Module 11 (Final)

Question 1

Rh Incompatibility

Answer 1

Rh - mother carrying a Rh + fetus

Mother’s body considers Rh+ blood an antigen and an antibody response is triggered.

Question 2

When does Rh incompatibility take place?

Answer 2

Pregnancy: small amount of fetal blood may enter maternal circulation VIA microtears in placenta

Placental separation (greatest risk): Larger amounts of fetal blood enter maternal circulation

Question 3

Fetal/Newborn Effect of Rh incompatibility

Answer 3

Antibodies from mother attack Rh+ blood cells. Hemolysis of fetal/newborn RBCs takes place.

Result: hemolytic anemia, pathological jaundice

Question 4

How is Rh incompatibility prevented?

Answer 4

Rhogam

Question 5

What does Rhogam do?

Answer 5

Suppresses mother’s normal immune response. The mother’s cells no longer recognize fetal cells as foreign and no antibody formation occurs.

Question 6

How long does Rhogam last?

Answer 6

12 weeks

Question 7

Coombs Test

Answer 7

Identifies antibodies to Rh+ blood. It is interpreted as positive or negative.

Question 8

Direct Coombs

Answer 8

Done on baby. Identifies antibodies to Rh+ blood in the neonate’s serum.

Question 9

Indirect Coombs

Answer 9

Done on momma. Identifies antibodies to Rh+ blood in maternal serum.

Negative: no antibodies. given rhogam.

Positive: antibodies. No rhogam (too late). The fetus is at risk for hemolytic anemia and pathological jaundice.

Question 10

When is indirect coombs testing performed?

Answer 10

Indirect coombs testing is performed on all Rh- women at about 28 weeks’ gestation

Question 11

When is direct coombs testing performed?

Answer 11

postpartum, on a neonate with a Rh + blood sample.

Negative: mother recieves Rhogam within 72 hours to prevent antibody formation to protect future pregnancies.

Positive: Infant has been exposed to maternal antibodies. Monitor infant for jaundice. Treat infant for hemolytic anemia (transfusion)

Question 12

When does ABO incompatibility occur?

Answer 12

Type O mother, Type A, B or AB fetus

Mother may have naturally occurring antibodies to blood type A or B, so sensitation does not necessarily have to be from fetal/maternal blood crossing.

Antibodies hemolyze type A and/or type B RBCs. Typically mild.

Question 13

Effects of ABO incompatibility on the newborn and fetus

Answer 13

Fetus: No effects

Newborn: Potential hemolytic anemia, potential jaundice

Question 14

How would you manage ABO incompatibility postpartum?

Answer 14

If mother is blood type O: Determine newborn blood type and perform direct coombs to detect antibodies to both blood type and Rh.

Coombs Positive: Monitor infant for jaundice, anticipate treatment for possible pathologic jaundice and/or hemolytic anemia (HA is rare)

Negative: Infant not at risk. No interventions necessary.

Question 15

PP Hemorrhage Vaginal Birth

Answer 15

greater that 500mL blood loss

Question 16

PP Hemorrhage Cesarean Birth

Answer 16

greater that 1000mL blood loss

Question 17

Other criterion for PP Hemorrhage

Answer 17

Decrease in HCT of 10% or more from admission

Question 18

Early postpartum hemorrhage

Answer 18

Criteria are met within 24 hours after birth

Question 19

Late postpartum hemorrhage

Answer 19

Criteria are met after the first 24 hours

Question 20

Cause of early postpartum hemorrhage

Answer 20

Uterine atony associated with “boggy” fundus

Predisposing factors: uterine overdistention, multiparity, rapid labor, prolonged labor, macrosomia, rapid labor, assisted birth

Other causes: trauma, lacerations (perineum, vagina, cervix), hematoma (vagina, perineum)

Question 21

Prevention and Treatment of early postpartum hemorrhage

Answer 21

Prevention: Identification of risk factors

Treatment: Fundal massage, IV fluid replacement, oxytocic medications, foley catheter (inserted for pressure from inside), treat underlying cause, monitor blood loss (weigh pads)

Question 22

Causes of late postpartum hemorrhage

Answer 22

Uterine subinvolution

Other: retained placental fragments

Question 23

Management of late postpartum hemorrhage

Answer 23

Outpatient: surgical removal of placental fragments

Question 24

What is a puerperal infection?

