Maternity 5-2 Flashcards
1st appointment when? and when comprehensive apt?
within first 3 weeks, and comprehensive at 12 weeks
4 most common conditions (HT IB)
hemorrhage, thromboembolic disease (clotting), infections, PP affect disorder (blues - psychosis)
postpartum hemorrhage - how long after pregnancy can you hemorrage?
Defined as a blood loss of > 1,000ml in the first 24 hours after c-section delivery and 500 for vaginal
QBL not EBL
Accurate blood loss can be hard due to:
Pooling of blood in the uterus
Pooling of blood on the floor
Large hematomas of the labia, vulva, or vagina
you can hemorrhage up to 12 weeks after pregnancy - not common though.
typical signs of hypovolemic shock - how much loss before the pt has symptoms?
Decreased B/P
Increased Heart Rate
Decrease in Urine Output
These signs do not manifest themselves until the patient has an 1,800 – 2,100 ml blood loss
hematoma - how much blood?
can be up to 500 mL trapped
5 Ts of the PP hemorrhage
tone (hypo or hypertonic), tissue, trauma, thrombin (can be inherited or acquired), traction (inversion of uterus, pulling hard on the cord)
tone
Take a good patient history
Anticipate Risk
Overdistended
tone- first intervention (same w/ everything)
fundal massage
placenta
500 - 800 ml blood flowing (check this)
nursing management for tone (hmm…it’s tone)
misoprostol 800 mcg rectally, methegrine 0.2 mg IM (HTN contraindications), hemabate 0.25 mg IM (asthma contraindicated)
nursing management for hemorrhage - how often to assess VS?
Weigh everything that is blood soaked.
Call provider
Pain Management
May need 2nd IV site for transfusion
Monitor V/S every 15-30 min (B/P, HR, R, Temp)
Monitor Capillary refill, urine output, & LOC
Foley catheter insertion to keep bladder empty
Avoid antiplatelet medications (NSAIDs, ASA, Antihistamines)
Shock - Catabolic state develops…(end the shock)
Inflammation
Endothelial dysfunction (back up in system)
Disruptive metabolic state of organs
Hard to recover once this cascade of events occur, even with transfusions.
bochary balloon (check sp) (the hemorrhage debachary) - how much fluid can it hold?
can hold up to 800 mL of fluid, usually used as a stop gap, for like 24 hours
shock - DIC
Monitor for areas of bleeding
Bleeding of gums or nose
Unusual Bleeding
Hematuria
Order DIC panel (always check for blood pooling under pt)
Use multiple blood products
Venous Thromboembolic Condition
Inherited & Acquired bleeding disorders
Relatively uncommon as sole reason
Thromboembolic Thrombocytopenia Purpura (rash)
Von Willebrand Disease
DIC can be listed here also
Venous Thromboembolic Condition
Occurs 1 in 1,000 Pregnancies
One of the leading causes of pregnancy related deaths
thrombosis - superficial venous thrombosis - DVT to PE
nursing management - Venous Thromboembolic Condition
Monitor for calf pain, LE edema, sudden onset of SOB with decreased O2 sats
Oxygen delivery
Apply compression stocking
Apply SCDs (sequential compression devices)
Administer Lovenox
Increase fluid intake
IV heparin (maybe)
NSAIDs for pain with SVT
Educate
Possibly administer tPA (breaks up clots in blood)
PP infection - temp?
Fever >100.4 degrees at least 2 of the first 10 days PP ( not including the first 24 hours)
Foul smelling vaginal discharge
8% of all births will experience this
PP infection - RISK FACTORS
c-section, prolonged rupture of membrane, long labor w/ multiple SVE, internal fetal monitoring, chorioamniotis (inflammation of the placenta), operative vaginal delivery, retained placenta fragments, tissue laceration, site of placental separation, extreme maternal age
TYPES OF INFECTIONS
Endometritis Infection (Uterine), surgical site (c-section), UTIs, mastatitis, perineum
nursing management - infection
Wound Culture if ordered
Antibiotic administration
Good hand hygiene
Perineum assessment (REEDA)
Educate on hand hygiene, peri bottle wash use, frequency of pad changes, & discharge education on caring for infection.
Encourage rest, fluid intake, & good nutrition
REEDA
redness, edema, ecchymosis, discharge, approximation
REEDA - total score**on test
healed - 0
moderately healed - 1-5
mildly healed - 6 - 10
not healed - 11-15
be sure to study slide 19
it’s on the test
PP affective disorders (affected by hormones)
related to hormone changes
PP Blues
Peaks day 4-5 and over around day 10
Self-limiting
No treatment
F/U needed, 20% progress to depression
PP Depression - what is the minimum time frame?
Manifests in mind, body, & lifestyle changes
A form of Clinical Depression
Feel worse overtime (changes of mood & behavior do not go away)
Persists for a minimum of 6 months
Needs treatment
PP nursing management for psychosis
Medication administration –antidepressants, antianxiety
Encourage adequate sleep
Psychotherapy
Use facility screening tools
Assess partner, up to 50% of partners will show depressive symptoms
pp psychosis
Occurs in 1 in 1,000 live births within 1 year of delivery
sudden/abrupt onset
sleep disturbances
delusional beliefs
hallucinations
extreme disoragnziation of thought
anger towars herself or infant
self-harm or harm to infant
lose touch w/ reality
could be caused by hormones or underlying mental issues
pp psychosis
Do not leave mom alone with infant
Transfer to Inpatient Behavioral Tx
Administer psychotropic drugs
Set up psychotherapy (individual & group)
Educate yourself to be able to give the becst possible care
Educate patient
cardiovascular disease
1 - leading cause of MM
physiologic changes in preg may exacerabate known and unknown cardiac complications
stopped at 27
pay attention to vital signs***
pay attention to
failure rate w/ birth control
causes of tone issues - just 3 things
Magnesium Sulfate
Medication effect
Precipitous Delivery
what happens w/ tone issues? (what about the position of the uterus)
Retained placenta fragments
Unable to keep tonicity
Distended Bladder
Pushes uterus from midline position
tone - nursing management (2 things)
fundal massage (only if it’s boggy), IV pitocin (never give as an IV push)
mastatitis symptoms
flu like symptoms
no birth control
85% fail rate
refrain from sex during fertile period
25% fail rate
withdrawal
22% failure
condom
18% fail rate
diaphragm
12% fail rate
oral contraceptives, patch, ring
9% fiail rate
implant
.05% fail rate
emergency contraceptives
80% fail rate
risk factors for cardiovascular disease
race, age, HTN, obesity, sleep apnea, substance abuse, previous chemo
cardiac output - early first labor
increase 15%, and 15% w/ each contraction
cardiac output - late first labor
increase 30%, and 15% w/ each contraction
cardiac output -second - labor
increase 45%, and 15% w/ each contraction
cardiac output - postpartum - 5 min
increase 65%
cardiac output - postpartum - 60 min
increase 40%
pulse pressure
systolic - diastolic (this equals 1/2 stroke volume)
red flag - HR
over 120 bmp
red flag - BP
over 160
red flag - RR
over 30
when is the fundus not palpable?
10 days after birth
