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NURS 2156 OB 2 > Postpartum Complications & Childbearing Family With Special Needs > Flashcards

Postpartum Complications & Childbearing Family With Special Needs Flashcards

1
Q

Typically postpartum complications (4)

A

Hemorrhage
Infection
Thromboembolic disease
Postpartum Affective Disorder

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2
Q

PPH

Vag delivery ____

CS delivery _____

Any amount that causes hemodynamic instability

A

Vag <500

CS <1000

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3
Q

4 Ts of Pathophysiology of PPH

Tone
Tissue
Trauma
Thrombin

A

Tone: Uterine tone most common cause 80%

Tissue: Retained placental fragments

Trauma: Lacerations, Episiotomy, Uterine Inversion

Thrombin: Coagulation Disorders

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4
Q

Grand multipara….

A

4 or more previous pregnancy and deliveries

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5
Q

Maternal Factors
(Macrosomia, Grand Multipara, Multiple fetal pregnancy, Over Distention)

Preexisting clotting disorder

Long labor

Tocolytics/ Uterotonics

Use of forceps

Cesarean

General Anesthesia

Manual removal of Uterus

All risk factors for….

A

PPH

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6
Q

Soft boggy uterus

2 most important interventions

A

Massage Fundus

&

Call for help

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7
Q

Hemorrhage

Increase IV fluids containing Oxytocin

A

False

Increase IV without Oxytocin

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8
Q

Hemorrhage

Methylergonovine (Methergine)
0.2 mg IM (may repeat)

Avoid with…

A

HTN

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9
Q

Carboprost (Hemabate)

250 micrograms IM

May repeat q15min Max 8 doses

Avoid with….

A

Asthma

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10
Q

Stage 1 PPH

Define

A

CS >1000 mL

Vag >500 mL

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11
Q

Stage 2 Hemorrhage

Define

A
  1. EBL up to 1500 mL
  2. Use to 2 Uterine tonics (Not effective)

Oxytocin 10 - 40 U

Methylergonovine 0.2 mg IM May repeat

Carboprost 250 micrograms May repeat q15m Max 8 doses

Misoprostol 800-1000 micrograms Per Rectum

  1. Vital signs Normal
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12
Q

Stage 2 Hemorrhage

Define

A

EBL up to 1500 mL

Use to 2 Uterine tonics (Not effective)
Oxytocin 10 - 40 U

Methylergonovine 0.2 mg IM May repeat

Carboprost 250 micrograms May repeat q15m Max 8 doses

Misoprostol 800-1000 micrograms Per Rectum

Vital signs Normal

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13
Q

During the Stage 2 PPH (EBL upto 1500ml or atleast 2 uterotonics used & normal VS)

Consider this medication….

Describe administration…

A

Tranexamic Acid (TXA)

1 G over 10 minutes

Add 1 G to 100mL NS IV & give over 10 minutes. Maybe repeated once after 30 minutes

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14
Q

Possible interventions for STAGE 2 PPH

4

A

Bakri balloon

Compression suture/B-Lynch suture

Uterine artery ligation

Hysterectomy

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15
Q

Stage 3 PPH

Define…

A

EBL >1500mL

Or

2 RBC givn

Or

At risk for Occult bleeding/Coagulopathy

Or

Any patient with abnormal VS/labs/ oliguria

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16
Q

Stage 4 PPH

Define…

A

Cardiovascular collapse (massive hemorrhage, profound Hypovolemic shock, amniotic fluid embolism)

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17
Q

1st line of intervention for Stage 2 PPH

A

Bakri Balloon: Uterine Tamponade

Stays in for 24 hours

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18
Q

If Uterine Artery Embolization fails what is the next treatment…

A

Hysterectomy

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19
Q

Care for a Hematoma…

A

Surgically drained & Blood vessels ligated

Presents as a very painful perineal lump

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20
Q

Lacerations

Describe the degrees..

1st
2nd
3rd
4th

A

1st
Superficial vaginal mucosa or perineal skin

2nd
Above plus, deeper tissues may include muscles

3rd
2nd degree plus sphincter

4th
3rd degree plus, rectal mucosa

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21
Q

Sub Involution…

A

Slower than expected return of the uterus to its non-pregnancy size.

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22
Q

Subinvolution

Involves the uterus retuning to its pre pregnancy size slower than expected.

How fast should the uterus descend?

When should it be no longer palpable

A

Descend 1 cm daily

No longer palpable in 2 weeks time

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23
Q

Cause…

SS…

TX….

Subinvolution

A

Causes: Placental fragments & Pelvic Infection

SS Prolonged lochia, excessive bleeding, Pelvis pain, large & soft uterus

Tx: Methergine, antibiotics (if Infected), removal of retained tissue

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24
Q

Thrombus vs Thrombophlebitis

A

Thrombus = Blood clot

Thrombophlebitis = inflammation of the vessel wall

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25
Q

Lovenox is given during pregnancy and Coumadin is given postpartum to prevent DVT.

WHY?

A

Coumadin is Contradicted during pregnancy

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26
Q

Varicosities ( Varicose Veins)

Tx…

A

Compression Hose

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27
Q

Puerperal Infection (Postpartum Infection)

Risk factors: CS, Prolonged ROM, Bladder catherization, hemorrhage, Poor nutrition, DM

Describe Fever criteria….

A

38 or 100.4 with in first 24-hour and up to 10 days postpartum

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28
Q

Metritis (Infection of the Uterus)

Onset: with in 2 - 7 days postpartum

Labs WBC >20,000

TX: Ampicillim, cephalosporin, clindamycin, gentamycin

Could spread to….

