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Maternal Exam 4 > Postpartum Complications > Flashcards

Postpartum Complications Flashcards

1
Q

New criteria for EBL in PPH?

A

EBL increased to 1000 mL for any type of delivery due to how hard it is to see the actual blood loss

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2
Q

What criteria can help you put together that there’s been a PPH?

A

EBL of 1000 ml
Signs of shock
H&H levels

BUT it depends on when you are hemorrhaging (early vs late)

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3
Q

What H&H levels are indicative of PPH?

A

Decrease of 10% from admission H&H

Hematocrit - below 33%
Hemoglobin - below 11

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4
Q

What if then H&H does show there’s been a hemorrhage?

A

H&H will determine the IV fluids, blood products, ,iron, etc

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5
Q

Two types of Post Partum Hemorrhage?

A

Early (primary)

Late (secondary)

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6
Q

What is early PPH?

What is the criteria?

A

When PPH is occurring within first 24 hours after giving birth
- most happen right at birth tho

EBL of more than 1000 mL & can confirm with H&H check showing a change of more than 10%.

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7
Q

What is late PPH?

How does the patho work?

A

PPH that happens after 24 hrs up to 6 weeks post partum.
- usually happens 2-3 weeks out

PPH late patho is that there is sloughing of the placenta and breakthrough bleeding occurs.

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8
Q

The major complication of any type of PPH?

A

Hemorrhagic shock rt hypovolemia or when you can’t perfuse your organs anymore

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9
Q

Number one cause of early PPH

A

Uterine atony

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10
Q

What is uterine atony?

Time phrase this usually occurs in?

A

Flaccid uterus with no tone and clamping which leads to bleeding

1 hr after giving birth

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11
Q

List possible causes of uterine atony

A 
Over-distention of uterus 
Labor dystocia
Too much Oxytocin
Grandmultiparity
Agents that cause uterus to relax
Prolonged 3rd stage of labor
Operative births
Retained placenta
Asian, Hispanics, Gingers
Preeclampsia
Precipitous labor
NO risks
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12
Q

Explain how over-distention of the uterus can cause uterine atony

A

A big fetus or multiples/twins can lead to over distention and stretch making it harder for the uterus to clamp shut

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13
Q

Explain labor dystocia causing uterine atony

A

Labor dystocia or being prolonged can stretch out the uterus and cause atony issues

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14
Q

How can oxytocin use cause uterine atony?

A

Too much oxytocin to induce can cause aggressive contractions that can lead to trauma and therefore uterine atony

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15
Q

How is that grandmultiparity is a cause of uterine atony?

A

A high amount of births can make your uterus stretch and atony can occur.

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16
Q

Why do relaxation of uterus agents cause uterine atony?

A

Because if the uterus is relaxed by these then it can’t clamp

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17
Q

Why is a mom who has had a prolonged 3rd stage of labor be more likely to have uterine atony?

A

Prolonged 3rd stage means the placental separation takes a long time. This can create a larger time frame for the placenta to bleed since the uterus can’t clamp down if it is still attached

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18
Q

What are operative births and how can they cause uterine atony?

A

Operative births are episiotomies, vacuum, forceps, or C-sections.
And they can cause uterine atony bc it can cause more trauma to uterus.

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19
Q

What is the reason why a piece of the placenta being left behind can cause uterine atony?

A

A retained placenta means that the uterus can’t clamp and so the atony and bleeding occurs.

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20
Q

Which populations are at higher risk of uterine atony?

A

Asians, hispanics, and red heads

  • natural red heads have higher risk of bleeding
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21
Q

How is it that preeclampsia can cause uterine atony?

A

The pre-clampsia occurs and a hypovolemic state happens since the fluid moves into the vascular in order to try to compensate for high blood pressure (not a good comp tho)

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22
Q

Precipitous labor can cause uterine atony how?

A

Precipitous labor means a really fast labor and so with fast labors, there can be trauma which leads to uterine atony.

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23
Q

What should you as a nurse be doing if you patient doesn’t have any risk factors of PPH?

A

You still need to do all your assessments and checks. It can happen to anyone!

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24
Q

PPH assessment findings from Uterine Atony

Late signs of PPH?

