Exam 3 Blueprint Flashcards
Postpartum Hemorrhage.
- Its severe bleeding after giving birth
- Its the 1000mL or cumulative blood loss
- Bleeding with hypovolemia within 24 hrs of birth
- Its the leading cause of maternal death worldwide
- Pts with Hemophilia are at risk of PPH
Hemorrhagic (hypovolemic)
shock
- Its a an emergency in which the perfusion of body organs can become severely compromised & death can occur.
🔸 Its caused by Excess blood/fluid loss
Nursing Interventions of Hemorrhagic (hypovolemic)
shock
➤ Continuous assessment every 2 hrs
➤ Assess the vital signs (SPO2, BP, Temp, HR, RR)
➤ Check for Abnormal labs (HCT, RBC, HGB)
➤ Check the urine output for signs of oliguria
➤ Identify the cause of the Hemorrhage & treat it
Postpartum (puerperal)
infections
- Any infection of the genital tract that occurs within the 28 days of:-
* Miscarriage
* Abortion
* Birth - Fever of 38 degrees (100.4 F) or more on two successive days of the 1st 10days (not including the 1st 24hrs after birth)
Examples of Postpartum Infections
- UTI
- Mastitis (Breast duct clogging)
- Respiratory tract infection
- Endometriosis
Risk Factors of Postpartum Infection
- Anemia
- Diabetes
- Malnutrition
- Drug abuse
- Immunosuppression
- Frequent vaginal exam
- Catheterization during labor & delivery
Nursing Interventions for Postpartum Infection
➤ Antibiotic (Oral & IV)
➤ Hydration
➤ Wound care (clean & dry)
➤ Wipe front to back
➤ Encourage sitz bath
➤ Assess vital signs
➤ Give pain meds
➤ Encourage voiding & pad changing every 2 hrs
➤ Perineal cleaning with warm water
➤ Encourage pt to drink Cranberry juice for UTI management.
Signs & symptoms for Endometritis
- Fever >2days
- Tachycardia
- Uterine pain & tenderness
- Foul smell
- Elevated WBC
Which Postpartum infection is most common after birth/miscarriage?
Endometritis
Signs & symptoms for Wound infection
- Redness
- Smell
- Warmth upon touch
- Wound separation
Signs & symptoms for UTI
- Flank pain
- Frequent painful urination
- Burning sensation while urinating
- Cloudy foul urine
Postpartum Psychotic Disorders
- Its the most serious disorder
- Happens 2-4 days after birth
- Manifesting through :-
* Crying
* Mood swings
* Sleep disturbance - It causes :-
* Hallucination
* Thoughts of harming themselves/baby
🔸 Baby Blues lasts more than 1 wk
Nursing interventions of Postpartum Depression
➤ Ask them how they feel
➤ Share information & knowledge of what they are to expect
➤ Encourage regular exercises, meditation & relaxation
➤ Encourage them to share their feelings with people they trust or support groups
➤ Treat with Mood Stabilizers, Benzodiazepines, Lithium (safe for breastfeeding)
Postpartum fundal height (involution)
- The Fundus descends 1-2 cm every 24 hours.
🔸 Immediately after birth - 2 cm above the umbilicus
🔸 12 hrs - 1 cm above the umbilicus
🔸 1 hr (after birth) - 12 hrs - Midline the umbilicus
🔸 24 hrs (after birth) - 1cm below the umbilicus
🔸 2 days (after birth) - 2cm below the umbilicus
🔸 Full bladder - 1 to 2 cm above the umbilicus
🔸 2 wks after birth, the fundus should nolonger be palpable
What is Lochia?
Lochia - is the postbirth uterine discharge
Lochia changes
🔸 Lochia Rubra
- Its Normal
- Its bright red in color
- It lasts 1-3/3-4 days after birth
- Blood & decidual & trophoblastic debris
🔸 Lochia Serosa
- its pink/brown in color
- it lasts 22-27/4-10 days after birth
- Old blood, serum, leukocytes & debris
🔸 Lochia Alba
- Its white/yellow in color
- It lasts 2-6 wks after birth
- Leukocytes, decidua, epithelial cells, mucus, serum & bacteria
Postpartum fluid loss physiology
🔸 Profuse diaphoresis
- Its Normal
- Occurs in the first 12 hrs - 3 nights
- Its the body returning to base
🔸 Excessive bleeding
- Its due to displacement of the uterus if the bladder is full
🔸Uterine Atony
- If someone is bleeding out 3 hours post-partum we would say patient had uterine atony
Nursing interventions for Postpartum Hemorrhage
➤ Massage the fundus (maintins the uterine tone)
➤ Empty the bladder (prevent bladder distension)
➤ Administer Pitocin (encourages uterine contraction)
Postpartum Hemorrhage Vital signs & labs
🔸Vital signs
* BP (Hypotension)
* SPO2 (Low O2 saturation)
* Temperature ( Hypothermia/low temp)
* HR (tachycardia)
* RR (tachypnea)
🔸Labs
* RBC (low)
* Hct (low)
* Hgb (low)
4th trimester
- Its the period after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.