Answer 24

Bacterial infection during the six weeks following birth

Question 25

What are the most common puerperal infections?

Answer 25

1. Endometritis 2. Urinary Tract 3. Mastitis

Question 26

What is endometritis?

Answer 26

Infection of the endometrium

Question 27

What are the risk factors for endometritis?

Answer 27

* Prolonged rupture of membranes * Prolonged labor * Multiple vaginal exams * Trauma of the perineum, vagina, or cervix * Catheterization * Retained placental fragments * Cesarean birth * Concurrent problems (ie. diabetes)

Question 28

What assessment data would you find consistent with endometritis?

Answer 28

* Uterine tenderness * Chills and malaise * Abdominal cramping * Fever of 38 degrees or higher after the first 24 hours * Foul smelling lochia * Uterine subinvolution * Elevated WBCs

Question 29

What would you do for endometritis?

Answer 29

* Place the woman in fowler's position * Analgesics * IV antibiotics * Non-pharmacological comfort measures * Assistance with infant care

Question 30

What are the risk factors for urinary tract infection?

Answer 30

* Trauma (pressure on urethra from presenting part) * Catheterization * Stasis/reflux (regional anesthesia, pressure on bladder from presenting part)

Question 31

What assessment data would you find for urinary tract infection?

Answer 31

* Dysuria * Frequency * Suprapubic pain * Low grade temperature * Signs of ascending infection * Flank pain * Elevated temperature

Question 32

How would you manage a urinary tract infection?

Answer 32

* Antibiotics * Analgesics * Encourage frequent voiding * Reinforce perineal hygiene * Encourage increased fluid intake * Discharge teaching * Signs/symptoms of worsening urinary infection

Question 33

What are the risk factors for mastitis?

Answer 33

* Poor hand washing * Newborn oral contact (staph aureus) * Milk stasis * Infrequent breastfeeding * Engorgement * Clogged duct

Question 34

What assessment data would you find with mastitis?

Answer 34

* Flu like symptoms * Temperature of 38 degrees or greater * Localized pain over effected breast area * Warmth and erythema of affected breast

Question 35

How would you manage mastitis?

Answer 35

* Frequent breast feeding * Monitor breast feeding technique * Antibiotics * Analgesics * Non pharmacologic comfort measures * Assistance with newborn care

Question 36

What are the risk factors from thromboembolitic disorders?

Answer 36

* Compression of large veins of lower extemities during pregnancy * Venous stasis * Postpartum hypercoagulation

Question 37

What assessment data would you find with superficial thrombophlebitis?

Answer 37

* Localized tenderness * Swelling * Warmth * Erythema * Homan's negative

Question 38

How would you manage superficial thrombophlebitis?

Answer 38

* Ambulation as tolerated * Analgesics * Moist heat * Elevation of limb * Anticoagulation not indicated

Question 39

What assessment data would you find with deep vein thrombosis?

Answer 39

* Positive Homan's sign (pain) * Extemity cool to palpation * Edema of effected extremity * Diminished peripheral pulses in affected area

Question 40

How would you manage deep vein thrombosis?

Answer 40

* Doppler flow studies * Bedrest * Analgesics * IV anticoagulation * Monitor for pulmonary embolism * Dyspnea * Shortness of breath * Decreased oxygen status

Question 41

Define puerperal infection

Answer 41

Infection of the reproductive tract up to six weeks postpartum

Question 42

Define subinvolution

Answer 42

Failure of a part to return to its normal size after functional enlargement

Question 43

Define mastitis

Answer 43

Inflammation of the breast ocurring primarily in lactating women

Question 44

Describe the rationale for weighing perineal pads postpartum

Answer 44

1 gram = one mL of blood loss