Post-Partum Complications

Question 1

High risk, prolonged, or difficult delivery warrants increased PP monitoring because of increased risk of ______ , _____ and _________

Answer 1

Hemorrhage, infection and PPD

Question 2

What is the foci of nursing care of a PP woman?

Answer 2

BUBBLE…

Breasts, Uterus, Bowel, Bladder, Legs, Emotions AND baby.

Question 3

According to what we’re focusing our assessments on on a post-partum mom (BUBBLE), what common complications can arise?

Answer 3

B - mastitis, U - PPH, B- constipation, B- urinary retention, L- thrombophlebitis, E- PPD

Question 4

When might an “early” PPH occur? Late?

Answer 4

<24 hours. >24 hr - 6 wk.

Question 5

What are the “4 T’s” of risk factors for PPH? An example of each?

Answer 5

Tone: uterine atony. Trauma: forceps delivery. Tissue: retained POC. Thrombin: DIC

Question 6

What is the most common cause of PPH?

Answer 6

Uterine atony

Question 7

What is uterine atony?

Answer 7

Relaxation of the uterus, blood vessels cannot be pinched off where the placenta detached from and the woman bleeds.

Question 8

What can cause uterine atony? What should we encourage?

Answer 8

Full bladder. Urinating q2 hours.

Question 9

What are our interventions if our patient experiences uterine atony? (6)

Answer 9

Fundal massage, express clots from uterus, lower HOB, VS, IV NS/RL, oxytocin.

Question 10

What does our PPH assessment look like? How often are we assessing mom?

Answer 10

Fundus (placement/timing), lochia (amount/clots/timing/color), Perineum, VS, pallor/fatigue/SOBOE, Voiding? q 15 mins.

Question 11

What is the normal amount of lochia expected in a PP woman? What does lochia usually smell like?

Answer 11

6 in or less on peri pad in 1 hr. Odourless.

Question 12

How often are we changing mum’s peri pad?

Answer 12

q 3 hr

Question 13

In order of how we would give IV medications for PPH, what do we start with first and what would we use last? Give a short description of each.

Answer 13

Oxytocin (synthetic hormone causes contraction of the uterus - used to augment labour and control PPH). Mesoprostol (synthetic prostaglandin that causes contraction of the uterus). Ergometrin (ergot alkaloid causing smooth muscle contraction of uterus). Hemabate (used for abortion in first and second trimesters- given in PPH when conventional methods have not worked)

Question 14

What are four risk factors for PPI?

Answer 14

> 24 hr ROM, retained POC, PPH/anemia, internal FHR monitoring.

Question 15

When do signs of PPI usually come about? Day 3/4 what should we not mix up infection with? What are 5 things we might see that indicate PPI? What is something we normally look at that indicates infection that wont be useful in a PP woman?

Answer 15

3-4 days after delivery. Milk comes in on day 3/4 and mom might feel feverish/sweaty. Uterine pain, malaise, foul smelling lochia/discoloured lochia, increased temp, increased PV losses. WBC count usually is elevated after pregnancy - but if ++ elevated can indicate infection.

Question 16

What are our interventions for a mom with PPI (4)? What drug might be necessary for involution (shrinkage) of the uterus?

Answer 16

Teaching about SS of infection because mom will likely have already gone home by day 3-4 when an infection will pop up. Abx, analgesia, infection control. Oxytocin.

Question 17

Foci of nursing care for a high-risk newborn (7)?

Answer 17

Respiratory, temperature, extrauterine circulation. Fluids/lytes, nutrition/waste, preventing infection, bonding/attachment.

Question 18

Normal vital signs for a newborn?

Answer 18

Resp: 30-60. T: 36.5-37.4. PR: 110-160. BG: 3.2-6.

Question 19

What does the APGAR tell us? What should we NOT use this to determine?

Answer 19

Tells us how babe is adjusting to extrauterine life. Should not use this to determine whether or not a babe need resuscitation.

Question 20

What will our assessment be of a newborn? (6)

Answer 20

Review pregnancy/labour/birth history, review mom’s history (smoking, GBS, gestational DM, HIV etc), review APGAR, VS, physical assessment, review feeding/elimination patterns.

Question 21

What can happen to a baby if they are exposed to group B strep located in the mom’s vagina? When are mom’s tested for GBS? What does their care look like during labour?

Answer 21

Meningitis. Test mom at 35 wk gestation, if positive ABX will be given IV during labour.

Question 22

What does TORCH stand for?

Answer 22

Toxoplasmosis (cat feces), Other (syphilis, chicken pox), Rubella, Cytomegalo virus, Herpes.