A

1) boggy uterus
2) Lochia saturated pad with large clots
3) Pale, clammy skin
4) anxiety bc she knows something is wrong

Late sign) Tachycardia + Hypotension + Decrease UO

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25
Q

What should anticipate if someone is going to be high PPH risk patient?

What else do you need to?

A

Putting blood on hold for them

Establish and large bore IV site . 18 g usually or 16.
can’t hurt to have 2 ready to go either

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26
Q

When you feel the fundus and it feels high or shifted, what do you need to check?

What is the initial action you do if you learn the bladder is empty?

A

Check to see if the bladder is full by using the catheter
- if it was already a complicated delivery they Cather may even be already left in so you don’t even have to check

Initial action is to massage the uterus to express clots and maybe initiate contraction

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27
Q

What will the physician and ONLY the physician do if uterine atony is suspected?

A

Bimanual massage by physician which is when they have one outside uterus to massage and one inside to clean out clots.

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28
Q

What uterotonic drugs and what do they do?

A

Oxytocin (first line), Hemabate, Cytotec, Methergine

They improve tone/clamp of the uterus for uterine atony care

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29
Q

Oxytocin side effects and route

A

water intoxication on day 3 or so, N/V

IV route in labor but IM too after

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30
Q

Misoprostol side effects and route

A 
(Cytotec ) 
headache, n/v, hypertension
IM
Can give rectally too to control bleeding
Sublingual
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31
Q

Methergine side effects?
What route do we give it in?
Who would this med be a good option for?

A

Hypertension, N/V, headache
IM route

Good for grandmultiparity moms

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32
Q

Hemabate side effects and route

A

Prostaglandin SE’s of n/v, diarrhea, fever

Avoid is asthma

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33
Q

Cervidil side effects and route

A

Prosaglanding SE’S of n/v, diarrhea, fever

Avoid in asthma
Usually for induction of labor but can also be given for PPH

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34
Q

What is Transexamic Acid?

What can it be given for? Route? Other delivery?

A

TXA is an Antifibrinolytic and so it keeps clots together for longer to keep blood loss down

Post partum hemorrhage/atony!
Heavy Menstruation
Hemophiliacs
Dental surgery (or any other surgery)

Route IV or PO whole.
Works best around 3 hrs and can be given in c section too

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35
Q

What will you as the nurse have to administer in atony hemorrhage?
What do you need to monitor on labs?

A

Oxygen via facemask
IV fluids

Level of anemia so H&H

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36
Q

What can be activated in a hemorrhage from atony?

A

Massive blood transfusion protocol includes fibrinogen, coagulation factors, packed rbcs, etc
“I want everything you got”

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37
Q

What leg positioning can be helpful during atony pph?

A

Elevating the legs to increase circulation

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38
Q

How can we put pressure against placenta in order to delay bleeding?

A

BAKRI or uterine balloon tamponade can be filled with around 300 ml of fluid to go inside uterus to put pressure on placenta
- its like the same things is bimanual massage but with object

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39
Q

Surgical intervention needed for uterine atony pph if nothing else works?
What needs to be done for this to happen?

A

Hysterectomy to save mom’s life

Get verbal consent from spouse or whoever they can talk to

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40
Q

What are lacerations? And where?

A

Tear upon birth canal that occurs in the pathway of least resistance so anywhere

(perineum, cervix , vagina, labia, urethra for example)

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41
Q

Laceration causes

A 
Precipitous birth
Anesthesia epidural 
Macrosomic infants
Forceps/Vacuum
Too much Oxytocin
VBAC
Pelvic varicosities
Previous scarring
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42
Q

Which of these can cause Lacerations of the Birth canal….. ? part 1

Precipitous birth
Preterm labor
SGA baby
Macrosomic baby
Forceps/Vacuum
Too much Oxytocin
A

Laceration caused are…

Precipitous birth due to the birth going too fast and trauma

Macrosomic baby bc too large and trauma

Forceps/Vacuums bc of trauma

Too much oxytocin bc if too powerful of contractions, can lead to trauma

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43
Q

Which of these can lead to Laceration of the Birth canal ? part 2

VBAC
Pre-eclampsia
Chromosome abnormalities
Pelvic varicosities
Previous scarring
Epidural anesthesia
A

Laceration causes are..

