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Women's Health > High Risk Postpartum > Flashcards

High Risk Postpartum Flashcards

1
Q

must have birth and death certificate with funeral or cremation after ____ weeks gestation

A

20

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2
Q

post partum warning signs***

A 
fever > 100.4 F on two separate occasions
severe pain
increased vaginal bleeding
foul smelling vaginal discharge
redness in breast
flu like symptoms
symptoms of postpartum depression
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3
Q

what is defined as a postpartum hemorrhage (PPH)

A

loss of 500 mL of blood after vaginal birth
loss of 1000 mL of blood loss after Csection
a 10% change in Hct between labor and postpartum

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4
Q

what is the leading cause of maternal morbidity and mortality
often goes unrecognized until profound maternal symptoms

A

postpartum hemorrhage (PPH)

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5
Q

what are some causes of PPH

A 
uterine atony
lacerations of genital tract
retained placenta 
inversion of uterus
subinvolution of uterus
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6
Q

describe uterine atony

A 
marked hypotona (boggy uterus)
leading cause of PPH**
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7
Q

what is uterine atony associated with

A

high parity, hydramnios, macrosomic fetus, multifetal gestation, labor >24 hrs, labor <3hrs, use of Pitocin or Magnesium sulfate

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8
Q

excessive amniotic fluid accumulation during pregnancy

A

hydramnios

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9
Q

greater ____ makes you increasingly at risk of hemorrhage

A

parity

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10
Q

what do use of vacuum and forceps often lead to

A

lacerations of genital tract

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11
Q

what is indicative of retained placenta

A

uterus is soft and therefore not contracted, arterioles are open
usually darker red coagulated blood

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12
Q

if uterus is firm…

A

blood is NOT coming from uterus (fully contracted and vessels are closed)
blood is probably from genital lacerations
usually bright trickle of blood

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13
Q

this is LIFE THREATENING and may require a hysterectomy

placenta remains attached to uterus and uterus turns inside out as it pulls out

A

inversion of uterus

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14
Q

uterus is not fully contracted down (partially)

A

subinvolution of uterus

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15
Q

what are the vital signs changes for hemorrhage

A

1) widened BP (systolic increases, diastolic decreases)
2) Tachycardia (>100 bpm)
3) Narrowed BP (systolic and diastolic decrease)
4) death of tissue, turns grey, necrosis and cardiac/resp arrest occurs

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16
Q

describe lochia rubra degrees

A

aka bleeding

scant: less than 1 in
light: < 4 in
moderate: > 4 in
heavy: saturation of peripad in 1 hr
hemorrhage: saturation of peripad in 15 min

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17
Q

anticipate what test if hemorrhage

A

CBC

  • blood type and crossmatch done upon entry in preparation for hemorrhage
  • also ensure there is venous access for fluids
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18
Q

how do you stop a hemorrhage

A

massage uterus, give uterotonic (Pitocin), remove placenta/fragments

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19
Q

what do uterotonics do

A

*Pitocin

induce uterine contractions

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20
Q

what intervention is taken if massage and removal of placenta do not stop hemorrhage

A

surgical intervention

hysterectomy is last resort

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21
Q

this can result from a hemorrhage
emergency situation (possible death)
perfusion of organs may become severely compromised

A

hemorrhagic (hypovolemic) shock

22
Q

what is the main goal when hemorrhagic shock occurs

A

RESTORE circulation blood volume
fluid and blood replacement therapy
nurse monitors pulse and BP

23
Q

if hemorrhagic (hypovolemic) shock occurs what is the pt at risk for

A

INFECTION

decrease WBC, blood is essentially diluted with fluid replacement therapy

24
Q

autoimmune disorder
anti-platelet antibodies decrease lifespan of platelets
coagulopathy

A

idiopathic thrombocytopenic purpura (ITP)

25
Q

hemophilia (blood doesn’t clot properly)
deficiency in blood clotting protein
coagulopathy

A

van Willenbrand disease (VWD)

26
Q

what do you treat VWD with

A

desmopressin

27
Q

this occurs d/t formation of blood clot (s) inside blood vessel
caused by inflammation or partial obstruction vessel

A

thromboembolic disease (DVT)

28
Q

what is the cause of thromboembolic disease

A

venous stasis and hypercoagulation

29
Q

what makes DVT different from thrombophlebitis

A

DVT CANNOT pinpoint where inflamed vessel is, whole leg is inflamed

30
Q

describe endometritis

A

infection of uterus (usually E. coli)
**foul smelling odor/discharge
prolonged labor
treat with antibiotics

31
Q

describe wound infections

A

typically lacerations

treat with sitz bath and antibiotics

32
Q

are pregnant women at risk of contracting UTI

A

yes EXTREMELY

treat with Bactrim

33
Q

describe mastitis

A

unilateral breast swelling, tenderness, redness
flu like symptoms
poor latch causes laceration of nipple for bacteria to enter
treat with antibiotics and continue to breast feed

34
Q

what is the best way to prevent postpartum infections

A

HANDWASHING

35
Q

what drugs are sued to manage PPH

A 
oxytocin
Misoprostol
Methergine
Hemabate
Prostin
36
Q

a perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the client is experiencing profuse bleeding what is most likely the cause for this bleeding?

A

uterine atony

37
Q

what is the primary nursing responsibility for a client who is experiencing an obsteric hemorrhage associated with uterine atony?

A

performing fundal massage

38
Q

what is the most common reason for late PPH?

A

subinvolution of uterus

39
Q

which client is at greatest risk for early PPH?

A

woman with severe preeclampsia on magnesium sulfate whose labor is being induced

40
Q

nurse suspects that her postpartum client is experiencing hemorrhagic shock. which observation indicates or would confirm this diagnosis?

A

urinary output of at least 30 ml/hr

41
Q

the most effective and least expensive treatment of puerperal infection is prevention. what is the most important strategy for the nurse to adopt?

A

strict aseptic technique including hand washing by all health care personnel

42
Q

what is one of the initial signs and symptoms of puerperal infection in the postpartum client?

A

temp of 38 C (100.4 F) or higher on 2 separate occasions

43
Q

which statement regarding PPH is most accurate?

A

traditionally PPH has been classified as early PPH or late PPH with respect to birth

44
Q

a woman who has recently given birth complains of pain and tenderness in her leg. On physical examination the nurse notices warmth and an enlarged hardened area. which condition should the nurse suspect?

A

thrombophlebitis, using real time and color Doppler ultrasound

45
Q

which condition is considered a medical emergency that requires immediate treatment?

A

inversion of uterus

46
Q

what is the initial treatment for the client with vWD who experiences PPH?

A

desmopressin

47
Q

what would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?

A

laceration of genital tract

48
Q

if nonsurgical treatment for late PPH is ineffective what procedure would be appropriate to correct the cause of this condition?

A

dilation and currettage (D&C)

49
Q

what factors influence the causes and incidence of obsteric lacerations of the genital tract?

A

operative and precipitate births
abnormal presentation of fetus
congenital abnormalities of maternal soft tissue
previous scarring from infection

50
Q

pt has foul smelling lochia 32 hours post delivery. what care would you provide pt?

A

IV broad spectrum antibiotics
rest, hydration, and pain relief
comfort measures: cool compress, warm blankets, perineal care, sitz baths
discontinuation of IV antibiotics 24 hrs after the pt is asymptomatic

Women's Health (31 decks)

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