Question 23

If mom’s titre for rubella is low, can we give mom a vaccine while pregnant?

Answer 23

No cause it will cause brain injury to baby as it is a live vaccine. Give to mom before leaving hospital.

Question 24

If mom has active herpes lesions, can she deliver vaginally? What can we give mom?

Answer 24

No, baby could get herpes. Give mom acyclovir. Deliver baby via C/S.

Question 25

How often are we checking APGAR?

Answer 25

1 min, 5 min, and 10 min after birth.

Question 26

If babe’s APGAR is <5 at 1 min… what do we do?

Answer 26

Monitor more closely.

Question 27

If babe’s APGAR is <7 at 5 min… what do we do?

Answer 27

Transfer to NICU.

Question 28

If babe’s APGAR is <2-3 at 1 min what do we do?

Answer 28

Transfer to NICU.

Question 29

If an infant is born healthy, what are the only things we need to do for them when they come out?

Answer 29

Dry them off, and bundle them up.

Question 30

What are factors that lead to respiratory depression in preemies (6)?

Answer 30

Decreased surfactant/lung maturity, susceptibility to cold and stress/metb disturbances, immature organ development, immature CNS, reduced fat deposits/no brown fat, reduced ability to eat/absorb nutrition.

Question 31

What 2 main valves closed after birth? What did those valves in the heart do?

Answer 31

Ductus arteriosus and foramen ovale. Shunted blood away from the lungs while in utero.

Question 32

As a neonate, they are vulnerable to hypoglycemia and cold stress (especially if high risk), what can result from cold stress or hypoglycemia? How does this affect the infant?

Answer 32

Ductus arteriosus and foramen ovale might stay OPEN and not CLOSE, therefore blood will be routed around the lungs, not to the lungs. This can result acidosis and return to fetal circulation resulting in respiratory failure.

Question 33

What is important to remember for temperature regulation of an infant? What things can we do to keep babe warm?

Answer 33

All of the ways heat can be lost: radiation, conduction, convention. Bundle, incubator, dry linen, plastic wrap, warmed stethoscope.

Question 34

Does an infant lose blood during birth? What can happen easily to infants? How many mL can make an impact?

Answer 34

Yes through detachment of the placenta. Dehydration/FVD. 15 mL.

Question 35

How do we assess an infant for FVD?

Answer 35

Anterior fontanels (will be sunken), urine/feces, feeding

Question 36

Baby’s with respiratory distress are also at risk for what?

Answer 36

Fluid/lyte imbalance because of increased insensible fluid losses.

Question 37

A neonate can have FVE occur easily if they have an IV in situ. Why is this? What will occur?

Answer 37

Immature kidneys. Return to fetal circulation (opening of ductus arteriosus).

Question 38

How many times per dad does a baby usually feed? How long per feed?

Answer 38

8-12. 15-40 min.

Question 39

An infant born to a mother with gestational DM is at risk for what? What is the nursing care around this? What is usually necessary until breastmilk supply has fully been established?

Answer 39

Hypoglycemia due to a cut off of sugars from mom after birth and insulin that was produced remains in system for some time after birth. Frequent BG checks and ensuring adequate intake. Supplementation with formula.

Question 40

What are 4 indications a baby’s blood glucose might be low?

Answer 40

Shaking/jittery, flappy tone, reduced reflexes and cannot maintain temperature.

Question 41

How does macrosomia and respiratory distress go together?

Answer 41

A macrosomic infant’s heart and lungs have difficulty keeping up with having to supply a larger amount of O2 rich blood.

Question 42

If a macrosomic infant is not feeding well in the first few hours of life - what is the risk?

Answer 42

Decreased BG leading to acidosis and impeded respiratory function.

Question 43

What is the nursing care associated with a macrosomic infant who might develop respiratory distress?

Answer 43

Frequent BG check, supplemental feeds, possible IV and O2

Question 44

What are benefits of breastmilk for the baby’s immune system?

Answer 44

Breast milk has immunologic properties (antibodies)

Question 45

True or false: no matter how complex the infant’s condition, parent’s are partners in care for the infant?

Answer 45

True

Question 46

Are babies always encourages skin-skin whenever possible?

Answer 46

Yes

Question 47

What are 8 manifestations of neonatal abstinence syndrome?

