Exam 2 Saffian content Flashcards
What is the leading cause of pregnancy-related death worldwide?
Postpartum hemorrhage
What is early pp hemorrhage?
Within 24 hours of childbirth
What is late pp hemorrhage?
Occurs 24hrs to 6wks after birth.
What volume of blood loss qualifies as pp hemorrhage?
After vaginal delivery = 500mL
After c/s = 1000mL
What are the 3 ways that pp hemorrhage can be diagnosed?
- 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)
How quickly can a woman die after the onset of pp hemorrhage?
8-10min
What are the s/s of pp hemorrhage?
- Hypotension
- Tachycardia
- Increased pulse
- Thirst
- Restlessness
- Decreased UO
- Widening pulse pressure
What is the most common cause of early pp hemorrhage?
Uterine atony
What risk factors increase the likelihood of early pp hemorrhage?
- Multigravida
- Uterine atony
- Placental fragmentation
- Macrosomia
What could a firm fundus and bright red bleeding indicate?
Laceration of the genital tract
What are 2 possible causes of late pp hemorrhage?
- Subinvolution
- Retention
What is subinvolution?
When the uterus fails to fully contract back to baseline and lochia fails to progress from rubra –> serosa –> alba
During d/c teaching, what education should be provided to a patient about s/s of pp hemorrhage?
- Normal vs. irregular amount of blod
- Progression and timing of shift from rubra –> serosa –> alba
- Clots (big vs. little)
- Infections (s/s)
What is the most common infection r/t pregnancy and childbirth?
Endometritis
What are the s/s of endometritis?
- Pp fever
- Foul smelling lochia
- Lower abd pain
- Tachycardia
- Chills
- Uterine pain/tenderness
What is a risk of untreated endometritis?
Can progress to peritonitis (whole peritoneal cavity infection)
When are pp infections r/t the genital tract typically experienced?
W/in first 6 weeks pp
What are the risk factors for endometritis?
- C/S
- PROM
- Prolonged labor
- Compromised health status
- Obstetric trauma (episiotomy, etc.)
- Chorioamnionitis
- Manual removal of placenta
- Diabetes
What is the assessment tool for would infections?
REEDA (red, ecchymosis, edema, discharge, approximation)
When is mastitis typically detected?
2-8wks pp
What are the s/s of mastitis?
- Fever
- Chills
- HA
- Flu-like muscle aches
- Malaise
- Red area of breast
What are 2 common causes of mastitis?
Thrush and staph
How is mastitis tx?
- Antibiotics
- Rest
- Frequent emptying of breasts
- Increased fluid intake
- Local application of heat
Should a woman stop breastfeeding if she suspects mastitis?
No- breast feeding is even more important if mastitis occurs
What are the 3 subclasses of pp psychiatric disorders?
1 = adjustment rxn with depressed mood 2 = pp mood episode w/ psychotic features 3 = peripartum major mood episode
What are pp blues?
- Mild condition
- Mood lability w/ emotional hypersensitivity
- Occurs 2-4 days after birth
- More severe in primiparas
- R/t hormone changes pp
When do pp blues typically manifest?
2-4 days after delivery
How long do pp blues last?
About 14 days
What percentage of pp women are dx with pp depression?
10-20%
What are risk factors for pp depression?
- Hx of major depression
- Hx of pp depression
- Stressful life events
- Lack of social support
- Labor complications
During the pp period, when is the greatest risk for pp depression onset?
4th week pp
When is the risk of suicide highest with a woman dx with pp depression?
At start of s/s and recovery period (more energy to follow through on a plan for self-harm)
What is done within the pp period to screen for pp depression?
Telephone follow-up and early pp visit (before 6 weeks)
How is pp depression treated?
Combination of psychotherapy and antidepressants (SSRIs and TCAs are safe with breastfeeding)
What type of antidepressants are ok for breastfeeding?
TCAs and SSRIs
When does pp psychosis manifest during the pp period?
Within first few days pp
What are the s/s of pp psychosis?
- Sleep disturbance
- Woman is distanced/dazed/zoning out
- Disorganized thinking
- Mood swings
- Delusions
- Hallucinations
What are risk factors of pp psychosis?
- Hx of pp psychosis
- Hx of bipolar disorder
- Family hx of pp psychosis
What pp mood disorder is considered a medical emergency?
Pp psychosis
What is the difference between pp blues and pp depression?
- 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
What are the goals of pp care?
- Physiologic recovery of mom and infant
- Psychological well-being
- Ability of mom to care for infant
What part of a pp assessment is crucial after a c/s?
Lung and bowel sounds
What is included in a pp assessment of the mother?
BUBBLE-HE
- Breasts
- Uterus (fundus)
- Bladder
- Bowel
- Lochia
- Episiotomy (perineum)
- Hemorrhoids
- Emotions
What is the timeline for milk production pp?
- Colostrum first (clear, yellow fore-milk)
- Milk comes in 48-96hrs pp
How often should a mom breastfeed during the pp period?
Q2-3hrs and on demand
What positions can be used for breastfeeding?
- Football
- Sidelying
- Cradle
How do you tx engorgement?
