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Mgmt Test 3 - OB > postpartum complications/perinatal loss > Flashcards

postpartum complications/perinatal loss Flashcards

1
Q

postpartum hemorrhage can have an early and late onset t or f

A

true

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2
Q

risk fxr for postpartum hemorrhage

A 
c-section 
operative vaginal delivery (vacum, forceps)
precipitous labor (3 hrs start/finish)
atypically attached placenta
retained placenta fragments 
general anesthesia (uterus wont contract)
fetal demise
hx of postpartum hemorrhage
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3
Q

early postpartum hemorrhage occurs

A

within 1st hour after birth

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4
Q

the most common cause of early postpartum hemorrhage

A

***uterine atony (the uterus does not contract)

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5
Q

most likely cause of late postpartum hemorrhage

A

retained placenta fragments

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6
Q

other causes of early postpartum hemorrhage

A

lacerations (vagina, cervix, perineum)
hematomas (not necessarily outward)
uterine inversion
retained placenta fragments

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7
Q

risk fxrs for uterine atony

A

Over distension of the uterus from multiple gestations,
polyhydramnios, fetal macrosomia, or multiple fetuses
Uterine anomaly (fibroid tumors)
Poor uterine tone (long induction w/pitocin, receptors get tired; stops contracting like it should)

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8
Q

s/s of uterine atony

A

BOGGY fundus

excessive bleeding

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9
Q

mgmt for uterine atony

A

***massage the fundus, check often

medications (oxytocin, methergine, hemabate)

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10
Q

methergine - action

A

uterine stimulant

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11
Q

methergine - given

A

PO

IM

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12
Q

methergine s/e

A

very crampy - alot of pain

can raise BP

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13
Q

hemabate - action

A

uterine stimulant - usually used via c-section

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14
Q

methergine and hemabate are NEVER USED FOR INDUCTION t or f

A

true - only used during postpartum period to stop bleeding

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15
Q

hemabate is given

A

IM right into uterine muscle/fundus

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16
Q

misoprostil - action

A

controls post partum hemorrhage

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17
Q

misoprostil is given

A

PO

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18
Q

assessment findings for lacerations

A

excessive bleeding w/FIRM uterus

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19
Q

lacerations may be (4 types)

A

perineal
periurethral
vaginal
cervical

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20
Q

perineal lacerations are graded, how many degrees

A

four (4) (1, 2, 3, 4)

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21
Q

1st degree perineal laceration s/s

A

superficial; just subcutaneous tissue; may not need suture

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22
Q

2nd degree perineal laceration s/s

A

subcutaneous tissue & muscle (episiotomy) - needs suture

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23
Q

3rd degree perineal laceration s/s

A

extends into external anal sphincter

cold packs

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24
Q

4th degree perineal laceration s/s

A

extends into internal anal sphincter (local anesthesia)
take colace - no straining
cold packs

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25
Q

mgmt of lacerations

A

nurse assist in repair
inspect perineum, cervix, vagina
monitor blood loss

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26
Q

retained placental fragments risk fxrs

A

mismanaging 3rd stage of labor - pulling on placenta/cord - hindering uterine contractions
Placenta malformations -
Abnormal placenta implantation

27
Q

3 types of abnormal placenta implantation

A

acreta
increta
percreta

28
Q

Acreta placenta implantation s/s

A

placenta starts to invade myometrium - difficult to detach -

29
Q

increta placenta implantation s/s

A

invades the myometrium all together

30
Q

percreta placenta implantation s/s

A

permeates the entire uterine wall

31
Q

trt for increta and percreta

A

hysterectomy to stop bleeding

32
Q

trt for acreta

A

manual detachment - likely leave behind pcs of placenta

33
Q

retained placenta fragments assessment

A 
subinvolution - uterus not contracting the way it should
excessive bleeding
boggy fundus
Risk for DIC
u/s detects this during pregnancy
34
Q

mgmt of placental fragments

A

d&c and curettage to scrap uterus to ensure all pieces
manually explore the uterus
transfusion for lg amt of blood loss