VBAC (vaginal birth after section)

Pelvic varicosities or veins in the genital area which rupture ( is common in high gravidas)

Scarring due to the fibrous tissue not being able to stretch

Epidural anesthesia due to mom not feeling her push

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44
Q

What are classic findings of a laceration?

A

When there’s bleeding but the fundus is firm and midline like it should be

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45
Q

How to diagnose laceration?

What comes next?

A

Physician will go bottom to up to find the bleed.

Identify first then suture and manage will come next

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46
Q

What is there to manage after a suturing of a laceration?

What is there to prevent after laceration suture? And how?

A

Pain with meds

Infections with antibiotics

Constipation prevention with Colace, fiber, and WARM fluids.
- pain meds can contribute to the constipation

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47
Q

What is the meaning of Retained Placental fragments? And how long?

A

When the placental tissue is left behind for at least 3o min after delivery

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48
Q

What is a Retained Placental caused by?

A

An abnormally adherent placenta (there are categories of this)

Rare times when they had to manually remove placenta and some got left behind there too

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49
Q

What diagnostic test can be used to dx retained placenta?

What other assessment?

A

Sonogram/ultrasound can be used to check. The placenta will show up as a thicker segment of the uterus on the sonogram.

Physician needs to look at the intact placenta to make sure

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50
Q

Main 3 types of abnormally adherent placenta categories?

A

Accreta
Increta
Percreta

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51
Q

Accreta

A

slight penetration of the placenta into the myometrium

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52
Q

Increta

A

Deep latching of the placenta into the myometrium

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53
Q

Percreta

A

When the placenta is penetrating the myometrium and other organs causing perforations

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54
Q

What type of delivery will mom do if she is accreta, increta, or percreta?

What surgery may have to happen if they can’t get the placenta to separate?

A

Planned C-section

Hysterectomy

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55
Q

What if the physician walks over and see’s the placenta isn’t all there?

A

Physician will do a manual exploration to remove the clots and tissue
- bimanual massage I think?

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56
Q

What invasive like treatment will they do to remove clots/tissue in retained placenta situations?

Risk?

A

Can do Curettage by using a serrated blade to go up and remove the fragments

Infection risk so use antibiotics
- really a risk for anytime they go up the vaginal canal

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57
Q

What are Hematomas?

A

An injury to blood vessel from labor which causes bleeding into the tissue
- on avg around 250-500 mL

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58
Q

Common areas of hematomas?

A

Vulva, vagina, pelvis

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59
Q

Risk factors for Hematomas that rt trauma

A 
Episiotomy 
Forceps/Vacuum
Macrosomia 
Prolonged second stage due to pushing and friction
Precipitous birth going to fast
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60
Q

Vulva Hematoma symptoms

A

Vulva swelling, pain, and blue discoloration

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61
Q

Vaginal Wall Hematoma symptoms

A

Vaginal wall pain, pressure, and needing to urinate or stool but not being able to

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62
Q

What is pain like with Hematomas?

A

Very severe. You can give them pain meds but the pain comes right back.

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63
Q

What is an occult hematoma?

A

A lot of them can be seen but some are occult or hidden hematomas that you can’t see which are usually up high.

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64
Q

Retroperitoneal Hematoma symptoms?

A

Less pain due to less pressure but blood can pool more.
Tachycardia, hypotension can occur without other symptoms.
So if you see these trends and there’s no bleeding anywhere, talk to physician.

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65
Q

Late sign of Hematomas?

What if pt just doesn’t look right?

A

Fever due to blood being a foreign object in tissue

Make the resident come look. Ask physician if resident isn’t there.

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66
Q

Small Hematoma treatment

A

If less than 3 cm ice and apply pressure

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67
Q

Large Hematoma treatment

A

If greater than 3 cm, need to make incision, drain the blood, and suture.

  • can put drain to and pack in but up to doctor
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68
Q

Why might a physician use a drain and pack for hematoma treatment?

Why use an indwelling Cather?

A

Leaving the drain in can help you know if the initial drain worked.
Packing can help absorb/collect more blood.

