Exam 3 Flashcards
anticipatory signs of labor
Lightening: ability to breathe easier
loss of mucous plug
ROM
Nesting: burst of energy
effacement: thinning of cervix
dilation: opening of cervix
abor Contractions Have the Following Characteristics:
They are regular
They follow a predictable pattern (such as every eight minutes)
They become progressively closer
They last progressively longer
They become progressively stronger
Each contraction is felt first in the lower back and then radiates around to the front or vice versa
A change in activity or body position will not slow down or stop contractions
Your mucus plug may appear
Membranes might rupture
Your health care provider will notice cervical changes, such as effacement (thinning) or dilation
Powers
Purpose: Dilate the cervix + aid in the expulsion of the fetus.
Contractions originate in the fundus and radiate out
Measured by: Frequency: how often are they occurring from start of 1 contraction to the start of the next.
Duration: how long 1 contraction lasts - from start to end of 1
Intensity:
Mild - fundus is able to be pushed feels like the noseo
Moderate: chin
Strong: can’t push in like forehead
Can measure by
IUPC
Mild = <40mmhg
Mod = 40-70mmhg
Strong = >70mmhg
Passageway
Route the fetus must travel
- maternal pelvis
- cervix
Types of Pelvis
Gynecoid: true female - 50% , round, shallow, open
Android: male resemblance, more heart shape - c/s
Anthropoid: narrow + deep
Platypelloid: flat, least common, wide, shallow - egg/oval
Passageway
Route the fetus must travel
- maternal pelvis
- cervix; needs to be ripe –> BISHOP SCORE
- effacement
- dilation
Types of Pelvis
Gynecoid: true female - 50% , round, shallow, open
Android: male resemblance, more heart shape - c/s
Anthropoid: narrow + deep - could do vaginal but it could be a long labor
Platypelloid: flat, least common, wide, shallow - egg/oval c/s
Cardinal Movement of Fetus
- engagement with cervix, flexion, descent
- further descent, internal rotation
- complete rotation, extension
- complete the extension
- restitution - external rotation
- delivery of anterior shoulder
- delivery of posterior shoulder
Passanger
Fetal Attitude: general flexion
Mentum: face presentation, loosely flexed legs. back arched - 13.5cm
Brow: brown at the cervix, sitting like a genie
Sinciput: head is up and not flexed on the chest 10 cm
Vertex/Occiput: fully flexed head to chest, legs flexed up; optimal position - 95% - 9.5cm
Fetal Lie: how the fetus is positioned in the womb
longitudinal: fetus spine running the same direction parallel as mother’s spine; can also be breech
transverse: positioned horizontally - CANNOT HAVE VAGINAL BIRTH
oblique: the head is against the mother’s hip, above the birth canal no parts are against the cervix
Fetal Presentation: the fetus body part that is closest to the cervix; which is presenting first
Frank: buttocks first, legs up
Full: buttocks first but less flexed
Footling: feet first and not flexed
Occiput: head first
Positon
Fetal Position: how the fetus is positioned in the womb and what part of the baby emerges first
1st letter: which way is facing
L: left
R: right
2nd Letter: what part of the body is presenting
O: occiput
S: sacrum
T: transverse
3rd: direction the fetus is facing in relation to mother
A: anterior: facing forward
P: posterior: facing backward
LOA – left, occiput, anterior = fetus is head first, angled to the left of mom’s pelvis and facing mom’s anterior
LOP: sunny side up; back pain –> counter pressure
LOT:occiput isn’t anterior or posterior
Station: relation of the presenting part in relation to the maternal pelvis
0 = engaged at the ishial spines
-5 = higher on the ishial spines
+5 = lower towards cervix
Leopold Maneuvers
To feel the fetal presentation and maneuvers
1. feels the top of the fundus
2. side of the uterus
3. suprapublic
4. only if in cephalic presentation feel for fetal attitude and extension
True Labor
contractions: strong, regular, long and close together, more intense with walking
felt in the lower back and doesn’t stop with comfort measures PAIN RADIATES
Cervix: changes - softening, effacement, dilution
Fetus: presenting parts engage the cervix, easier to breathe (lightening)
show is present
False Labor
Contractions: irregular, stops while walking or comfort measures, felt in the back or above umbilicus; only in groin + lower abdomen
Cervix: may be soft but no significant changes, no bloody show, posterior position - posterior position
Fetus: not engaging cervix
Fetal Heart Tones
Early Dec
VEAL CHOP
Variable Decelerations –> Cord Compression
Early Decelerations –> head Compressio
Accelerations –> ok
Late Decelerations –> placental insufficiency
Accelerations: want to see 2 accelerations >15 bpm for 15s
Early decels: pressure on skull; nothing can be done
Late: hypoxia, need to promote perfusion to fetus. STOP OXY and change position
Variable: change position, fetal or Trendelenburg to relieve pressure.; STIOP INFUSION, O2, amniofusion
Maternal Assessment Before birth
Materal hx: allergies, medications, hx of preg, maternal testing (blood type, Rh, hct/hg, GBS, Hepatitis B, nonstress)
Vital signs
uterine activity
Bladder I&O
Membrane status –> nitrazine (pH strip), amnisure, fern test
Response to labor
discomfort
cultural needs
Fetal Assessment before birth
Fetal presentation and station
HR
Internal: on scalp of baby
External: on top of fundus + on the baby’s spine on the outside
Looking for baseline FHR, variability, accelerations, decelerations
gestational growth + age
Fetal Heart Rate
Goal is to interpret + assess fetal oxygenation
Auscultation use of fetoscope + doppler, internal, external monitoring
Baseline: 110 - 160
Tachy
Mild: 161-180
Severe: >180
Causes: infection, increase metab, hyperthyroid, dehydration, anxiety, stress, fetal hypoxia, corchioamniotesis
Brady
Mild: 100 - 109
Moderate: 70-99
Severe <70
Cause: increase vagal tone, beta blockers, supine hypo, cardiac defects, cord prolapse, CHP
Variability = status of CNS
normal –> 6-25 bpm
Decrease = decrease CNS, alcohol, heroin, hypoxia; if sustained then fetus may need to be immediately delivered
Psyche
The way a woman handles the labor process
influenced by:
Parity
age
culture
coping mechanisms
emotional factors
length + intensity of labor
maternal + fetal position
Pain caused by dilation, pressure on cervix + tissue anorexia
THE SIX CARE PRACTICES THAT SUPPORT NORMAL BIRTH
- labor begins on it’s own
- freedom of movement
- continuous labor support
- minimize intervention
- spontaneous pushing in non supine positions
- no separation of mother and baby
Categories of FHT
Category I: normal; no intervention
2: indeterminate; requires eval + continued monitoring
3: predictive of abnormal fetus acid base, requires prompt eval and interventions
Methods of pain management
Non pharm: moving freely, position change, support system, massage, heat, water immersion, relaxation, aromatherapy, acupuncture, counter pressure, walking, sensory - aroma therapy, breathing, cognitive: hypnosis
Pharm:
Analgeis: partial + full relief from pain: opiates, morphine, stadol, nubain
Anesthesia: loss of sensation
Epidural: blocking neurotransmission —> give bolus for hyptoT
Nitrous oxide
Spinal block
Administration:
Systemic: IV, IM +inhalation; opiates can slow progression + affect fetus
Regional: epidural, spinal - risk of spinal headache, combo
Local block: pupendal + para cervical nerve block
First Stage
True labor contractions –> full dilation of cervix
- Early/Latent Phase: 0-3 cm; irregular contractions 20-40s, 10-30 min apart
woman is excited!
