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OB Nursing > Postpartum Complications > Flashcards

Postpartum Complications Flashcards

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1
Q

1st degree laceration

A

Tear limited to fourchette, superficial skin, or vaginal mucosa

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2
Q

2nd degree laceration

A

Extends to perineal muscles and fascia

Spares anal sphincter

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3
Q

3rd degree laceration

A

Tear includes anal sphincter

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4
Q

4th degree laceration

A

Tear extends into rectal mucosa

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5
Q

Laceration risk factors

A

Operative vaginal birth - forceps, vacuum

Cephalopelvic disproportion

Macrosomia

Abnormal presentation/position

Prolonged pressure on vaginal mucosa from fetal head

Prior scarring of birth canal from infection, injury, operation

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6
Q

Laceration complication

A

Infection

Hemorrhage

Pain

Elimination disturbances/incontinence

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7
Q

What might be a clue that a laceration is present?

A

Vaginal bleeding even though uterus is firm and contracted

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8
Q

Postpartum hemorrhage

A

OB emergency following vaginal or C/S delivery

Early - hemorrhage in first 24 hrs

Late - hemorrhage after 24 hrs up to 12 weeks

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9
Q

PP hemorrhage diagnosis

A

Cumulative blood loss >1000 mL

OR

Blood loss w/ signs/sx of hypovolemia w/in 24 hrs after birth

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10
Q

Causes of early PP hemorrhage

A 
Atony
Hematoma
Retained tissue
Lacerations
Coagulation defects
Distended bladder
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11
Q

PP hemorrhage risk factors

A 
Grand multiparity (5+ births)
Overdistention of uterus - LGA, macrosomia, twins, polyhydramnios
Rapid, prolonged labor
Retained placenta
Placenta previa
Abruptio placentae
Drugs - tocolytics, Mg sulfate, general anesthesia, prolonged oxytocin use
Operative procedures - C/S, vacuum, forceps
Uterine fibroids
Hx of PP hemorrhage
Coagulation defects
Hx of hemorrhage
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12
Q

Management of Immediate PP hemorrhage

A

Uterine massage
Removal of retained tissue/clots
Meds
Monitor for signs of hypovolemic shock

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13
Q

Meds for subinvolution/PP hemorrhage

A

Pitocin 10-20 units IM or IV
Misoprostol (Cytotec) 800 mcg rectal
Methergine 0.2 mg IM - avoid in HTN
Hemabate 250 mcg IM - caution w/ asthma; potential significant diarrhea

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14
Q

Hematomas

A

Collection of clotted blood within tissues appearing as bulging, bluish mass in pelvic region, vagina, or broad ligament

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15
Q

Hematoma causes

A

Bleeding lacerations

Injury to blood vessel in absence of lac/incision

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16
Q

Hematoma expected findings

A

Pain, pressure, difficulty voiding

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17
Q

Hematoma risk factors

A 
Nulliparous
Macrosomia/LGA
Preeclampsia
Prolonged second stage of labor
Multifetal
Vulvar varicosities
Clotting disorders
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18
Q

Hematoma treatment

A

Conservative measures
Surgery
Arterial embolization

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19
Q

3 common thromboembolisms in PP

A

Superficial venous thrombophlebitis

DVT

PE

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20
Q

Common DVT sx

A

Pain in leg or groin

Swelling of leg, erythema, heat, tenderness

21
Q

DVT Diagnosis

A

Venous US, Doppler flow analysis, MRI

22
Q

DVT prevention

A

Prophylactic heparin if high risk
Early ambulation
Avoid pillows under knees
SCD, stockings

23
Q

DVT Risk factors

A 
Pregnancy
C/S
Operative vaginal birth
PE, varicosities
Immobility
Obesity
Smoking
Multiparity
Age >35
Hx of VTE
24
Q

PE sx

A

Dyspnea, chest pain, tachycardia, tachypnea, hemoptysis, low pulse ox

25
Q

PE nursing interventions

A 
Frequent RR & VS assessment
Auscultate breath sounds
Call for help
Admin O2 at 8-20 L/min via tight face mask
Raise head of bed
Narcotic analgesics for pain
IV access
26
Q

