Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURB 3230 > post partum risks > Flashcards

post partum risks Flashcards

1
Q

primary vs. delayed hemorrhage

A

-primary: within first 4-8 hrs
-delayed: later than 8 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

prompt intervention for hemorrhage

A

palpate and massage the fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

hemorrhage risk factors

A

-tone: overdistention, oxytocin, anesthesia, mg sulfate, retention
-tissue: subinvolution
-trauma: lacerations, hematomas
-thrombin: ITP, von willebrand, DIC
-traction: inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

uterine atony

A

-inability of uterus to contract adequately after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

causes of uterine atony

A

-retention, overdistenion of uterus, prolonged or forceful rapid labor, bacterial toxins, anesthesia, meds (mg, oxytocin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

uterine atony findings

A

-large & boggy uterus, lateral
-irregular or excessive bleeding
-tachycardia, hypotension
-later signs: pale, cool clammy skin, loss of skin turgor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mgmt of uterine atony

A

-ensure empty bladder
-assess fundus & massage
-monitor lochia
-monitor for clots
-frequent vitals
-maintain IVF
- 2-3L/min, can be with nasal cannula
-amin methergine, misoprostol
-encourage breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

subinvolution

A

failure of uterus to return to its pre-pregnant state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

subinvolution risks

A

-pelvic infection
-endometritis
-retained placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

subinvolution findings

A

-prolonged/irregular vaginal bleeding
-uterus higher than normal
-boggy uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

subinvolution tx

A

-D&C
-oxytocin
-methylergonovine
-abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

inversion

A

uterus turns partially or all the way inside out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

inversion risks

A

-retain placenta
-fundal pressure
-excessive traction on cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

inversion findings

A

-pain in lower abdomen
-large red rounded mass/smooth mass in the dilated cervic
-dizzy, pallor, low bp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

inversion tx

A

-replace uterus
-terbutaline (tocolytic)
-abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

retained placenta

A

placenta delivered in >30 min after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

retained placenta risks

A

-excessive traction on cord
-partial separation of placenta
-entrapment by uterine wing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

retained placenta findings

A

-excessive bleeding
-atony
-return of lochia progression
-malodorous discharge
-elevated temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

retained placenta tx

A

-manual removal
-D&C
-oxytocin
-terbutaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

lacerations & hematomas risks

A

-operative
-precipitous birth
-CPD/macro
-previous scarring
-prolonged pressure on fetus head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lacerations & hematomas findings

A

-lacerations: vaginal bleeding, firm uterus, continuous slow trickle of bright red blood
-hematoma: bulging bluish mass, red-purple discolor, difficulty voiding, possible pain

22
Q

lacerations & hematomas tx

A

-repair of laceration & hematoma
-ice packs
-pain meds

23
Q

ITP- idiopathic thrombocytopenia purpura

A

-autoimmune, low number of circulating platelets, due to antibodies
-low platelets, low fibrinogen
-increased bleeding times
-prothrombin, PTT, d-dimer

24
Q

ITP tx

A

-glucocorticoids
-caplacizumab
-platelet infusion
-splenectomy if needed
-avoid NSAIDS, ASA, antihistamines

25
Q

von willebrand disease

A

-congenital bleeding disorder with prolonged bleeding time
-deficiency of von willebrand factor, impairment of platelet adhesion
-bleeding gums, easy bruising, menorrhagia, blood in urine in stool, hematomas
-increases in pregnancy

26
Q

DIC- disseminated intravascular coagulation

A

-clotting/anticlotting occurs simultaneously, organ damage
-most important is to identify initiating cause
-tx focuses on perfusion through fluid therapy, heparin, blood & blood products, oxygen
-may use vasoactive meds, abc, uterotonic meds

27
Q

thrombin diseases assessments

A

-identify risk factors
-palpate uterus, massage if boggy
-assess quantitative amount of bleeding
-assess for 5Ts

28
Q

mgmt for bleedings disorders

A

-massage uterus, express clots
-uterotonic drugs- know CI & SE
-maintian primary IV infusion, 2nd infusion if needed
-foley catheter
-provide 02 via nasal cannula 2-3L/min, monitor o2 status
-elevate legs 20-30 degrees
-monitor vs, LOC, lochia
-be prepared for use of uterine tamponade or bimanual compression

29
Q

oxytocin

A

-stimulate uterine contraction
-assess fundus, monitor bleeding every 15 minutes, monitor uterine tone, monitor urine tention

30
Q

misoprostol

A

-stimulates the uterus to contract/reduce bleeding
-off label use for acute postpartum hemorrhage

