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
Why do you cover an ice pack with towel in managing perineal hematoma?
To prevent thermal injury to the skin
A placenta does not detach in its entirety; fragments of it separate and are left still attached to the uterus»_space;> Inhibits full contracting of the uterus»_space;> uterine bleeding
Retained Placental Fragments
Conditions associated with retained placental fragments are the following except which?
a. Succenturiate placenta
b. Placenta accreta a placenta that fuses with the myometrium
c. Placenta previa
d. Previous cesarean birth
C. Placenta previa is not directly associated with retained placental fragment but can be associated with other conditions.
In the assessment for retained placental fragments, differentiate which of these are Large or small fragments:
A. Bleeding may not be detected until postpartum day 6 to 10
B. Apparent bleeding during
postpartal period
A. Small fragments
B. Large fragments
Therapeutic Management for retained placental fragments for
Placenta accreta?
Balloon occlusion of the
internal iliac arteries.
Hysterectomy: Last option
Deficiency in clotting ability caused by vascular injury
Disseminated Intravascular Coagulation (DIC)
Infection of the reproductive tract in the postpartal period
Puerperal Infections
Inflammation and infection of the inner lining of the uterus
Endometritis
Normally, the white blood cell count of a postpartal woman is
increased to ______-______ cells/mm3 due to the stress of
labor. Because of this increase, the conventional method of
detecting infection (elevated white blood cell count) is not of
great value in the puerperium.
Normally, the white blood cell count of a postpartal woman is increased to 20,000 to 30,000 cells/mm3
It confirms the presence of placental fragments that could be a possible cause of the infection in the endometrium.
Sonogram/ Ultrasound
Diagnostic test for Endometritis that uses sterile vaginal swab rather than perineal pad.
Culture
Which of the assessment for Endometritis is Factual.
a. uterus is not well contracted and is painful to touch.
b. Lochia is dark red and has a foul odor
A.
Lochia is supposed to be dark brown and has a foul odor
Provide antibiotic prescribed to women with endometritis
-Clindamycin (Cleocin), as determined by the culture.
Oxytocic agent such as methylergonovine may also be prescribed to encourage uterine contraction.
If a woman has a suture line on her perineum from an episiotomy or a laceration repair, a ready portal of entry exists for bacterial invasion.
Infection of the perineum
What should be the assessments for Infection of the perineum.
- Inflammation: Pain, heat, redness,swelling
- A feeling of pressure.
- May or may not have an elevated temperature depending on the systemic effect and spread of the infection. Usually
localized. - One or two stitches may have sloughed away, so an area of the
suture line is open with purulent drainage present. - Infected secretions (purulent discharge)
Provide Therapeutic Managements for the Infection of perineum
- Systemic or topical antibiotic is ordered even before the culture report is returned.
- Analgesic
- It may be necessary to remove perineal sutures to open the area and allow for drainage.
- Sitz baths and moist warm compresses may be prescribed to hasten drainage and cleanse the area.
- Remind the woman to change perineal pads frequently (wipe front to back)
- Encourage the woman to ambulate
Infection of the peritoneal cavity, usually occurs as an extension of endometritis. One of the gravest complications of childbearing and is a major cause of death
from puerperal infection.
Peritonitis
The infection spreads from the uterus through the
lymphatic system or directly through the fallopian
tubes or uterine wall to the peritoneal cavity.
Peritonitis
An abscess may form in the cul-de-sac of Douglas because this is the lowest point of the peritoneal cavity and gravity causes infected material to localize there.
Peritonitis
A deep pouch formed by the most caudal extent of the parietal peritoneum
Cul-de-sac of Douglas
Provide assessments for peritonitis
- Rigid abdomen
- Abdominal pain
- High fever
- Rapid pulse
- Vomiting
Inflammation of the lining of a blood vessel (Endothelium).
Phlebitis
Inflammation of the vascular
endothelium with clot formation on the vessel wall.
Thrombophlebitis
Two classification of thrombophlebitis
Superficial vein disease (SVD)
Deep vein thrombosis (DVT)
Femoral, saphenous, or popliteal veins are involved. Decreased arterial circulation to the leg as manifested by edema
Femoral thrombophlebitis
This assessment may be positive where there is pain in the calf of the leg on dorsiflexion of the foot.
Homans sign
Antagonist for heparin
Protamine sulfate
Antagonist for Warfarin
Vitamin K
Antagonist for Warfarin
Vitamin K
Inflammation of the blood vessels in the pelvic area causes a partial obstruction, which leads to slowed blood flow and clots in the stagnant blood in the vessel.
Pelvic thrombophlebitis
TRUE OR FALSE
Regardless of the type of thrombophlebitis, teach
women preventive measures:
a. Wearing constricting clothing on their lower extremities
b. Resting with the feet elevated
c. Ambulating daily
FALSE. Women should wear NON-constricting clothes
After _____ days, postpartum woman notices feelings of sadness (postpartal “blues”) after
childbirth.
1-10 days
Postpartal Depression
-Experienced by ___ in ___ women. (CDC)
-Manifested by overwhelming sadness, can occur in both new mothers and father.
-Interfere with breastfeeding, child care, and returning to a career.
1 in 10
Provide Postpartal Depression Manifestations
a. Both women and men may notice extreme fatigue
b. Inability to stop crying
c. Increased anxiety about their own or their infant’s health
d. Insecurity (unwillingness to be left alone or inability to make
decisions)
e. Psychosomatic symptoms (nausea and vomiting, diarrhea)
f. Depressive or extreme mood fluctuations
When post-partal depression coincides with the postpartal period or occurs during the following year, it is termed ________ _______.
Postpartal psychosis
TRUE OR FALSE.
Post partal psychosis are experienced by 1 woman in 600.
FALSE. 1 in 500
Provide factors for Postpartal Psychosis
a. Probably a response to the crisis of childbearing.
b. Symptoms of mental illness before pregnancy.
c. Death in the family
d. Loss of a job or income
e. Divorce
f. Some other major life crisis
