POSTPARTUM: DISORDERS

Question 1

DVT

Risk Factors

Answer 1

Pregnancy
Multiparity
> 35
Diabetes

Question 2

DVT

Physical Assessment

Answer 2

Unilateral area of swelling, warmth, and redness

Question 3

DVT

Diagnostics (3)

Answer 3

Doppler
CT scan
MRI

Question 4

DVT

Management

Answer 4

Rest
Warm compress
DO NOT MASSAGE
Measure
Administer anticougulants

Question 5

DVT

Heparin
Route/Duration
Antidote
Monitor (Lab)
Client Ed..when to report?

Answer 5

Heparin: Anticoagulant prevent formation of other clots prevent enlargement of existing clot

Route: IV continuous 5-7 days

Antidote: PROTAMINE SULFATE

Monitor: aPTT will take longer to clot

Client Ed: report bleeding from gums or nose or blood in urine, frequent bruising

Question 6

DVT

Warfarin
Route/Duration
Antidote
Monitor (Lab)
Client Ed:  Teratongenic Effects

Answer 6

Warfarin: Tx of clots

Route/Duration: Oral for 3 months

Antidote: Vit K Phytonadione

Monitor: PT and INR will take longer to clot

Client Ed: Use birth control but not oral contraceptives (risk of DVT/thrombosis), warfarin is inhibited by alcohol

Question 7

Heparin and Warfarin

Health Promotion and Disease Prevention

Answer 7

no aspirin or NSAIDs increase bleeding
no electric razor
Avoid massaging legs
soft toothbrush

Question 8

Pulmonary Embolus

Answer 8

Pulmonary embolism complication of DVT moves into lungs

Question 9

Coagulopathies (Idiopathic Thrombocytopenic Purpura and Disseminated Intravascular Coagulation)

Answer 9

Autoimmune platelets attacked and reduced. Coagulopathies suspected when usual measure to stimulate UC fail to stop bleeding

Question 10

ITP and DIC

Nursing Care

Answer 10

Uninarty catheter
Transfuse platelets
Possible Splenectomy
tx underlying cause

Question 11

Postpartum Hemorrhage
Loss of 500ml Vaginal
Loss of 1000ml Csection

Nursing Care

ATI 236

Answer 11

Assess Fundus
lochia
bladder distention
IV isotonic 
Blood products 
O2
Pitocin
Assess uterine tone and vaginal bleeding
MONITOR FOR WATER INTOXICATION side effect of pitocin
Methylergonovine (methergine) for UC only used after labor never during labor or if pt is HTN

Question 12

Water Intoxication s/s (side effect of pitocin)

Answer 12

Lightheadedness, N/V, HA, malaise can progress to cerebral

Question 13

Uterine Atony
Diagnostic Procedure

PT ED: Eat more protein

Answer 13

Inability of the uterine muscle to contract adequately after birth can lead to hemorrhage

Bimanual Compression or manual exploration cavity for retained placental fragments
DO NOT EXPRESS CLOTS UNTIL UTERUS IS FIRMLY CONTRACTED
Hysterectomy

Question 14

Subinvolution of the Uterus

Can lead to infection of?

Encourage use of activities that enhance uterine involution
voiding, BF, walking

Answer 14

Uterus remains enlarged with continued local discharge can lead to hemorrhage

Endometritis

Question 15

Inversion of the uterus
EMERGENCY
STOP Pitocin adm
C-section will be used for future deliveries

Answer 15

Uterus turning inside out can be partial or complete

adm Terbutaline to relax uterus
AVOID AGGRESSIVE Fundal massage

Question 16

Lochia amount is assessed by the quantity of saturation of the perineal pad
Scant
Light
Moderate
Heavy
Excessive

Answer 16

Scant  less than 2.5 cm
Light less than 10 cm
Moderate more than 10 cm
Heavy one pad within 2 hrs
Excessive one pad 15 mins or less pooling of blood under buttock