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Exam III > Postpartum Complications > Flashcards

Postpartum Complications Flashcards

1
Q

Oxytocin

A

Action: contraction of the uterus Side effects: water intoxication, NV Nursing: monitor bleeding and uterine tone

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2
Q

What are the different types of postpartum hemorrhage?

A

-Atony -Lacerations -Hematoma -Hemorrhagic shock

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3
Q

Management of hypovolemic shock involves:

A

-restoring circulating blood volume -eliminating the cause of the hemorrhage (lacerations, uterine atony, or inversion).

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4
Q

Nursing/medical care for UTI:

A
  • antibiotic therapy, analgesia, and hydration. -teach to monitor temperature, bladder function, and appearance of urine. -teach about signs of potential complications and the importance of taking all antibiotics as prescribed - prevention of UTIs include proper perineal care, wiping from front to back after urinating or having a bowel movement, and increasing fluid intake, and using Unsweetened cranberry juice or cranberry supplements
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5
Q

What care is given to the woman with lacerations?

A

-position changes -analgesia as needed for pain -warm or cold applications as necessary -measures to prevent constipation (straining is not good for sutures)

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6
Q

Etiology for Endometritis:

A

-an infection of the lining of the uterus -usually begins as a localized infection at the placental site but can spread to the entire endometrium. -The highest incidence occurs in women who gave birth by cesarean after prolonged labor and rupture of membranes -Prophylactic antibiotics administered during labor and during cesarean surgery can help reduce the incidence and severity of endometritis.

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7
Q

Clinical manifestations for Endometritis:

A

-fever (usually greater than 38 ° C [100.4 ° F]) -increased pulse -chills -anorexia -nausea -fatigue and lethargy -pelvic pain -uterine tenderness -foul-smelling, profuse lochia -Leukocytosis and a markedly increased RBC sedimentation -Anemia

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8
Q

What is the initial intervention in management of excessive postpartum bleeding due to uterine atony?

A

firm massage of the uterine fundus

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9
Q

Carboprost hemabate

A

Action: contraction of the uterus Side effects: HA, NV, fever, chills, tachycardia, hypertension, diarrhea Contraindications: avoid with asthma or htn Nursing: monitor bleeding and uterine tone

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10
Q

Name 5 drugs used to treat uterine atony induced postpartum bleeding:

A
  1. Oxytocin 2. Misoprostol (Cytotec) 3. Methylergonovine (Methergine) 4. Carboprost hemabate 5. Dinoprostone (Prostin E2)
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11
Q

Nursing/medical care for Pulmonary Embolism:

A

-Immediate treatment of PE is anticoagulant therapy -Continuous IV heparin therapy is used for PE until symptoms have resolved -Intermittent subcutaneous heparin or oral anticoagulant therapy (usually warfarin [Coumadin]) is often continued for up to 6 months

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12
Q

When do Vaginal hematomas usually occur?

A

-occur more commonly in association with a forceps-assisted birth, an episiotomy, or primigravidity

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13
Q

Best tools to diagnose thromboembolism:

A

-Compression ultrasonography with or without color Doppler is the most commonly used -A ventilation-perfusion scan -spiral computed tomography scan -magnetic resonance angiography -pulmonary arteriogram

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14
Q

Clinical manifestations for UTI:

A

-dysuria -frequency and urgency -low-grade fever -urinary retention -hematuria -pyuria -Costovertebral angle tenderness or flank pain can indicate upper UTI

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15
Q

Describe vulvar hematomas:

A

-Vulvar hematomas are the most common. -Pain is the most common symptom -most vulvar hematomas are visible.

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16
Q

Describe QBL or quantitative blood loss in reference to vaginal and cesarean birth:

A

-For vaginal birth, QBL should begin immediately after birth, prior to delivery of the placenta, using a calibrated under-buttocks drape and weighing all blood-soaked items. -With cesarean birth, QBL begins when the membranes are ruptured or after birth of the neonate, measuring fluids in suction canisters (subtracting irrigation fluid) and weighing all blood-soaked materials and clots

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17
Q

refer to page 725: algorithm for PP bleeding. Draw out the pathways.