Answer 47

Irritability, disturbed sleep pattern, frequent sneezing, shrill/high-pitched cry, possible hyperreflexia and clonus, convulsion, inc RR, vomiting/diarrhea

Question 48

______ and ____ influence ABCs of infant

Answer 48

Thermoregulation and blood sugars

Question 49

Keeping baby warm thinking about all of the ways heat is lost… conduction, evaporation, radiation, convection… give example for each.

Answer 49

Conduction - don’t put baby on cold surface. Evaporation - dry baby right after birth. Radiation - don’t put baby near window. Convection - draft takes heat away from baby.

Question 50

Eight risk factors putting pregnant women at risk for DVT?

Answer 50

Inactivity in labor, legs in stirrups for long time, history of thrombophlebitis, inactivity in pregnancy, pre-existing varicose veins, PPI, increase parity, cigarettes.

Question 51

What three factors predispose a pregnant woman to DVT development?

Answer 51

Increased fibrinogen, increased estrogen levels, and dilation of lower extremity veins causing pooling.

Question 52

Five strategies to prevent a DVT in a perinatal period?

Answer 52

Side-lying or back-lying during birth, hydrate, ambulate ASAP after birth, quit smoking, do leg/feet exercises while in bed.

Question 53

Why is it dangerous to massage the skin over a clotted area?

Answer 53

Can loosen clot and cause PE or cerebral embolism.

Question 54

Five ways to prevent the development of mastitis?

Answer 54

Position baby correctly and help grasp nipple properly, baby releases grasp before removing breast, wash hands before touching breasts, expose nipples to air, Vit E oil to soften nipples.

Question 55

What organisms are associated with nosocomial mastitis?

Answer 55

Staph aureus and candidiasis

Question 56

5 findings associated with mastitis?

Answer 56

Unilateral, fever, scant breast milk production, painful and swollen.

Question 57

4 medical/nursing interventions to treat mastitis? Where is most of the treatment done (hospital/home?)

Answer 57

Abx, cold compress, continue to feed from affected breast (more milk=more bacteria growth), supportive bra. Done at home.

Question 58

Why are women prone to UTIs after delivery?

Answer 58

Catheterization. Also maybe decreased sensation leading to urinary retention.

Question 59

Assessment findings of UTI (5)? Management of UTI after delivery?

Answer 59

Dysuria, frequency, hematuria, low-grade fever, discomfort in lower abdo. Abx, hydrate (flush out bacteria from bladder), tylenol.

Question 60

If a child is born with a physical challenge/illness when should the child be shown to parents? Why at this time? What are some common responses to delivering a child with an illness or physical challenge? What are some helpful nursing interventions and responses for a family whose newborn has died?

Answer 60

Immediately so problem/illness can be described and a prognosis given. Grief response, shock. Reinforce/review information, open line of communication. Allow parents to see deceased baby, remain with them but allow to tough. They might want to take a photo. Also need to sign certain forms. Provide them with a private room for family to give them enough time they need to grieve and visit freely.

Question 61

What 4 kinds of babies are at risk for RDS? When does surfactant usually form? What are SS of RDS (6)? Describe action of CPAP/PEEP oxygen administration? What is a risk of O2 admin for very immature infants?

Answer 61

Preterm, born to DM mom, C/S (no pressure to expel fluid from lungs like vag birth), decreased perf of lungs (MAS baby). Surfactant forms 34 wk gestation. SS: diff initiating resps, decreased temp, nasal flaring, sternal/subcostal retractions, inc RR, cyanotic mucous memb. CPAP/PEEP following surfactant admin exerts pressure on alveoli to keep open. Retinopathy of prematurity (ROP) or bronchopulmonary dysplasia.

Question 62

What is the cause of TTN? Normal RR? Rate seen in TTN? Why is feeding difficult when newborn has TTN? Which babies are more at risk (3)? What nursing actions are required? When should TTN resolve?

Answer 62

Retained lung fluid. Normal = 30-60. TTN = 80-120. Infant can’t complete suck/swallow/breath cycle effectively when RR is high. C/S, mom received ++ IVF during labor, preemie. Monitor infant for increasing resp. efforts/tiring, administer glucosteroid to decreased resp tract inflm. Will begin to resolve after 36 hours of life, typically gone by 72 hours of life.

Question 63

What causes MAS? Why is it a concern… causes resp distress in what three ways? What SS will the nurse note (5)?

Answer 63

Hypoxia leading to vagus nerve stimulation and rectal spincter relaxation. Causes severe resp distress in three ways: inflammation of bronchioles, block small bronchioles by mechanical plugging, and causes a decrease in surfactant production due to lung trauma. Difficulty est. resps at birth, dec APGAR, inc RR, retractions, cyanosis.