- Frequent feedings
- Warm compresses
- Supportive bra
- Motrin or tylenol
- Change position of breastfeeding
- Pump first to soften nipple
- Cabbage leaves
- Hand let-down
What is done to dry up milk supply for a mom who isn’t breastfeeding?
Key = decreases stimulation
- Ice
- Tight bra
- Avoid direct heat (shower, etc.)
- No breast stimulation
- Cabbage leaves
How long does it take for the milk supply to dry up?
7-10 days of no stimulation
How big is a newborn’s stomach during the first month?
Day 1 = cherry (5-7mL)
Day 3 = peach pit (1oz)
Week 1 = peach (45-60mL; 1.5-2oz)
Month 1 = egg (2.5-5oz)
What is assessed when considering the uterus during the pp period?
- Fundal height
- Fundal position
- Fundal quality (boggy or firm)
Where should the fundus be located during the pp period?
- Midline
- At umbilicus immediately (6-12hrs) pp
- Decline 1cm/day
- At symphysis 10-14 days pp
- Not palpable 21 days pp
What risk factors increase the likelihood and severity of afterpains?
- Multiparous
- Breastfeeding
- Overdistended uterus
- Pitocin use during pregnancy
Does UO increase or decrease pp?
Increase (diuresis d/t fluid shifts, hormone changes, etc.)
What should be assessed is uterus/fundus is detected to the R of midline?
Bladder distention/urine retention
What are normal changes to the abdomen during pregnancy?
- Striae
- Diastasis recti abdominis
- Linea nigra
- Hair
When does first BM often occur in pp period?
Not for a couple of days (not much food in system, body in recovery mode)
What medication is often given to support BM pp?
Stool softener (not laxative)
What is assessed when considering lochia?
- Color (rubra, serosa, alba)
- Amount
- Odor
- Clots
When should lochia progress from rubra –> serosa –> alba?
- Rubra = 2-3 days pp
- Serosa (pink/brown) = 3-10days
- Alba (yellow/clear) = 1-2 weeks
Is more or less lochia common after c/s?
Less
What are causes of irregular bleeding?
- Lacerations (vaginal or cervical)
- Retained placental fragments
- Boggy uterus (atony)
Discuss clotting during pp period…
Body working to clot in uterus; increases clotting factor production = increased risk for thrombus
Is leukocytosis common or uncommon during pp period?
Common- WBCs typically elevate a bit (25,000-30,000)
What are the classifications of lacerations?
1 = skin, superficial 2 = into muscle 3 = extends to anal sphincter 4 = extends into rectum
What is given to a woman with 2nd degree tear?
- Stool softeners
- Pain management
- Info that may be itchy = normal
- Pat dry after urination (don’t wipe)
What is given to a woman with a 3rd degree tear?
- Donut to sit on
- Long term use of stool softener
- Ice pack or heat pack to perineal area
What are possible effects of a 4th degree perineal tear?
- Fecal incontinence
- Painful intercourse
- Need for surgery
What did Homan’s sign assess?
Presence of possible DVT
What are the “pink” and “blue” periods?
Pink = first couple of days pp; heightened feelings and excitement Blue = peaks @ days 5-7pp, resolves by week 2, overwhelmed with new life
How often should VS be assessed during pp period?
Q15min during first hour
Q30min x 2
Q4 for 24 hours
What are the four actions of the nursing process?
- Assess
- Plan
- Implement
- Evaluate
What vaccinations are given in pp period to mom?
- Rubella
- Tdap
- Rh
When does pp teaching start?
During prenatal consults
What is the order of interventions for early pp hemorrhage?
- Uterine massage
- IVF and Pitocin
- Provider manual stimulation
- More medical intervention
Pitocin: usage, side effects, and contraindications
- Promote rhythmic uterine contraction
- Dose IV or IM (NOT IV bolus) @ 10-40u
- Side effects: uterine hyperstimuation, hypotension (if too fast IV), hypertension
Methergine: usage, side effects, and contraindications
- 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
Prostaglandin/Hemabate: usage, side effects, and contraindications
- 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
Dinoprostone/Prostin: usage, side effects, and contraindications
- 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
Misoprostol/Cytotec: usage, side effects, and contraindications
- Rectal admin 800-1000mcg
- Tx uterine atony
- Due not use if hx of allergy to prostaglandins
- Side effects = diarrhea, ab pain, HA
Which meds for uterine atony can NOT be administered via IV?
Methergine (causes HTN and stroke)
Which med for uterine atony can NOT be administered via IV bolus?
Pitocin (risk for hypotension)
Which med for uterine atony can NOT be given to a woman with asthma?
Prostaglandin/hemabate and Dinoprostone/Prostin
Which med for uterine atony can be given rectally?
Dinoprostone/Prostin and Misoprostol/Cytotec
Which med for uterine atony is stored frozen and needs to be thawed prior to administration?
Dinoprostone/Prostin
Which med for uterine atoney can be given IM?
Pitocin, Methergine, Prostaglandin
Which med for uterine atony is contraindicated for a woman with HTN or cardiac condition?
Methergine and Prostaglandin