Doc will want indwelling catheter to make sure she can void after hematoma drain treatment.

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69
Q

What meds do you expect patient to be on after drainage of hematoma?

A

Antibiotics due to the pooling of blood being a good place for bacteria to breed

Analgesics for pain

Antipyretics for fever

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70
Q

Comfort intervention for hematoma treatment?

A

Warm sitz bath

- can also help clots absorption

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71
Q

In regarding hematoma, what should nurse do first before one even occurs?

A

Review chart for risk factors of hematoma in mom

Monitor mom frequently

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72
Q

What should nurse do with a hematoma?

A

Apply ice for up to 24 hrs.
Use pain scale and locate pain
Monitor vitals and pay attention to tachycardia
- bc mom’s hr should never go up after birth

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73
Q

What things to do with hematoma regarding physician?

Avoiding lawsuits nursing actions

A

Communicate
Know lab trends and report them to him

AND document well! avoid lawsuits

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74
Q

What is Uterine Inversion?

A

A prolapse of the uterine fundus through the cervix to the point it hangs out of the vagina

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75
Q

When doing a fundus check, what will a Uterine inversion feel like?

Is this a post or pre delivery problem?

A

The fundus will be unpalpable.

It comes post delivery or after the delivery of the fetus.

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76
Q

What can happen if you place too much traction on the umbilical cord?

Other reason due to placenta?

A

It can cause the uterine inversion or the flipping out of the vagina by pulling too hard during placenta separation with forceps

This may also be due to a placenta that is abnormally adhered to the uterus.

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77
Q

How can drugs cause uterine inversion? And which drugs?

A

Drugs can relax the uterus too much to where it inverts

Mag sulfate is one drug and Terbutaline (or even a long labor)

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78
Q

Main causes of Uterine inversion summary?

A

Excessive traction on the umbilical cord

Abnormal adherence to placenta

Fundal pressure applied to the relaxed uterus

Drugs relaxing a uterus too much

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79
Q

How can too much fundal pressure on a uterus cause uterine inversion?

A

If you apply pressure to a relaxed uterus you can just push it out

80
Q

What does uterine inversion look like?

A

A. beefy red mass hanging out

81
Q

How do you know not to push forceps to hard on the cord to avoid uterine inversion?

A

If you get resistance - need to stop.

82
Q

First step in uterine inversion treatment?

A

Immediate recognition

83
Q

When dealing with uterine inversion, what do the physician have to do?
Is this painful?

A

Physician will have to reposition the uterus

Very painful so may need tocolytic or general anesthesia

84
Q

After the physician repositions the uterus in a uterine inversion, what needs to be done?

A

Mom needs to be on Oxytocin to promote uterine clamp and tone

85
Q

What surgical treatment may be needed for a uterine inversion?

A

A hysterectomy if no other option

- in order to avoid large blood loss

86
Q

What risk goes up with uterine inversion?

A

Infection risk due to the uterus literally being turned inside out
- so give antibiotics

87
Q

What needs to be replaced for uterine inversion?

A

Blood product replacement and IV fluids

88
Q

After uterine inversion treatment and repositioning, should you do fundal checks?

What should you do?

A

No because it can push the fundus out again

Keep mom flat and assess lochia and vitals

89
Q

3 R’s with uterine inversion

A

Recognition
Replacement
Restitution

90
Q

What is a uterine rupture?

A

Just a uterine wall tear

91
Q

Biggest risk factor of a uterine rupture?

A

A previous uterine scar that ruptures

- so this risk only occurs in a TOLAC or trial of labor after c section

92
Q

How can over distention cause a uterine rupture?

A

The over distention causes thinning of the uterus and so the uterus just breaks

93
Q

How can grand multiparity hx cause a uterine rupture?

A

Having lots of babies can thing uterus too and so it just ruptures

94
Q

What types of operative births can cause uterine rupture?

A

Vacuum

Forcep

95
Q

How can too much Oxytocin induction cause uterine rupture?

A

It’s only if the oxytocin is given too aggressively but the induction causes too much pushing for the body to handle and so there’s a rupture

96
Q

What happens to FHR if uterine rupture occurs?

A

FHR changes very abruptly

97
Q

What will mom feel if there is a uterine rupture?

