Postpartum. Lecture 9

Question 1

Four Most Common conditions that can cause death

Answer 1

• Cardiac conditions
• Hemorrhage used to be number one, but now it’s hypotension (cardiac disease).
• The last ones in order are:
  
  • Thromboembolic Disease
  • Infections
  • Postpartum Affective Disorder (PPA) - (defined as a mood disorder that can occur after childbirth, characterized by symptoms such as sadness, anxiety, and fatigue)
• A patient returns 3 weeks postpartum, and then they have to come back again 3 months later for a full comprehensive assessment.

Question 2

PP Hemorrhage

Answer 2

• PP Hemorrhage Defined as a blood loss of > 1,000 ml in the first 24 hours after delivery
• Quantitative Blood Loss (QBL) measurement, including weight, bedding, pads, etc., not Estimated Blood Loss (EBL)
• Accurate blood loss measurement can be challenging due to:
  
  • Pooling (accumulation) of blood in the uterus
  • Pooling of blood on the floor (use a towel to collect it)
  • Large hematomas of the labia, vulva, or vagina. Large hematomas can contain up to 500 ml of blood.

Question 3

Typical Signs of Hypovolemic Shock: When these signs show up we are we late in the game.

Answer 3

• Decreased Blood Pressure (B/P)
• Increased Heart Rate
• Decrease in Urine Output (Kidneys retain urine to increase pressure)
• These signs do not manifest until the patient has experienced a blood loss of 1,800 – 2,100 ml (Note: It’s important to monitor for these signs early to stay ahead of the situation).

Question 4

Tone
Tissue (retained)
Trauma
Thrombin
Traction

The 5 T’S of PP Hemorrhage. The “5 T’s of Postpartum Hemorrhage (PPH)” is a healthcare framework to help identify and manage causes of excessive post-childbirth bleeding.

Answer 4

1. Tone:
   
   • Explanation: “Tone” refers to the contraction and firmness of the uterus after childbirth. Proper uterine contraction is essential for controlling bleeding as it helps to compress the blood vessels at the site where the placenta was attached during pregnancy.
   • Significance: If the uterus does not contract adequately (uterine atony), it can lead to excessive bleeding. Healthcare providers will assess the uterine tone and may administer medications (such as uterotonic drugs) or perform uterine massage to improve contraction.
2. Tissue:
   
   • Explanation: “Tissue” in the context of PPH refers to any retained placental tissue or fragments in the uterus. After childbirth, it is essential for the uterus to expel all placental tissue completely.
   • Significance: Retained placental tissue can prevent the uterus from contracting properly and may cause ongoing bleeding. It can be detected through clinical examination, ultrasound, or other imaging methods, and if found, it needs to be removed through manual extraction or suction curettage.
3. Trauma:
   
   • Explanation: “Trauma” in this context refers to any injuries or lacerations that occur during childbirth, especially in the birth canal, perineum, or cervix.
   • Significance: Tears or lacerations can cause significant bleeding. Healthcare providers will assess the extent of the trauma and may repair the tears through suturing if necessary.
4. Thrombin:
   
   • Explanation: “Thrombin” is an enzyme involved in the blood clotting process. This component of the 5 T’s acknowledges the role of blood clotting disorders or coagulation abnormalities that can contribute to postpartum hemorrhage.
   • Significance: If a woman has a coagulation disorder or other bleeding disorders, it can increase the risk of excessive bleeding during childbirth. Management may involve administering clotting factor replacements or medications to promote clotting.
5. Traction:
   
   • Explanation: “Traction” refers to the pulling or manipulation of the umbilical cord or placenta during delivery. Excessive or forceful pulling can lead to trauma and bleeding.
   • Significance: Healthcare providers should avoid excessive traction when assisting with the delivery of the placenta to prevent trauma. Gentle management of the placenta’s delivery can help reduce the risk of postpartum hemorrhage.
     They have to clamp both ends of the tear.

Question 5

Tone

Answer 5

• Take a thorough patient history.
• Anticipate Risks: Consider factors such as multiple births/gestation, scar tissue, a past history of postpartum hemorrhage, macrosomic baby (uterus contracts too much to deliver baby and then has no energy to contract more and involute), and bleeding disorders.
• Overdistended Uterus: (excessively stretched or enlarged)
  
  • Causes
    
    • Magnesium Sulfate given during giving birth: Medication effect - relaxes the uterus, preventing proper contraction.
    • Precipitous Delivery: Everything happens rapidly, and the body may not have time to respond appropriately. (rapidity of contractions and the birth itself may not allow the uterine muscles enough time to contract and retract properly, which can lead to uterine atony)
    • Retained Placenta Fragments: Inability to maintain uterine tonicity, leading to a failure of the brain to recognize that the pregnancy is over.
    • Distended Bladder: Pushes the uterus from its midline position, affecting its ability to function correctly.

