High Risk Postpartum Flashcards
must have birth and death certificate with funeral or cremation after ____ weeks gestation
20
post partum warning signs***
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
what is defined as a postpartum hemorrhage (PPH)
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
what is the leading cause of maternal morbidity and mortality
often goes unrecognized until profound maternal symptoms
postpartum hemorrhage (PPH)
what are some causes of PPH
uterine atony lacerations of genital tract retained placenta inversion of uterus subinvolution of uterus
describe uterine atony
marked hypotona (boggy uterus) leading cause of PPH**
what is uterine atony associated with
high parity, hydramnios, macrosomic fetus, multifetal gestation, labor >24 hrs, labor <3hrs, use of Pitocin or Magnesium sulfate
excessive amniotic fluid accumulation during pregnancy
hydramnios
greater ____ makes you increasingly at risk of hemorrhage
parity
what do use of vacuum and forceps often lead to
lacerations of genital tract
what is indicative of retained placenta
uterus is soft and therefore not contracted, arterioles are open
usually darker red coagulated blood
if uterus is firm…
blood is NOT coming from uterus (fully contracted and vessels are closed)
blood is probably from genital lacerations
usually bright trickle of blood
this is LIFE THREATENING and may require a hysterectomy
placenta remains attached to uterus and uterus turns inside out as it pulls out
inversion of uterus
uterus is not fully contracted down (partially)
subinvolution of uterus
what are the vital signs changes for hemorrhage
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
describe lochia rubra degrees
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
anticipate what test if hemorrhage
CBC
- blood type and crossmatch done upon entry in preparation for hemorrhage
- also ensure there is venous access for fluids
how do you stop a hemorrhage
massage uterus, give uterotonic (Pitocin), remove placenta/fragments
what do uterotonics do
*Pitocin
induce uterine contractions
what intervention is taken if massage and removal of placenta do not stop hemorrhage
surgical intervention
hysterectomy is last resort
this can result from a hemorrhage
emergency situation (possible death)
perfusion of organs may become severely compromised
hemorrhagic (hypovolemic) shock
what is the main goal when hemorrhagic shock occurs
RESTORE circulation blood volume
fluid and blood replacement therapy
nurse monitors pulse and BP
if hemorrhagic (hypovolemic) shock occurs what is the pt at risk for
INFECTION
decrease WBC, blood is essentially diluted with fluid replacement therapy
autoimmune disorder
anti-platelet antibodies decrease lifespan of platelets
coagulopathy
idiopathic thrombocytopenic purpura (ITP)
hemophilia (blood doesn’t clot properly)
deficiency in blood clotting protein
coagulopathy
van Willenbrand disease (VWD)
what do you treat VWD with
desmopressin
this occurs d/t formation of blood clot (s) inside blood vessel
caused by inflammation or partial obstruction vessel
thromboembolic disease (DVT)
what is the cause of thromboembolic disease
venous stasis and hypercoagulation
what makes DVT different from thrombophlebitis
DVT CANNOT pinpoint where inflamed vessel is, whole leg is inflamed
describe endometritis
infection of uterus (usually E. coli)
**foul smelling odor/discharge
prolonged labor
treat with antibiotics
describe wound infections
typically lacerations
treat with sitz bath and antibiotics
are pregnant women at risk of contracting UTI
yes EXTREMELY
treat with Bactrim
describe mastitis
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
what is the best way to prevent postpartum infections
HANDWASHING
what drugs are sued to manage PPH
oxytocin Misoprostol Methergine Hemabate Prostin
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?
uterine atony
what is the primary nursing responsibility for a client who is experiencing an obsteric hemorrhage associated with uterine atony?
performing fundal massage
what is the most common reason for late PPH?
subinvolution of uterus
which client is at greatest risk for early PPH?
woman with severe preeclampsia on magnesium sulfate whose labor is being induced
nurse suspects that her postpartum client is experiencing hemorrhagic shock. which observation indicates or would confirm this diagnosis?
urinary output of at least 30 ml/hr
the most effective and least expensive treatment of puerperal infection is prevention. what is the most important strategy for the nurse to adopt?
strict aseptic technique including hand washing by all health care personnel
what is one of the initial signs and symptoms of puerperal infection in the postpartum client?
temp of 38 C (100.4 F) or higher on 2 separate occasions
which statement regarding PPH is most accurate?
traditionally PPH has been classified as early PPH or late PPH with respect to birth
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?
thrombophlebitis, using real time and color Doppler ultrasound
which condition is considered a medical emergency that requires immediate treatment?
inversion of uterus
what is the initial treatment for the client with vWD who experiences PPH?
desmopressin
what would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?
laceration of genital tract
if nonsurgical treatment for late PPH is ineffective what procedure would be appropriate to correct the cause of this condition?
dilation and currettage (D&C)
what factors influence the causes and incidence of obsteric lacerations of the genital tract?
operative and precipitate births
abnormal presentation of fetus
congenital abnormalities of maternal soft tissue
previous scarring from infection
pt has foul smelling lochia 32 hours post delivery. what care would you provide pt?
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
