care for infant
42
Q

What part of a pp assessment is crucial after a c/s?

A

Lung and bowel sounds

43
Q

What is included in a pp assessment of the mother?

A

BUBBLE-HE

  • Breasts
  • Uterus (fundus)
  • Bladder
  • Bowel
  • Lochia
  • Episiotomy (perineum)
  • Hemorrhoids
  • Emotions
44
Q

What is the timeline for milk production pp?

A
  • Colostrum first (clear, yellow fore-milk)

- Milk comes in 48-96hrs pp

45
Q

How often should a mom breastfeed during the pp period?

A

Q2-3hrs and on demand

46
Q

What positions can be used for breastfeeding?

A
  • Football
  • Sidelying
  • Cradle
47
Q

How do you tx engorgement?

A
  • Frequent feedings
  • Warm compresses
  • Supportive bra
  • Motrin or tylenol
  • Change position of breastfeeding
  • Pump first to soften nipple
  • Cabbage leaves
  • Hand let-down
48
Q

What is done to dry up milk supply for a mom who isn’t breastfeeding?

A

Key = decreases stimulation

  • Ice
  • Tight bra
  • Avoid direct heat (shower, etc.)
  • No breast stimulation
  • Cabbage leaves
49
Q

How long does it take for the milk supply to dry up?

A

7-10 days of no stimulation

50
Q

How big is a newborn’s stomach during the first month?

A

Day 1 = cherry (5-7mL)
Day 3 = peach pit (1oz)
Week 1 = peach (45-60mL; 1.5-2oz)
Month 1 = egg (2.5-5oz)

51
Q

What is assessed when considering the uterus during the pp period?

A
  • Fundal height
  • Fundal position
  • Fundal quality (boggy or firm)
52
Q

Where should the fundus be located during the pp period?

A
  • Midline
  • At umbilicus immediately (6-12hrs) pp
  • Decline 1cm/day
  • At symphysis 10-14 days pp
  • Not palpable 21 days pp
53
Q

What risk factors increase the likelihood and severity of afterpains?

A
  • Multiparous
  • Breastfeeding
  • Overdistended uterus
  • Pitocin use during pregnancy
54
Q

Does UO increase or decrease pp?

A

Increase (diuresis d/t fluid shifts, hormone changes, etc.)

55
Q

What should be assessed is uterus/fundus is detected to the R of midline?

A

Bladder distention/urine retention

56
Q

What are normal changes to the abdomen during pregnancy?

A
  • Striae
  • Diastasis recti abdominis
  • Linea nigra
  • Hair
57
Q

When does first BM often occur in pp period?

A

Not for a couple of days (not much food in system, body in recovery mode)

58
Q

What medication is often given to support BM pp?

A

Stool softener (not laxative)

59
Q

What is assessed when considering lochia?

A
  • Color (rubra, serosa, alba)
  • Amount
  • Odor
  • Clots
60
Q

When should lochia progress from rubra –> serosa –> alba?

A
  • Rubra = 2-3 days pp
  • Serosa (pink/brown) = 3-10days
  • Alba (yellow/clear) = 1-2 weeks
61
Q

Is more or less lochia common after c/s?

A

Less

62
Q

What are causes of irregular bleeding?

A
  • Lacerations (vaginal or cervical)
  • Retained placental fragments
  • Boggy uterus (atony)
63
Q

Discuss clotting during pp period…

A

Body working to clot in uterus; increases clotting factor production = increased risk for thrombus

64
Q

Is leukocytosis common or uncommon during pp period?

A

Common- WBCs typically elevate a bit (25,000-30,000)

65
Q

What are the classifications of lacerations?

A 
1 = skin, superficial
2 = into muscle
3 = extends to anal sphincter
4 = extends into rectum
66
Q

What is given to a woman with 2nd degree tear?