A

What are is in the stem? What is in the next part? Say it aloud and draw it a few times.

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18
Q

Clinical manifestations for Wound Infections:

A

-fever -erythema -edema -warmth -tenderness -pain -seropurulent drainage -wound separation

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19
Q

Signs of Anaphylactoid Syndrome of Pregnancy:

A
  • Respiratory distress - Restlessness - Dyspnea - Cyanosis - Pulmonary edema - Respiratory arrest - Circulatory collapse - Hypotension - Tachycardia - Shock - Cardiac arrest - Hemorrhage - Coagulation failure: bleeding from incisions, venipuncture sites, trauma (lacerations); petechiae, ecchymoses, purpura - Uterine atony
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20
Q

Etiology for UTI:

A

UTIs occur in 2% to 4% of postpartum women. The most common infecting organism is Escherichia coli, although other gram-negative aerobic bacilli can cause UTIs. Risk factors include urinary catheterization, frequent pelvic examinations, regional (epidural or spinal) anesthesia, genital tract injury, history of UTI, and cesarean birth.

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21
Q

Etiology of Pulmonary Embolism:

A

-Complication of DVT occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lung -Acute PE is an emergent situation that requires prompt treatment -Massive pulmonary emboli can lead to pulmonary hypertension and right ventricular dysfunction; if right ventricular dysfunction is present, mortality can be as high as 25% -Acute PE usually results from dislodged deep vein thr-ombi.

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22
Q

Etiology for Mastitis:

A

-breast infection

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23
Q

Describe the etiology of atony hemorrhage:

A

Contraction of the uterus creates constriction of the smooth muscle blood vessels and controls bleeding. Failure of this function is called uterine hypotonia. The woman will have excessive bleeding and a soft, boggy uterus.

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24
Q

Nursing/medical care for DVT:

A

-initially treated with IV anticoagulant therapy, bed rest with the affected leg elevated, and analgesia. -After the symptoms have decreased, the woman may be fitted with elastic compression stockings to wear when ambulating (teaching needed) -After several days, anticoagulant therapy will be changed to oral administration. -If a breastfeeding mother is on long-term anticoagulant therapy, the infant’s prothrombin time should be monitored at least monthly and vitamin K should be given to the infant if necessary

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25
Q

A patient has excessive bleeding due to uterine atony. The first step has been taken by massaging the fundus. What medical interventions may take place next?

A

-Expression of any clots in the uterus -elimination of bladder distention -continuous IV infusion of 10 to 40 units of oxytocin added to 1000 ml of lactated Ringers or normal saline

26
Q

What 8 clinical manifestations are associated with shock according to this textbook?

A
  1. Rapid and shallow breathing 2. Rapid, weak, irregular pulse 3. Decreasing BP- late sign 4. Cool, pale, clammy skin 5. Decreasing urinary output 6. Lethargy leading to coma 7. Anxiety leading to coma 8. Decreased CVP
27
Q

Who should not receive ergonovine or methylergonovine? Why?

A

The use of ergonovine or methylergonovine is contraindicated in the presence of hypertension or cardiovascular disease.

28
Q

List the nursing steps taken in a situation where the patient is showing manifestations of shock:

A
  1. call for assistance and gather equipment 2. IV infusion per orders 3. Airway and Oxygen 4. Monitor status
29
Q

Etiology of SVT:

A

-Involvement of the superficial saphenous venous system -most common form of postpartum thrombophlebitis

30
Q

Describe the care associated with retained placenta and placenta accrete syndrome:

A

Retained placenta: Manual separation. Additional pain relief may be given. IV nitroglycerin may be used to relax the uterus. Placenta accrete syndrome: Blood component products. Hysterectomy if cannot be controlled.