A

Salpingitis, oophoritis, peritonitis

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29
Q

Wound infection at episiotomy or CS

Can baby stay with mom?

Most important teaching

A

Yes

Teach mom Hand Hygine

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30
Q

Don’t dispel milk when mastitis is present

A

False

Empty chest of milk

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31
Q

Baby Blues goes away how quickly…

If it doesn’t go away?

Why baby blues…

A

2 weeks

It’s called postpartum depression

Drop of estrogen & progesterone

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32
Q

Postpartum Depression

Onset with in first year Postpartum

Last how long?

A

Atleast 6 weeks

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33
Q

Can you take Zolfot while breast feeding

A

Yes

34
Q

Use this screening for postpartum affective disorders

A

Edinburgh

35
Q

Postpartum Patient is out of touch with reality.

When is it safe to leave them alone?

A

Never

Don’t leave them alone

36
Q

Teen moms growth needs compete with her growing baby

A

True

37
Q

Neonatal increased risk with teen pregnancy (4)

A

Premature
Low birth weight
Low APGAR
Neonatal death

38
Q

2 goals of sex education

A

Teach how to set limits

Instruct in effective contraceptive & prevent STIs

39
Q

Most common form of substance abuse in pregnancy?

Maternal Effects?

Infant Effects?

A

Tobacco

Decreased placental perfusion, anemia, PROM, Preterm labor, spontaneous abortion

Premature, LBW,death, dev delays, SIDS, pneumonia

40
Q

Leading cause of preventable retardation

A

Alcohol when preggers

41
Q

FAE…

A

Milder form of FAS Fetal Alcohol Syndrome

Fetal Alcohol Effects

42
Q

Born with congenital anomalies

How should nurses speak of infant?

When should parents hold infant?

A

Praise and call it special

Hold ASAP

43
Q

Percent of women who are physically or sexual abused by partner…

High incidences in teenagers

White women most likely

A

31.5

44
Q

Human trafficking

How many annually…

Average age….

A

2.5 million

12 - 14

45
Q

Stages of Greif

1st stage during first 2 weeks

A

Denial

46
Q

Stage 2

Searching & Yearing

Duration….

A

2nd week - 4th month

47
Q

Stage 3 Disorientation

Duration….

A

5th - 9th month

48
Q

Stage 4

Reorganization / Resolution

Duration…

A

18th - 24th month

49
Q

Do you present a stillborn to their parents?

A

Yes, just as you would any infant

50
Q

Communication interventions for a Still Born

Listen more than talk

Call baby by its name.

Focus on positive traits

A

🥺

51
Q

Methergovine 2nd choice for hemorrhage med.

Contradicted with …

A

HTN / preE

52
Q

Carboprost hemorrhage

Contradicted with this problem…

A

Asthma

53
Q

Which hemorrhage medication is considered last choice but no SE

A

TXA

54
Q

Longest time you can leave Bakri Balloon in…

A

24 hrs

55
Q

Newest intervention for PPH

A

Jada

Uses vacuum to increase tone

56
Q

How long is Postpartum bleeding normal…

A

4 - 6 weeks

57
Q

Why is stool used in shoulder dystocia…

A

To stand on to allow Suprapubic pressure

58
Q

FFN Test results

Postive / Negative

A

Negative result means there’s less than a 1% chance of delivering within the next two weeks.

A positive result indicates a higher risk of preterm delivery

59
Q

Everyone who has HELLP has preE but not everyone with preE has HELLP

T / F

A

T

60
Q

HELLP Meds (mother)

Fetus. Meds & test

A

Mag & Antihypertensive

Steroids/ BPP

61
Q

Cure for HELLP & preE

A

Delivery

62
Q

What are the urine test looking for in mom….

A

Protein & Bacteria

63
Q

TORCH Test…

A

Toxoplasmosis, rubella, cytomegalovirus, and herpes simplex.

The TORCH test detects antibodies to the various diseases

64
Q

Use a speculum to inspect for lesions of Herpes before vag birth

A

True

65
Q

Acyclovir how long before giving vag birth with Herpes

A

30 days

66
Q

Fetus is viable at ___ weeks

A

24

67
Q

Marginal cord insertion = risk of…

A

Tearing

68
Q

Myomectomy is…

A

Removal of fibroids (noncancerous growths) from uterus

69
Q

How long after CS to get pregnant?

Min…

Preferred…

A

18 months

2 - 3 years

70
Q

Contractions suddenly stop with this problem…

A

Uterine Rupture

71
Q

What does station receding mean…

A

It goes up.

72
Q

Describe what happens in Anaphylactoid Syndrome.

How dangerous is it…

A

An embolism of amniotic fluid enters moms blood vessels.

Deadly

73
Q

How long to monitor fetus min. After trauma to momma

A

4 hrs min

74
Q

How long after ROM does the risk of infection increase

A

18 hrs

75
Q

Can a distended bladder cause uterine atony…

A

Yes

76
Q

When giving a fundal massage ensure that…

A

You support the nexk of the uterus

77
Q

Hcg is secreted by…

A

Trophoblast

78
Q

(This hormone) Keeps the pregnancy going and thickens the cervix

A

Progesterone

79
Q

Is there a fetus with a Molar pregnancy…

A

No

80
Q

Can metformin/ glyburide be used safely during pregnancy

A

Yes

81
Q

Changing partners can increase the risk of preeclampsia in a subsequent pregnancy, especially for women who haven’t had preeclampsia before.

However, changing partners can reduce the risk for women who’ve had preeclampsia before

T or F

A

T

NURS 2156 OB 2 (8 decks)

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