Actions: review plan, reinforce breathing techniques, lab tests per orders - Active: 4-7 cm; intense contractions, every 2-5 min, 45-60 s each, discomfort increases
Actions: monitor FHR, assess pain/admin analgesia, oral fluids - Transition: 8-10cm; shortest but most intense, 1-2 min 60-90 s N/V, diaphoresis
Actions: assess FHR + contractiosn Q15 min, assist with toileting, comfort + support
Second Stage
complete cervical dilation –> birth
INTENSE CONTRACTIONS Q2 min 60-90 s
URGE TO BEAR DOWN (ferguson’s reflex); don’t push until completely effaced and dilated
Actions: instruct when to bear down, monitor FHR Q5-15 / after each contraction, comfort
Third Stage
Birth –> placenta
Uterus contracts until placenta is out ~ 30 mins
You’ll know it’s coming when the uterus gets smaller and there’s a gush of blood.
Actions: assess vitals q15, utertonics as prescribed
Fourth Stage
postpartum –> 4hrs
Chills, pain fatigue,
newborn skin - skin
ASSESS FOR HEMORRHAGE
Preterm Labor
regular contractions occuring between 20-37wks with
- progressive cervical changes
- effacement >80%
- dilation > 1cm
Factors:
Infection + inflammation
decidual hemorrhage
excessive uterine stretch (multiple + polyhydraminos)
maternal or fetal stress
Greatest contributor of infant mortality <32wks
Risks:
Demographic risk: AA highest. Alaskan 11.6%, Hispanic 9.6%
Medical risk in current/ predating preg
environmental/behavioral/ psychosocial
biochemical marker –> fetal fibronectin fFn = protein that acts like a glue attaching sac to the uterine lining.
presence of fFn 24-34 indicated increased risk of preterm labor
absence is a reliable predictor of preg continuing for 2wks
Wouldn’t test if >3cm dilated
there’s vaginal bleeding
ROM
had sex or a vaginal exam 24hrs
gestational age <22wks or >35wks
suspected abruption and previa
Shortened cervix >3cm / 30 mm before 34 wks are less likely to have preterm birth than those who are <3cm
WARNING SIGNS
uterine cramping
backache
pressure on pelvis/ change in vaginal discharge
Abdominal cramping diarrhea
contraction Q10m in 1hr
general sense there is something wrong
change in fetal movement
Management
Assess for infection
restricting activity
hydration
tocolysis - Stop contractions via med
promote lung maturity - corticosteroids
Prevention; progesterone in singleton not multiples
Fetal Reserves
When O2 decreses blood flow is deferred to vital organs.
if placental reserves are depleted fetus may not be able to adapt or tolerate decreased O2 during contraction
Phases of contraction
- increment = begining
- Acme = peak
- decrement = decrease; relaxation
the resting tone is critical to return O2 to baby after contraction - <20 mmHg
Freq: how often
Duration: how long
Initiation of Labor
Must include 1+ regular phasic uterne contraction that increase in freq + intensity + progressive effacement + dilaion.
