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NUR 318 > module 11 > Flashcards

module 11 Flashcards

1
Q

what is the leading cause of maternal mortality?

A

postpartum hemorrhage

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2
Q

what is the estimated blood loss for a woman considered to be having a hemorrhage?

A

> 500 ml following a vaginal birth and >1000 ml following a c-section
-any amount of bleeding that places the mother in hemodynamic jeopardy

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3
Q

primary vs delayed hemorrhage

A

a primary hemorrhage is within the first 24 hours

delayed or late ones happen from 24 h to 12 weeks after birth

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4
Q

causes of postpartum hemorrhage

A
  • uterine atony
  • lacerations of the genital tract
  • episiotomy
  • retained placental fragments
  • uterine inversion
  • coagulation disorders
  • hematoma of the vulva, vagina, or sub peritoneal areas: unremitting pain and pressure
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5
Q

the four Ts of PP hemorrhage

A

tone, tissue, trauma, thrombin

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6
Q

tone

A
  • abnormal uterine contractility. risk factors include prolonged labour, multiple gestations, oxytocin augmentation, polyhydraminos.
  • inflammation due to infection (chorioamnionitis)
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7
Q

tissue

A

placental complications

  • placenta accerta, incerta, percreta: retain placental products, risk factors includes multiple gestation
  • placenta praevia: the blockage of cervix
  • placental abruption
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8
Q

trauma

A

physical injury: laceration of the cervix, vagina or perineum
causes include malpresentation, and instrumental delivery
-injury during caesarean section
-uterine rupture form previous trauma
-grand multiparty previous vertical uterine incision

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9
Q

thrombin

A
  • congential coagulation disorders: hemophilia, vWD
  • acquired coagulopathy: DIC, hyperfibrinolysis, pharmacologic anticoagulation
  • the major coagulopathy independently associated with PPH is low fibrinogen levels
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10
Q

signs of PPH

A

hypotonic uterus, bleeding with a contracted uterus, inversion of the uterus (life threatening and occurs in 1 in 2500 births), sub involution of the uterus (late postpartum bleeding)

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11
Q

hemorrhagic shock resulting from hemorrhage

A

organ perfusion may be severely compromises and potentially cause death

  • medical management: restore blood volume
  • nursing interventions: monitor vitals (HR, BP), massage uterus, admin meds as ordered(fluid and blood replacement therapy), monitor for sighs and symptoms of shock emotional support to pt and fam
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12
Q

uterotinics vs tocolytics vs methylergonovine (methergine) vs hemabate vs misoprotosl (cytotec)

A

uterotonics are medications to contract the uterus
tocolytics are meds that relax the uterus
methergine is contraindicated in hypertension, preeclampsia, and cardiac disease
-hemabate: contraindicated in asthma and hypertension
-cytotec: contraction of the uterus

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13
Q

therapeutic management of hemorrhage

A

focus on the underlying cause, uterine massage, removal of retained placental frags, antibiotics for infection, repair of saceration

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14
Q

DIC

A

clotting and anticlotting mechanisms occur at the same time

  • it is not a primary condition but is usually secondary to pregnancy complications such as preeclampsia, and hemorrhage
  • unusual spontaneous bleeding from gums and nose; oozing, trickling or flow of blood from incision/lasceration; petechiae, hematuria
  • usually a transfer to the icu and get labs: CBC, blood type and cross, clotting factors
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15
Q

nursing intervetnion DIC

A

admin fluid volume replacement (blood and blood products)
admin pharmacological interventions like antibiotics, vasoactive meds and uterine tonic meds
admin supp o2
protect from injury

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16
Q

DVT an pulmonary embolism

A

blood clot or clots formed inside vessels. unilateral swelling of the leg

causes: venous stasis, hypercoagulation, inflammation (thrombophlebitis), partial obstruction of the vessel
incidence: 1/1000-2000 women

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17
Q

thromboembolitic disease types

A

superficial venous thrombus
deep venous thrombus
pulmonary embolism

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18
Q

superficial venous thrombus

A

involves superficial saphenous venous system: most common PP usually comes with pain and tenderness in the lower extremity with warms, redness and a hardened vein over the thrombus

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19
Q

DVT

A

lower extremitis, varuous veins from foot to illiofemoral region. this is the most common during pregnancy. causes unilateral leg pain, calf tenderness, swelling, warmth, possible positive Homans sign
may be asymptomatic

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20
Q

PE

A

a complication of a DVT, the clot travels to the pulmonary artery and occludes blood flow to the lungs. causes dyspnea, tachypnea, tachycardia, apprehension, pleuritic chest pain, cough, hemoptysis, elevated temp, syncope, cardiac arrest

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21
Q

medical management of thrombus

A
  • superficial: analgesics (NSAIDS), rest, elevation, compression stockings, heat locally
  • DVT: anticoagulants initially IV heparin, bed rest, elevate affected leg, analgesia, later oral anticoagulants warfarin, compression stockings, ambulation
  • PE: emergent treatment: IV anticoagulation including IV heparin, later SQ or oral antigoags. meds containing aspiring are not given because it ihibites the synthesis of clotting factors
22
Q

thrombus nursing management

A
  • physical assessment: visual inspection of the area, measure circ, assess pulses, vitals as indicated
  • pain management: analgesics as ordered
  • anticoagulation medications as ordered: monitor lab values, monitor for side effects
  • enducation and support of patient and family: inpatient education of medication and side effects, education on condition, home management (alternate sites because of bleeding, bruising, and necrosis), s/s to report
23
Q

puerperal infections

A

clinical infectin of the genital tract occurign within 28 days after birth, miscarrage, or induced abortion
-us definition is a fever of 100.4 for 2 or more consecutive days postpartum excluding the first 24 hours. occurs in 2% of caginal birhts, 10-15% in caesarian births

