Postpartum

Question 1

Uterine involution &

Answer 1

hemorrhage

Question 2

3 things to reduce risk of hemorrhage

Answer 2

admin of utero-tonic agent (pitocin)
controlled cord traction
uterine massage after delivery of placenta

Question 3

Early hemorrhage cause

Answer 3

uterine atony
trauma

every 15 min checks
fundus: should be firm/hard

Question 4

clinical signs of uterine atony

Answer 4

cannot feel it
soft/boggy
loses tone when massage stopped
above expected level
bright red lochia
excessive clots

Question 5

Methylergonovine (Methergine)

Answer 5

given for uterine atony

cannot be given for pts with HTN
check BP prior

Question 6

Prostaglandins/methylprostoglandin (hematite)

Answer 6

uterine atony

AVOID WITH ASTHMA/HTN PTS

Question 7

surgical measures

Answer 7

Dilation & Curettage

scraping stuff out of uterus

Question 8

How to determine trauma PPH

Answer 8

firm fundus that is midline or around umbilicus
showing other signs of hemorrhage

vital signs/bleeding
subjective symptoms

CALL FOR HELP

Question 9

laceration hemorrhage causes

Answer 9

steady trickle (or heavier flow) bright red, firm fundus

Question 10

suspect hematoma if

Answer 10

firm fundus
normal lochia
s/s hypovolemic shock accompanied by extreme perineal p! or pressure

Question 11

reasons for late PPH

Answer 11

sepsis

retained piece of placenta

Question 12

placenta attaches deep into the myometrium & pieces of placenta are left behind

Answer 12

placenta accreta

Question 13

Late PP med management

Answer 13

Pitcoin
methergine
hemabate

Question 14

Priority assessment for PPH

Answer 14

Fundus
bladder
loch
VS
Skin temp/color Q15m

Question 15

what day does the uterus turn to normal?

Answer 15

day 10

completed by 6 weeks

Question 16

cause of sub involution of uterus

Answer 16

retained placental fragments
pelvic inflammation

slower than expected return (it is still enlarged)

Question 17

Postpartum infection fever

Answer 17

100.4 or higher after first 24 hrs & occurring on at least 2 days during first 10 days after childbirth.

Question 18

Mastitis management

Answer 18

antibiotic therapy w/ continued emptying of breast

Question 19

Risks for mastitis

Answer 19

Sore nipples when feedings skipped
Fatigue
Stress
Massaging the breast

Question 20

expressing clots only when uterus is firmly contracted bc

Answer 20

pushing on an uncontracted uterus can lead to inverted uterus aka more hemorrhaging