Question 6

Nursing Management Of tone

Answer 6

• The first intervention is to perform a Fundal Massage.
• If the fundus gets firm during the massage but becomes boggy as soon as you stop, proceed to administer IV Pitocin (Never administer as an IV push); it is given through an infusion bag and is considered one of the riskier interventions in the hospital.
• Misoprostol: 800 mcg rectally, sometimes orally.
• Methergine: 0.2 mg IM (contraindicated in patients with hypertension). coz it’s a vasoconstrictor
• Hemabate: 0.25 mg IM (contraindicated in patients with asthma due to the risk of bronchospasms). coz it’s a muscle contractor

Question 7

Nursing Management hemorrhage continues

Answer 7

• Weigh everything that is blood-soaked, and if there’s excessive bleeding, contact the healthcare provider.
• Contact the provider for further guidance.
• Manage pain as it’s a common issue in these situations.
• Consider the need for a second IV site for transfusion if there is significant bleeding.
• Monitor vital signs (Blood Pressure, Heart Rate, Respiratory Rate, and Temperature) every 15-30 minutes.
• Monitor Capillary refill, urine output (little output means that the body is keeping pee to create volume and compensate for blood loss), and Level of Consciousness “no blood to brain=decreased LOC” (communication with the patient is the best way to assess LOC).
• Consider Foley catheter insertion to keep the bladder empty, especially if the patient is experiencing effects from epidural, opioids, pain due to lacerations, or is anxious about urinating. This is done when the uterus can’t contract due to full bladder.
• Avoid anti-platelet medications (such as NSAIDs, ASA, and antihistamines).

Question 8

Shock Very low BP due to blood loss or as a result of inflammation in sepsis because the blood leaves the BV and ends up in the interstitial fluid

Answer 8

Catabolic State Development
- The body enters a catabolic state, where it consumes its muscles and fat tissues for energy, leading to the accumulation of various toxins in the blood, including ketones, etc.

1. Inflammation, typically initiating the shock process, is triggered by neutrophils and cytokines, causing damage when they become trapped in tissues due to their overreaction.
2. Endothelial dysfunction affects vessel cells, causing irregularities due to cytokines and neutrophils, leading to artery blockages and spasms that obstruct blood flow.
3. Organs enter a disruptive metabolic state, rendering them incapable of functioning properly.
4. Recovery is challenging once this cascade of events occurs, even with transfusions, and organ damage may persist.

Development of DIC (Disseminated
all over body Intravascular Coagulation) Body tries to compensate for blood loss
- DIC is a serious medical condition characterized by abnormal blood clotting and simultaneous bleeding throughout the body.

1. Monitor for bleeding in areas such as IV sites, etc.
2. Watch for bleeding from the gums or nose.
3. Be alert for unusual bleeding.
4. Check for hematuria (blood in the urine).
5. Order a DIC panel, consisting of several blood tests, including platelet count, prothrombin time, partial thromboplastin time, fibrinogen level, D-dimer, fibrin split products, antithrombin III, protein C, protein S, and thrombin time. This panel is used to diagnose and monitor the condition.
6. Administer multiple blood products; it often takes several to bring DIC under control.

Question 9

Venous ThromboembolicCondition

Answer 9

• Inherited & Acquired Bleeding Disorders
  
  • Relatively uncommon as the sole reason for bleeding issues (meaning that they are usually accompanied by a cut for example)
  • Thromboembolic Thrombocytopenic Purpura (TTP: Thromboembolic Thrombocytopenic Purpura (TTP) is a rare and serious blood disorder characterized by abnormal blood clotting in small blood vessels throughout the body. It is primarily an acquired disorder, meaning it is not typically inherited but rather develops later in life.)
  • Von Willebrand Disease: A lifelong bleeding disorder caused by a deficiency in a blood clotting protein.
  • DVT (Deep Vein Thrombosis): Can progress to a Pulmonary Embolism (PE), with the most common sign being shortness of breath (“I can’t breathe”).
  • DIC (Disseminated Intravascular Coagulation): Can also be included in this category.

Question 10

Occurs 1 in 1,000 Pregnancies (Venous ThromboembolicCondition) meaning 0.1%

Answer 10

1. One of the leading causes of pregnancy-related deaths.
2. Thrombosis can occur, including:
   
   • a) Superficial Venous Thrombosis
   • b) DVT (Deep Vein Thrombosis), which can lead to a Pulmonary Embolism (PE).

Question 11

Nursing Management (Venous ThromboembolicCondition)

Answer 11

Nursing Management (Venous Thromboembolic Condition)

• Monitor for calf pain, lower extremity (LE) edema, and the sudden onset of shortness of breath (SOB) with decreased oxygen saturation.
• Ensure oxygen delivery as needed.
• Apply compression stockings to improve circulation.
• Apply Sequential Compression Devices (SCDs) to prevent blood clots.
• Administer Lovenox, which is preferred for post-pregnant women. Lovenox is a low molecular weight heparin.
• Encourage increased fluid intake to help prevent clot formation.
• Administer intravenous (IV) heparin as prescribed.
• Use NSAIDs for pain management in cases of Superficial Venous Thrombosis (VT).
• Educate the patient on the condition, preventive measures, and medications.
• Consider the possibility of administering tissue plasminogen activator (tPA) as indicated and under medical guidance.
  That’s correct. Tissue plasminogen activator (tPA) is typically not given prophylactically (as a preventive measure) like heparin or Lovenox.

Question 12

PP Infection

Answer 12

Postpartum Infection

• Postpartum infection is diagnosed when a fever exceeds 100.4 degrees Fahrenheit for at least 2 of the first 10 days postpartum (excluding the first 24 hours) and is not associated with foul-smelling vaginal discharge.
• Approximately 8% of all births will experience this postpartum infection.

Question 13

RISK FACTORS (Infection)

Answer 13

Factors Increasing Risk of Postpartum Infection

• Cesarean section (surgical entry).
• Prolonged rupture of membranes.
• Extended labor with multiple Sterile Vaginal Examinations (VE), even with sterile gloves, as the vagina is never completely sterile.
• Internal fetal monitoring, which can create a pathway for bacterial entry.
• Chorioamnionitis increases the risk of infection.
• Operative vaginal delivery methods, such as vacuum extraction, which can damage tissues.
• Retained placental fragments.
• Tissue lacerations.
• Site of placental separation.
• Extreme maternal ages, either very young or advanced in age.
• An alkaline environment due to amniotic fluid and blood/lochia, which is more alkaline than normal.
• Typically, infections are caused by normal flora.