Factors:
uterine stretching – release of prostaglandins
Oxytocin release - increase contractility
decrease progesterone - inhibits contraction
increase prostaglandin
Cortoisol release inhibit prog and increase prost
placental aging
Tocolytic Therapy
Process of admin of a drug for purpose of inhibiting uterine contractions. Main goal is to stop labor long enough to get steroids to mature lungs
Contradictions:
Severe HT or preeclampsia
fetal compromise
fetal death
anomaly incompatible with life
lungs are mature
Types:
Beta-adrenergic agonist
Mg Sulfate
Ca Channel Blockers –> Nifedipine/Procardia
Prostaglandin inhibitors
Terbutaline
Beta-adrenergic Agonist
Promotion of smooth muscle relaxation
IV or SubQ -> RAPID ONSET
Side Effects:
Maternal + fetal tachy
PE
Hyperglycemia + hypokalemia
hypot
Cardiac insufficiency + arrhythmias
myocardial ischemia
maternal death
Mg Sulfate
Prevents Ca into the myometrial cells –> uterine relax + CNS depressant
USED FOR FETAL NEUROPROTECTION NOT TOCOLYSIS
SE: maternal flushing, headache, nausea, blurred vision
Toxicity
Loss of deep tendon reflexes
loss of consciousness
Respir <7
PE
Hypot
Cardiac arrhythmias
CALCIUM GLUCONATE 1g IV over 3 min
Indomethacin
ANTIINFLAM -> powerful prostaglandin synthesis and readily crosses placenta
adjunt therapy with other tocolytic therapy – Mg - oral or rectal
Prolongs preg for 48-72hrs
could close ductus arterious if admin >32wk, Nectrotizing enterocolitis, hemorrhage + renal failure
Ca Channel Blockers
Nifedipine - smooth muscle relaxer + potent vasodilator
SE: hypot, flushing, headache, tachy, nausea, dizziness, palpitation
Bethamethasone + Dexamethasone
Corticosteroids –> stimulate lung maturity
Only evidenced based rational for tocolysis
Can last 1wk and can be repeated
Nursing Care for Preterm Labor
Stopping contractions
Activity restriction + bed rest —> be aware of DVT and PE
Left side to promote perfusion to uterus
avoid sex
hydration –> dehydration stims pituitary to secrete ADH and Oxytocn
treat infection + have patient report abnormal findings
vitals
monitor FHR and contraction pattern – if tachy for a prolong period could be infection
Risk of PTL
Infections of the urinary tract, vagina, or chorioamnionitis (infection of the amniotic sac)
* Previous preterm birth
* Multifetal pregnancy
* Hydramnios (excessive amniotic fluid)
* Age below 17 or above 35
* Low socioeconomic status
* Smoking
* Substance use
* Domestic violence
* History of multiple miscarriages or abortions
* Diabetes mellitus or hypertension
* Lack of prenatal care
* Recurrent premature dilation of the cervix
* Placenta previa or abruptio placentae
* Preterm premature rupture of membranes
* Short interval between pregnancies
* Uterine abnormalities
Dystocia
Abnromal, long and/or difficult labor as related to the passenger, power, passageway or psyche
Dystocia related to powers
contractions don’t produce progressive dilation, effacement and descent of the presenting part; quantified as the # of contractions in a 10 min window avg over 30 mins
Hypotonic: Arrest of descent/dilation
need to amniotomy –> AROM
Oxytocin augmentation
overdistention – hydaminos + multiparty; must deliver at risk for cord prolapse and infection
Tachysystole: ineffective / erratic contraction pattern
>5 contractions in 10 min time/ 30 mins with less than 60 s of relaxation
–> related to stress + anxiety
Ineffective dilation or pushing
fetal deoxygentation
uterine rupture
Precipitous Labor
rapid labor, is defined as giving birth after less than three hours of regular contractions
Dystocia related to the passenger
abnormal presentation
Malposition: - posterior
Malpresenation:
brow
face
breech
transverse
Dystocia related to the passageway
Cephalopelvic disproportion: fetal head is larger than the maternal pelvic diameter
- lack of descent w. strong contractions
- prolonged labor
Shoulder dystocia –> EMERGENCY!
