Final Flashcards
What is primary PPH?
Within the first 24 hrs
What is secondary PPH?
24hrs–12 wks
What are some interventions for uterine atony?
Assess for bleeding/fundal height/ fundal massage Encourage voiding Oxytocin (Pitocin) Contact physician Methylergonovine (Methergine) IV fluid and/or transfusion Bimanual compression of uterus Ligation of uterine vessels or hysterectomy
What are the 3 types of puerperal infections?
Metritis, perineal, cesarian infections
What are the causes of metritis?
Cesarean - Prolonged labor PROM - Multiple vaginal exams Scalp electrodes - Internal uterine monitor OB trauma - Instrument assisted birth Manual removal of placenta Prexisting infection Compromised health status
What are the assessments for metritis?
Abd/Uterine pain Foul smelling vaginal discharge Fever 101-104 F Chills Malaise 30% increase in WBC
What are the interventions for metritis?
CBC Cultures Hygiene Abscess is drained IV antibiotics Antipyretics ICU hospitalization
What is metritis?
inflammation of the uterus
When do Superficial thrombophlebitis occur?
3rd to 4th day after delivery
When do Deep vein thrombosis occur?
10-20 days after delivery
What assessment findings would you want to look out for, for a pulmonary embolism?
Dyspnea » Chest pain
Cough » Hemoptysis
Cyanosis » Hypotension
Tachypnea » Tachycardia
What are the two biggest signs of pyelonepritis?
flank pain and high fever
What are the assessment findings of pyelonephritis?
UTI signs » High fever
Chills » Flank pain
N&V » Acutely ill
What are the values for
Urine protein: > 300 mg. of protein in 24 hours
Blood Pressure: > 140/90 in two readings 4 hours apart after 20 weeks
Platelets: < 100,000
Serum createnine . 1.1 mg.
Liver function: double the normal values
What is the definition for preeclampsia?
Vasospastic disease with reduced organ perfusion
Protein in urine
CNS irritability
Hypertension
When does preeclampsia develop?
after 20 weeks gestation
What are some risk factors for preeclampia?
Chronic renal disease/ hypertension Family hx of preeclampsia Multiple gestations/first baby First baby with a new partner Younger than 19 or greater than 40 years of age Diabetes/Obesity RH incapability
What are some theories of why women get preeclampsia?
Vasoconstrictor tone Abnormal prostaglandin action Endothelial cell dysfunction Coagulation abnormalities Abnormal trophoblastic invasion Dietary deficiencies or excesses
When giving magnesium for preeclampsia, what are some important things to remember?
NPO
Have antidote: Calcium gluconate
Vitals and urine output Q1Hr
Keep it quiet
Education of the magnesium: metallic taste, muscle weakness, feels very hot internally
Monitor fetal response (usually has flat variability on the fetal monitor)
Labs: mag levels/ liver damage
What is one thing to be very aware about post delivery when giving mag?
Will probably bleed a lot more than normal, so be ready
How long post-partum does the mother have to have high BP for it to be considered chronic?
12 weeks
What is the HELLP syndrome?
Checks hepatic disfunction with preeclampsia with:
H: hemolysis
EL: elevated liver enzymes
LP: low platelets
What are some risk factors for hemorrhage ?
prolonged/augmented labor HX of it in the past Overdistended/ ruptured uterus Operative delivery Unrepaired lacerations of the birth canal *Placenta Previa *Mag admin during labor Coagulation disorders
What is true PPH?
Bleeding after the placenta is delivered
What is the #1 cause of secondary/ delayed hemorrhage?
uterine subvolution, retained products.tissue
What are the steps to stopping hemorrhage?
1- Fundal massage- get help 2- Pit 3-other hemorrhage drugs 4-Vitals Q5mins 5- Empty bladder (O2)
When do “baby blues” normally start?
When do they end?
around day 3
after 10 days
how common are baby blues?
80% of women
What are the signs of baby blues?
General irritability
- Weepiness
- Feeling down
How common is postpartum depression?
15-20% women
10% partners
What are the signs of PPD and how many have to be present to be classified?
4 present Depressed mood Agitation Fatigue/ Insomnia/ Lack of interest Poor concentration and decision making Poor appetite Feelings of failure as a mother Guilt Unusual worry over infant's health Suicidal thoughts
What are some coping treatments for PPD?
Sleep Nutrition Exercise Social support system Counseling with a therapist specializing in perinatal mental health
Which drug is the first line for breastfeeding mothers who have PPD?
Zoloft
What are the signs of postpartum psycosis?
Bizarre behavior
Disorganization of thought
Hallucinations/ Delusions(strange beliefs)
Irritation
Hyperactive/ Decreased need for sleep
Significant mood changes with poor decision making
What are some contraindications to using nexplanon?
Known or suspected pregnancy *Active DVT *Sever Hepatic Disease *Personal hx of Breast Cancer *Undiagnosed vaginal bleeding *inability to tolerate irregular menses, bleeding and spotting
What are LARCS?
Long ascting reversible contraceptives
What are examples of LARCS?
IUDs or Nexplanon
