Exam 3 Essays Flashcards
patho of pulmonary embolism
- complication of DVT occurring when 1 part of blood clot dislodges and is carried to the pulmonary artery
- occludes the vessel and obstructs blood flow to the lungs
- more common in postpartum period
estrogen influence of pulmonary embolism
- plasma fibrinogen (coagulation/clots) increase during pregnancy
- plasminogen (lysis of cells) does NOT increase
assessment of pulmonary embolism
- check resp. status and auscultate for crackles
- echocardiogram abnormalities may be seen
- pulmonary arteriogram used for diagnosis
treatment of pulmonary embolism
- anticoagulant therapy
- continuous heparin therapy until symptoms have resolved
- intermittent subcut heparin or oral anticoagulant therapy for up to 6 mos
s/s of pulmonary embolism
dyspnea, chest pain, cough, hemoptysis
physical signs of pulmonary embolism
tachypnea (RR >16), rales, tachycardia, fever, diaphoresis
what are the acute respiratory consequences of pulmonary emobolism
- increased alveolar dead space (diminished breath sounds)
- hypoxemia (decreased O2 sat)
- hyperventilation (decreased O2 and paresthesia)
who should pulmonary embolisms be actively sought in
pts with respiratory symptoms that are unexplained by an alternate diagnosis (high index of suspicion d/t nonspecific symptoms)
diagnostic features of pulmonary embolism
acute chest pain, syncope, abdominal pain, fever, productive sputum cough, wheezing, decreased level of consciousness
patho of deep vein thrombosis
- occurs in lower extremities, involvement varies but can extend from the foot to the iliofemoral region
- DVT occurs most often during pregnancy
estrogen influence of DVT
plasma fibrinogen (clotting) increased during pregnancy plasminogen (lysis) does not increase
s/s of DVT
unilateral leg pain, calf tenderness and swelling
redness and warmth
assessment of DVT
- inspect/palpate affected area, palpate peripheral pulse, check homan’s sign, measure/compare leg circumference
- assess for unusual bleeding, increased lochia, petechiae, hematuria, oozing from venipuncture
what is the status of homan’s in r/t DVT
positive homan’s needs more diagnostic testing, NOT performed because it can dislodge clot and cause PE
treatment of DVT
- anticoagulant therapy and continuous IV heparin, bed rest, affected side elevated and analgesic
- fitted with compression sock when allowed to ambulate
- IV heparin continued 3-5 days or until ss resolve
- oral anticoagulant therapy (warfarin/coumadin) continued 3 mos
- prothrombin time monitored at least monthly
assessment for BOTH DVT and PE
venous ultrasound
labs-prothrombin time
patho for BOTH DVT and PE
venous stasis and hypercoagulation
estrogen influence for BOTH DVT and PE
SAME
increased fibrinogen
decreased plasminogen/fibrinolytic activity
barrier methods for B/C
condom and diaphragm
describe BC for breastfeeding mothers
- start progesterone only BC methods after 3 wks of breastfeeding
- *progesterone only BC
types of BC allowed for breastfeeding mothers
minipill (Micronor), Depo-provera (lasts 3 mos), Nexplanonon (arm, last 3 yrs), Mirena (IUD, lasts 5 yrs), Skyla (smaller mirena, lasts 3 yrs)
describe BC for nonbreastfeeding mothers
- start on low dose hormonal BC containing estrogens and progesterone OR just progesterone AFTER 6 wk mark
- wait 6 wks d/t risk of developing DVT/PE after delivery
what to watch for in estrogen containing BC
*ACHES Abdominal pain Chest pain Headaches Eye pain Severe leg pain
what are you at an increased risk for developing with estrogen containing BC
blood clot or stroke
what to watch for with IUB BC
*PAINS Period late/pelvic pain Abdominal pain Infection Not feeling well Strings missing (dislodged IUD=ineffective)
what is postpartum blues
a let down of feeling, accompanied by irritability and anxiety
usually begins 2-3 days after birth and disappears within a week or two
how do mothers feel with postpartum blues
- emotionally liable and often cry easily for no apparent reason
- overwhelmed and in vulnerable state from giving birth
what is postpartum depression
a major depressive episode with an onset of pregnancy or within 2 wks of childbirth with symptoms lasting up to a year
what is a risk factor for postpartum depression
hx of anxiety or depression
symptoms of postpartum depression
depressed mood, fatigue, irritability, loss of appetite, sleep disturbance, loss of libido
treatment for postpartum blues
no treatment, educate, resolves on own
treatment of postpartum depression
ranges with severity
antidepressants (ssri)
psychotherapy
when should pt contact HCP when depressed
change in appetite, feelings of guilt, lack of interest in baby/friends, thoughts of harming baby or self