assistance: use forcepts or vacuum (unless <34wks)
Dystocia Assitance
Forceps
Vacuum
risk: succedaneum, hematoma, intracranial hemorrhage
Labor Enhancers
Pitocin - stimulates contractions
–> drug med error = injury ; lack of timely recognition
Must be medically necessary; preeclampsia, postterm hemorrhage, prom,
Contra: transverse lie, scarring, cephalopelvic, previa, herpes, cord prolapse
Caution: fetal distress, premature, overdistention
want to make sure that cervix is ripe >8 Bishop score
SE: increase contraction, resting tone, HR, decrease BP, water intoxication ICP increase, fetal tachy
Risk: ftal hypoxia, uterine rupture, abruption, hemorrhage, fetal hyptot
C/S
32% and increasing; performed because of factors related to
mother: diabetes, CD, preeclampsia, infection, dystocia, herpes
fetus: distress, malpresentation, position, anomalies
+ other
Classic: vertical: increased risk of uterine rupture in subsequent pregnancies and labor
Transverse: Pfannenstiel’s most common
Risk: infection, hemorrhage, thrombophlebitis, atelectasis
Post Op care:
pain
respir f(x)
I&O
Incision
bowel f(x)
circulation
psychological response
Shoulder Dystocia
Anterior fetal shoulder is behind the pubic bone of the mother
Risks: Fetal macrosomia >4000
diabetes
obesity
previous shoulder dystocia
McRoberts Postion: pelvis tilt orienting symphaysis more horizontally to facilitate should delivery
Cord Prolapse
umbilical cord drops down alongside or infornt of the presenting part.
This can reduce the circulation to the fetus –> vasoconstriction and resultant fetal hypoxia, which can lead to fetal death or disability if not rapidly diagnosed and managed
Care: Trendelenburg or knee-chest. to relieve pressure, elevate part with STERILE gloved hand.
IF CORD IS VISIBLE DO NOT TOUCH, cover with warm, sterile, saline soacked gauze and continuously assess FHR
Amniotic Fluid Embolism
Amniotic fluid escapes into the maternal circulation –> open sinus of the placental site
Can be fatal to the mother; amniotic fluid has debris, lanugo, vernix, meconium
Signs: dyspnea, chest pain, cyanosis, shock
Interventions: delivery, CV and Respir support
Post partum complications
- Postpartum Hemorrhage
- Complications of breast feeding
- Postpartum Infections
- Endometritis
- UTI
- Mastisis
- Wound Infection
- Thrombophlebitis
- Pulmonary Embolism
- Postpartum Psychiatric disorders
Postpartum hemorrhage
most common - 2.9% ~ 183% increase - 125,000 affected ONE OF THE ONLY COUNTRIES WHERE MATERNAL DEATH + INJURIES ARE INCREASING
* Blood loss >500mL after vag * >1000mL after C/S Early Hemorrhage: first 24hrs after delivery; atony Late: 24hrs - 6wks after; retaining of placental tissue
Causes:
1. Tone: uterine atony; overdistention, infarction, rapid labor, placental abnormality, polyhydraminos, fatigue, Pitocin, NSAIDs, anesthetics, Mg Sulfate + placenta at the lower segment of the uterus (doesn’t contract as well)
2. Tissue: retained placenta; commonly with accreta + previa
3. Trauma: damage to the genital tract spontaneously or manipulation/ cerival laceration - forceps DON’T EVER ATTEMPT WITHOUT THE CERVIX BEING FULLY DILATED
Thrombin/Clotting: clotting abnormalities; hemophilia, Von Willebrand, HELLP, abruption, DIC or sepsis
Hematomas can present as pain or as a change in vital signs disproportionate to the amount of blood loss.
Uterine rupture: most common in women who have significant uterine scarring
Risk factors for PPH
Risk Factors of PPH
* Uterine over-distention - multiple, LGA, polyhydraminos, clots
* Previous PPH
* Anesthesia or MgSO4
* Additional drugs used to make the uterus relax - nifedipine, terbutaline
* Operative birth/ assisstive device - vacuum, forceps
* Trauma
* Grand multiparity
* History of maternal anemia + hemorrhage
* Infection
* Uterine inversion or rupture
* Previa or accreta
* Abnormal labor pattern (hypotonia/hypertonic)
* Retained placenta
* Prolonged labor or fast
* Obesity
* Oxytocin admin during labor
Signs of PPH
Signs of impending Hemorrhage
* Excessive bleeding >2 pads/30-1hr; 1 pad >15mL
* Light headedness, nausea, visual disturbances
* Anxiety, pale/ashen, clammy
* Elevated HR, respir rate and or same/lower BP; you’ll see pulse elevation before BP drop – change in vital signs is a late sign of hemorrhage
=MAP = A MAP of 60 is necessary to perfuse coronary arteries, brain + kidneys; usual = 80-110
* Hematomas - 3-500mL of blood; often feel like they need to have a bowel movement due to the pressure
Interventions + medications for PPH
Interventions
* Risk assessment
* Inspect placenta
* Avoid overmanipulating of uterus - don’t want to tire out
* Active Management: Pitocin @ 3rd stage of labor to promote uterine contraction
* If at risk make sure blood match + have IV access
* Fundal massage if they begin to hemorrhage to firm up the uterus
* Empty bladder to prevent overdistrention
Medications: Oxytocin, Cytotec, Methergine, Hemabate
Oxytocin: Produces uterine contractions, vassopressive + antidiruetic.
