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Nursing of Women > SIM Lab Quiz 4 > Flashcards

SIM Lab Quiz 4 Flashcards

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1
Q

early PPH

A

first 24 hrs after childbirth
loss of > 500mL

diagnosed when provider determines blood loss is greater than normal

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2
Q

late PPH

A

after 24 hours post-birth

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3
Q

% of women who will experience PPH

A

10%

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4
Q

early PPH causes

A

uterine atony
lacerations
hematomas

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5
Q

late PPH causes

A

hematomas
subinvolution
retained placental tissue

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6
Q

PPH risk factors

A 
macrosomia
polyhydramnios
operative vaginal delivery
augmented labor
ineffective contractions
prolonged 1st/2nd stage
precipitous labor/birth
general anesthesia
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7
Q

indications of possible early PPH

A
  • 10% decrease in hematocrit post birth
  • saturation of peripad w/in 15 min
  • boggy fundus after massage
  • tachycardia
  • decrease in BP
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8
Q

uterine atony

A

decreased tone of uterine muscle - primary cause of early PPH

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9
Q

assessment findings of uterine atony

A 
boggy fundus
peripad saturation w/in 15 min
slow/steady or sudden/massive bleeding
blood clots
pale, clammy skin
anxiety, confusion
tachycardia
hypotension
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10
Q

medical management of uterine atony

A

oxy, methergine, hemabate - uterine contractions

IV - hypovolemia

blood replacement - hemorrhagic shock

surgical interventions

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11
Q

nursing actions for uterine atony

A
  • review risk factors for PPH
  • assess for displaced uterus (distended bladder)
  • assess fundus firmness (massage)
  • assess lochia (amount, clots)
  • review lab tests (HgB, Hct)
  • notify provider
  • oxy, methergine, hemabate
  • blood transfusion monitoring
  • emotional support
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12
Q

methergine

A

Indication: PPH s/t uterine atony or subinvolution

Action: stimulates contraction of uterine smooth muscle

Side effects: N/V/cramps

Route/dose: IM/IV, 200mcg every 2-4 hr

Caution: check BP - HTN contraindicated

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13
Q

hemabate

A

Indication: PPH that is unresponsive to oxy or methergine

Action: uterine contraction

Side Effects: N/V/D/fever

Route/doe: IM, 250 mcg every 15-90 min (total

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14
Q

lacerations

A

2nd most common cause of early PPH

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15
Q

common sites for lacerations

A

cervix
vagina
labia
perineum

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16
Q

laceration risk factors

A

fetal macrosomia
operative vaginal delivery
precipitous labor/birth

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17
Q

laceration assessment findings

A

firm, midline uterus w/ heavy bleeding

steady bleeding w/o clots

tachycardia

hypotension

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18
Q

medical management of lacerations

A

visual inspection
suturing
IV meds for pain

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19
Q

nursing actions for lacerations

A 
review risk factors
vitals
blood loss
notify provider
pain meds
pelvic exam preparation
emotional support
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20
Q

hematoma

A

occurs when blood collects w.in connective tissue of vagina or peineal areas r/t vessel that ruptures and continues to bleed

hard to diagnose degree of blood loss

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21
Q

hematoma risk factors

A

episiotomy
forceps
prolonged 2nd stage

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22
Q

hematoma assessment findings

A
  • severe pain in vagina/perineal area
  • not managed w/ normal postpartum pain management
  • tachy and hypotension
  • heaviness/fullness of vagina or rectal pressure if in vagina
  • in perineum - swelling, discoloration, tenderness
  • hematomas of 200-500 ml can displace uterus and cause uteirne atony
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23
Q

medical management of hematoma

A

evaluated and monitored if small

surgically excised if large

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24
Q

nursing actions w/ hematoma

A 
review risk factors
ice for 24 hrs
assess pain
ask pt to verbalize pain, heaviness
monitor for BP decrease
monitor for HR increase
pain meds
review lab reports
notify provider
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25
Q

subinvolution of uterus

A

uterus does not decrease in size nor descend into pelvis

usually later in postpartum period

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26
Q

uterine subinvolution risk factors

A

fibroids
endometritis
retained placental tissue

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27
Q

assessment findings of uterine subinvolution

A

soft, large uterus
lochia returns to rubra, heavy
back pain

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28
Q

medical management of uterine subinvolution

A

D&C for retained placental tissue
methergine for fibroids
antibiotic for endometritis