Question 14

TYPES OF INFECTIONS

Answer 14

Types of Postpartum Infections

Endometritis Infection (Uterine):
- Can develop as early as 2 to 4 days postpartum and as late as 6 weeks.
- It can extend to the fallopian tubes if left untreated.

Surgical Site (Cesarean):
- Infections can occur at the site of a cesarean section incision.

UTI (Urinary Tract Infection):
- UTIs can develop, sometimes even from vaginal exams, which can introduce bacteria.

Mastitis:
- Mastitis can occur from breastfeeding, often caused by Staphylococcus aureus, especially when breastfeeding is decreased or interrupted.

Perineum:
- Infections can also affect the perineum, especially if there are lacerations during childbirth.

Best way to fight infection is to change the pads as often.

Question 15

Nursing Management (Infection)

Answer 15

Management and Prevention of Postpartum Infections

• Perform a wound culture if ordered, and observe for any changes in wound color.
• Monitor for erythema (redness) around the wound.
• Administer antibiotics as prescribed.
• Promote good hand hygiene among healthcare providers.
• Conduct perineum assessments using the REEDA (Redness, Edema, Ecchymosis, Discharge, and Approximation) scale.
• Administer prophylactic antibiotics before cesarean section surgery.
• Educate patients on the importance of hand hygiene, peri bottle use for washing, the frequency of pad changes, and provide discharge education on caring for infections.
• Encourage rest, increased fluid intake, and good nutrition to enhance the body’s ability to fight infection.
• Teach patients about the signs of endometritis, including low abdominal tenderness, foul-smelling lochia, flu-like symptoms, and fever (temperature ≥38°C).

Question 16

Reeda slide 19

Answer 16

REEDA . Osmosis

• REEDA is an acronym used in nursing to assess the healing progress and condition of the perineum after childbirth. It stands for:
  
  • Redness: Assess the area for any redness, which may indicate inflammation or infection.
  • Edema: Check for swelling or edema in the perineal area, which is a common occurrence after childbirth.
  • Ecchymosis: Look for any bruising, as bruising may be present due to the trauma of childbirth.
  • Discharge: Examine any discharge from the perineal area, including the type, color, and odor. Foul-smelling or discolored discharge can indicate infection.
  • Approximation: Assess how well the edges of any lacerations or episiotomies are coming together. Proper approximation is important for healing.
• The REEDA assessment helps healthcare providers monitor the healing process and identify any issues that may require further evaluation or intervention in the postpartum period. It is particularly relevant for women who have had perineal tears or episiotomies during childbirth.

Question 17

PP Affective Disorders. Caused by Plummeting estrogen and progesterone levels

Answer 17

• Blues
  
  • Clinical Depression
  • Psychosis

Question 18

PP Blues

Answer 18

• Peaks on day 4-5 and resolves around day 10
• Self-limiting, meaning symptoms improve over time
• No treatment required
• Follow-up needed
• 20% progress to depression

Question 19

PP Depression

Answer 19

• Manifests in mind, body, and lifestyle changes
• Individuals may struggle to get out of bed
• A form of Clinical Depression
• Symptoms worsen over time (changes in mood and behavior do not improve)
• Persists for a minimum of 6 months
• Requires treatment

Question 20

Nursing Management

Answer 20

• Medication administration (antidepressants, antianxiety)
• Encourage adequate sleep
• Psychotherapy
• Use facility screening tools
• Assess the partner (male), as up to 50% of partners may exhibit depressive symptoms

Question 21

PP Psychosis. It’s hallucinations, even self harm to them and infant.

Answer 21

• PP Psychosis
  
  • Hallucinations, including self-harm to oneself and the infant
  • Occurs in 1 in 1,000 live births within 1 year of delivery
  • Sudden and abrupt onset
  • Sleep disturbances
  • Delusional beliefs
  • Hallucinations
  • Extreme disorganization of thoughts
  • Feelings of anger towards herself or the infant
  • Self-harm or harm to the infant
  • Loss of touch with reality

Question 22

Nursing Management (PP Psychosis)

Answer 22

• Do not leave mom alone with the infant
• Transfer to Inpatient Behavioral Treatment
• Administer psychotropic drugs
• Set up psychotherapy (individual and group)
• Educate yourself to provide the best possible care
• Educate the patient

Question 23

• Cardiovascular disease in pregnancy
  
  • Leading cause of maternal mortality
  • Physiologic changes during pregnancy can exacerbate known and unknown cardiac complications that a woman may already have.

Question 24

Four key risk factors for cardiovascular disease in pregnancy include:

1. Race/Ethnicity (due to lack of insurance and potential disparities in prenatal care)
2. Hypertension
3. Advanced maternal age
4. Obesity
5. Sleep apnea
6. Substance abuse
7. Previous chemotherapy treatment

Question 25

Most common heart complications postpartum

Answer 25

• Heart failure
• Myocardial infarction
• Aortic dissection: Aorta cuts or breaks, initially presenting as weakening
• Arrhythmia, especially in the first few hours

Question 26

Readiness. We are not that ready for heart complications at hospitals.

Answer 26

A comprehensive cardiovascular screening for every patient should include:

Patient History of Cardiac Conditions: Collecting information about the patient’s past cardiac problems or heart-related illnesses.