24
Q

postpartum infections

A

endometritis (RF: premature rupture of membrane, c. section)
wound infection
UTI
mastitis

25
Q

preconception or antepartal factors for postpartum infection

A 
histpry of previous venous thrombosis, UTI, mastitis, pneumonia
diabetes mellitus
achoholism
drug abuse
immunosuppression
anemia
malnurtiroion
obesity 
preeclampsia
26
Q

intrapartal factors contributing to pp infection

A 
c. section
operative vaginal birth
prolonged rupture of membranes
chorioamniotnitis
prolonged labor
bladder catheterization
internal fetal heart rate/ uterine monitoring
multiple vaginal exams after ROM
epidural
retain placental frags
hemorrhage
episiotomy or lasceration
hematoma
27
Q

pp endometritis

A
  • infection of the linign of the uterus (most common)
  • s/s: fever, chills, lethargy, tachycardia, lochia foul odor, large amount, pelvic pain, uterine tenderness
  • management: cultures may be done, IV antibiotic, broad spectrum, hydration, rest, pain relief
  • nursing assessments: lochia, vitals, changes in patient condition
  • nursing education: prevent spreading infection, side effects of antibitoits to report. support bonding with newborn
28
Q

pp UTI

A
  • develop in 2%-4% of pp women and caused by e. coli
  • RF: catheterization, frequent pelbic exams, epidural or spinal anesthesia, gential tract injury, hx of UTIs, c. section
  • s/s: frequency, urgency, dysuria, retention, low grade fever, heaturia, polyuria. pp women may have some of these symptoms in general
  • management: antibiotic, anaglesc, hydration, outpatient treatment: education and prevention
29
Q

pp wound infections

A

often develop after discharge: cesarean incision, episiotomy or lasceration

  • s/s: fever, erythema, edema, pain, warmth at site, tenderness, drainage, wound opening, foul odor
  • managementL antibiotic, wound debridment
  • assessment: vitals, wound care, changes in condition
30
Q

pp mastitis

A

breast infection
RF: nipple abrasion, fissure, blocked milk ducts, incomplete let down
s/s: fever, chills, malaise, flu like symptoms, pain, tenderness and swelling in the affected breast. different from normal engorgment which is usually bilateral
-treatment: antibiotics, emptying breast: breast feeding or pumping. it is ok to feed the milk to the baby but you must be on an antibiotic

31
Q

nursing actions with pp infection

A

assessments: take a history including prenatal, labor, and birth. look for s/s including increased temp, redness, swelling, uterine tenderness, chills, local pain. take labs: blood culture, CBC, uterine culture
prevention: good handwashing, aseptic technique, teaching pericare, teaching signs and symptoms of infection

32
Q

pp blues

A

are usually self limiting and require no formal treatment other than reassurance and validation of the woman experience likely due to changes in hormones

33
Q

pp depression

A

feel worse over time, and changes in mood and behavior that do no go away on their own. may persist up to 6 months

34
Q

pp psychosis

A

an emergency psychiatric conditions

-nurses are advised to be alert for mothers who are agitated, overactive, confused, complaining or suspiscous

35
Q

signs of pp blues and depression

A

sad, anxious, or overwhelmed feelings, crying spells, loss of appetite, difficulty sleeping, thoughts of harmin self or baby and not having any interest in the baby

36
Q

signs of pp psychosis

A

seeing ro hearing things that are not there, feelings of confusion, rapid mood swings, trying to hurt self or baby,

37
Q

attachment

A

process of bonding, proximity and interaction help achieve this

38
Q

mutuality

A

infants behavior and characteristics that eleicit parental behavior and characteristics: acquaintance, claiming process

39
Q

facilitating behaviors infant

A

visually alert with eye to eye contact and tracking of the parents face, appealing facial appearance, crying only when hungry or wet

40
Q

inhibiting behavior infant

A

sleepy, eyes closed most of the time, gaze aversion, bland facial expression, crying and colicky behavior, poor feeding

41
Q

facilitating behavior parent

A

looks, gazes, eye contact, claims infant as a family member,

42
Q

inhibiting behaviors parent

A

tuns away from infant, avoids infant, does not incorporate infant into like, does not interpret infant needs

43
Q

communication between parent and infant

A

touch, eye contact, voice, odor (mother)

44
Q

bonding

A

entrainment (common rhythym between mom and baby)
biorhythmicity (fetus in tune with mothers heartbeat)
reciprocity and synchrony (body movement and behavior uces. the fit btw infant cues and parent response)

45
Q

fathers

A 
engrossment 
included yeet excluded
spend less time: play
less support given
classes
46
Q

parents

A

adjustment as a couple
resuming intimacy
infacnt patent adjustment

47
Q

visually impaired parent

A

does not have negative effect on parenting
heightened sensitivity to other sensory output
skepticism by health care professionals
infant will need sensory input from other parent

48
Q

hearing impaired parent

A

mother and partner establish an independed household
technolgic devises ain in parenting
young children acquire sign language readily

49
Q

sibling adaptation

A

siblings have to assuem new positions withing the family hierarchy
reactions manifested in behavioral changes
incolcement in planning and care
acquaintance behaviors

50
Q

grandparent adaptation

A

most often associated with joy so may feel regret due to poor health or geographical distance
grandparents are eager to help (maternal grandmother is called the most)
intergenerational relationships shft
involvement dependent on cultural and familial factor

NUR 318 (10 decks)

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