Exam 2 ++ Summary Set- Postpartum Complications Flashcards
___ is an obstetrical emergency that can follow vaginal or cesarean delivery
postpartum hemorrhage
____ accounts for more than 10% of pregnancy-related deaths
postpartum hemorrhage
Cumulative blood loss of 1000mL or greater OR blood loss accompanied by s/s of hypovolemia within the first 24 hours after birth
postpartum hemorrhage
hemorrhage in the first 24 hours after childbirth
early postpartum hemorrhage
hemorrhage after 24 hours and for up to 12 weeks after birth
late postpartum hemorrhage
name at least 3 primary causes of postpartum hemorrhage
(1) uterine atony
(2) lacerations
(3) retained placenta
(4) abnormally adherent placenta
(5) defects of coagulation
(6) uterine inversion
subinvolution of the placental site, retained POC, infection, and inherited coagulation defects are _____
secondary causes of postpartum hemorrhage
risk factors that put someone at low risk for postpartum hemorrhage include
(1) singleton pregnancy
(2) <4 previous deliveries
(3) unscarred uterus
(4) absence of PP hemorrhage history
risk factors that put someone at medium risk for postpartum hemorrhage include
(1) prior C-section or uterine surgery
(2) more than 4 previous deliveries
(3) multiple gestation
(4) large uterine fibroids
(5) chorioamnionitis
(6) Mg sulfate use
(7) prolonged use of oxytocin
risk factors that put someone at high risk for postpartum hemorrhage include
(1) placental abnormalities
(2) Hct <30
(3) bleeding at admission
(4) known coagulation defect
(5) h/o postpartum hemorrhage
(6) abnormal VS
risks for uterine atony are (6)
(1) overdistention of the uterus
(2) multiparity
(3) prolonged or fast labor
(4) use of labor augmentation medications
(5) obesity
(6) infection
genital tract trauma can be caused by
(1) episiotomy
(2) lacerations
(3) uterine rupture
retained placental tissue can be caused by
(1) retained placenta
(2) placenta accreta
abnormalities of coagulation can be caused by
(1) preeclampsia
(2) clotting factor deficiency
(3) severe infection
(4) amniotic fluid embolism
(5) excessive crystalloid replacement
(6) therapeutic anticoagulation
___ accounts for 70-80% of early postpartum hemorrhage cases
atony
A condition where the uterus fails to contract effectively after childbirth, leading to inadequate muscle tone
atony
overdistention of the uterus can be caused by…
multiple gestation, large infant, polyhydramnios
name at least 3 symptoms of PPH
(1) uterine atony
(2) blood clots
(3) perineal pad saturation in 15 min or less
(4) constant oozing or flow of bright red blood
(5) tachycardia or hypotension
(6) pallor of skin - cool and clammy
(7) oliguria
what lab tests do you perform to assess for PPH?
(1) Hgb and Hct
(2) coagulation profile (PT)
(3) blood type and crossmatch
the primary role of the nurse during immediate PPH management is to ___
quantify blood loss (QBL)
how does a nurse quantify blood loss?
(1) weigh saturated items
(2) measure fluids
(3) subtract irrigation
what are the key nursing interventions during immediate management of PPH?
(1) QBL
(2) assess & manage uterus
(3) monitor for bleeding sources
(4) VS & circulation
(5) bladder management
(6) fluid & O2 support
the primary nursing action when the fundus is boggy is ___
to massage the fundus
name the main PPH medications
(1) oxytocin / pitocin
(2) methylergonovine / methergine
(3) misoprostol / cytotec
(4) hemabate (carboprostromethamine)
pitocin action
contracts uterus
pitocin route
IM, IV dilution, IU (intrauterine)
the dose for an IM route of pitocin is ___
10-20 units
the dose for an IV or NS route of pitocin is ____
10-40 units/L
which medication is given routinely postpartum as PPH prevention?
pitocin
methergine action
contracts vascular smooth muscle
methergine route
IM, PO
when do you give methergine IM?
in acute situations
methergine IM dose
0.2 mg every 2-4 hours x5
methergine is contraindicated with
HTN or cardiac disease
misoprostol action
contracts uterus
misoprostol route
buccal, PR
misoprostol dose
400-800 mcg
which route of misoprostol is more effective?
PR (rectal)
misoprostol onset of action is
15-20 min
hemabate action
contracts uterus
hemabate dose
250 mcg
hemabate route
IM
hemabate contraindications
asthma; renal, liver, or cardiovascular disease
the main side effect of hemabate is ___
diarrhea
if a patient has HTN, ____ can be a good option instead
hemabate
tranexamic acid (TXA) action
antifibrinolytic / aids in blood clotting
____ is either given 30 minutes prior to or PRN for PPH
TXA
TXA route
IV
forms when blood enters loose connective tissue while the overlying tissue remains intact
hematoma
causes of hematomas are
(1) bleeding lacerations r/t operative deliveries or episiotomy
(2) result of an injury to a blood vessel
discolored bulging mass that is sensitive to the touch
vulvar hematoma
what are the risk factors for hematoma?
