Postpartum complications Flashcards
Which after birth conditions are considered medical emergencies that require immediate treatment?
Inversion of the uterus and hypovolemic shock
Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin. Coagulopathies should be identified before delivery and treated accordingly. Although subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP) are serious conditions, they do not always require immediate treatment. ITP can be safely managed with corticosteroids or IV immunoglobulin. Disseminated intravascular coagulation (DIC) and uterine atony are very serious obstetric complications; however, uterine inversion is a medical emergency requiring immediate intervention.
The priority nursing intervention when a nurse observes profuse after birth bleeding is to:
palpate the uterus and massage it if it is boggy.
The priority nursing intervention is to stop the bleeding. Once the nurse has applied firm massage of the uterine fundus, the primary health care provider should be notified or the nurse can delegate this task to another staff member. This intervention is appropriate after assessment and immediate steps have been taken to control the bleeding. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Vital signs will need to be ascertained after fundal massage has been applied.
Which after birth infection is most often contracted by first-time mothers who are breastfeeding?
Mastitis
Endometritis is the most common after birth infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. Wound infections are also a common after birth complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are first-timers who are breastfeeding. Urinary tract infections (UTIs) occur in 2% to 4% of all after birth women. Risk factors include catheterizations, frequent vaginal examinations, and epidural anesthesia.
The priority nursing intervention for a woman who suffered a perineal laceration is to:
establish hemostasis.
Bleeding should be stopped first. After bleeding has been controlled, the care of the woman with lacerations of the perineum includes analgesia administration, hot or cold applications, and stool softeners. Stool softeners may be used to assist the woman in reestablishing bowel habits without straining and putting stress on the suture lines.
What treatment that should be considered first for the client with von Willebrand disease who experiences a after birth hemorrhage is:
desmopressin.
Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer. Treatment with plasma products, such as factor VIII and vWf, are an acceptable option for this client. Because of the repeated exposure to donor blood products and possible viruses, this is not the initial treatment of choice. Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. Although the administration of this prostaglandin is known to promote contraction of the uterus during after birth hemorrhage, it is not effective for the client who presents with a bleeding disorder.
A woman gave birth to a 7-lb, 3-ounce boy 2 hours ago. The nurse determines that the woman’s bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:
excessive uterine bleeding.
A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended, because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.
Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that:
the expected weight loss immediately after birth averages about 11 to 13 lbs.
Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week after birth period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 lbs. The expected weight loss immediately following delivery is 11 to 13 lbs, followed by a gradual decrease and a return to prepregnancy weight in 2 to 3 months. Weight loss continues during breastfeeding since fat stores developed during pregnancy and extra calories consumed are used as part of the lactation process.
Which description of after birth restoration or healing times is accurate?
Rugae reappear within 3 to 4 weeks.
The cervix regains its form within days; the cervical os may take longer. Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.
With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:
fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium.
Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Excess fluid loss through other means occurs as well. Bladder tone usually is restored 5 to 7 days after childbirth.
Baby-friendly hospitals mandate that infants be put to breast within what time frame after birth?
1 hour
Baby-friendly hospitals mandate that the infant be put to breast within the first hour after birth (BFHI, 2010). The ideal time to initiate breastfeeding is within the first 1 to 2 hours after delivery. In many countries this is the norm; however, the Baby-Friendly Hospital Initiative (BFHI) mandates 1 hour. Ideally an infant should go no longer than 2 hours after delivery before being put to breast. This is much too long to wait to initiate breastfeeding, whether the hospital is baby-friendly or not.
When palpating the fundus of a woman 18 hours after birth, the nurse notes that it is firm, two fingerbreadths above the umbilicus, and deviated to the left of midline. The nurse should:
assist the woman to empty her bladder.
A firm fundus should not be massaged since massage could overstimulate the fundus and cause it to relax. Methergine is not indicated in this case since it is an oxytocic and the fundus is already firm. The findings indicate a full bladder, which pushes the uterus up and to the right or left of midline. The recommended action would be to empty the bladder. If the bladder remains distended, uterine atony could occur, resulting in a profuse flow. This is not a normal finding, and an action is required.
Two hours after giving birth a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm at the umbilicus and midline. Her lochia is moderate rubra with no clots. The nurse suspects:
hematoma formation.
Bladder distention results in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony results in a boggy fundus. Constipation is unlikely at this time. Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.
Which findings would be a source of concern if noted during the assessment of a woman who is 12 hours’ after birth? (Select all that apply.)
Pain in left calf with dorsiflexion of left foot
Postural hypotension is an expected finding related to circulatory changes after birth. A temperature of 100.4° F in the first 24 hours most likely indicates dehydration, which is easily corrected by increasing oral fluid intake. A heart rate of 55 beats/min is an expected finding in the initial after birth period. These findings indicate a positive Homans’ sign and are suggestive of thrombophlebitis and should be investigated. Lochia with odor may indicate infection.
CORRECT
Lochia rubra with foul odor
The nurse examines a woman 1 hour after birth. The woman’s fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse’s initial action would be to:
massage her fundus.
There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methergine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.
Perineal care is an important infection control measure. When evaluating a after birth woman’s perineal care technique, the nurse would recognize the need for further instruction if the woman:
uses the peribottle to rinse upward into her vagina.
These are all appropriate measures. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina since debris would be forced upward into the uterus through the still-open cervix.