SE: water intoxication - ADH like behaviors, NV
Conta: none if for PPH
10-49u/500-1000mL >500mL/hr titrated; 10-20mL IM
WATCH FOR BLEEDING + TONE
Methergine: sustained tetanic uterotonic effect that reduces bleeding and shorten the 3rd stage of labor.
SE: HT, Hypot, NV headache
Contra: HT, cardiac, preeclampsia
.2mg IM up to 5 doses 2-4hrs
CHECK BP Before giving don’t give if >140/90 watch bleeding
Misoprotol/Cytotec: Synthetic prostaglandin analog. Mixed results for uterine atony but used for reducing risk of GI ulcers by NSAIDs
SE: headache, NVD, fever, chills
Contra: allergies to prostaglandins
100 - 200mcg tabs – 600 - 1000mcg rectally or sublingually
Monitor bleeding + tone
Hemabate: prostaglandin similar to F2-alpha but has a longer duration. Produces myometrial contractions
SE: headache, NVD, fever, tachy, HT, fever
Contra: Asthma, HT
.25mg IM or intrauterine
Monitor
Caregivers underestimate blood loss by 50%
Most woman are healthy can tolerate blood loss - since most patients give birth doral recumbent need a lot of blood loss before the effects are felt.
Postpartum infections
Puerperal sepsis: any infections of genital canal within 28 days after abortion or birth
* occurs within 28 days after and 6 wks, on 2 successive days within the first 10 days postpartum not including the first 24hrs
* Commonly in C/S
* Leading cause of maternal morbidity + morality worldwide
Pathogens: normal vaginal, cervical or bowel organisms - GBS or E.Coli
Characterized by
* Temperature >100.4 at least 2/10 days post birth
* >101 within first 24hrs
Common infections:
1. Endometritis
2. Wound infections
3. UTI
4. Mastitis
5. Respir
Prevention:
1. Handwashing
2. Perineal hygiene
3. Antibiotic administration
4. Wound management
5. Breast care
Risk Factors Preconception
* History of previous venous thrombosis, UTI, mastitis, infection
* Diabetes
* Alcoholism
* Drug abuse
* Immunosuppression
* Anemia
* Malnutrition
Risk Factors Intrapartum
* Prolonged labor
* Poor aseptic technique
* Birth trauma
* C/S
* Prolonged ROM
* Chorioamnionitis
* Bladder catheterization
* Internal fetal/uterine pressure monitoring
* Vaginal examinations after ruptured membranes
* Epidural anesthesia
* Retained placental fragments
* PPH
* Episiotomy + lacerations
* Hematomas
Endometris/metris
- most common cause of postpartum infection
- Begins as localized infection but can spread – outside uterine cavity
Higher risk if C/S
- Begins as localized infection but can spread – outside uterine cavity
Symptoms
1. Lower abdominal tenderness + pain
2. >100.4 temp + Chills
3. Foul smelling lochia
4. Tachycardia
5. Subinvolution
Treatment
* Broad spectrum antibiotic - take cultures
* Analgesia
* Emotional support
Incidence: <3% Vag; 10-50% C/S
Interventions:
* Monitor vitals q4h
* Assess for abdominal pain
* Monitor lab values, CBC, blood cultures, sed rate
* Antibiotics
* Increase fluid intake
SEMI FOWLERS + AMBULATION = uterine drainage
Wound Infection
- Most commonly at site of incision
- Episiotomy + laceration infections occur less often; symptoms 24-48 hrs
- Aseptic wound management
- Frequent perineal pad changes
- Good handwashing
Admin antibiotic + analgesics
