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OB - Spring 2016 > Postpartum Complications - Unit 3 > Flashcards

Postpartum Complications - Unit 3 Flashcards

1
Q

What’s the traditional definition of postpartum hemorrhage? (3 numbers)

A

> 500 ml blood loss after vaginal birth.
1000 ml blood loss after cesarean birth.
1500 ml blood loss after a repeat cesarean birth.

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2
Q

__% increase in plasma volume.

___% increase in red cell mass.

A

40% increase in plasma volume.

25% increase in red cell mass.

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3
Q

When does an early hemorrhage occur?

A

First 24 hours.

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4
Q

When does a late hemorrhage occur?

A

24 hours –> 6-12 weeks after delivery

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5
Q

What are the % T’s for causes of postpartum hemorrhage?

A

Tone, tocolytics, tissue, trauma, thrombim

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6
Q

What are some things that can affect tone?

A

Large baby, multiples, hydraminos, multiple babies in the past (5 or more) - - these things stretch the pudenda out so it’ll bleed.

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7
Q

What do tocolytics do for the 5 T’s?

A

this causes the uterus to not contract. Mag sulfate is one (think that the risk for preeclampsia still exists for 48 hours after..so they might still need the med)

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8
Q

What is the tissue part of the 5 T’s?

A

retained placenta/tissue that’s left behind. Clots form around it and then they come out later.

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9
Q

What’s the trauma in the 5 T’s?

A

lacerations, episiotomies, hematoma’s, etc.

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10
Q

What’s the thrombin part of the 5 t’s?

A

Bleeding disorders.

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11
Q

How do we fix the 5 T’s?

A

Treat the cause

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12
Q

What should the fundus feel like? Where should it be?

A

Firm ball roughly the size of a grapefruit.it should be level of the umbilicus and midline.

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13
Q

What do we assess blood loss?

A

Weight peripads or chux - excessive bleeding (saturated peripad within 15 minutes).

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14
Q

Every g (weight) = 1 ml of urine. T/F?

A

True

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15
Q

Fundal massage - always the first intervention. T/F?

A

TRUE

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16
Q

Management of hemorrhage - assess vital signs how often?

A

Every 3-5 minutes.

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17
Q

Changes in MAP - first sign of what?

A

Blood loss.

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18
Q

What are some other management things for postpartum hemorrhage?

A

Bladder management (foley?), pain meds, elevate legs, medications, I/O, IV access, assess for shock, lab work (HgB, Hct, coag studies, clot observations tests, arterial blood gas, etc.

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19
Q

Hct in a postpartum lady can get low before we transfuse - T/F?

A

TRUE - they go way lower than most others.

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20
Q

What are some intense interventions for postpartum hemorrhage?

A

Packing uterus or balloon tamponade, dilation and curettage, exploratory laparatomy, bilateral uterine artery ligation, hysterectomy, embolism (yup, they put a clot in!)

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21
Q

Oxytocin (rapid IV infusion) - __ to ___ units in 1000 ml of IV solution

A

10-40

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22
Q

Oxytocin - start infusion at a rate of 20-40 mu/min (1 mu = .001 unit or 1 unit = 1000 mu) T/F?

A

True

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23
Q

Methlergonocine 0.2 mg IM every 2-4 hours for 5 doses? - T/F? Or oral route, 0.2 mg ever 6-8 hours for a max dose of 7 days?

A

True

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24
Q

Methylgonovine - okay with patients with hypertension. T/F?

A

FALSE

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25
Q

Misoprostiol 250 mcg (how do we give it?)

A

PO or rectal

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26
Q

Carboprost tromethamine 250mcg IM every 15-90 minutes - Max total dose 2mg. T/F? Do not use with what?

A

TRUE

Do not use with asthma!

27
Q

Cytotec - can give during hemorrhage, but should we give it vaginally?

A

NO, it’ll probably just come out.

28
Q

SVT - very deep. T/F?

A

False - it’s superficial!

29
Q

DVT - where is it usually at?

A

calves.

30
Q

What causes a thromboembolic disorder?

A

Venous stasis, hypercoagauable blood, injury to the endothelial surface of the blood vessel

31
Q

What is the definition of a puerperal infection?

A

Bacterial infection of 100.4 degrees or higher fever after the first 24 hours and occurring on at least 2 of the first 10 days postpartum.

32
Q

What are the types of puerperal infection?