Patient Reported Symptoms: Listening to the patient’s description of current symptoms, which can include chest pain, shortness of breath, fatigue, and more.

Orthopnea: Inquiring if the patient experiences easier breathing when sitting or standing rather than lying down.

Dyspnea: Asking if the patient experiences difficulty breathing, particularly during exertion.

Palpitations: Inquiring about any abnormal heart sensations, such as rapid or irregular heartbeats.

Dizziness: Asking if the patient has experienced dizziness, which can be related to cardiac conditions.

Fainting/Syncope: Inquiring about any episodes of sudden loss of consciousness.

Vital Signs: Measuring key vital signs to assess overall health, including heart rate, respiratory rate, blood pressure, and pulse oximetry (oxygen saturation level).

Physical Examination: Conducting a physical examination, including:
- Listening for abnormal heart sounds (murmurs, irregular rhythms).
- Checking for abnormal lung sounds (crackles, wheezes).
- Examining extremities for swelling (peripheral edema), a sign of heart failure.
- Observing neck veins for signs of elevated central venous pressure (Jugular Venous Distension - JVD), which can occur in heart conditions.

Question 27

Certainly, here’s the information summarized into bullet points:

Common Discomforts of Pregnancy:
- Nausea: Often known as morning sickness due to hormonal changes.
- Indigestion: Including heartburn, caused by hormonal changes and uterine pressure.
- Breast Tenderness: Due to hormonal fluctuations.
- Frequent Urination: Caused by the expanding uterus.
- Headaches: Resulting from hormonal changes and increased blood volume.
- Backache: Due to weight gain and posture changes.
- Sweating: A normal part of pregnancy.

Potential Cardiovascular Symptoms:
- Chest Pain or Discomfort: Should not be ignored during pregnancy.
- Shortness of Breath: Especially when at rest.
- Palpitations: Rapid or irregular heartbeats.
- Swelling (Edema): Sudden or severe swelling of hands, face, or legs.
- Dizziness or Fainting: Frequent episodes should be reported to a healthcare provider.
- High Blood Pressure (Preeclampsia): A serious condition that requires monitoring and management.

Answer 27

S

Question 28

Cardiac output in labor, birth and postpartum

Answer 28

Early First Stage of Labor:
- Gradual increase in cardiac output.
- Initial increase of 15%, with an additional 15% per uterine contraction.

Late First Stage of Labor (Active Labor):
- Continued rise in cardiac output.
- Initial increase of 30%, with an additional 15% per uterine contraction.

Second Stage of Labor (Pushing and Birth):
- Significant increase in cardiac output.
- Initial increase of 45%, with an additional 15% per uterine contraction.

Postpartum - 5 Minutes:
- Cardiac output remains elevated compared to pre-pregnancy levels.
- Typically increases by around 65% to aid recovery from labor.

Postpartum - 60 Minutes:
- Cardiac output starts returning to pre-pregnancy levels.
- Typically increases by around 40% at this stage.
- This marks the beginning of a gradual adjustment to the postpartum state, eventually returning to baseline.

In summary, during labor, there is a progressive increase in cardiac output to meet the demands of the uterus contracting and pushing during childbirth.(this is because during contractions the smooth muscle surrounding the uterus has to work harder and therefore it needs more blood with oxygen to produce ATP
) After birth, cardiac output remains elevated initially to support the body’s recovery process. Over time, usually within the first hour postpartum, cardiac output begins to return to its pre-pregnancy levels as the body readjusts to its non-pregnant state. These changes are a natural part of the physiological adaptations that occur during and after childbirth.

Question 29

Recognition

Answer 29

Absolutely, here’s a breakdown of the key elements involved in a clinical recognition or diagnostic scenario:

Elements in Clinical Recognition/Diagnosis:
- Recognition: The process of identifying or diagnosing a specific medical condition based on clinical signs, symptoms, and objective data.

• Vital Signs: Essential measurements indicating overall health status:
  
  • Heart Rate (Pulse): Number of heartbeats per minute.
  • Respiratory Rate: Number of breaths per minute.
  • Blood Pressure: Measurement of systolic and diastolic blood pressure.
  • Temperature: Body temperature, measured in Fahrenheit or Celsius.
• Lung Auscultation: The practice of listening to lung sounds using a stethoscope, helping to detect abnormal sounds like crackles, wheezes, or diminished breath sounds, which aid in diagnosis.
• Labs (Laboratory Tests): Various diagnostic tests, including blood tests, urine tests, imaging studies (X-rays, CT scans), and other procedures, used to assess a patient’s health and diagnose medical conditions.
• Jugular Venous Distension (JVD): A clinical sign where the jugular veins in the neck become visibly distended, often indicating increased central venous pressure, which can be associated with conditions such as heart failure.
• Edema: Abnormal accumulation of fluid in tissues, resulting in swelling, with peripheral edema often linked to conditions like heart failure.
• Algorithm: A step-by-step decision-making process or set of evidence-based guidelines used by healthcare professionals to diagnose or manage specific medical conditions, ensuring standardized care and decision-making.

