PP complication PP

Question 1

Is this normal?
Urine output of 3,000 mL in 12 hr

Answer 1

Yes
On the second to fifth day after birth, the urinary output of the woman increases to as much as 3000 mL per day.
Usually 800 to 2,000 milliliters per day

Question 2

Lauren is a 26-year-old G6 T3 P1 A2 L4
delivered her fourth baby at 39 weeks via c-section due to macrosomia two hours ago.
She was in labor for several hours and wasn’t progressing She developed an elevated temp of 101.2
A STAT c-section was performed when her baby showed signs of distress on the monitor
Her baby was transferred to the NICU after delivery
No one has returned to give Lauren an update as of yet

What risk factors do you see in Lauren’s history?

Answer 2

G6 T3 P1 A2 L4
C-Section due to macrosomia
two hours ago
labor for several hours
elevated temp of 101.2
A STAT c-section
Her baby was transferred to the NICU

Question 3

Postpartum assessment?

Answer 3

Breasts
Uterus
Bladder
Bowel
Lochia
Episiotomy/Incision

Question 4

When is the highest risk for bleeding due to atony?

Answer 4

Only a few hours out from delivering

Question 5

Besides atony any other risk factors for PPH?

G6 T3 P1 A2 L4
C-Section due to macrosomia
two hours ago
labor for several hours
elevated temp of 101.2
A STAT c-section
Her baby was transferred to the NICU

Answer 5

Macrosomic baby
Prolonged labor
Multiparity
Not breastfeeding currently due to separation

Question 6

You assess Lauren’s lochia and find her pad saturated, what should you do?

Answer 6

Ask her how long she has had it on
Assess her fundus/ Massage her fundus if needed

Question 7

Lauren’s fundus is NOT firm.
you massage her fundus and it starts to firm up but relaxes again as soon as you stop.

Answer 7

Full bladder!!!!
(most common cause in 1st 24 hours)
Retained Placental Fragments
Macrosomia
Prolonged labor

Question 8

What are some pharmacologic interventions?

Answer 8

Oxytocin
Methergine
Cytotec
Hemobate

Question 9

Methergine
a) indication
b) contraindication

Answer 9

a) Firm Fundus
Decreased lochia
b) hypertension

Question 10

administering blood products
a) Hemoglobin is less than?
b) Before administering?
c) How often do we assess V/S?\
d) How long do we stay with the pt?

Answer 10

a) 10g/dl
b) Verify the client’s identity and blood type with 2 nurses
c) First 30 minutes. Then take v/s hourly
d) during the first 30 minutes

Question 11

administering blood products
What reaction may occur at the first 50 ml of infusion?

Answer 11

a) An acute hemolytic reaction (chills, fever, low back pain, tachycardia, tachypnea, and hypotension)

If a reaction occurs, stop the infusion immediately. Keep the IV line open with .9% Sodium Chloride

Question 12

Ana, was diagnosed with a DVT
But why must be a bedrest?

Answer 12

The clot could dislodge and travel to her lungs, heart

Question 13

What other interventions should be done for a patient with an existing DVT?

Answer 13

Elevate affected leg
Do not massage
Analgesics for pain
Watch for bleeding while receiving anticoagulant medication

Question 14

Sara has saturated her peri pad
Vaginal delivery with forceps
The fundus is firm, midline at U-1.
What else can you do?

Answer 14

Ask her how long she has had this pad on
Change her pad and reassess in 15 mins
Check her vital signs

Question 15

Sala B/P is 98/66
Her pulse is 110
Felt weak and dizzy upon standing
W
a) hat could this mean?
b) What should you do?

Answer 15

a) Vaginal or cervical laceration
b) Call the provider
The laceration may need to be sutured

Question 16

a) Since Sara had an operative vaginal delivery, what other problems do we need to look for in Sara?
b) What are some signs of this?

Answer 16

a) Hematoma
b)Severe pain in the perineal area
Swelling or discoloration of the perineal area

Question 17

What are some signs of surgical site infection?

Answer 17

Fever greater than 100.4
Redness
warmth
Edema
Purulent discharge
Increased pain
Wound edges may be puckering

Question 18

What are the signs for DVT?

Answer 18

Unilateral: Tenderness
Warmth
Edema
Change in color

Question 19

a) How can we prevent DVT?
b) if pt cannot get out the bed, then?

Answer 19

a) Encourage Ambulation
b) Encourage the use of SCDs
Encourage leg exercises in bed (pointing and flexing foot, ankle rotations)

Question 20

a) What are some risk factors that you may want to assess PPD?
b) What is our main concern in patient with PPD?

Answer 20

a)
Lack of support
History of PPD or major depression
Depression during pregnancy
Body image problems/eating disorders
Stressful life events
b)
Harming herself

Question 21

What symptoms differentiate PPD apart from Postpartum Psychosis?

Answer 21

Hallucinations/Delusions
Disorientation/confusion

Question 22

a) What are some risk factors of Postpartum Psychosis?
b) What is our biggest concern when it comes to these patients?

Answer 22

a)
History of Postpartum psychosis
History of Bipolar disorder
b)
Harming their baby or themselves

Question 23

On day 4th, Lauren is complaining of her breasts were sore and firm. She thinks she has mastitis.
What are some signs of mastitis?

Answer 23

Warmth, redness and swelling of one breast
Fever/chills
Flu-like symptoms
Usually occurs between 2-8 weeks

Question 24

is causing her breasts to be sore and firm on day 4th?

Answer 24

Her milk has come in.