- It lasts between 3-6 wks after birth
Postpartum headaches
🔸 Facts
* They are common in the first week postpartum
* Assess the BP
🔸 Causes
* Postpartum Preeclampsia
* HTN
* Spinal headaches
🔸 Nursing interventions
* Encourage the pt to lay flat to relieve pain
* A Blood patch may be needed
Kegel exercises
- They are pelvic exercises that encourage healing on the pelvic muscles
➤ Pretend like your peeing and stop urine stream…. Squeeze
Nursing care for Episiotomy/Laceration pts
🔸Apply ice packs in the first 24 hours after birth that reducing pain and
promoting healing and comfort.
🔸Use sitz baths 3-4 times a day for a maximum of 20 minutes each time.
🔸Change the pads every 2 to 4 hours.
🔸 Keep the area around the stitches clean and dry by washing the area from front to back, and the dry with a clean towel after urinate or have a bowel movement.
🔸 Drink lots of water and eat foods with plenty of fiber this will prevent
constipation.
🔸 Explain that these sutures usually dissolve within 10 days
🔸 Inspect the perineum for redness, sloughing of sutures, pus formation,
drainage at the suture, and if the pain gets worse.
Engorgement
- Its the overfilling of breasts with milk
- Often occurring in the early days postpartum
- It results in :-
* Swollen
* Hard
* Painful breasts - It may lead to :-
* Premature cessation of breastfeeding
* Decreased milk production
* Cracked nipples
* Mastitis - The discomfort decreases within 24 -36 hrs
🔸 Nursing Interventions
- Apply cold cabbage leaves on the breasts
- Wearing a well-fitting bra
➤ Do not use cabbage leaves on a lactating mother, but only when the mother intends to stop breastfeeding
Cultural care/therapeutic communication
- Sometimes in birth there are different cultures.
- The nurse should try to accommodate what is being asked of you even if you don’t believe in it.
- Use therapeutic communication with them.
What are the causes of Postpartum Hemorrhage?
➤ Uterine tone/boggy uterus (leading cause)
➤ Retained placenta fragments
➤ Hematomas (collection/pooling of blood under the skin)
➤ Infection
➤ Coagulation disorder
➤ Subinvolution of the uterus
➤ Lacerations of the genital tract that were not repaired following the birth
Quantitative Blood Loss (QBL) vs Estimated Blood Loss (EBL)
EBL or QBL of 1500 mL…what is our expected finding as far as vital signs for mom?
- Hypotension (she’s hemorrhaging).
- Blood loss of 1000mL is a hemorrhage .
What is the process for QBL (quantitative blood lost)?
- Weigh a dry pad and a soaked pad and the difference is QBL.
- Always measured by weight of the pads and if you’re in OR they’ll add blood that’s in the canisters prior to rupture.
Venous Thromboembolic Disease (VTE)
- Its the formation of the Blood Clots in the Lower Extremities caused by:
* Inflammation
* Partial obstruction of vessels
🔸 Nursing Care
- Check the leg circumference
- Assess for edema
- Check the peripheral pulses
- Compression socks
- SCD’s
- Elevate the leg
- Ambulation
Nursing Interventions of VTE
🔸Graduated compression stockings.
- Compression stockings prevent dislodgement of the thrombus.
🔸Pneumatic compression device.
- Intermittent pneumatic compression devices increase blood velocity beyond that produced by the stockings.
🔸Leg exercises.
- Encourage early mobilization and leg exercises to keep the blood circulating adequately.
Clinical manifestations of VTE
- Chest pain
- Shortness of breath (SOB)
Risk factors of VTE
- Maternal Age
- Underlying disease
- Smoking
- C- section
Etiology of VTE
Hypercoagulation
Superficial Venous Thrombosis
- Also known as Varicose veins
- Its the most common form of postpartum VTE
- Occurs mostly Behind the Knee where the skin is the thinnest
- It may be unilateral or bilateral
Signs & symptoms of Superficial Venous Thrombosis
- Warmth
- Redness
- Swelling & discoloration
- Dull pain in the affected extremity
- Tenderness in the affected extremity
Deep vein Thrombosis (DVT)
- Its a blood clot that forms in a Vein deep in the body
- Mostly occur in the Lower leg or Thigh
- A DVT can break loose & cause a serious problem in the :-
* Lungs (Pulmonary Embolism)
DVT is more common in the?
