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NURS 501 > Exam 3 - Late Postpartum Complications > Flashcards

Exam 3 - Late Postpartum Complications Flashcards

1
Q

What would be considered a postpartum infection?

A

Any infection of the genital tract following childbirth, spontaneous abortion, pregnancy termination

  • Commonly occur during first few weeks postpartum
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2
Q

Common sites of infection following vaginal delivery

A
  • Perineal laceration
  • Episiotomies
  • Placental implantation site
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3
Q

Common causative agents of postpartum infections

A
  • Steptococcus species, s. aureus, s. epidermidis
  • Gram negative aerobes
    • E. coli
    • Klebsiella pneumoniae
    • Enterobacter cloacae
    • Proteus mirabilis
  • Mycoplasma, chlamydia, gonorrhea
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4
Q

Signs and symptoms of postpartum infection

A
  • Elevated temperature
  • Malaise
  • Pain
  • Malodorous lochia
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5
Q

Risk factors of endometritis

A
  • C-section
  • Prolonged labor
  • Frequent vaginal exams
  • Retained placental fragments
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6
Q

Signs and symptoms of endometritis

A
  • Generalized malaise
  • Fever
  • Chills
  • Flu-like symptoms
  • Foul smelling lochia
  • Uterine tenderness
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7
Q

Labs and imagins used to manage endometritis

A
  • Urine culture and sensitivity
  • Blood cultures
  • CBC
  • Chest x-ray to rule out PNA
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8
Q

Pharmacological treatment for endometritis

A

IV antibiotics - clindamycin and gentamicin

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9
Q

What happens to patients with undiagnosed/untreated endometritis?

A

Can lead to salpingitis, septic thrombophlebitis, peritonitis, necrotizing fascitis

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10
Q

What causes postpartum women to develop UTI and pyelonephritis?

A

Urinary stasis from decreased bladder tone, increased bladder volume

  • Particularly following epidural anesthesia, incomplete bladder emptying during labor, urethral catheterization
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11
Q

UTI symptoms

A
  • Urinary frequency
  • Urgency
  • Dysuria
  • Super pubic pain or pressure
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12
Q

Pyelonephritis symptoms

A
  • Low grade fever
  • Flank pain
  • CVA tenderness
  • N/V
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13
Q

What is uterine subinvolution?

A

Failure of uterus to return to pre-pregnancy size during 4-6 week postpartum period

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14
Q

What causes uterine subinvolution?

A

Uterine myometrium does not contract effectively

  • Due to retained placental fragments, infection, excessive maternal activity
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15
Q

Subinvolution occuring at placental site can cause bleeding due to?

A

Inadequate sloughing and regeneration of endothelial lining up to 4-6 weeks after birth

  • Involution normally occurs by week 2
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16
Q

Clinical presenation of uterine subinvolution

A
  • Extended period of lochial discharge followed by heavy irregular bleeding
  • Boggy uterus or larger than expected
  • Symptoms resemble uterine infection
    • Malodorous discharge
    • Adnexal, cervical, uterine tenderness
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17
Q

What should be done for a patient with uterine subinvolution and infection is suspected?

A

Obtain cultures and treat with broad spectrum antibiotics

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18
Q

If retained placental fragments are a concern for patients with uterine subinvolution, what should be done?

A

Obtain ultrasound and refer

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19
Q

Pharmacological treatment for women with uterine subinvolution and excessive bleeding

A

Ergonovine (ergotrate) or methylergonovine (methergine)

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20
Q

What counts as delayed (secondary) postpartum hemorrhage?

A

Increased bleeding after first 24 hours to 12 weeks

  • Most commonly occurs during first 2 weeks due to subinvolution
21
Q

Signs and symptoms of delayed (secondary) postpartum hemorhage

A
  • Excessive vaginal bleeding
  • Signs of shock
  • Anemia
22
Q

Delayed (secondary) postpartum hemorrhage: risk factors

A
  • Retained placental fragments
  • Previously undiagnosed vaginal/cervical laceration
  • Hematoma
  • Uterine infection
  • Uterine atony
  • Coagulopathy (vWD)
23
Q

What labs should be collected for patients with delayed (secondary) postpartum hemorrhage?

A

If no other source of bleeding can be identified, consider

  • CBC, platelet count, PTT, PT in fibrinogen
24
Q

What causes DVT during the postpartum period?

