Postpartum DVT/Preeclampsia Flashcards
List the risk factors for postpartum DVT (6)
- obesity
- sedentary habits post-delivery
- personal/family hx of DVT or abnormal clotting
- cesarean birth
- prolonged time in stirrups
- travel post-delivery
why is obesity a risk factor for DVT?
it impairs venous flow, increasing risk of clot formation
what is critical for prevention of DVT, especially after c-section?
walking
when is pain relief necessary for DVT prevention?
if it is necessary to encourage movement
stirrups are used less in vaginal deliveries today, except for what? (3)
Complicated perineal repairs.
D&C procedures.
Hematoma evacuation.
what should be turned on when a pt is in stirrups to promote circulation?
sequential compression devices (SCVs)
What is discouraged post-delivery?
airplane travel
if a pt is traveling by car post-delivery, what should they do?
take frequent rest breaks to move around
List the sx of DVT (7)
- unilateral leg swelling
- redness in affected leg
- warmth in affected leg
- pain in affected leg
- low-grade fever that may progress to higher
- palpable cord
- milk leg
in postpartum women, what leg does DVT typically occur in?
left leg
why might low-grade fever from DVT progress to higher temp?
due to inflammation
what is a palpable cord?
hardened vein due to clot formation
What is milk leg?
Spasm distal to the clot leads to:
- Pale, cold leg below the clot.
- Reduced circulation.
What DVT test is unreliable? In how many cases is it positive?
homan’s sign
positive in only ~⅓ of DVT cases
why is homan’s sign not used?
Sharply dorsiflexing the foot may dislodge the clot
What is a safer method to use as opposed to homan’s sign?
Use gentle palpation with the back of the hand over the calf without pressing deeply.
What is used to confirm clot and diagnose DVT?
doppler ultrasound
what diagnostic finding is suspicious for DVT but not conclusive?
Elevated D-Dimer
what must a pt with DVT strictly follow and why? (2)
STRICT BEDREST! Do NOT allow pt to walk → walking can dislodge the clot and cause a pulmonary embolism
Do NOT massage the clot → to prevent dislodging
how is DVT treated? (3)
- heparin
- transition to warfarin (coumadin)
- long-term anticoagulant therapy
Heparin is a ______ based ___ ______
weight based IV infusion
what does heparin do?
Prevents clot progression & new clots from forming
If a pt is on heparin, what is required?
frequent monitoring
What overlaps with heparin and until when? what is crucial?
warfarin (coumadin) overlaps with Heparin until INR reaches 2-3
PT/INR monitoring is crucial
what is the most common long-term anticoagulant agent despite newer agents?
warfarin (coumadin)
A pt taking anticoagulants should be taught to monitor ________. what should they look for? (4)
bleeding
look for:
- Bleeding gums
- Excessive bruising
- Increased vaginal bleeding
- Cuts that take too long to stop bleeding
how can pts be taught to prevent bleeding? (2)
Avoid razors (use electric shaver or depilatory cream instead).
Avoid activities that increase risk of cuts.
what counteracts warfarin?
vitamin K
pts should be taught to avoid sudden changes in ________ in their diet
vitamin K
what foods decrease the effectiveness of warfarin?
foods high in vitamin K including green leafy vegetables such as spinach, broccoli and kale
If there is over-anticoagulation, what will be too high?
INR
what is the antidote if INR is too high?
vitamin K
It is very important for the nurse to monitor for _________ _______ when a pt has DVT
pulmonary embolism
when monitoring for pulmonary embolism, what should the nurse assess frequently?
respiratory status
list the signs and sx of pulmonary embolism (5)
- Sudden shortness of breath.
- Coughing.
- Feeling of impending doom/severe anxiety.
- Chest pain (pleuritic pain).
- Tachypnea (rapid breathing)
how long can postpartum preeclampsia last?
6 weeks
postpartum preeclampsia can look similar to what?
preeclampsia in the antepartal period
What signs of postpartum preeclampsia should the postpartum pt be taught to report? (4)
Severe headache
Visual disturbances
Epigastric pain
Severe nausea and vomiting.
If a postpartum pt had preeclampsia in pregnancy, what should she report regarding BP?
a systolic blood pressure of 160 or greater and/or diastolic pressure of 110 or greater.
If a visiting nurse assessed the patient and found signs of severe preeclampsia, she should contact the provider and anticipate that the patient would have to go to the hospital for admission and administration of _________ ________
magnesium sulfate