- Left leg
- Iliofemoral vein
Signs & symptoms of DVT?
- Swelling
- Warmth
- Redness
- Sudden onset of unilateral pain
- Positive Homan’s sign (rapid dorsiflexion of the foot)
Which diagnostic testing is used for DVT?
- MRI
- Doppler ultrasound
Nursing interventions for a DVT
➤ Don’t massage the leg
➤ Use Compression socks
➤ Elevate the leg 30 degrees
➤ Administer pain meds
➤ Teach pt how to use stockings
➤ Teach pt to watch for the s/s of DVT
➤ Administer Anti-coagulant meds (Heparin)
➤ Assess for bleeding
➤ Have Protamine sulfate close by
➤ Avoid contraceptives
Bladder distention.
If a pt had an epidural and is pp floor. Went to bathroom and couldn’t pee. Walked to bathroom just and still can’t pee. What would you do?
- Put some warm water in peri-bottle and spray on vagina.
- Turn the faucet and the the water run
- Put an In and Out catheter (Last resort)
Rhogam administration
- Its due 12 hrs - 72 hrs after delivery
- We give Rhogam when the (Negative mom & Positive baby)
Postpartum period
- Its the period/interval between Birth & the return of reproductive organ to their non-pregnant state (Usually 6 wks)
What is Subinvolution
- Its the failure of the uterus to return to non-pregnant state
- Its caused by :-
* Infection
* Retained placental fragments
Where should the Fundus be 2 wks after delivery
- Behind the symphysis pubis
- Which is also the exact spot where we push down if we have a should dystocia.
What are the priority assessments before discharging a woman from the recovery area?
- Airway (1st/important)
- Level of Consciousness
What does LDRP stand for?
Labor
Delivery
Recovery
Postpartum
BUBBLEHE
Breast
Uterus (Fundus)
Bladder
Bowels
Lochia
Episiotomy
Hemorrhage
Emotional state
Blood loss assessment
🔸 Scant
< 2.5 cm
🔸 Light
< 10 cm
🔸 Moderate
> 10 cm
🔸 Heavy
- 1 pad soaked in 2hrs
🔸 Excessive Blood loss
- 1 pad saturated in 15 mins or less
What is first thought when you think of sewing someones rectum back together? What kind of medicine will be want to give them?
- Stool softners
- Encourage walking
- Increasing fiber intake
- Increase fluids
- Recommend Peri-bottle & Witch Hazel
Risk factors for Uterine atony (Boggy uterus)
- Multigravida
- Polydramnios
- Macrosomnia
- Infection (infected muscle won’t contract the way we need it to)
Which Meds are given for Postpartum Hemorrhage?
- Oxytocin/Pitocin
- Methergen
- Cytotec/Misopristol,
- Hemabate(carboprost)
🔸 CODE BROWN (watch out for asthma with hemabate/carboprost contraindicated)
How would you tell if your kidneys are being profused?
- A Urine output of 30 mL/hr or more is normal.
What is the first sign we are looking for if someone is septic after delivery? Septic
- A Temp of 100.4 or higher
What type of patient are we worried about the most as far as postpartum infection?
Diabetic Pts
What do we want to teach patient with UTI?
- Don’t hold urine
- Wipe front to back,
- Drink water (PUSH FLUIDS)
- Med compliance & finish all antibiotics
What are some endometritus symptoms?
- Tenderness
- Pain
- Discomfort
- Rubra (excessive if they just had baby)
🔸 Remember infected muscle can’t contract!!!
What do we use to test for PP depression?
Edinburg Post Natal Depression Scale
What do we worry about someone who says they don’t like their baby?
Worry about harm to self or baby
What can we give to reverse heparization (someone who has had too much heparin or someone who is bleeding excessively?
Protamine sulfate
Where is most common spot for VTE?
Directly behind knee
How do we know if someone is experiencing a PE or AFE?
- Chest pain,
- Trouble breathing
What are time period of early PPH and late PPH?
- Early PPH - is within 24 hours
- Late PPH - is after 24 hours and lasts upto 12 weeks.
What causes DVT?
Venous Stasis (The pt is just laying in bed, not moving)
What do you do if a pt has a boggy uterus when you walk into the patients room?
Massage the Fundus
What are the causes of Maternal death?
- Hemorrhage
- Infection
- Pulmonary Embolism (PE)
- Hypertension
- Cardiomyopathy
- Trauma
Bladder distention can lead to?
- Hemorrhage
- Bladder damage
- Risk for UTI
Estimated Blood Loss (EBL) Postpartum hemorrhage
500mL for Vaginally
1000mL for C-section
When giving Methergine we should assess for?
- Assess the BP (the BP may increase)