A

She will feel sudden onset of pain that feels like a tearing sensation

98
Q

During a uterine rupture what symptoms can arise from blood loss?

A

Shock like symptoms due to excessive bleeding

99
Q

How serious is a uterine rupture?

What do you need to make sure of?

A

An obstetric emergency. You will be racing to the OR to save mom’s life immediately .
- so make sure you have a plan

100
Q

How many IV sites do you need incase of uterine rupture ?

A

Two IV sites

- so definitely make sure to have a 2nd IV site before going into birth if you think she might bleed or rupture

101
Q

What do you need to provide for family during uterine rupture of mom?

A

Provide support for family and keep them informed

102
Q

What directions can a uterine rupture occur?

A

Literally anywhere and any direction

103
Q

Types of Coagulation Disorders that can cause blood loss?

A

HELLP Syndrome

DIC

104
Q

What is HELLP syndrome again?

What is HELLP syndrome associated with?

A

Lab diagnosis of Hemolysis , Elevated Liver, Low platelets

Pre-eclampsia but you don’t actually have to be hypertensive

105
Q

What is DIC?

A

Disseminated Intravascular Coagulation syndrome that coagulation pathways are hyper activated and you use up factors way too quickly and thus you eventually bleed out orifices (DIC)
- too many mini clots that use up the factors and plug organs too

106
Q

What causes DIC usually?

A

It is secondary to another cause therefore it has a trigger

- abruptio placenta is very common

107
Q

What other things can cause the DIC or hyper- clotting?

A

Retention of the demised fetus due to thromboplastin release

Septicemia

Severe Preeclampsia or HELLP

Amniotic Fluid emboli

Septic abortion

Maternal liver disease

Any major trauma
- icu is common to see DIC

Essentially some trauma causes it.

108
Q

Other names for DIC?

A

Consumption Coagulapathy

Defibrination Syndrome

109
Q

How can DIC affect organs?

A

Mini clots get pilled up and can cause organs from getting blood and have organ failure

110
Q

Fibrinogen levels of DIC

A

Fibrinogen levels drop

111
Q

D-dimer levels of DIC

A

Elevated D-dimer

- should be single digits

112
Q

In DIC they have present of FSP or FDP. What does this mean?

A

In DIC, there will be Fibrin Split Products or Fibrin Deprivation Products
- same thing just means fibrin is breaking down means no coagulation/clotting

113
Q

What will H&H levels in DIC be?

Platelets of DIC?

RBC of DIC?

A

Decreased H&H

Decreased platelet

Decreased RBC

114
Q

Prothrombin/INR time of DIC?

A

Prolonged prothrombin/INR time

115
Q

What will you see on CBC morphology smear in DIC?

A

Torn or fragmented RBC - - known as Schistocytes

116
Q

What peripheral signs will you see with DIC around the mouth? What are some you can’t see right away?

What about their neurologic symptoms?

A

Peripheral signs of the thrombosis such cyanosis around the mouth.
Organ failure or impairment that you may not pick up on.

Confusion, drowsiness, and then slip into coma

117
Q

What will bleeding be like in DIC?

A

Prolonged uncontrolled bleeding and can occur at 3 or more sites really anywhere

118
Q

Attitude of DIC patient?

A

Anxious

119
Q

Body marks of DIC?

A

Bruising and Petechia

- especially from Blood pressure cuff

120
Q

From bleeding, DIC can cause what shock symptoms?

A

Pale, clammy skin
Tachycardia
Tachypnea
Hypotension

121
Q

First step of DIC management

A

Treat the cause or trigger:

Abruptio Placenta

Retention of the demised fetus due to thromboplastin release

Septicemia

Severe Preeclampsia or HELLP

Amniotic Fluid emboli

Septic abortion

Maternal liver disease

Any major trauma
- icu is common to see DIC

Essentially some trauma causes it.

122
Q

What do we give to mom with DIC?

A

Oxygen
IV
Blood transfusions
- monitor for reaction here

123
Q

What to monitor for DIC care?

A

Monitor reactions to blood transfusions

Monitor blood loss

Monitor I&O

Monitor lab trends

124
Q

Why is it so important to monitor I&O with DIC?

