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Maternity > Module 6: Postpartum Complications > Flashcards

Module 6: Postpartum Complications Flashcards

1
Q

identify and differentiate the types of lacerations

A
  • can occur in perineum, vagina, cervix or around urethra
  • vasculature bed in these areas is engorged
  • blood is usually brighter red than lochia and flows in a continuous trickle
  • uterus is typically firm
  • treatment is usually suturing
  • keep woman NPO until further assessment can be made by health care provider
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2
Q

Perineal lacerations

A

uncontrolled tearing of perineal tissue

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3
Q

first degree

A

superficial vagina mucosa or perineal skin

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4
Q

second degree

A

involves vaginal mucosa, perineal skin and deeper tissues of the perineum

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5
Q

third degree

A

same as second degree, plus involves anal sphincter

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6
Q

fourth degree

A

extends through the anal sphincter into the rectal mucosa

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7
Q

Episiotomy

A

> controlled surgical enlargement of the vaginal opening during birth
indiction for episiotomy
- better control over where and how much the vaginal opening is enlarged
- an opening with a clean edge rather than a ragged opening of a tear
- note: perineal massage and stretching exercises before labor may bee an alternative to an episioptomy

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8
Q

midline episiotomy

A
  • from the inferior vagina opening, directly down towards the anal sphincter
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9
Q

mediolateral episiotomy

A

down and to the left or right of the anal sphincter

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10
Q

Nursing care for Lacerations & Episiotomy

A
  • apply cold pack for at least 12 hours to reduce pain, bruising and edema
  • after 12-24 hours, apply warm packs, provide site bath to increase blood circulation
  • administer oral analgesics as ordered
  • no suppositories or enemas for 3rd or 4th degree tears
  • encourage high fiber diets and fluids
  • administer stool softeners to ease passage of stools
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11
Q

Major risk is hypovolemic shock

A
  • interrupts blood flow to body cells, occurs when volume of blood is depleted and cannot fill the circulatory system
  • prevents normal oxygenation, nutrient delivery and waste removal
  • if not corrected quickly, the woman can die
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12
Q

Body’s response to hypovolemia

A

> initially: increased heart and respiratory rates
purpose of response:
- increase oxygen content of red blood cells
- speed up circulation of remaining blood in system
blood pressure shows narrow pulse pressure (falling systolic, rising diastolic readings)
blood flow to nonessential organs gradually stops
skin and mucous membranes become pale, cold and clammy

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13
Q

Immediate Medical and Nursing interventions To correct Hypovolemia

A

> giving intravenous fluids to maintain the circulating volume and to replace fluids
giving blood transfusions to replace lost erythrocytes
giving oxygen to increase the saturation of remaining blood cells; a pulse oximeter is used to assess oxygen saturation of the blood
placing an indwelling (foley) catheter to asses urine output, which reflects kidney function
administration of oxytocin (piton), ergot alkaloids, misoprostol
Nursing Care
frequent vital signs
monitor oxygen saturation levels
assessment of lochia
- observation for perineal hematoma
assessment of fundus
- firm with bleeding may indicate vaginal laceration
accurate measurement of intake and output
- monitoring iv fluid therapy
monitor for signs of anemia
provide emotional support to the woman

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14
Q

Postpartum Hemorrhage (early/late)

A

> early
- within 24 hours postpartum
causes:
- uterine atony, lacerations or tears of the reproductive tract hematoma in the reproductive tract
>late
- between 24 hours and 6 weeks postpartum
causes:
- retention of placental fragments
- sub involution
Nursing Care
- teach the woman to report persistent bright red-bleeding
- return of red bleeding after it has changed to pink or white
Prepare for intravenous medication
Prepare for possible surgi cal intervention

S&S:
- tachycardia, narrow pulse pressure, BP continues to drop, pale, cold, and clammy skin, mental status - anxiety, confusion, restlessness, and decreased urinary output

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15
Q

Sepsis

A
  • puerperal sepsis
  • an infection or septicaemia after childbirth, with a fever of 38 degrees after the first 24 hours and for at least 2 days during the first 10 days postpartum
  • risks
    • cracks in the nipples of the breasts
    • surgical incision
    • tissue trauma during labor
    • open wound at the placental insertion site
    • retained placenta or blood clots
    • increased pH of the vagina after birth
    • endometritis (inflammation of the lining of the uterus)
  • Nursing care
  • the objective is to prevent the infection from occurring
    • use and teach hygienic measures
    • promote adequate rest and nutrition for healing
    • teach and observe for signs of infection
    • teach the woman how to correctly apply perineal pads (front to back)
    • teach the woman to take all antimicrobial medications as prescribed
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16
Q

