Module 6 Flashcards
First Degree Perineal Laceration
- Superficial vaginal mucosa or perineal skin
Second Degree Perineal Laceration
- Involves vaginal mucosa, perineal skin and deeper tissues of the perineum
Third Degree Perineal Laceration
- Same as second degree but involves the sphincter
Fourth Degree Perineal Laceration
- Extends through the anal sphincter into the rectal mucosa.
Treatment for Perineal Lacerations
-Usually suturing
Episiotomy
-Controlled surgical enlargement of the vaginal opening during birth
Indications for an Episiotomy
- Control over how much and where the vaginal opening is enlarged
- Clean edged opening
What is an alternative to an episiotomy ?
Perineal massage and stretching before labor
Midline Episiotomy
Directly down to the sphincter
Mediolateral Episiotomy
Directly down and then to the side of the sphincter
Nursing Care after episiotomy
- Cold packs for first 12 hours
- Hot packs sitze baths after 12-24 hours
- Oral analgesics as ordered
- No suppositories or enemas for 3-4 degree tears
- High fibre diets and fluids
- Stool softeners
4 types of Shock
- Hypovolemic
- Septic
- Cardiogenic
- Anaphylactic
HypoVolemic Shock
- Volume of blood is depleted and cannot fill circulatory system
- Caused by Postpartum Hemorrhage or blood clotting disorders
Body Response to Hypovolemia
- Increased heart and respiratory rate
- Increase o2 content of red blood cells
- speed up circulation of blood in system
- BP shows narrow pulse pressure
- Blood flow to nonessential organs gradually stops
- Skin and mucosa membranes become pale, cold and clammy
Narrow pulse pressure
Falling systolic
Rising Diastolic readings
Immediate Medical and Nursing interventions to Correct HypoVolemia
- Give IV fluids to maintain circulating volume and replace fluids
- Blood Transfusions to replace lost erythrocytes
- Give O2 to increase saturation in blood cells
- Indwelling foley catheter to assess urine output
Medication intervention to correct hypovolemia
- Oxytocin
- Ergot Alkaloids
- Misoprostol
Nursing Care for Hypovolemia
- VS often
- O2 saturations
- Assess Lochia ( for clots )
- Assess Fundus
- Measurements of intake and output
- Monitor for signs of Anemia
- Emotional support to woman
Postpartum Hemorrhage
- Blood loss greater then 500mL for vaginal birth or 1000mL for section.
Postpartum hemorrhage early and late
Early within 24 hrs postpartum
Late between 24 hrs- 6 weeks postpartum
What is the major risk of Hemorrhage
Hypovolemic shock
Signs and Symptoms of a hemorrhage
- Tachycardia
- Active bleeding
- Narrow pulse pressure
- Pale, Cold, Clammy Skine
- Mental status changes
- Decreased urinary output.
Causes of Early(Primary) Postpartum hemorrage
- Uterine atony
- lacerations or tears of the reproductive tract
- Retained products
Uterine Atony
- Collection of blood in Uterus
Medications used to Treat PPH
- Oxytocin : stimulate upper muscles of uterus
- Carbetocin ( long acting oxytocin)
- Ergonovine ( Ergot Alkaloids): Stimulates the myometrium and upper/lower uterine segments
- Misoprstol: Vasoconstrict and enhance contractility.
Late PPH causes
- Retention of placenta
- Subinvolution
- Preparation for IV medication
- Prepare for possible surgical intervention
Nursing care for late PPH
- Teach to report persistent bright red bleeding
- return of red bleeding after it has changed to pink or white
Puerperal Sepsis
Infection after child birth
fever 38 after first 24hr
lasts 2days for first 10 dats postpartum
Risks of Puerperal Sepsis
- Cracked Nipples
- Surgical incision
- tissue trauma during labor
- Open wound at placental insertion site
- retained placenta or blood clots
- increased pH of the vagina after birth
- Endometritis ( inflammation of the uterus lining)
Nursing care for Infection
- teach hygienic measures
- promote adeqüei rest and nutrition
- teach and observe for signs of infection
- teach how to correctly apply perineal pads
- teach the woman to take all antimicrobial medications as prescribed.
Thromboembolic Disorders
- Venous thrombosis blood clots
Types of thromboembolic Disorders
Superficial Vein Thrombosis
- Deep Vein thrombosis
Pulmonary embolism
Anticoagulant teachings
- Prolonged bleeding from minor injuries
- Nosebleeds
- Unexplained bruising
- stress importance of completing follow up blood tests
Rh incompatability medication
- Rh0 immunoglobulin is administered at 28 weeks and within 72 hours after delivery
ABO blood incompatibility
Mothers blood type is O and babies is A or B this is life threatening