Question 30

Certainly, here’s an explanation of each parameter and its significance in assessing a patient’s vital signs:

• Resting Heart Rate (HR) ≥ 110 bpm: A resting heart rate of 110 beats per minute (bpm) or higher suggests tachycardia, which is an abnormally fast heart rate at rest. Tachycardia can have various causes, including fever, anxiety, anemia, or underlying heart conditions. It requires further evaluation to determine the underlying cause.
• Systolic Blood Pressure (BP) ≥ 140 mm Hg: A systolic blood pressure reading of 140 mm Hg or higher indicates high blood pressure (hypertension). Elevated systolic blood pressure can strain the heart and increase the risk of cardiovascular issues, including heart disease, stroke, and kidney problems. It often warrants monitoring and possible intervention.
• Respiratory Rate (RR) ≥ 24: A respiratory rate of 24 breaths per minute or higher indicates an elevated breathing rate. This can be a sign of respiratory distress, lung disease, fever, or metabolic issues. It’s crucial to assess the patient’s breathing pattern and investigate the underlying cause, as it can be indicative of significant health problems.
• Oxygen Saturation (SpO2) ≤ 96%: Oxygen saturation measures the percentage of oxygen-bound hemoglobin in the blood. An SpO2 level of 96% or lower suggests inadequate oxygenation of the blood. This can occur in conditions such as respiratory disorders (e.g., pneumonia), lung disease, or issues affecting oxygen transport (e.g., anemia). Low oxygen saturation levels require prompt evaluation and appropriate management to ensure sufficient oxygen supply to the body’s tissues and organs.

Question 31

Pulse pressure:

Answer 31

You’ve provided an accurate breakdown of the concept of pulse pressure and its relationship to stroke volume, along with the associated calculations. Here’s a summary:

• Pulse Pressure (PP): Pulse pressure is calculated as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP):PP = SBP - DBP
• Stroke Volume (SV) Relationship: Pulse pressure is approximately equal to half of the stroke volume (SV). Stroke volume is the amount of blood ejected by the heart with each heartbeat:PP ≈ 1/2 SV
• Example Values: In an example scenario:
  
  • SBP (Systolic Blood Pressure) = 120 mm Hg
  • DBP (Diastolic Blood Pressure) = 80 mm Hg
• Degree of Vasoconstriction: The degree of vasoconstriction is the difference between SBP and DBP, which in this case is 120 - 80 = 40 mm Hg.
• Stroke Volume Calculation: To estimate stroke volume using pulse pressure, you can multiply the degree of vasoconstriction by 2:SV ≈ 2 × Degree of Vasoconstriction
  SV ≈ 2 × 40 mm Hg = 80 ml/beat

This calculation provides a rough estimate of stroke volume based on pulse pressure. However, it’s important to note that the relationship between pulse pressure and stroke volume can be influenced by various factors, and this calculation serves as a simplification for educational purposes.

Question 32

Symptomps suggestive of several cardiac issues:

Answer 32

Symptoms Suggestive of Heart Failure:
- Dyspnea: Shortness of breath, which can happen during exertion or at rest.
- Mild Orthopnea: Easier breathing when sitting or standing compared to lying down.
- Tachypnea: Rapid breathing as the body compensates for reduced cardiac output.
- Asthma Unresponsive to Therapy: Asthma-like symptoms that don’t improve with typical asthma treatments.

Symptoms Suggestive of Arrhythmia (Irregular Heartbeat):
- Palpitations: Sensations of rapid, strong, or irregular heartbeats.
- Dizziness/Syncope: Dizziness or fainting resulting from disrupted heart rhythms affecting blood flow.

Symptoms Suggestive of Coronary Artery Disease (CAD):
- Chest Pain: Especially chest pain triggered by exertion (angina pectoris), indicating reduced blood flow to the heart muscle.
- Dyspnea: Shortness of breath, particularly during physical activity.

Question 33

Red flags for cardiac issues

Answer 33

You’ve provided a clear explanation of various vital signs and clinical findings that can indicate potential health concerns. Here’s a summary:

Abnormal Vital Signs and Clinical Findings:

• HR > 120 beats per minute: Indicative of tachycardia, potentially associated with cardiac issues, infections, or systemic problems.
• BP > 160 mm Hg systolic: Suggests severely elevated blood pressure, which may signal hypertensive emergencies like preeclampsia or cardiovascular issues.
• RR > 30: Indicates rapid breathing, possibly linked to respiratory distress, infection, or pulmonary issues.
• O2 saturation ≤ 94%: Signifies decreased oxygen levels in the blood, which can result from respiratory or cardiac problems and can be harmful to both the mother and fetus.
• Lung findings - crackles, wheezes: Presence of abnormal lung sounds (crackles or wheezes) may indicate lung congestion, infection, or other respiratory issues, necessitating evaluation.
• Cardiac findings - loud murmur, JVD (Jugular Venous Distension): Suggests potential cardiac problems such as valvular issues or heart failure, requiring prompt assessment.
• Extremities - edema (should be resolving postpartum): While some edema in the extremities is normal during pregnancy, persistent or worsening edema after childbirth can signal more serious conditions like heart failure.

Question 34

Postpartum presentations :

Answer 34

Postpartum Physiologic Changes:
- After childbirth, many physiological changes that occurred during pregnancy should gradually improve.
- These changes include symptoms like shortness of breath, swelling, and alterations in blood pressure.
- Healthcare providers should monitor and assess these changes to ensure they are resolving as expected.

Dyspnea and Cardiovascular Disease:
- Dyspnea (shortness of breath) is a symptom with various potential causes.
- Significant dyspnea in the postpartum period should raise suspicion for underlying cardiovascular disease.
- Conditions like heart failure or peripartum cardiomyopathy can sometimes present with dyspnea after childbirth.

Questioning About Recent Pregnancies:
- When evaluating women of childbearing age, healthcare providers should inquire about recent pregnancies in addition to menstrual history.
- Knowledge of recent pregnancies is essential for assessing the potential impact of pregnancy-related factors on a woman’s current health status.