Dangers of puerperal infection

A
  • a localized infection of the perineum, vagina, or cervix can ascend into the reproductive tract and spread to the uterus, fallopian tubes and peritoneum, causing peritonitis, a life-threatening condition
17
Q

thromboembolic

A
  • a venous thrombosis is a blood clot within a vein
  • causes or risks:
    • venous stasis during pregnancy, pressure behind knees if legs are in stirrups, fibrinogen levels increase during pregnancy, but clot-dissolving do not increase, varicose veins
18
Q

Nursing care to Prevent a Thromboembolism

A
  • watch for signs or symptoms of PE
    • dyspnea, coughing and chest pain
  • teaching woman not to cross legs because it impedes blood flow
  • avoid pressure in the popliteal space behind the knee
  • early ambulation and range of motion exercises
  • if anti embolic stockings are prescribed, the nurse should teach the woman the correct method of putting on the stockings
19
Q

Anticoagulant Therapy

A

teach the woman taking this type of medication
>danger signs:
- prolonged bleeding from minor injuries, nosebleeds, unexplained bruising
- use a soft bristled toothbrush
- stress the importance of completing follow up blood tests
- help the woman cope with this form of medical therapy

20
Q

Rh incompatibility

A
  • if the mom is Rh - and the fetus is Rh+ the mother will make antibodies that will destroy the Rh+ erythrocytes
  • Rh0 (D) immunoglobulin is administered at 28 weeks gestation and within 72 hours after delivery of an Rh+ infant
21
Q

ABO Incompatibility

A
  • if the mothers blood type is O and the fetus is A or B a similar response can occur though is normally life threatening
22
Q

postpartum depression

A
  • manifests within 2-4 weeks
    > risk factors:
    • inadequate social support
    • poor relationship with partner
    • life and childcare stress
    • low self-esteem
    • unplanned pregnancy
      > S&S
    • lack of enjoyment in life
    • lack of interest in others
    • intense feeling of inadequacy, unworthiness or guilt
    • inability to cope
    • loss of mental concentration or inability to make decisions
    • disturbed sleep or appetite
    • constant fatigue and feelings of ill health
      > Nursing care
    • refer to a multidisciplinary team
    • be a sympathetic listener for the woman
    • elicit feelings
    • observe for complaints of sleeplessness or chronic fatigue
    • provide support
    • help woman identify her support system
    • determine if the mother is getting enough exercise, sleep, and neutron
    • help the woman identify way to meet her own needs
    • refer to support groups
23
Q

postpartum psychosis

A
  • impaired sense of reality
  • bipolar disorder
    • characterized by episodes of mania
  • major depression
    • deep feelings of worthlessness, guilt, and sleep and appetite disturbances
    • delusions
  • can be fatal for both mother and infant because of use of poor judgement
  • possibility of suicide of infanticide
  • referral for counselling is essential
  • virtually all anitypsychobtic medications pass through the breast milk; therefore, breastfeeding is contraindicated
24
Q

Uterine Atony

A
  • muscle fibres are flaccid and do not compress vessels at placenta site
    • worsen atony and postpartum hemorrhage
  • cause are uterine over-distention, retained placental fragments prolonged labour, or use of drugs during labor that relaxes uterus

Characteristics of Uterine Atony

  • difficulty to feel but is boggy (soft)
  • fundal height usually above umbilicus
  • lochia is increased; may contain large clots
  • true amount of blood being lost may not be immediately apparent until she stands
  • collection of blood in the uterus further interferes with contractions worsening atony
25
Q

Hematomas of the Reproductive Tract

A
  • collection of blood within tissue
  • birth trauma, usually on vulva or inside vagina
  • if seen, looks like bulging bluish or purplish mass
  • unrelenting pain unrelieved by analgesics
  • may complain of pressure in vulva, pelvis, or rectum
  • will not have unusual amounts of lochia
26
Q

Subinvolution of the Uterus

A
  • the slower than expected or failure of the uterus to return to its normal pre-pregnant condition
  • normally, the uterus descends at the rate of 1cm per day.
  • S&S:
    • fundal height is greater than expected, persistence of lochia rubra, pelvic pain and heaviness, fatigue

Maternity (6 decks)

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