Complications involving breasts
Engorgement, cracked nipples + blocked ducts are increased risk of mastitis
* A sign of engorgement = poor feeding -> good latching best form of prevention of engorgement
= warmth/ warming pad and ice after breastfeed, breast massage
* Cracked nipples = poor latch, baby should feed on other nipple
=lanolin, hydrogeal disks, education on proper latch
* Plugged ducts = inadequate removal of milk from underwire bra, clothing baby should feed on other side
Mastitis: influenza like symptoms
* It can happen any time, most commonly with lactating
* Happens in the upper outer quadrant, can be both breasts most commonly unilateral
* Caused by S.aureaus, can enter through cracked nipples, engorgement + stasis of milk come before
Treatment: antibiotics, continue to breastfeed, warm compress
UTI
straight cath > indwelling = avoid CAUTI
* Frequent cervical exam in labor
* Anesthesia can cause urinary retention = stasis
* GU injury
* C/S
* Atonic bladder + urethra post delivery
Lower UTI
* Dysuria
* Urgency + Frequency
* Suprapubic pain
* Low grade fever
* Hematuria
* Cloudy + smelly urine
Upper UTI
* Pyelonnephritis
* Develops 3-4 days
* Chills + fever
* Costovertebral angle tenderness
* Nausea + vomiting
Symptoms + Treatment
* Burning + pain urination
* Lower adnominal pain
* Low grade fever
* Flank pain
* Proteinuria, hematuria, bacteriuria nitrates + WBC
Assess vitals Q4H
>fluids + I&O
Antibiotics, antipyretics, antispasmodics, antiemetics
Rest
Thromboembolic Disease
formation of blood clots inside blood vessel
1. Superficial thrombosis: involves the veins of the superficial saphenous system
2. Deep thrombosis: lower extremities
3. PE: complication of DVT
Causes: venostasis + hypercoagulation
Declining due to early ambulation
Risks: >fibrinogen, hx of DVT, increased parity, obesity, >35, immobility, C/S, tissue trauma, blood other than O, dehydration
Thrombophlebitis
Assess for hot, red painful, edematous areas of lower extremities + groin >100 temp
HOMAN CONTRA BECAUSE YOU CAN DISLODGE CLOT
Treatment: analgesics rest + elevation superficial
DVT: heparin + coumadin
PE
SS: dyspnea, sweating, pallor, chest pain, cyanosis, confusion, tachypnea, cough, temp, sense of impending death
Treatment: elevate head of bed, O2 8-10L, clot busters
Psychological Complications
- Have implications for mother, newborn + family, can interfere with the attachment + integration, can threaten the safety/ well being
Postpartum Depression - 10 -20%; first 3 mo - 1 yr- Intense, pervasive sadness
- Labile mood swings
- Intense fear, anger, anxiety
- Unable to care for self or infant
- Irritability –> violent outburst
- Rejection of infant
- Obsessive thoughts
Treatment: Edinburgh Scale, Postpartum depression scale - Depression responds best to a combo psychotherapy, medication, social support
Postpartum Psychosis - rare but immediately needs to be treated, psychiatric emergency - Depression, delusion, bizarre + irrational behavior, thoughts of harming self + infant
- Predictors = hx of bipolar or postpartum psychosis
- Risk of homicide + suicide is high
Antipsychotics + mood stabilizers = lithium
