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
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?
3
Q
What is the key to treating hemorrhage?
A
Early recognition and quick/effective action
4
Q
Hemorrhage 4 Ts?
A
- Tone: uterine atony (most common)
- Tissue: retained placenta
- Trauma: lacerations, uterine rupture
- cloTTing: coagulopathy
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
6
Q
Primary PPH
A
first 24 h of delivery
7
Q
Secondary PPH
A
24 h - 12 weeks after delivery
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
9
Q
Puerperal (Postpartum) Infections
A
- Infections of the reproductive tract associated with childbirth
10
Q
Three types of puerperal infections
A
- Metritis
- Perineal
- Cesarean wound
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
12
Q
Metritis Assessment
A
- Significant abdominal/uterine pain
- Foul smelling vag discharge
- Fever 101-104 deg F
- Chills
- Malaise
- 30% increase in WBC
13
Q
Metritis Intervention
A
- CBC
- Cultures
- Hygiene
- Drain abscess
- IV antibiotics
- Antipyretics
- ICU hospitalization
14
Q
Cesarean Wound Infection S/S
A
- Pain
- Redness
- Odor
- Temp above 101.5 deg F
- Drainage
15
Q
Cesarean Wound Dehiscence
A
- Wound has reopened
- Can be many degrees of this (should measure opening)
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
Deep Vein Thrombosis Prevention
- Promote ambulation
- TED hose
- SCDs
26
Pulmonary Embolism
- Clot moves to pulmonary artery
27
Pulmonary Embolism Assessment
- Dyspnea
- Cough
- Cyanosis
- Tachypnea
- Chest pain
- Hemoptysis
- Hypotension
- Tachycardia
28
Pulmonary Embolism Treatment
- Alert physician
- O2
- Anticoagulation with heparin
- Elevate head of bed
- Narcotics
29
Paralytic Ileus
Slowed movement through gut
30
Causes of paralytic ileus
- Post-op complication
- Abdominal surgery
- Use of narcotic drugs
- NPO before/after surgery
31
Assessment of paralytic ileus
- 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
Intervention for paralytic ileus
- Assess
- Document
- Notify MD of findings
- May do X-ray and CT scan to confirm diagnosis
- May have to insert NG tube
33
Cause of UTIs
- Retention of urine
| - Bacteria from catheterization (most commonly E. Coli)
34
Cystitis Assessment
- Bladder infection
- Increased urinary frequency
- Urgency
- Dysuria
- Pain above pubic region
- WBCs and bacteria in urine
- More common in women
35
Cystitis Intervention
- Increase fluids
- Empty bladder
- Void frequently
- Urine culture
- Antibiotics
36
Cystitis Prevention
- Hygiene
- Void Q2-4 h
- Increase acidity of urine
37
Pyelonephritis Assessment
- Kidney infection
- UTI signs
- Chills
- N/V
- High fever
- Flank pain
- Acutely ill
38
Pyelonephritis Intervention
- IV antibiotics
- Antipyretics
- Increase fluids
- Analgesic
- Follow-up culture in 2 weeks