A

They’re at a renal failure risk

So monitor for blood and color in urine, SG, I&O hourly with catheter

125
Q

Why do DIC patients go to ICU?

A

They can be monitored there better

126
Q

After DIC, what is a patient considered

A

Anemic

- so put on blood products and iron

127
Q

How long is DIC hospital stay?

A

Prolonged

128
Q

What is ITP or Idiopathic thrombocytopenia?

A

Antibodies kill of platelets causing decreased count of platelets and more bleeding due to fragile capillaries

129
Q

Risks of Idiopathic thrombocytopenia or ITP?

What about risks to newborn with ITP?

A

Bleeding in vaginal or C-section birth

Newborn being born with thrombocytopenia

130
Q

What meds can help with Idiopathic thrombocytopenia or ITP to stabilize platelets?

A

Prednisone but only until close to delivery so corticosteroids

IV immunoglobulin

131
Q

What more invasive methods can help manage ITP or idiopathic thrombocytopenia?

A

Platelet transfusion

Splenectomy if medical management needs it

132
Q

Main lab to check for ITP or Idiopathic thrombocytopenia?

A

CBC or platelet

133
Q

What are blood dyscarshias?

A

Blood issues that cause bleeding with no other obvious cause

134
Q

What is a von Willebrand Disease?

Main risk? And how long?

A

Type of hemophilia lacking vW factor.

They can bleed out in labor and can be at risk for up to 4 weeks

135
Q

Symptoms of von Willebrand Disease?

A 
Nosebleeds and bruises
Prolonged bleeding 
Factor 8 deficiency 
Lochia progression (or regression?)
136
Q

Treatment of von Willebrand Disease?

A

Desmopressin and with a little bit of factor 8

Transfusion w plasma

Antihemophiliac factor

137
Q

Diagnosis of von Willebrand Disease sometimes if someone doesn’t know they have it?

A

Blood clotting factor panel is ordered for those who are showing signs but have no hx of Willebrand disease.

138
Q

How to be 1. Ready for OB hemorrhage of any kind (safety bundle)?

A

Hemorrhage cart and meds
Team on stand by
Massive blood transfusion protocols
Unit education drills

139
Q

How to 2. Recognize and Prevent hemorrhage?

A

Assess risk factors for hemorrhage and inform others like anesthesia and aid

Do Active Blood Loss measurement - but don’t estimate

Active management of 3rd stage (placenta stage)

140
Q

How to 3. Respond to hemorrhage?

A

Emergency plan with checklist

Pt and family support

141
Q

How to 4. Report and System learn?

A

Debrief post incident

Multidisciplinary review to improve (what could be done better)

Monitor outcomes and process (was there good communication, call back of meds)

142
Q

Major 4 steps of safety bundle for OB Hemorrhage

A

1) Readiness
2) Recognize and Prevention
3) Response
4) Report and System Learn

143
Q

What is Late Hemorrhage due to?

A

Sub-involution of uterus due to retained placenta and infection caused by it
- sub involution is just the uterus not going back to normal

144
Q

Signs of Late Hemorrhage (3 groups)?

A

Fundus does not firm and it is high

Unexpected Lochia that is heavy or is regressing (should be rubra, serosa, alba so if its backwards its a problem)

Symptoms of Endometritis
- foul odor, fever, uterine tenderness, bachache

145
Q

Endometritis signs (rt to late hemorrhage)

A

Symptoms of Endometritis
- foul odor, fever, uterine tenderness, bachache

She acts like a C-section
Vaginals don’t feel super painful with fundal checks

146
Q

How is diagnoses of Late hemorrhage done?

A

Ultrasounds to see if there’s still fragments and signs

147
Q

Procedure for Late Hemorrhage?

What is given after?

A

D&C to remove placental fragments left behind

Oxytocin and Antibiotics
- start on IV but only in hospital for 24 hours so then oral

148
Q

What position is required for Late Hemorrhage post procedure of D&C?

A

Semi Fowlers

149
Q

Discharge instructions for moms with Late hemorrhage?

Diet?

A

Limit activity and tell mom need will assistance

Increase iron, protein, and fluids

150
Q

How can a late hemorrhage affect breastfeeding?

