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N395 Exam 2 > Postpartum Surgical Care > Flashcards

Postpartum Surgical Care Flashcards

1
Q

Know your patient history

A

Risk Factors?

  • Bleeding disorders
  • Diabetes
  • Heart disease
  • UTI
  • Liver disease
  • Fever
  • COPD
  • Immunological disorders
  • Street drug abuse
  • Chronic pain
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2
Q

Other questions to ask

A
  • How much blood did she lose in the OR?
  • Incision type
  • Dressing condition
  • Uterus firm in PACU?
  • How much Pit did she receive?
  • How is pain managed/is it effective?
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3
Q

What is the key to treating hemorrhage?

A

Early recognition and quick/effective action

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4
Q

Hemorrhage 4 Ts?

A
  1. Tone: uterine atony (most common)
  2. Tissue: retained placenta
  3. Trauma: lacerations, uterine rupture
  4. cloTTing: coagulopathy
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5
Q

Definition of Hemorrhage

A
  • 500 mL + loss after vag delivery
  • 1000 mL + loss after cesarean
  • blood loss significant enough to cause hemodynamic instability
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6
Q

Primary PPH

A

first 24 h of delivery

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7
Q

Secondary PPH

A

24 h - 12 weeks after delivery

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8
Q

Interventions for uterine atony

A
  • Assess for bleeding
  • Assess fundal height
  • Encourage voiding
  • Pit
  • Fundal massage
  • Contact physician
  • Methergine
  • IV fluid/blood transfusion
  • Bimanual compression of uterus
  • Ligation of uterine vessels or hysterectomy
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9
Q

Puerperal (Postpartum) Infections

A
  • Infections of the reproductive tract associated with childbirth
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10
Q

Three types of puerperal infections

A
  • Metritis
  • Perineal
  • Cesarean wound
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11
Q

Causes of metritis

A
  • Cesarean
  • PROM
  • FSC
  • OB trauma
  • Manual removal of placenta
  • Preexisting infection
  • Compromised health status
  • Prolonged labor
  • Multiple vag exams
  • IUPC
  • Instrument assisted birth
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12
Q

Metritis Assessment

A
  • Significant abdominal/uterine pain
  • Foul smelling vag discharge
  • Fever 101-104 deg F
  • Chills
  • Malaise
  • 30% increase in WBC
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13
Q

Metritis Intervention

A
  • CBC
  • Cultures
  • Hygiene
  • Drain abscess
  • IV antibiotics
  • Antipyretics
  • ICU hospitalization
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14
Q

Cesarean Wound Infection S/S

A
  • Pain
  • Redness
  • Odor
  • Temp above 101.5 deg F
  • Drainage
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15
Q

Cesarean Wound Dehiscence

A
  • Wound has reopened

- Can be many degrees of this (should measure opening)

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16
Q

Thrombophlebitis

A

Blood clot formed from impeded blood flow

17
Q

Causes of thrombophlebitis

A
  • Hypercoagulability of blood
  • Venous stasis
  • Injury to epithelium of vessels
18
Q

Prevention of thrombophlebitis

A
  • Avoid dehydration
  • Early PP ambulation
  • Leg exercises to support venous return
  • No smoking
  • Antiembolism stockings
19
Q

Assessment of Superficial Thrombophlebitis

A
  • Tenderness
  • Swelling
  • Low fever
  • Localized heat
  • Redness
20
Q

Intervention for Superficial Thrombophlebitis

A
  • Elevate leg
  • Local moist heat
  • Support hose
  • Bed rest
  • Analgesia
21
Q

Superficial Thrombophlebitis

A
  • Usually 3-4 day after delivery
  • Superficial vein, can be seen on surface (inflammation)
  • Little risk of pulmonary embolism
22
Q

Deep Vein Thrombosis

A
  • 10-20 days after delivery
  • Deep vein
  • Clot can travel to lungs and cause pulmonary embolism
23
Q

Deep Vein Thrombosis Assessment

A
  • Swelling
  • Pain
  • Erythema
  • Heat
  • Pedal edema
  • Low to high fever
  • Sometimes decreased perfusion
  • Chills
24
Q

Deep Vein Thrombosis Intervention

A
  • Bed rest
  • Analgesia
  • Elevate leg
  • Antibiotics
  • Anticoagulant therapy: IV heparin, Coumadin for 2-6 months
  • Monitor for pulmonary embolism
25
Q

Deep Vein Thrombosis Prevention

A
  • Promote ambulation
  • TED hose
  • SCDs
26
Q

Pulmonary Embolism

A
  • Clot moves to pulmonary artery
27
Q

Pulmonary Embolism Assessment

A
  • Dyspnea
  • Cough
  • Cyanosis
  • Tachypnea
  • Chest pain
  • Hemoptysis
  • Hypotension
  • Tachycardia
28
Q

Pulmonary Embolism Treatment

A
  • Alert physician
  • O2
  • Anticoagulation with heparin
  • Elevate head of bed
  • Narcotics
29
Q

Paralytic Ileus

A

Slowed movement through gut

30
Q

Causes of paralytic ileus

A
  • Post-op complication
  • Abdominal surgery
  • Use of narcotic drugs
  • NPO before/after surgery
31
Q

Assessment of paralytic ileus

A
  • Abdominal pain/distention
  • Absent bowel sounds
  • N/V
  • Always assess bowel sounds post-op before feeding (and do ab assess)
  • Ask about passing gas
32
Q

Intervention for paralytic ileus

A
  • Assess
  • Document
  • Notify MD of findings
  • May do X-ray and CT scan to confirm diagnosis
  • May have to insert NG tube
33
Q

Cause of UTIs

A
  • Retention of urine

- Bacteria from catheterization (most commonly E. Coli)

34
Q

Cystitis Assessment

A
  • Bladder infection
  • Increased urinary frequency
  • Urgency
  • Dysuria
  • Pain above pubic region
  • WBCs and bacteria in urine
  • More common in women
35
Q

Cystitis Intervention

A
  • Increase fluids
  • Empty bladder
  • Void frequently
  • Urine culture
  • Antibiotics
36
Q

Cystitis Prevention

A
  • Hygiene
  • Void Q2-4 h
  • Increase acidity of urine
37
Q

Pyelonephritis Assessment

A
  • Kidney infection
  • UTI signs
  • Chills
  • N/V
  • High fever
  • Flank pain
  • Acutely ill
38
Q

Pyelonephritis Intervention

A
  • IV antibiotics
  • Antipyretics
  • Increase fluids
  • Analgesic
  • Follow-up culture in 2 weeks

N395 Exam 2 (11 decks)

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