Thrombophlebitis nursing interventions

A 
Bed rest
Elevate extremity above level of heart
Frequent position changes
Intermittent/continuous moist heat
NO massage of affected area
Measure leg circumferences
Thigh-high antiembolism stockings
Administer analgesics
Administer anticoagulants for DVT
27
Q

Patient education on anticoagulants

A 
Avoid aspirin, ibuprofen
Use electric razor for shaving
Avoid alcohol (warfarin)
Brush teeth gently
Avoid rubbing/massaging legs
Avoid periods of prolonged sitting/crossing legs
28
Q

Two week PP visit

A

C/S patients - check steri-strips

All other birthing persons w/ access

Mental Health Assessment

29
Q

6 week PP visit

A

H&P
Assessments - Brain/Blues, Breast/Bottle, Bottom, Bleeding, Bladder, Bowel, Baby, Birth Control

Labs - diabetes screen, Hgb

30
Q

6 week PP visit - physical exam

A 
Physical survey
Palpate thyroid
Breast exam
Abdomen - resolution of diastasis?
Perineum
Bimanual exam - pelvic floor muscles, cervix closure, complete involution
Speculum exam if needed, f/u Pap?
Possible rectal exam
31
Q

Postpartum Infections

A

Endometritis, Mastitis, Wound infections, UTI

32
Q

Endometritis

A

Infection of uterus, most common, usually beginning on day 3-4 PP beginning at placental attachment site and spreading

33
Q

Wound infection sites

A

C/S, episiotomies, lacs, trauma wounds

34
Q

Mastitis

A

Infection of breast, usually unilateral; can progress to abscess if untreated

35
Q

Endometritis risk factors

A 
Prolonged labor
Prolonged ROM
Multiple cervical exams
Internal fetal or uterine monitoring
Large amount of meconium in amniotic fluid
Manual placenta removal
Low SES
Maternal DM, severe anemia
PTB
BV
Operative vaginal delivery
Postterm pregnancy
HIV infection
GBS colonization
36
Q

Endometritis signs/sx

A

Appear ‘sick’ - fever, chills, malaise, abdominal pain/tenderness/cramping, uterine tenderness, purulent, malodorous lochia, fatigue, loss of appetite

37
Q

Endometritis treatment

A

IV broad-spectrum abx initially - penicillins, cephalosporins, clindamycin, gentamicin

Comfort measures

38
Q

Mastitis signs/sx

A

Preceded by engorgement, stasis of milk

‘Flu-like’ - fever, chills, achiness, headache, localized lump, wedge-shaped area of pain, redness, heat, inflammation, enlarged axillary LNs, tender, palpable hard region

39
Q

Mastitis complication

A

Abscess

40
Q

Mastitis risk factors

A 
Milk stasis
Nipple trauma
Poor breastfeeding technique
Decrease in feeding frequency
Contamination of breasts due to poor hygiene
41
Q

Mastitis treatment

A

PO abx

Heat/cold application

Analgesics

Continue feeding on both sides! (milk is not infected)

42
Q

UTI PP risk factors

A 
Postpartal hypotonic bladder or urethra
Epidural anesthesia
Urinary bladder catheterization
Frequent pelvic exams
Genital tract injuries
Hx of UTIs
C/S birth
43
Q

UTI complication

A

Pyelonephritis w/ permanent kidney damage –> renal failure

44
Q

UTI signs/sx

A 
Urgency, frequency, dysuria, pelvic discomfort
Fever, chills, malaise
VS changes
Urinary retention
Pain in suprapubic region
CVA tenderness
45
Q

UTI diagnosis

A

Urinalysis - WBC, RBC, protein, bacteria

46
Q

UTI treatment

A 
PO abx
Maintain hydration
Proper perineal care
Frequent urination
Acetaminophen for pain
47
Q

Wound infection signs/sx

A

Fever, redness, swelling around incision, drainage/bleeding, abdominal pain, pain at incision site, not approximated/dehiscence

48
Q

Wound infection management

A

Office visit - potential I&D, culture

Abx prescribed

Analgesics for pain

Warm compresses, sitz baths

49
Q

Painful intercourse management

A

Vaginal dryness (low E2), lac, episiotomy

Use lubricant, E2 therapy

If persists past 3 months, refer to gynecology or PT

OB Nursing (7 decks)

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