Postpartum High Risk Flashcards
readiness for hemorrhage
hemorrhage cart, meds, response team, transfusion protocol
recognition/prevention of hemorrhage
assess risk pre and post delivery, assess blood loss
response of hemorrhage
emergency plan and support
PPH
more than 500ml vag and 1000ml c/s w 10% drop in hematocrit/hemoglobin
low risk for PPH
no incisions, single preg, less than 4 vag births, no bleeding disorder/hx of PPH
med risk for PPH
induction/ripening, more than 4 vag births, incision, hx of PPH, multi gestation, chorioamnionitis, fetal demise, fibroids
high risk of PPH
2 or more of med w active bleeding, accrete/precreta, placenta previa
PPH greatest risk
1st hr after delivery but can also up to 6 wks post
causes of PPH
tone, tissue, trauma, thrombin
risk factors of PPH
macrosomia, precipitous, multiple gestation, prior PPH, uterine surgery, placenta abnl, high parity
tone medical factors
macrosomia, high parity, fever, fibroids, rapid labor
S/S of altered tone
slow/profuse bleeding, boggy uterus, clotting
tone nursing actions
assist uterus w massage/meds, monitor bleeding, maintain fluid balance
uterine atony - tone
decreased uterine tone with bleeding
stg 1 of PPH
more than 500ml vag and 1000ml c/s w norm labs/VS
stg 2 of PPH
1000-1500ml, 2 uterotonics, monitor labs/VS
stg 3 of PPH
more than 1500mls, 1 unit packed RBC, 1 unit plasma, abnl VS/labs
stg 4 PPH
cardio collapse, shock, amniotic embolism
lacerations/hematoma risk factors - trauma
macrosomia, OVD, precipitous
laceration - trauma
tear during birth with continuous bright red blood
hematoma - trauma
bruise not always visualized that causes pain, heavy, rectal pressure and difficult voiding
if hematoma is too big
it displaces uterus and causes atony
retained placental tissue- tissue
part of placenta remain attached in uterus from manual removal
S/S of retained placental tissue -tissue
profuse bleeding, subinvolution, fever, tachycardia, hypotension
treatment of retained placental tissue- tissue
D+C, IV antibiotics, O2, s/s of shock
coagulation disorders - thrombin
DIC, DVT, VTE, anaphylactic syndrome
S/S of coagulation disorders -thrombin
pale, clammy, tachycardia, hypotension
testing of coagulation disorders - thrombin
doppler, MRI, ultrasound, PTT
treatment of coagulation disorders -thrombin
anticoagulation therapy, stockings, elevation, heparin
thrombin disorders
preeclampsia/stillbirth caused by DIC, bleeding gums, s/s of shock, abnl clotting values
managing thrombin disorders
early recognition, I+O, accurate blood loss, platelet replacement, O2, IV
wound infections
laceration, episiotomy, c/s incision (staph/strep)
risk factors of wound infections
obesity, diabetes, malnutrition, long labor
S/s of wound infections
erythema, swelling, tender, drainage, fever, pain
assessment of wound infections
REEDA, drainage, symptoms
mastitis
infection/inflammation of breast tissue (staph)
S/S of mastitis
tender, engorged, red
nursing action of mastitis
keep breastfeeding, antibiotics, handwashing, massage
acute onset of severe hypertension
more than 160/110
management of severe hypertension
mag sulfate until 24 hrs after delivery, labetalol, hydralazine, nifedipine
nursing actions of severe hypertension
assess BP every 5-10 mins, admin meds, monitor signs of preeclampsia
diabetes type 1/2
should go back down to norm range of sugars after preg
diabetes gestational
blood tests done 2-6wks post to make sure sugars are down (15-50% of getting type 2)
mag sulfate
for pt at high risk for seizures from preeclampsia w severe features 24 hrs pre/post bith
interventions for mag sulfate
monitor strict I+O, O2 saat, hrly BP/RR, assess DTR/lungs
toxicity of mag sulfate
RR less than 12, UO less than 30ml in hr or 50ml in 2 hr, no DTR
postpartum depression
severe depression in 6-12 mon postpartum w inability to care for self/infant
risk factors of postpartum depression
hx of depression, anxiety, lack of support, poor relationships, complicated preg
assessment of postpartum depression
sleep/appetite changes, uncontrolled crying, fear and anxiety
manage of postpartum depression
psychotherapy(mild) + meds (mod) and intensive inpt treatment (severe)
baby blues
3rd day post for 2 wks from hormonal changes/lack of sleep w ability to still care for child
baby blues S/S
weepy, happy, exhausted, overwhelmed, emotional lability
manage baby blues
rest, take time to self, monitor symptoms
postpartum psychosis
variant of bipolar disorder w cog impairment and disorganized behavior in first 3 wks
risk factors of postpartum psychosis
bipolar disorder
assessment of postpartum psychosis
paranoia, mood swings, agitation, confusion, strange beliefs, infant/suicide
manage postpartum psychosis
hosp, psych eval, therapy, remove infant