A
  • Venous stasis from relaxed vascular walls in pregnancy
  • Hormonal influence
  • Hypercoagulopathy
  • Vascular trauma from inflammation
25
Q

Clinical presentation for pulmonary embolism

A

Greatest concern is pulmonary embolism

  • Tachypnea, dyspnea, chest pain of sudden onset
  • Altered lung and heart sounds
  • Apprehension as oxygen level decreases
26
Q

Clinical presentation for DVT

A
  • Abrupt severe leg or calf pain with/without ambulation
  • Generalized edema in extremity
  • Slight fever
  • Tachycardia
27
Q

How does SVT and DVT present on the lower extremeties?

A

Localized extremity pain in a palpable cord-like structure

  • Edema, erythema, warmth
28
Q

Risk factors for postpartum thrombophlebitis

A
  • Obesity
  • Maternal age >35 years
  • History of thrombosis
  • Anti-phospholipid antibody syndrome
  • Sickle cell disease
  • Heart disease
  • Diabetes
29
Q

SVT and DVT management (severe)

A
  • Avoid massage, manipulation, use of Homan’s sign to assess (test used to detect DVT)
  • Anticoagulant therapy
  • Rest
30
Q

SVT and DVT management (when symptoms resolve)

A
  • Light activity
  • Compression stockings
  • Analgesia (NSAIDs)
31
Q

What imaging should be ordered when the provider suspects DVT?

A

Ultrasound with doppler imaging to confirm diagnosis

32
Q

What is postpartum thyroiditis?

A

Inflammation of thyroid gland with alternating hyper and hypothyroidism

  • Excessive release of thyroid hormone followed by insufficient amounts of thyroid hormone secretion
33
Q

Postpartum thyroiditis signs and symptoms

A

Difficult to recognize because they are similar to symptoms experienced during postpartum

  • No recognizable pain or swelling of thyroid gland
34
Q

What is considered the hyperthyroid phase during postpartum?

A

1-4 months postpartum

35
Q

What causes the hyperthyroid phase (1-4 months postpartum) with postpartum thyroiditis?

A

Low TSH and lack of thyroid perioxidase antibodies and TSH receptor antibodies

36
Q

Signs and symptoms of hyperthyroidism

A
  • Fatigue
  • Palpitations
  • Anxiety
  • Difficulty sleeping
  • Irritability
  • Weight loss
37
Q

What is considered the hypothyroid phase during postpartum period?

A

4-8 months postpartum

38
Q

What causes the hypothyroid phase (4-8 months) postpartum?

A

Elevated TSH noted and positive for antibodies

39
Q

Signs and symptoms of hypothyroidism

A
  • Fatigue
  • Difficulty focusing
  • Depression
  • Goiter
  • Constipation
  • Weight gain
40
Q

Postpartum thyroiditis management

A
  • Refer to endocrinologist
  • Hyperthyroid –> beta blockers
  • Hypothyroid –> thyroid supplementation (levothyroxine)

Breastfeeding can continue

41
Q

What is thyroid storm (thyrotoxicosis)?

A

Abrupt, acute, potentially fatal exacerbation of hyperthyroidism

  • Normally occurs during first month postpartum –> elevated T4 levels
42
Q

Signs and symptoms of thyrotoxicosis

A
  • Fever
  • N/V/D
  • Tremors
  • Tachycardia
  • Dehydration
  • Seizures
  • Cardiomyopathy
  • HF
  • Coma
  • Death
43
Q

How are thyrotoxicosis and preeclampsia different?

A

Thyroid storm clinical presenation is similar to preeclampsia

  • Differ by high fever and neuropsych symptoms with thyroid storm
44
Q

Management of thyroid storm

A

Immediate ICU admission to reduce thyroid hormone levels and hydrate

45
Q

What what point would postpartum preeclampsia occur?

A

48 hours postpartum but before 4 weeks

46
Q

Risk factors for postpartum preeclampsia

A
  • Gestational hypertension
  • Preeclampsia during pregnancy
47
Q

What could the postpartum patient be at risk for after IV fluid therapy during labor and delivery?

A

Pulmonary edema and renal dysfunction

48
Q

Clinical presenation of postpartum preeclampsia

A
  • Headache
  • Visual disturbances
  • N/V
  • Epigastric pain
49
Q

Management of postpartum preeclampsia

A
  • Antihypertensive thearpy
  • Magnesium sulfate to prevent eclamptic seizures

NURS 501 (66 decks)

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