A
  • Stool softeners
  • Pain management
  • Info that may be itchy = normal
  • Pat dry after urination (don’t wipe)
67
Q

What is given to a woman with a 3rd degree tear?

A
  • Donut to sit on
  • Long term use of stool softener
  • Ice pack or heat pack to perineal area
68
Q

What are possible effects of a 4th degree perineal tear?

A
  • Fecal incontinence
  • Painful intercourse
  • Need for surgery
69
Q

What did Homan’s sign assess?

A

Presence of possible DVT

70
Q

What are the “pink” and “blue” periods?

A 
Pink = first couple of days pp; heightened feelings and excitement
Blue = peaks @ days 5-7pp, resolves by week 2, overwhelmed with new life
71
Q

How often should VS be assessed during pp period?

A

Q15min during first hour
Q30min x 2
Q4 for 24 hours

72
Q

What are the four actions of the nursing process?

A
  • Assess
  • Plan
  • Implement
  • Evaluate
73
Q

What vaccinations are given in pp period to mom?

A
  • Rubella
  • Tdap
  • Rh
74
Q

When does pp teaching start?

A

During prenatal consults

75
Q

What is the order of interventions for early pp hemorrhage?

A
  • Uterine massage
  • IVF and Pitocin
  • Provider manual stimulation
  • More medical intervention
76
Q

Pitocin: usage, side effects, and contraindications

A
  • Promote rhythmic uterine contraction
  • Dose IV or IM (NOT IV bolus) @ 10-40u
  • Side effects: uterine hyperstimuation, hypotension (if too fast IV), hypertension
77
Q

Methergine: usage, side effects, and contraindications

A
  • Tx pp subinvolution and induce sustained uterine contraction
  • 0.2mg IM or PO Q2-4hrs (NOT IV- severe HTN and stroke)
  • Do not use w/ cardiac disease or chronic HTN
  • Side effects = HTN, dizziness, HA, hot flashes, tinnitus, N/V, palpitations, OD = siezure, tingling in extremities
78
Q

Prostaglandin/Hemabate: usage, side effects, and contraindications

A
  • 0.25mg IM Q15-90min (possibly IM directly into intramyometrium)
  • Tx uterine atony (after attempted use of Pitocin)
  • Do not use w/ cardio, renal, liver disease, or asthma
  • Side effects = N/V, diarrhea, HA, bradycardia, bronchospasm, wheezing, fever
79
Q

Dinoprostone/Prostin: usage, side effects, and contraindications

A
  • Vaginal or rectal suppository 20mg Q2hr
  • Store frozen, thawed to room temperature before use
  • Causes uterine contractions
  • Do not use if hypotensive, astha, or inflammatory disease
  • Side effects = fever w/in 15-45min of insertion, bleeding, abdominal cramping, N/V
80
Q

Misoprostol/Cytotec: usage, side effects, and contraindications

A
  • Rectal admin 800-1000mcg
  • Tx uterine atony
  • Due not use if hx of allergy to prostaglandins
  • Side effects = diarrhea, ab pain, HA
81
Q

Which meds for uterine atony can NOT be administered via IV?

A

Methergine (causes HTN and stroke)

82
Q

Which med for uterine atony can NOT be administered via IV bolus?

A

Pitocin (risk for hypotension)

83
Q

Which med for uterine atony can NOT be given to a woman with asthma?

A

Prostaglandin/hemabate and Dinoprostone/Prostin

84
Q

Which med for uterine atony can be given rectally?

A

Dinoprostone/Prostin and Misoprostol/Cytotec

85
Q

Which med for uterine atony is stored frozen and needs to be thawed prior to administration?

A

Dinoprostone/Prostin

86
Q

Which med for uterine atoney can be given IM?

A

Pitocin, Methergine, Prostaglandin

87
Q

Which med for uterine atony is contraindicated for a woman with HTN or cardiac condition?

A

Methergine and Prostaglandin

Repro exam 2 (2 decks)

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