(1) nullip
(2) birth of an infant >4000g
(3) preeclampsia
(4) prolonged 2nd stage of labor
(5) multifetal pregnancy
(6) vulvar variscosities
(7) clotting d/o
most common locations for a hematoma are
vulva, vagina, retroperitoneum, labia
Deep, severe, unilateral pain and feelings of pressure not relieved by usual measures describes a ____
hematoma
hematoma can lead to ____, ___, and ____
hypovolemia, tachycardia, and decreased BP
how do we treat hematomas?
(1) conservative management
(2) surgical intervention
(3) arterial embolization
placenta is not delivered within 30 minutes of delivery of the fetus
retained placenta
risk factors for retained placenta
(1) grand multip (>5)
(2) placenta previa
(3) previous c/s
(4) prematurity
(5) manipulation of the placenta during 3rd stage
(6) prolonged 3rd stage >30m
what are the two ways to get retained placenta out?
(1) manual removal
(2) dilation & curettage
what must nurses always do after placenta is out?
inspect to make sure it is intact and nothing is left inside the body
name the most common postpartum infection types
(1) uterus - endometritis
(2) bladder - UTI
(3) wound - surgical, peri laceration
(4) breast - mastitis
a single prophylactic IV dose of antibiotic before skin incision should be given to any person having a c-section to prevent ___
endometritis
____ is more common in c-section
endometritis
clinical presentation of endometritis includes
(1) fever
(2) chills
(3) malaise
(4) abdominal pain
(5) uterine tenderness
(6) foul-smelling lochia
the goal of treatment for endometritis is to ___
confine the infection to the uterus
infection of the breast usually with initiating factor of milk stasis
mastitis
symptoms of ____ are typically flu-like
mastitis
locallized lump or wedge-shaped area of pain is typical of
mastitis
initial treatment for endometritis is
IV antibiotics
what is the treatment for mastitis?
(1) PO antibiotics
(2) application of heat or ice packs
(3) analgesics
(4) continue to feed on both breasts to avoid milk stasis
____ is the major complication of mastitis
abscess
what are 2 risk factors for UTI / cystitis?
(1) catheter insertion
(2) urinary stasis
name at least 3 symptoms of UTI / cystitis
(1) dysuria
(2) urgency
(3) frequency
(4) low grade fever
(5) suprapubic pain
inflammation of the kidneys caused by a bacterial infection
pyelonephritis
spiking fever, chills, CVA tenderness, flank pain, and N/V are signs of
pyelonephritis
primary nursing action for UTI is
to advise an office visit for UA/UC
UTI is treated with ___
antibiotics
what is the key education for UTI?
(1) importance of peri care
(2) frequent urination
Fever, redness/ swelling around incision, drainage from incision site, abdominal pain or pain at the incision site, edges of the wound may pull apart
wound infection
Nurses should advise ____ for a wound infection
an office visit
what are the treatment options for a wound infection?
(1) incision and drainage
(2) wound exudate may be cultured
(3) antibiotics
(4) analgesics
(5) warm compresses or sitz baths
signs of wound infection include
(1) purulent discharge
(2) swelling
(3) edema
(4) painful intercourse
The key nursing roles for postpartum infections are ___, ___, and ___
assessment, intervention, and education
blood clot (thrombus) forms in a blood vessel and travels to another part of the body, blocking blood flow
thromboembolism
the 3 most common types of thromboembolism are
(1) superficial venous thrombophlebitis
(2) deep vein thrombosis
(3) pulmonary embolism
commonly confined to lower leg, involvement of superficial saphenous venous system
superficial venous thrombophlebitis
may involve veins from the foot to the iliofemoral region; predisposes a pt to a PE
deep vein thrombosis
complication of a DVT
pulmonary embolism
3 major causes of thrombosis are
(1) venous stasis
(2) hypercoaguable blood
(3) injury to the endothelial surface of the blood vessel
name the 3 common symptoms of a DVT
(1) unilateral area of swelling, warmth, and redness
(2) hardened vein over the thrombus
(3) calf tenderness
how do you diagnose a DVT?
(1) doppler US scanning
(2) computed tomography
(3) MRI
key prevention of DVT includes
(1) SCDs
(2) passive ROM exercises in bed
(3) early and frequent ambulation
(4) compression stockings
name at least 4 appropriate actions for management of DVT
(1) keep affected limb elevated above the heart
(2) do NOT use a knee gatch / pillow under knees
(3) encourage frequent position changes
(4) apply warm, moist compresses intermittently or continuously
(5) avoid massaging
(6) measure leg circumference
(7) use thigh-high antiembolism stockings
(8) administer NSAIDs and anticoagulants
____ is a fast-acting anticoagulant
heparin
a long-term anticoagulant option is
warfarin
name at least 4 symptoms of PE
(1) dyspnea
(2) chest pain
(3) tachycardia
(4) tachypnea
(5) hemoptysis
(6) decrease O2 sat on pulse ox
name at least 3 nursing interventions for PE
(1) frequent assessment of RR / other VS
(2) call for help!
(3) administer O2 at 8-20 L/min by tight face mask
(4) raise HOB to facilitate breathing
(5) narcotic analgesics to relieve pain
(6) ensure IV access