A

Endometritis, wound infection, UTI, mastitis, septic pelvic thrombophlebitis

33
Q

What is postpartum depression? Blues?

A

Depression - lasts longer and is more severe - depressed mood/loss of interest. Blues = just being sad.

34
Q

Postpartum psychosis = rare? What is it?

A

Rare - they go cookoo. No interest and hallucinations are present!

35
Q

Bipolar - does it get better with pregnancy?

A

NO, it gets worse.

36
Q

Panic disorder/anxiety disorders for pregnancy. What are they?

A

THEY GET ANXIOUS - preoccupied, all that!

37
Q

What is the role of the nurse during contraception?

A

Counselor/education - talk about types available, risks and benefits, how to ensure proper use of each method, emergency contraception, backup methods and when they should be used, what to do if the woman wants to change methods?, questions and concerns.

38
Q

What are some things we need to consider with contraceptions?

A

Safety, effectiveness, acceptability, convenience, benefits, side effects, expensive, preference, culture, etc.

39
Q

Adolescents - know everything and aren’t immature about sex. T/F?

A

FALSE

40
Q

Sterilization - very common in women over __.

A

30

41
Q

Smoking and contraception and being over 35 years old - it’s fine. T/F?

A

FALSE - it increase the risk for clots!

42
Q

What is a tubal sterilization? Warning signs? how do we check it?

A

Cutting or occluding the fallopian tube - no sex for one week or strenuous activity/heavy lifting.
Warning signs = fever, fainting, severe pain, bleeding/discharge.

Hystosaphylogram is used to see if it’s properly done!

43
Q

Vasectomy - what is it? Warning signs?

A

Cut/tie/cauterize the danglers ;) No sex for one week (but not sterile then!) No bathing for 24 hours after. Warning signs - fever, severe pain, bleeding/discharge from the site, swelling greater than twice the size/painful nodule.

44
Q

What are some side effects of IUD’s?

A

Cramping and bleeding following insertion, menorrhagia and dysmenorrhea, irregular bleeding/spotting, perforation of the uterus at time of insertion, expulsion

45
Q

Should ladies with an IUD check the strings?

A

YES

46
Q

Mirena - no backup if within 5 days of last period. It not, use for 5 days. T/F?

A

TRUE

47
Q

Paragard lasts __ years, Mirena lasts ___.

A

10/5

48
Q

What’s inplanon?

A

Progestin implant - subcutaneous upper arm. Inhibits ovulation, thickens cervical mucus, makes the endometrium unfavorable. Lasts for 3 years and has a S/E of irregular menstrual bleeding.

49
Q

What’s Depo Provera?

A

IM or Sub Q every 15 weeks (scheduled every 13). NO backup needed if within 7 days of the beginning of the last menstrual cycle. Side effects include menstrual irregularities, weight gain, headache, depression, hair loss, nervousness, decreased libido, breast discomfort, decreased bone density.

50
Q

Depo - can it cause bone issues?

A

Yes, so increase calcium, vitamin D, weight baring exercises

51
Q

What are monophasis contraceptives? Multiphasis?

A

Mono = all pills are the same. Multi = different levels each week.

52
Q

Progestin - not as good at what?

A

Not as good at stopping ovulation.

53
Q

What are some side effects of hormonal contraceptives?

A

similar to side effects of pregnancy, usually lessens after first couple of months on medication, change to different med to change side effects, etc.

54
Q

What’s quick start? Backup?

A

Start that day! No backup if within the first 7 days.

55
Q

What’s the first day?

A

First day of their next period start.

56
Q

What’s the sunday start? Backup?

A

First sunday after period - backup for first 7 days.

57
Q

If you forget more than 2 pills, start over. T/F?

A

TRUE

58
Q

No one should take oral contraceptives until 3 weeks after birth, 4 for breastfeeding. T/F?

A

TRUE

59
Q

Progestin-only pills - affect breastmilk, too. T/F?

A

FALSE -

60
Q

Which is over the counter - One-Step Plan B or Ella?

A

One Step Plan B

61
Q

Patch - watch how it’s applied for bigger ladies?

A

YES

62
Q

How long does the sponge last for?

A

24 hours. Risk for TSS if left in for longer.

63
Q

Diaphragm - must be fitted. T/F?

A

TRUE

64
Q

Cervical cap - doesn’t need fitted. T/F?

A

FALSE

OB - Spring 2016 (18 decks)

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