A

Delayed lactogenesis leading insufficient milk production from anterior pituitary necrosis rt cushings

151
Q

What doe late hemorrhage increase risk of mental health wise?

A

Post partum depression risk increased with late hemorrhage

152
Q

What is the defintion of Postpartum infections?

A

Any infection of the genital tract within 28 days after birth (miscarriage and abortion count too)

153
Q

Types of Post partum infections?

A

Endometritis or Metritis

Pelvic Cellulitis/Perimetriritis

Wound Infections

154
Q

What is Endometritis or Metritis?
What has reduced this?

Symptoms?

A

Involved endometrial lining

Prophylactic antibiotics before c-section or invasive procedures

Symptoms of Endometritis
- foul odor, fever, uterine tenderness, bachache, tachycardia, chills

155
Q

What is Pelvic Cellulitis/ Perimetritis?

A

A spreading of the original endometritis to the pelvic area from the cervix or lymphatic system

156
Q

Symptoms of Pelvic Cellulitis/ Perimetritis?

A

Go to ICU

High fever, rebound pain, sub involution of uterus, tachycardia, Abscess!!!

157
Q

Why are wound infections from C-Sections so low?

A

Due to prophylactic antibiotics but they still happen.
Lexus ring
Closure technique
Irrigation

158
Q

Assessment for C-sections to avoid the Post partum infection?

A

REEDA assessment

159
Q

Why are crash emergency C-sections more likely to have post partum infection?

A

Due to them being done quick and being unexpected so asepsis is altered

160
Q

How do they diagnose the post partum infection?

A

Culture the exudate - especially if wound is open.

161
Q

Treatment for wound after section (to avoid post partum infection?)

A

NS irrigation w frequent dressing changes

Wound vac
- But sometimes people go home with open wounds so they could go home with this too

162
Q

Puerperal Morbidity?

Why are the first days not included?

A

Temp greater than 100.4 on days 2-10 days after delivery

Due to dehydration and fatigue

If it is high later on, its an infection.
- uti/cystitis
- pyelonephritis
-

163
Q

Why is UTI a risk postpartum 2-10 days ?

A

Due to her using a urinary catheter

Anesthesia stopping mom from peeing

Frequent pelvic exams

Postpartum urinary retention

164
Q

Symptoms of UTI and cystitis?

A

Dysuria, frequency increase, urgency, hematuria, pyuria (puss in urine_

165
Q

DX of UTI and cystitis?

A

Clean catch of the urine
UA micra
Culture and sensitivity
- just typical UTI treatment

166
Q

Pyelonephritis?

A

Kidney infection that is an ascending infection from elsewhere
- usually happens in right kidney

167
Q

Pyelonephritis signs and symptoms?

A

Cystitis symptoms, high fever, flank pain, n’v, CVA tenderness, acute illness

168
Q

Pyelonephritis diagnosis?

A

Urine culture to dx organism for antibiotics

169
Q

Pyelonephritis treatment?

A

Antibiotics

Fluids

Acidify urine with cranberry, plum, apricot , prune juice and vitamin C (bc less friendly to organisms)

Void frequently

Repeat urine culture and sensitivity after treatment to make sure

170
Q

What is Mastitis?

A

Can be 10 days - 2 weeks out from delivery

One breast that is warm to touch and painful with maybe even a fever
- can be from plugged duct

171
Q

Contributing factors to Mastitis?

A

Milk stasis - so empty breasts and empty one before next
Alternate starts
Hygiene

172
Q

Assessment of the breast for mastitis?

What if it yeast?

How can bacteria cause the mastitis?

A

Breast consistency, skin color, surface temp

Nipple is pink, shiny, itchy and painful . Milk smells like yeast.
- treat w anti fungal like Diflucan

cracked nipple so keep the area clean

173
Q

Mastitis prevention

A 
Proper feeding
Consult with lactation nurse
Bra must be supportive
Hygiene
Check to see if breast is fully soft all the way around
174
Q

Why does the breast need to be soft all the way around?

A

If it is hard, then it is blocked duct and can lead to mastitis.

175
Q

How to empty the breast to keep from mastitis?

