Module 3: Nursing Care of a family experiencing a postpartum complication

Question 1

defined as blood loss of 500 ml or more following a vaginal birth. with a cesarean birth, there is a 1,000ml blood loss or a 10% decrease in the hematocrit level.

Answer 1

Postpartum Hemorrhage

Question 2

Four main reasons for postpartum hemorrhage

Answer 2

uterine atony
trauma
retained placental fragments
disseminated intravascular coagulation

Question 3

relaxation of the uterus. most frequent cause of postpartum hemorrhage.

Answer 3

uterine atony

Question 4

what are the conditions that includes in risk for a postpartal hemorrhage?

Answer 4

1. distended the uterus beyond average capacity
2. caused cervical or uterine lacerations
3. varied placental site or attachment
4. leave the uterus unable to contract readily
5. lead to inadequate blood coagulation

Question 5

what is the first step in controlling hemorrhage?

Answer 5

fundal massage to encourage contraction

Question 6

If the patient’s uterus does not remain contracted what is the intervention to increase contraction?

Answer 6

administering bolus or a dilute intravenous infusion of oxytocin can be prescribed to help the uterus maintain tone

Question 7

if oxytocin is not effective at maintaining tone what would be the next intervention?

Answer 7

administer carboprost tromethamine (hemabate) or methylergonovine maleate

Question 8

what procedure is called when health care provider inserts one hand into a woman’s vagina while pushing against the fundus through the abdominal wall with the other hand.

Answer 8

bimanual compression

Question 9

what is the purpose of fundal massage

Answer 9

to stimulate uterine contraction,
promote uterine tone and consistency
minimizes the risk of hemorrhage

Question 10

what would be the recommended therapy to ensure good hemoglobin formation

Answer 10

Iron therapy

Question 11

where do occur lacerations?

Answer 11

cervix,
vagina
perineum

Question 12

where do cervical lacerations found and what color of the blood compared to the blood lost of uterine atony?

Answer 12

sides of the cervix, near the branches of the uterine artery and brighter red than the venous blood

Question 13

what is the 1st priority of therapeutic management for cervical laceration?

Answer 13

maintain an air of calm and if possible stand beside the woman at the head of the table

Question 14

defined as easier to locate and assess than cervical lacerations because they are so much easier to view

Answer 14

vaginal lacerations

Question 15

what is the 1st priority of therapeutic management for vaginal laceration?

Answer 15

balloon tapenade similar to the type used with a uterine hemorrhage may be effective is suturing does not achieve hemostasis

Question 16

occurs when a woman is placed in a lithotomy position for birth rather than a supine position because a lithotomy position increases tension on the perineum

Answer 16

perineal lacerations

Question 17

what is the 1st priority of therapeutic management for perineal lacerations

Answer 17

a diet high in fluid and a stool softener

Question 18

fragments of its separate and are left still attached to the uterus

Answer 18

retained placental fragments

Question 19

what is the findings of retained placental fragments?

Answer 19

if an undetected retained fragment is large, bleeding will be apparent in the immediate postpartal period because the uterus cannot contract with the fragment in place.

Question 20

what is the recommended management for retained placental fragments?

Answer 20

dilatation and curettage (D&C)

Question 21

what is the prescribed medication to destroy the retained fragments?

Answer 21

methotrexate

Question 22

is a prolapse of the fundus of the uterus through the cervix so that the uterus turns inside out.

Answer 22

uterine inversion

Question 23

deficiency in clotting ability caused by vascular injury. It is usually associated with premature separation of the placenta, a missed early miscarriage, or fetal death in utero.

Answer 23

Disseminated Intravascular coagulation

Question 24

is the incomplete return of the uterus to its pregnant size and shape

Answer 24

subinvolution

Question 25

what is the recommended management of subinvolution and its indication of the drug?

Answer 25

methylergonovine, 0.2mg four times daily. to improve uterine tone and complete involution.

Question 26

is a collection of blood in the subcutaneous layer of tissue of the perineum.

Answer 26

Perineal Hematomas

Question 27

what is the common organism that is postpartally include in culturing?

Answer 27

E. Coli

Question 28

the infection of the endometrium. The lining of the uterus is also usually associated with chorioamnionitis and a cesarean birth

Answer 28

endometritis

Question 29

what is the recommended management of endometritis

Answer 29

prescribe methylergonovine to encourage uterine contraction and drink additional fluid to combat the fever. Also sitting in semi-fowler’s position or walking to encourage lochia drainage by gravity and helps prevent pooling of infected secretions.

Question 30

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

Answer 30

infection of the perineum

Question 31

all postpartum women are at risk for uterine hemorrhage. What assessment data should the nurse first collect when appraising ms. cheshire’s risk for hemorrhage?

Answer 31

a. ask her to describe her perineal care
b. assess the skin integrity of her abdomen.
c. assess her oxygen saturation level
d. assess her uterus for height and tone.

Question 32

suppose bailey Cheshire has a retained placental fragment that is causing extensive postpartal bleeding. Which test prescribed by her primary care provider would best reveal a retained fragment is present?

Answer 32

a. placental and cord blood estrogen
b. progesterone
c. human chorionic gonadotropin hormone
d. oxytocin

Question 33

what is an infection of the peritoneal cavity that is usually occurs as an extension of endometritis. It is also one of the gravest complications of childbearing and is a major cause of death from peurperal infection

Answer 33

peritonis

Question 34

it is an inflammation with the formation of a blood clot

Answer 34

thrombophlebitis

Question 35

also called milk leg or phlegmasia alba dolens (white inflammation)

Answer 35

femoral thrombophlebitis

Question 36

what is the recommended management for femoral thrombophlebitis?

Answer 36

application of moist heat (to decrease inflammation) and best rest with the affected leg elevated.

Question 37

a woman suddenly becomes extremely ill with a high fever chills, abdominal pain, weakness, and general malaise

Answer 37

pelvic thrombophlebitis

Question 38

obstruction of the pulmonary artery by a blood clot usually occurs as a complication of thrombophlebitis when a blood clot moves from a leg vein to the pulmonary artery.

Answer 38

pulmonary embolus

Question 39

what is the management of pulmonary embolus

Answer 39

needs oxygen administered immediately

Question 40

a woman has symptoms of a rigid abdomen, abdominal pain, high fever, rapid pulse, vomiting, and the appearance of being acutely ill.

Answer 40

peritonitis