31
Q

methylergonovine maleate

A

-stimulates the uterus to prevent and treat postpartum hemorrhage due to atony or subinvolution
-assess baseline bleeding, uterine tone, and vitals every 15min
-monitor for htn, seizures, cramping, n/v , and palpitations
-Contraindications: HTN

32
Q

carboprost (prostaglandin)

A

-stimulates uterine contractions/to treat postpartum hemorrhage due to uterine atony when not controlled by other methods
-assess vitals, contractions, bleeding status
-contraindications: asthma active CV disease

33
Q

tranexamic acid (TXA)

A

-1gm IV over 10 min, IV push
-antifibrinolytic
-contraindicated: hx of thromboembolic events, hx of coagulopathy

34
Q

assessing for shock (hemorrhagic)

A

-monitor vs, mental status, output
-goal: control bleeding, fluid resuscitation (fluids or blood), correct imbalance of 02 delivery & consumption

35
Q

post partum infections

A

-endometritis
-surgical sites
-uti
-mastitis

36
Q

risk factors for pp infections

A

-18-24 prom/ prolonged labor/c-section
-invasive procedures/birth
-chronic conditions/pre-existing infections

37
Q

venous thromboembolic conditions

A

-thrombophlebitis caused by thrombus can become embolus
-superficial and deep vein thrombosis, can lead to pulmonary embolus
-s/s: calf pain, hardened area, redness, warmth, edema
-dx: doppler, ct, mri

38
Q

prevention of thromboembolus

A

-SCDs, TED hose
-if BR >8hr, perform ROM
-early ambulation
-avoid prolonged sitting, standing, immobility
-elevate legs, avoid crossing legs
-hydration, d/c smoking
-may have heparin injection before delivery

39
Q

mgmt of thromboembolus

A

-encourage rest
-BR & elevate legs
-intermittent warm compress
-dont massage
-leg circumference
-anti-embolism stockings
-analgesics (no NSAIDS or ASA), anticoagulants

40
Q

thromboembolus treatments

A

heparin and warfarin

41
Q

heparin

A

-prevent clots formation & growth
-IV 3-5 days adjusted by coag. studies
-aPTT 1.5-2.5 times the control of 30-40 seconds
-protamine sulfate on hand

42
Q

warfarin

A

-oral tx for clots
-taken for 3mo
-monitor PT 1.5-2.5 times control, 11-12.5 seconds, INR 2-3
-vitamin K on hand
-teratogenic, no OCs

43
Q

pulmonary embolus

A

-s/s: apprehension, chest pain, dyspnea, tachycardia, hemoptysis, hypotension, hypoxia
-dx: ventilation/perfusion lung scan, CXR
-semi fowlers, o2 by face mask
-warfarin and heparin
-thrombolytics: altepase, streptokinase

44
Q

endometritis

A

-can involve endometrium ( & decuda, myometrium)
-organisms: normal flora- E. coli, klebsiella, G vaginalis
-s/s: pelvic pain, anorexia, fever >100.4 after first 24 hrs, bad lochia, flu like sx

45
Q

surgical site infections

A

-c section incision, episiotomy, genital laceration
-redness, swelling, drainage, tenderness, unapproximation, dehiscence, evisceration
-high wbc

46
Q

UTI

A

-organisms: e. coli, klebsiella, proteus, enterobacter species
-causes: freq. vaginal exams, catherization, genital trauma
-s/s: freq., urgency, dysuria, lower abdominal pain, costovertebral (pyelo), fever
-dx: ccms
-teaching: hygiene, fluid intake, cranberry/prune juice

47
Q

mastitis

A

risk factors: milk stasis, nipple trauma, prev. poor hygiene
-s/s: red, hot, painful, tender area on breast, fever, malaise,
-goals: reverse cause, maintain milk, breastfeed
-admin pain meds, hydrate, abx

48
Q

PP baby blues

A

-mild depressive sx, anxiety, irritability, mood swings, tearfulness, increased sensitivity, fatigue
-usually peak at 4-5days and resolve by day 10
-if longer than day 10, seek tx

49
Q

PP depression

A

-sx last longer and are more severe and need tx
-may lead to poor bonding, alienation, daily dysfunction, violent thoughts/actions

50
Q

psychosis

A

-onset can be abrupt, around 3 months PP, hx of mental illness
-emergency
-s/s: mood lability, delusional beliefs, hallucination, disorganized thinking, anger
-early sx mimic depression, sleep disturbance, fatigue
-dont leave mother alone with infant
-tx: psychotropic drugs, psychotherapy, support groups
-education is key

NURB 3230 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions