Postpartum High Risk Flashcards by Emma Fowler

readiness for hemorrhage

hemorrhage cart, meds, response team, transfusion protocol

How well did you know this?

Not at all

Perfectly

recognition/prevention of hemorrhage

assess risk pre and post delivery, assess blood loss

How well did you know this?

Not at all

Perfectly

response of hemorrhage

emergency plan and support

How well did you know this?

Not at all

Perfectly

PPH

more than 500ml vag and 1000ml c/s w 10% drop in hematocrit/hemoglobin

How well did you know this?

Not at all

Perfectly

low risk for PPH

no incisions, single preg, less than 4 vag births, no bleeding disorder/hx of PPH

How well did you know this?

Not at all

Perfectly

med risk for PPH

induction/ripening, more than 4 vag births, incision, hx of PPH, multi gestation, chorioamnionitis, fetal demise, fibroids

How well did you know this?

Not at all

Perfectly

high risk of PPH

2 or more of med w active bleeding, accrete/precreta, placenta previa

How well did you know this?

Not at all

Perfectly

PPH greatest risk

1st hr after delivery but can also up to 6 wks post

How well did you know this?

Not at all

Perfectly

causes of PPH

tone, tissue, trauma, thrombin

How well did you know this?

Not at all

Perfectly

risk factors of PPH

macrosomia, precipitous, multiple gestation, prior PPH, uterine surgery, placenta abnl, high parity

How well did you know this?

Not at all

Perfectly

tone medical factors

macrosomia, high parity, fever, fibroids, rapid labor

How well did you know this?

Not at all

Perfectly

S/S of altered tone

slow/profuse bleeding, boggy uterus, clotting

How well did you know this?

Not at all

Perfectly

tone nursing actions

assist uterus w massage/meds, monitor bleeding, maintain fluid balance

How well did you know this?

Not at all

Perfectly

uterine atony - tone

decreased uterine tone with bleeding

How well did you know this?

Not at all

Perfectly

stg 1 of PPH

more than 500ml vag and 1000ml c/s w norm labs/VS

How well did you know this?

Not at all

Perfectly

stg 2 of PPH

1000-1500ml, 2 uterotonics, monitor labs/VS

How well did you know this?

Not at all

Perfectly

stg 3 of PPH

more than 1500mls, 1 unit packed RBC, 1 unit plasma, abnl VS/labs

How well did you know this?

Not at all

Perfectly

stg 4 PPH

cardio collapse, shock, amniotic embolism

How well did you know this?

Not at all

Perfectly

lacerations/hematoma risk factors - trauma

macrosomia, OVD, precipitous

How well did you know this?

Not at all

Perfectly

laceration - trauma

tear during birth with continuous bright red blood

How well did you know this?

Not at all

Perfectly

hematoma - trauma

bruise not always visualized that causes pain, heavy, rectal pressure and difficult voiding

How well did you know this?

Not at all

Perfectly

if hematoma is too big

it displaces uterus and causes atony

How well did you know this?

Not at all

Perfectly

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