A

Start with unaffected breast, let down, switch to affected breast last
- but some will just quick

176
Q

How to make breast feel better for mastitis?

A

Analgesics
Warm moist compress
Supportive bra
Bedrest

177
Q

How to treat bacterial mastitis?

A

Dicloxacillin

Cephalosporins

178
Q

What happens if you delay treatment fo mastitis?

Treatment?

Post - treatment needs?

A

Abscess formation

IV antibiotics
I&D to open, drain , pack and suture up the breast

Continue to empty breast with breast-feeding or pumping

179
Q

What is a VTE or Venous Thromboembolism?

A

Blood clot in vein wall in response to inflammation

180
Q

When is the VTE risk the highest?

A

During PG and into 6 weeks post partum. Blood is thicker and women is less active after delivery

181
Q

What is VTE cause rt Virchow’s triad?

A

Venous stasis

Increased clotting factors and fibrinogen

Injury to epithelium of blood vessels

(The perfect storm for clot formation)

182
Q

Birth that can cause VTE?

PG Conditions related to it?

A

Csection

Endometritis
Inherited clotting disorder (Leiden 5 factor )

High parity (so experienced moms)
 advanced maternal age (so old moms)
183
Q

Lifestyle choices that cause VTE?

Limitations that cause VTE?

A

Obesity
Smoking

Anything that cause decreased mobility

184
Q

Meds that cause VTE?

A

Fibronolysis inhibitors

185
Q

What meds will you be on for Factor 5 Leiden?

A

Anticoagulants like Lovenox or heparin

186
Q

Major concern with VTE?
Example?

What kind is worse?

A

Main concern is that the clot will become an emboli.

Example : deep leg vein clot traveling to pulmonary artery and causing an obstruction flow

Deep VT is way more serious

187
Q

Should you use homans sign for VTE or DVT?

A

No probably not

188
Q

Where will pain be in the VTE?

What else happens to leg?

A

Pain in leg, inguinal area, or lower abdomen

Edema in leg (2cm difference) that feels cool to touch

189
Q

Perfusion assessment fr VTE?

Which leg is VTE in PG more common in?

A

Diminished pulses, change in limb coloring, circumference change of greater than 2 cm

Left leg

190
Q

VTE/DVT diagnosis

What meds are you going to put them on if its just superficial?
What interventions?

What is the seriousness of a DVT?

A

Doppler ultrasound and physical findings

If positive superficial, not a big issue. Put on aspirin or heparin if you need to and give analgesics, stockings, heat and rest

If deep vein, this is a concern.

191
Q

Treatment meds for DVT for the clots, infection , and pain?

Can mom breast feed?

A

Heparin,
Lovenox
Oral anticoagulants (newer ones like Xarelto or Eliquis can be used)
Coumadin later on.

Antibiotics if there’s an infection

Analgesics for pain

Probably no breast-feeding. Will have to pump and dump.
Watch prothrombin time.

192
Q

Once mom is walking under a VTE risk, what do you do?

How will we position mom to avoid VTE?

A

Use support stockings

Leg elevated and bed rest

193
Q

Dietary teaching to avoid VTE while on medicatons?

A

Avoid VIt K foods like leafy greens if you aren’t used to eating them

  • kale
  • canola oil, mayo
  • mint
  • peppers
  • watercress
194
Q

Family planning with VTE?

What other med to avoid?

A

Avoid estrogen products bc of increased clots

Avoid aspirin too bc it inhibits clotting

195
Q

Ways to decrease risk of VTE for mom to know for Antepartum?

A

Stay active and hydrated (even in the car)
Quit smoking
Elevate legs when sitting
Don’t wear constrictive garments

196
Q

Ways to decrease risk of VTE for mom to know for Intrapartum?

A 
Walk if you can
Leg exercises
Avoid pillow under knees
Pad the stirrups and correct positioning
But limit stirrup time
Anti-embolism stockings for high risk patients
197
Q

Postpartum measures for VTE risk?

A 
Early walking 
Turning and leg exercise while in bed
Stay hydrated
No smoking
Antiembolism stockings
Penumatic compression stockings 
Don't sit or cross legs 
Elevate legs

Maternal Exam 4 (6 decks)

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