Postpartum Dyspnea and New-Onset Cough:
- Postpartum dyspnea, especially when accompanied by a new-onset cough, can be a red flag for cardiovascular disease, particularly conditions affecting the heart and lungs.
- Prompt investigation of these symptoms is crucial to rule out serious medical conditions.

Question 35

Certainly! Here are some key points and concepts related to contraceptives that you should be familiar with as a nursing student studying obstetrics:

1. Types of Contraceptives:
   
   • Barrier Methods: These include condoms, diaphragms, and cervical caps. They physically block sperm from reaching the egg.
   • Hormonal Methods: Birth control pills, patches, injections, and implants contain hormones that prevent ovulation or thicken cervical mucus to impede sperm movement.
   • Intrauterine Devices (IUDs): T-shaped devices placed in the uterus to prevent pregnancy. They can be hormonal or non-hormonal.
   • Emergency Contraception: Also known as the “morning-after pill,” it is used after unprotected sex to prevent pregnancy.
   • Sterilization: Permanent methods like tubal ligation (female sterilization) and vasectomy (male sterilization) for those who do not want more children.
2. Effectiveness: Contraceptive methods vary in their effectiveness. Understanding the failure rates and how to use them correctly is crucial.
3. Side Effects and Risks: Each contraceptive method can have side effects and risks. For example, hormonal methods may cause nausea, weight gain, or mood changes.
4. Contraindications: Know when certain contraceptives are contraindicated based on a patient’s medical history. For example, estrogen-containing contraceptives are not suitable for women with a history of blood clots.
5. Patient Counseling: As a nurse, you will need to educate patients about the pros and cons of different contraceptive methods, helping them make informed choices.
6. Emergency Contraception: Understand the different types of emergency contraception, when they are effective, and how to administer them.
7. Sexually Transmitted Infections (STIs): Contraceptives primarily prevent pregnancy, not STIs. Encourage the use of condoms to reduce the risk of STIs.
8. Fertility Awareness Methods: Familiarize yourself with tracking methods like the calendar method, basal body temperature method, and cervical mucus method. These are natural ways to identify fertile days.
9. Cultural and Religious Considerations: Respect patients’ cultural and religious beliefs regarding contraception and provide alternative options when necessary.
10. Legal and Ethical Issues: Understand the legal and ethical aspects of prescribing and providing contraceptives, especially when dealing with minors.
11. Patient Follow-Up: Know the importance of follow-up appointments to monitor the patient’s health and adjust the contraceptive method if needed.
12. Emergency Situations: Be prepared for situations where contraceptive failure may lead to unintended pregnancy and the steps to take in such cases.
13. Special Populations: Consider the unique contraceptive needs of adolescents, postpartum women, and women with certain medical conditions.
14. Patient Communication: Develop effective communication skills to discuss sensitive topics related to contraception and sexual health.
15. Documentation: Properly document contraceptive discussions, prescriptions, and follow-up care in the patient’s medical record.
16. Community Resources: Be aware of local resources and clinics that provide contraceptive services for patients who may not have access to healthcare.

Remember to consult your course materials, textbooks, and any additional resources provided by your instructors for specific information relevant to your obstetrics course. Studying in advance and seeking clarification on any unclear topics will help you excel in your exam.

Question 36

Contraceptives 1

Answer 36

No Birth Control Method Used
- Description: No birth control method used
- Pros: No side effects; acceptable to most religious groups
- Cons: High failure rate with incorrect use

Fertility Awareness-Based Methods
- Description: Refrain from sex during fertile period
- Pros: Involves no devices and is always available
- Cons: Requires considerable self-control

Withdrawal (Coitus Interruptus)
- Description: Man withdraws before ejaculation
- Pros: Not coitus-linked
- Cons: Requires considerable self-control by the man

Lactational Amenorrhea Method (LAM)
- Description: Uses lactational infertility for protection from pregnancy
- Pros: No cost; effective for only 6 months after giving birth
- Cons: Temporary method; requires strict adherence to breastfeeding

Male Condom
- Description: Thin sheath placed over an erect penis, blocking sperm
- Pros: Widely available; low cost; provides some STI protection
- Cons: Decreased sensation for the man; risk of breakage

Female Condom
- Description: Polyurethane sheath inserted vaginally to block sperm
- Pros: Nonhormonal; considered medically safe; provides some STI protection
- Cons: Expensive for frequent use; may be cumbersome

Diaphragm with Spermicide
- Description: Shallow latex cup with a spring mechanism to hold it in place in the vagina
- Pros: Requires accurate fitting by a healthcare professional
- Cons: Requires accurate fitting by a healthcare professional; increases risk of UTIs

Cervical Cap with Spermicide
- Description: Soft cup-shaped latex device that fits over the base of the cervix
- Pros: Provides continuous protection while in place
- Cons: Requires accurate fitting by a healthcare professional; may cause odor if left in too long

Intrauterine Contraception Systems (IUS)
- Description: A time-release implant (one rod) of levonorgestrel for 3 years
- Pros: Long duration of action; low dose of hormones; reversible
- Cons: Insertion requires a skilled professional; may have side effects

Postcoital Emergency Contraceptives (ECs)
- Description: Various options used after unprotected intercourse
- Pros: Provides a last chance to prevent a pregnancy
- Cons: Must be taken within a specific timeframe to be effective

Permanent Sterilization (Male and Female)
- Description: Procedures for permanent sterility
- Pros: Offers permanent sterility
- Cons: Difficult to reverse; initial cost may be high