31
Q

Clinical manifestations of Pulmonary Embolism:

A

-dyspnea and chest pain - tachypnea (more than 20 breaths/ min) -tachycardia (more than 100 beats/ min) -apprehension -cough -hemoptysis -elevated temperature -sweating -Syncope is rare and usually indicates a massive embolism -echocardiographic abnormalities may be seen in right ventricular size or function

32
Q

Nursing/medical care for SVT:

A
  • analgesia, support from elastic compression stockings, heat, and rest. -If it does not quickly improve or if DVT is suspected, appropriate diagnostic testing is performed
33
Q

What is the first step if blood loss appears to be excessive?

A

-evaluate the contractility of the uterus -if it is boggy/hypotonic focus on increasing contractility

34
Q

Nursing/medical care for Wound Infections:

A
  • -Wound exudate may be cultured to identify the causative organism.
  • -Wound infections are treated with IV antibiotic therapy.
  • -When pus is present in the incision, the wound is opened and drained.
  • -Wounds are irrigated with normal saline and redressed several times daily; healing occurs by secondary intention.
  • -In some cases, a wound vacuum device is used.
  • -Antibiotic treatment is continued until the base of the wound appears clear and there are no apparent signs of cellulitis
35
Q

What is the typical care for a hematoma?

A

Hematomas are generally surgically evacuated Once the bleeding has been controlled: -careful attention to pain relief -monitoring the amount of bleeding -replacing fluids -reviewing laboratory results (h+h)

36
Q

In terms of IV fluids associated with hemorrhagic shock, differentiate between Crystalloid solutions, PRBCs, and fresh frozen plasma. When and why is it appropriate to administer each?

A
  • a rapid IV infusion of crystalloid solution is given at a rate of 3 mL infused for every 1 mL of estimated blood loss (e.g., 3000 mL infused for 1000 mL of blood loss)in order to = restore circulating blood volume, -Packed red blood cells (PRBCs) are usually infused= if the woman is still actively bleeding and no improvement in her condition is noted after the initial crystalloid infusion -Infusion of fresh frozen plasma may be needed if clotting factors and platelet counts are below normal values
37
Q

Methylergonovine

A

Action: contraction of the uterus Side effects: hypertension, hypotension, NV, HA Contraindications: HTN, Preeclampsia or cardiac disease Nursing: check BP, don’t give if above 140/90

38
Q

What does the nurse understand about retroperitoneal hematomas?

A

-least common but are life threatening -usually associated with rupture of a cesarean scar during labor -if the woman reports persistent perineal or rectal pain or a feeling of pressure in the vagina, a careful examination is made -can cause minimal pain and the initial symptoms may be signs of shock

39
Q

Bad Tools for diagnosing Thromboembolism:

A

-physical exam and arterial blood gases/pulse Ox are not good tools for diagnostics -Contrast-enhanced magnetic resonance venography is bad for baby

40
Q

Misoprostol

A

Action: contraction of the uterus Side effects: HA, NV, diarrhea, fever, and chills Nursing: monitor bleeding and uterine tone

41
Q

What is a pelvic hematoma?

A

-a collection of blood in the connective tissue -can be vulvar, vaginal, or retroperitoneal in origin

42
Q

Describe the 3 types of placenta accrete syndrome:

A

Placenta accreta— Slight penetration of myometrium Placenta increta— Deep penetration of myometrium Placenta percreta— Perforation of myometrium and uterine serosa, possibly involving adjacent organs

43
Q

Clinical manifestations of DVT:

A

-unilateral extremity edema -erythema, warmth -pain -tenderness -positive Homans sign

44
Q

Etiology for Wound Infections:

A

-Wound infections are common postpartum infections that often develop after women are discharged home. -Rates of wound infection after cesarean birth are 3% to 5% -Women can also develop infection in the perineum in a repaired laceration or episiotomy site.

45
Q

What causes uterine atony?

