MCN High-RiskPostpartal Client and STI Flashcards
Defined as the 6-week period of time beginning immediately after birth, during which the reproductive organs and maternal physiology return toward the pre-pregnant state.
The postpartum (puerperium)
One of the primary causes of maternal mortality. Also defined as blood loss of 500 ml or more following a vaginal birth or more than 1,000-ml blood loss for a cesarean section.
Postpartum Hemorrhage/s
4 T’s of postpartum hemorrhage” (4 main reasons):
Tone, Trauma, Tissue, and Thrombin
Relaxation of the uterus and failure of the uterus to contract adequately following delivery, is the most frequent cause of
postpartum hemorrhage.
Uterine atony
Conditions that leave the uterus unable to contract readily
- Deep anesthesia or analgesia
- Labor initiated or assisted with an oxytocin agent
- High parity or maternal age over 35 years of age
- Previous uterine surgery
Provide pharmacological management for Uterine Atony
- Oxytocin (Pitocin)- has short duration of action, approximately 1 hour.
- Carboprost tromethamine (Hemabate): via IM. May be repeated every 15 to
90 minutes up to 8 doses - Methylergonovine maleate (Methergine): via IM. May be repeated every 2 to 4 hours up to 5 doses.
- Misoprostol (Cytotec): Rectally
Out of these Pharmacological management for Uterine atony which is given Rectally
- Oxytocin (Pitocin)
- Carboprost tromethamine (Hemabate):
- Methylergonovine maleate (Methergine)
- Misoprostol (Cytotec)
- Misoprostol (Cytotec)
Provide medical or surgical procedures in managing Uterine Atony
- Blood Transfusion
- Ligation ofuterine arteries
- Hysterectomy: Last resort
Provide risk factors for Uterine Atony
- Prolonged and difficult labor
- Chorioamnionitis or endometritis
- Secondary maternal illness such as anemia
- Prolonged use of magnesium sulfate or other tocolytic therapy
Carboprost and ________ tend to cause diarrhea and nausea as side effect for uterine atony.
Misoprostol
TRUE OR FALSE
All of these medications can decrease blood pressure. Assessing blood pressure prior to administration and about 15 minutes afterward is advisable.
1. Oxytocin (Pitocin)
2. Carboprost tromethamine (Hemabate):
3. Methylergonovine maleate (Methergine)
4. Misoprostol (Cytotec)
FALSE. It increases the blood pressure.
TRUE OR FALSE
Extensive or difficult case in a patient with cervical laceration may be necessary for the
woman to be given a general anesthetic to relax the uterine muscle and to prevent pain.
FALSE. Regional anesthetic.
General anesthesia induces a reversible loss of consciousness and sensation throughout the entire body, thus unnecessary.
What degree of perineal laceration is this?
The vaginal mucosa is torn
1st Degree
What degree of perineal laceration is this?
The perineal muscles are torn
2nd Degree
What degree of perineal laceration is this?
The anal sphincter is torn
3rd Degree
What degree of perineal laceration is this?
The rectum is torn
4th Degree
Medical term for when perineal lacerations are sutured and treated the same as anepisiotomy repair.
Episiorrhaphy
TRUE OR FALSE
Any woman who has a third- or fourth-degree laceration should not have an enema or a rectal suppository prescribed or have her temperature taken rectally.
TRUE
Reiterating that _____-degree lacerations can lead to long-term
dyspareunia, rectal incontinence, or sexual dissatisfaction but usually heal without further complications.
Fourth-Degree Lacerations
A collection of blood in the subcutaneous layer of tissue of the perineum. The overlying skin, as a rule, is intact with no noticeable trauma.
Perineal hematoma
Most likely to occur after rapid, spontaneous births and in women who have perineal varicosities. May also occur at the site of an episiotomy or laceration repair if a vein was punctured during suturing.
Perineal hematoma
Assessments for Perineal hematoma
a. Perineal sutures: discomfort
b. Severe pain and feeling of pressure between her legs.
c. Area of ________ discoloration with obvious swelling (2 cm or as large as ____ in diameter) with tenderness.
purplish
8cm
Usually, a hematoma is absorbed over the next _____ days.
3 or 4 days
One therapeutic management for perineal hematoma is Vaginal packing, may be removed for how many hours? Provide the range.
24-48 hours