Oral Contraceptives (Combination)
- Description: A pill that suppresses ovulation by combined action of estrogen and progestin
- Pros: Easy to use; high rate of effectiveness
- Cons: Must be taken daily; may have undesirable side effects

Oral Contraceptives (Progestin-Only Mini-Pills)
- Description: A pill containing only progestin that thickens cervical mucus
- Pros: No estrogen-related side effects; may be used by lactating women
- Cons: Must be taken with meticulous accuracy; may cause irregular bleeding

Patch (Ortho Evra)
- Description: Transdermal patch that releases estrogen and progestin
- Pros: Easy to remember; very effective
- Cons: May cause skin irritation and fall off

Ring (NuvaRing)
- Description: Vaginal contraceptive ring that releases estrogen and progestin
- Pros: Easy to remember; very effective
- Cons: May cause vaginal discharge and can be expelled unnoticed

Depo-Provera Injection
- Description: An injectable progestin that inhibits ovulation
- Pros: Long duration of action; highly effective; can be used by lactating women
- Cons: Menstrual irregularities; return to fertility delayed

These summaries should help nursing students understand the key points about each contraceptive method.

Question 37

contraceptives 2

Answer 37

Certainly! Here are some key points and concepts related to contraceptives that you should be familiar with as a nursing student studying obstetrics:

1. Types of Contraceptives:
   
   • Barrier Methods: These include condoms, diaphragms, and cervical caps. They physically block sperm from reaching the egg.
   • Hormonal Methods: Birth control pills, patches, injections, and implants contain hormones that prevent ovulation or thicken cervical mucus to impede sperm movement.
   • Intrauterine Devices (IUDs): T-shaped devices placed in the uterus to prevent pregnancy. They can be hormonal or non-hormonal.
   • Emergency Contraception: Also known as the “morning-after pill,” it is used after unprotected sex to prevent pregnancy.
   • Sterilization: Permanent methods like tubal ligation (female sterilization) and vasectomy (male sterilization) for those who do not want more children.
2. Effectiveness: Contraceptive methods vary in their effectiveness. Understanding the failure rates and how to use them correctly is crucial.
3. Side Effects and Risks: Each contraceptive method can have side effects and risks. For example, hormonal methods may cause nausea, weight gain, or mood changes.
4. Contraindications: Know when certain contraceptives are contraindicated based on a patient’s medical history. For example, estrogen-containing contraceptives are not suitable for women with a history of blood clots.
5. Patient Counseling: As a nurse, you will need to educate patients about the pros and cons of different contraceptive methods, helping them make informed choices.
6. Emergency Contraception: Understand the different types of emergency contraception, when they are effective, and how to administer them.
7. Sexually Transmitted Infections (STIs): Contraceptives primarily prevent pregnancy, not STIs. Encourage the use of condoms to reduce the risk of STIs.
8. Fertility Awareness Methods: Familiarize yourself with tracking methods like the calendar method, basal body temperature method, and cervical mucus method. These are natural ways to identify fertile days.
9. Cultural and Religious Considerations: Respect patients’ cultural and religious beliefs regarding contraception and provide alternative options when necessary.
10. Legal and Ethical Issues: Understand the legal and ethical aspects of prescribing and providing contraceptives, especially when dealing with minors.
11. Patient Follow-Up: Know the importance of follow-up appointments to monitor the patient’s health and adjust the contraceptive method if needed.
12. Emergency Situations: Be prepared for situations where contraceptive failure may lead to unintended pregnancy and the steps to take in such cases.
13. Special Populations: Consider the unique contraceptive needs of adolescents, postpartum women, and women with certain medical conditions.
14. Patient Communication: Develop effective communication skills to discuss sensitive topics related to contraception and sexual health.
15. Documentation: Properly document contraceptive discussions, prescriptions, and follow-up care in the patient’s medical record.
16. Community Resources: Be aware of local resources and clinics that provide contraceptive services for patients who may not have access to healthcare.

Remember to consult your course materials, textbooks, and any additional resources provided by your instructors for specific information relevant to your obstetrics course. Studying in advance and seeking clarification on any unclear topics will help you excel in your exam.

Question 38

Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process,

Question 39

Magnesium sulfate is given in certain medical situations to relax the uterus, which helps prevent it from contracting too strongly or too frequently, such as in cases of preterm labor or preeclampsia, to protect the health of both the mother and baby.

Question 40

All mentioned medications (IV Pitocin, Misoprostol, Methergine, Hemabate) are used to manage postpartum hemorrhage.
They are uterotonics, promoting uterine contractions.
Uterine contractions help prevent or treat postpartum hemorrhage by reducing uterine atony.
Medications have various administration methods and potential contraindications based on patient factors.

Question 41

No O2 = no energy. Because it can’t be made in cell. Since the mitocondria needs to mix glucose and O2 to be made
When the body experiences significant blood loss, it faces a reduced oxygen-carrying capacity, which can lead to a state of shock. In an effort to maintain essential functions, the body enters a catabolic state. In this catabolic state, it breaks down muscles and fat tissues to release stored energy in the form of glucose and fatty acids. This process provides additional fuel for vital organs and tissues, such as the brain and heart, which require a constant supply of energy to function properly.

The reason for consuming muscles and fat tissues, even when the primary issue is blood loss, is that the body needs energy to compensate for the decreased oxygen delivery caused by the blood loss. By breaking down these energy stores, the body attempts to ensure that critical functions continue, albeit at a reduced capacity. This mechanism helps buy some time for medical intervention and blood transfusions to restore the lost blood volume and oxygen-carrying capacity.

