Maternity Peds Flashcards
Oxytocin - pitocin
Oxytocin (pitocin)
• Hormone to stim uterine contractions and prevent hemorrhage from placental site
• Prior to discontinuingbo make sure uterus is contracting by assessing fundal firmness
Interventions after delivery for client with residual anesthesia
Interventions after delivery for client with residual anesthesia
• priority 1st 24-48 hrs - perineal ice packs to cause local vasoconstriction and decrease swelling and tissue congestion prevent hematoma
• No sitz bath until day2-3 coz it causes increased circulation and thus increase swelling.
Post partal hemorrhage
Post partal hemorrhage
• loss of > 500 ml blood after the end of 3rd stage of labor
• Causes: uterine atony or relaxation, laceration of genital tract, retained placetal fragments, large infant overdistension uterus, forceps del, oxytocin, prolonged labor
Tetralogy of fallot
Tetralogy of fallot
• heart defect involving 4 problems
1. Ventricular septal defect - hole between the lower chamber
2. Ventricular hypertrophy - right ventricles thicken
3. Overriding aorta - aorta lies over the hole between lower chambers
4. Pulmonary stenosis - obstruction going to the lungs
• Expect to hear systolic murmurs, crying or fatiggue with feeding, poor weight gain
- results in chronic hypoxemia dt decrease blood flow to lungs and poorly oxygenated blood
- Complication of hypoxemia. Compensation: body increases prod of eryhthropoeiten to increase rbc that can carry o2 - increased rbc leads to higher blood viscosity or polycythemia (hemoglobin > 22 G/dL or 220 g/L or hematocrit >65%
Complication of polycythemia
Complicafion of polycythemia
• increased blood clotting which can lead to stroke
What to assess prior to discontinuing iv oxytocin (pitocin)
uterine firmness to make sure uterus is contracting
• Pitocin hormone for stimulating uterine contractions to prevent bhemorrhage from placental site
Priority nursing diagnosis for pt experiencing residual effects of epidural anesthesia
Priority nursing diagnosis for pt experiencing residual effects of epidural anesthesia
• risk for injury
• Causes temp loss of boluntary movement and muscle strength of the lower extremities
• Would not be able to bear weight
Postartal hemorrhage
- loss greater than 509ml of blood after the end of third stage of labour
- Causes are uterine atony (relaxation of uterus) laceration of genital tract and retained placental fragments
Uterine inversion
Uterine inversion
• postbirth complication
• Fundus collapses into uterine cavity causing sudden bleeding and hypovolemia
• Interventions
• Do not administer oxytocin until the inversion is resolved. The uterus needs to be soft snd not contracted dor this procedure
• Initiatd a second large bore e.g. 18g iv line which allows volume replacement for hemorrhage
• Serial monitoring of bo every 3-5 mins to assess for hypovolemia
• If manual replacement does not work — surgical laparotomy
Ectopic pregnancy symptoms
Ectopic pregnancy symptoms
• lower abdominal and pelvic pain (progresses to severe and generalized), amenorrhea then vaginal spotting or bleeding, palpable adnexal mass on pelvic exam
Pitocin desired action
Pitocin desired action
• uterine contraction evidenced by firm fundus
• Uterine contraction during postpartum is impt to prevent further hemorrhage
• Hemorrage is blood loss above 500 ml within first 24/hours of delivery
Uterine atony
Uterine atony
• uterine cannot contract. Causes hemorrage post partum
• Caused by large baby (uterine overdistension) and prolonged labor (muscle fatigue)
Administering blood
Administering blood
• see md order for type of blood product and units
• Verify blood is crossmatched and ready in blood bank. Must be administere within 20 mins after leaving blood bank to prevent bacterial growth - infection
• Ask for allergies and previous reactions
• Follow procedure for consent forms
• Assess and document vitals on transfusion record - deviation signals adverse reaction
• Assemble equipment. Get the blood from bank
• With another rn, compare blood and crossmatch skip from blood bank. Compare with clients arm band. Must be correct client name, id number, blood type and rh factor, donor nunber and exp date
• Gloves
• Prime y tubing. Ns first up to drip chamber.close clamp Then blood up to drip chamber. Close clamps
• If no iv line, venipuncture using 18-19g cath (not smaller coz it will damage blood cells and slow transfusion
• Infuse abput 50 ml of ns at slow rate to very patency. Close clamp
• Infuse blood at kvo rate for 15 mins. Stay with pt. Most transfusion rxns occur within 15 mins
• Monitor vitals and transfusion rxns symtpoms - chills, flushing, rash, headache, chest or back pain, nausea, fever, tachy, resp distress, hypotension
• After 15 mins if no rxn infuse as ordered
• Continue to monitor vitals as per policy most every 15mins dor firs hour then every 30 mins until transfusion complete
*admin of cold blood causes clieng to feel cold but not chills and fever which indicate febrile nonhemolhtic reaction
Why is it important to evaluate urine output after hemorrhage
- Hemorrhage stresses kidneys
* Also if bladder is full. Displaces uterus and stops contractions increasing further hemorrhage
Postdural puncture headache
Postdural puncture headache
• Occurs when pt sits up. occur after epidural abesthesia
• Dt csf leakage at puncture site - when pt sits up causes decreasing intracranial pressure- shifting of fluids
• Goes away after 3-5 days, need bedrest and pain meds, caffeine sodium benzoate (constricts cerebral bv and alleviate pdph)