35
Q

a d/c procedure will not work w/abnormal placental implantation t or f

A

true

36
Q

what level of H/H would require transfusion

A

7

37
Q

hematoma assessment findings

A

usually not outward/visible bld’g; more into tissues
mom complains of pain in perineal/vaginal area; feeling of fullness/pressure in vagina
may see outline of hematoma

38
Q

trt of hematoma

A

surgical drainage (severe cases)
antibiotics
analgesics
blood products if excessive loss

39
Q

late postpartum hemorrhage mgmt

A 
control bleeding
prevent hypovolemic shock
d/c
may require antibiotics
massage fundus
administer uterine stimulants
40
Q

late postpartum hemorrhage occurs

A

sometimes without warning 1-6 weeks postpartum

delivery w/o issues then heavy bld’g

41
Q

nursing implication for postpartum hemorrhage

A

assess quantity/quality of bld’g (hourly)
assess level of consciousness
monitor vitals
large bore iv fluids (at least an 18 guage)
administer oxygen, assess saturation
assess urine output (hourly) - decreased
administer/monitor fluids, blood products
draw/monitor labs
emotional support for family (extremely distressful)
educate pt

42
Q

s/s of hypovolemia

A

BP drops

HR increases

43
Q

postpartum infection is also called

A

puerperal infection

44
Q

what is postpartum infection

A

fever of 100.4 or greater occurring days 2-10, 2 days

45
Q

what is endometritis

A

infection of uterine lining caused by various organisms including group B strep

46
Q

s/s endometritis

A

foul smelling lochia
sub-involution
elevated wbc (after 1st 24hrs)

47
Q

mgmt of endometritis

A

broad spectrum IV antibiotics (sometimes double/triple)

going home on PO antibiotics

48
Q

nursing implications for endometritis

A

monitor for complications
manage pain
pt education
f/u w/provider earlier than norm

49
Q

what is mastitis

A

an infection of the breast (lactating); unilateral

50
Q

mastitis vs engorgement

A

mastitis is unilateral

engorgement is bilateral

51
Q

engorgement occurs

A

1st few days postpartum due to mom not emptying breast

52
Q

s/s of mastitis

A

fever, chills

53
Q

trt of mastitis

A

BREASTFEED - empty the breast; or pump

antibiotics (cont. to breastfeed)

54
Q

what condition should mom not breast feed with

A

abscess - ruptures - if its in the duct it will pass to baby

55
Q

thrombophlebitis where can it occur

A

in legs and pelvis (septic pelvic thromophlebitis due to c-sect and became infected)

56
Q

what is thrombophlebitis

A

DVT - clot formation

57
Q

thrombophlebitis s/s

A

redness/warmth in abdomen or calf

58
Q

mgmt of thrombophlebitis

A

IV heparin (anti-coagulants)
bedrest w/elevation of limb
analgesics
antibiotics w/septic pelvic thrombophlebitis

59
Q

nursing implications of thrombophlebitis

A

may be started on warfarin before heparin is stopped
continued for 6 weeks
monitor symptoms
lifestyle changes (do not wear stockings)

60
Q

when does baby blues occur

A

first week to 10 days, mom needs TLC

61
Q

baby blues caused by

A

hormonal imbalance
feeling overwhelmed, worried
sleep deprivation

62
Q

postpartum depression onset; s/s

A

2 weeks or longer (2-4 weeks)
affects ability to take care of self/baby
suicidal ideation

63
Q

trt for postpartum depression/psychosis

A

meds
psychotherapy
hospitalization

64
Q

postpartum psychosis

A 
early onset 2 days postpartum up to 8 weeks
manic psychosis
depressed mood
suicidal ideations
delusions (voices)

Mgmt Test 3 - OB (7 decks)

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