Answer 41

this is because oxygen is used inside the mitochondria through the curb cycle using glucose to create energy in the form of ATP

?
Exactly, you’ve made a valid point. The breakdown of glucose and fatty acids in muscles and fat tissues during a catabolic state is part of the body’s effort to generate energy (in the form of ATP) to support essential cellular functions, including those that occur within the mitochondria.

Inside the mitochondria, glucose undergoes a series of metabolic processes, including glycolysis and the citric acid cycle (Krebs cycle), which ultimately lead to the production of ATP, the primary energy currency of cells. Oxygen plays a crucial role in this process as it is used in the electron transport chain within the mitochondria to generate ATP through oxidative phosphorylation.

During shock or other situations of decreased oxygen availability (such as significant blood loss), the body may resort to breaking down glucose and fatty acids to generate ATP through alternative pathways as a means of survival, even if it involves consuming muscle and fat tissues. This mechanism helps provide energy for vital cellular processes in conditions where oxygen delivery to cells is compromised.

Yes, you’ve articulated it well. The body’s priority is to ensure the survival of vital tissues and organs, even in situations where oxygen delivery may be compromised. To achieve this, it can resort to breaking down its own tissues, such as muscles and fat stores, as a source of energy to sustain critical cellular functions.

this is because body tissues need to stay alive regardless of there is oxygen or not so it starts breaking itself to feed the rest of the population of cells by sacrificing some cells

This mechanism can be seen as a form of self-preservation, where the body sacrifices some cells or tissues to provide energy and resources to the most essential functions, like those of the heart, brain, and other vital organs. It’s a survival strategy employed by the body to cope with the challenges posed by conditions like severe blood loss or shock, ensuring that the core functions necessary for life are maintained even when oxygen availability is limited.

Question 42

Venous thromboembolic conditions, such as deep vein thrombosis and pulmonary embolism, occur in approximately 1 in 1,000 pregnancies, although the risk can vary depending on individual factors.

Answer 42

“Thrombo-“ comes from the Greek word “thrombos,” which means “clot” or “curdled milk.”

“-Embol-“ is derived from the Greek word “embolos,” which means “a plug” or “anything inserted.”

Question 43

That’s correct. Tissue plasminogen activator (tPA) is typically not given prophylactically (as a preventive measure) like heparin or Lovenox.

Question 44

Psychosis etymology

ChatGPT
The word “psychosis” has its roots in ancient Greek. It is derived from the Greek word “psyche,” which means “mind” or “soul,” and the suffix “-osis,” which is used to indicate a medical condition or disorder. Therefore, “psychosis” essentially means a disorder or abnormal condition of the mind or soul.

Answer 44

The word “psychiatry” has its roots in Greek origins. It is derived from two Greek words:

“Psychē” (ψυχή): This word means “mind” or “soul” in Greek. It represents the psychological and mental aspects of an individual.

“Iatreia” (ἰατρεία): This word means “healing” or “medical treatment” in Greek and is related to the practice of medicine.

When you combine these two Greek words, you get “psychiatría” (ψυχιατρία), which means “healing of the mind” or “medical treatment of the mind” in the context of mental health and mental illness. Psychiatry is the medical specialty that focuses on the diagnosis, treatment, and prevention of mental disorders, emphasizing a medical and biological approach to understanding and addressing psychological and emotional issues.

Question 45

1. Normal Blood Pressure:
   
   • Systolic Pressure: Less than 120 mm Hg
   • Diastolic Pressure: Less than 80 mm Hg
   • Written as “120/80 mm Hg”
2. Elevated Blood Pressure:
   
   • Systolic Pressure: 120-129 mm Hg
   • Diastolic Pressure: Less than 80 mm Hg
   • Written as “120-129/less than 80 mm Hg”
3. Hypertension Stage 1:
   
   • Systolic Pressure: 130-139 mm Hg
   • Diastolic Pressure: 80-89 mm Hg
   • Written as “130-139/80-89 mm Hg”
4. Hypertension Stage 2:
   
   • Systolic Pressure: 140 mm Hg or higher
   • Diastolic Pressure: 90 mm Hg or higher
   • Written as “140 or higher/90 or higher mm Hg”
5. Hypertensive Crisis:
   
   • Systolic Pressure: Higher than 180 mm Hg
   • Diastolic Pressure: Higher than 120 mm Hg
   • Seek immediate medical attention
6. Low Blood Pressure (Hypotension):
   
   • Systolic Pressure: Less than 90 mm Hg
   • Diastolic Pressure: Less than 60 mm Hg
   • Symptoms of low blood pressure can include dizziness, fainting, and fatigue.

Question 46

estrogen-containing contraceptives are not suitable for women with a history of blood clots.
Effects on clotting factors: Estrogen can stimulate the liver to produce more clotting factors, such as fibrinogen and certain clotting proteins. Elevated levels of these clotting factors can increase the likelihood of blood clot formation.

Answer 46

Yes, that’s correct. The antiplatelet effect of some NSAIDs, particularly aspirin, is a secondary or side effect of their primary mechanism of action, which is to inhibit the production of prostaglandins and reduce inflammation and pain.

Question 47

Yes, that’s correct. Retained placental fragments can decompose, providing an environment where bacteria can thrive as they feed on the decomposing tissue. This bacterial growth in the uterus increases the risk of infection.

Question 48

Low Blood Pressure (Hypotension):
Systolic Pressure: Less than 90 mm Hg
Diastolic Pressure: Less than 60 mm Hg
Symptoms of low blood pressure can include dizziness, fainting, and fatigue.