A

retained placenta: not expelled after 30 min placenta accrete syndrome/morbidly adhered placenta: abnormally implanted or adhered placenta

46
Q

Describe additional interventions associated with post partum hemorrhage:

A

-Oxygen can be given by nonrebreather face mask to enhance oxygen delivery to the cells. -An indwelling urinary catheter is usually inserted to monitor urine output as a measure of renal perfusion, which in turn reflects perfusion of other vital organs -Laboratory studies usually include a complete blood count with platelet count, fibrinogen, fibrin split products, prothrombin time, and partial thromboplastin time. -Blood type and antibody screen are done if not previously performed

47
Q

Etiology of Anaphylactoid Syndrome of Pregnancy or Amniotic Fluid Embolis (AFE):

A

-a rare but devastating complication of pregnancy characterized by the sudden, acute onset of hypotension, hypoxia, and hemorrhage caused by coagulopathy. -AFE is considered to be unpreventable. -AFE is neither an embolism or amniotic fluid-related, although it’s timing suggests a breach of the normal physiologic barriers between woman and fetus

48
Q

The classic signs of shock may not show up until women have lost 30% of blood volume. What is the shock index?

A

-Shock index is the ratio of heart rate to systolic blood pressure; with shock, as the heart rate increases, the blood pressure decreases. -For example, with a heart rate of 120 and a systolic blood pressure of 90, the shock index is 1.3. -A shock index greater than 1.1 suggests significant blood loss, even before there are notable changes in the vital signs

49
Q

Emergency Interventions for Anaphylactoid Syndrome of Pregnancy:

A

1 Oxygenate - Administer oxygen by nonrebreather face mask (8-10 L/ min) or resuscitation bag delivering 100% oxygen. - Prepare for intubation and mechanical ventilation. - Initiate or assist with cardiopulmonary resuscitation. Tilt pregnant woman 30 degrees to her side to displace uterus. #2Maintain cardiac output, and replace fluid losses. - Position woman onto her side. - Administer intravenous fluids. - Administer blood products: packed cells, fresh-frozen plasma. #3 Monitor status: Insert indwelling catheter, and measure hourly urine output. - Correct coagulation failure. - Monitor fetal and maternal status. - Prepare for emergency birth once woman’s condition is stabilized.

50
Q

What additional assessments will be made if the source of bleeding is not due to uterine atony?

A

-visual or manual inspection of the perineum, the vagina, the uterus, the cervix, or the rectum -laboratory studies (hemoglobin, hematocrit, coagulation studies, platelet count)

51
Q

When should the nurse suspect bleeding secondary to lacerations?

A

If bleeding continues despite a firm, contracted uterine fundus. This bleeding can be a slow trickle, an oozing, or frank hemorrhage.

52
Q

Clinical manifestations for Mastitis:

A

-fever -malaise -flulike symptoms -sore area on a breast

53
Q

dinoprostone

A

Action: contraction of the uterus Side effects: HA, NV, fever, chills, diarrhea Contraindications: caution with asthma or hypertension or hypotension Nursing: monitor bleeding and uterine tone

54
Q

Who should not receive prostaglandin F2a? Why?

A

Prostaglandin F2α should not be given to women with a history of asthma as it can cause bronchoconstriction

55
Q

Clinical manifestations of SVT:

A
  • pain and tenderness in the lower extremity. -warmth, redness, and an enlarged, hardened vein over the site of the thrombosis.
56
Q

What is the nursing alert for 3rd and 4th degree lacerations?

A

To avoid injury to healing tissues, a woman with third- or fourth-degree lacerations is not given rectal suppositories or enemas

57
Q

Nursing/medical care for Mastitis:

A

antibiotics

58
Q

The most objective and least invasive assessment of adequate organ perfusion and oxygenation is:

A

a urine output of at least 30 mL/ hr and preferably ≥ 50 mL/ hr

59
Q

Etiology of DVT:

A

-Occurs most often in the lower extremities; involvement varies but can extend from the foot to the iliofemoral region -hard to diagnose in pregnant women

60
Q

Nursing/medical care for Endometritis:

A

-IV broad-spectrum antibiotic therapy (cephalosporins, penicillins, or clindamycin and gentamicin) and supportive care, including hydration, rest, and pain relief. -Antibiotic therapy is usually discontinued 24 hours after the woman is asymptomatic. -Assessments of lochia, vital signs, and changes in the woman’s condition continue during treatment. -Comfort measures depend on the symptoms and may include cool compresses, warm blankets, perineal care, and sitz baths.

Exam III (6 decks)

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