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29
Q

nursing actions for uterine subinvolution

A 
risk factors
monitor pt
pt education
S/Sx: increased bleeding, clots, lochia change
reduce risk for infection
discharge meds
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30
Q

retained placental tissue

A

most common cause of LPH - when small portions of placenta (cotyledons) remain attached to uterus during 3rd stage

can interfere with involution of uterus and lead to endometritis

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31
Q

cotyledons

A

small portions of placenta still in uterus

32
Q

risk factors for retained placental tissue

A

manual removal of placenta

33
Q

assessment findings for retained placental tissue

A 
sudden profuse bleeding after 1st wk
subinvolution of uterus
high temp
uterine tenderness
pale 
tachy
hypotension
34
Q

medical management of retained placental tissue

A

D&C to remove tissue

IV antibiotic therapy (endometritis)

35
Q

nursing actions for retained placental tissue

A
  • risk factors
  • monitor
  • review labs
  • patient education (bleeding)
  • teach fundus assessment/massage
  • assess fundus/lochia every hr for 4 hrs after hemorrhage
  • oral/IV fluid intake
  • prevent overdistended bladder
  • assist w/ ambulation
  • rest
  • uninterrupted rest
  • emotional support
  • food high in iron
36
Q

chronic hypertension

A

HTN before conception or before 20th wk of gestation

high risk of preeclampsia

37
Q

preeclampsia-eclampsia

A

pre: HTN w/ proteinuria after 20th wk
eclampsia: convulsive stage of disease

38
Q

preeclampsia superimposed on chronic HTN

A

new-onset proteinuria
proteinuria before 20th wk
sudden uncontrolled HTN

39
Q

gestational hypertension

A

high BP for first time mid-pregnancy w/o proteinuria

diagnosis is made postpartum and is relatively benign w/o underlying physiological changes

40
Q

arteries in normotensive pregnancies

A

spiral arteries of uterus are remodeled by invasion of endovascular trophoblast cells of placenta, which allows them to widen to accommodate 10-fold increase in blood flow

41
Q

arteries in hypertensive pregnancies

A

remodeling of spiral arteries of uterus is incomplete

arteries remain thick-walled, resulting in suboptimal placental perfusion

42
Q

uteroplacental perfusion

A

can be diminished 50% before onset of preeclamptic symptoms

43
Q

ischemia of uteroplacental tissue

A

results in endothelial cell dysfxn, resulting in multiorgan endothelial cell damage and dysfxn

triggers vasospasm w/ poor tissue perfusion to all organs

increased peripheral resistance and elevated BP

44
Q

liver in preeclampsia

A

fat deposits - epigastric pain

HELLP

45
Q

HELLP

A

Hemolysis
Elevated Liver enzymes
Low Platelets

46
Q

hepatic involvement in preeclampsia

A

periportal hemorrhagic necrosis of liver

subcapsular hematoma

47
Q

GFR in preeclampsia

A

glomerular endothelial damage
fibrin deposition
resulting ischemia

reduce GFR - protein excreted

48
Q

coagulation system in preeclampsia

A

activated - thrombocytopenia

49
Q

endothelial damage in preeclampsia

A

damage to brain

fibrin deposition, edema, hemorrhage

50
Q

retinal arterial spasms in preeclampsia

A

blurring, double vision

photophobia, scotoma

51
Q

leakage of serum protein in preeclampsia

A

decreased serum albumin

tissue edema

52
Q

pulmonary edema in preeclampsia

A

volume overload r/t to left ventricular failure s/t high vascular resistance

53
Q

preeclampsia risk fx

A 
nulliparity
younger than 19; older than 35
obesity
multiple gestation
family hx
preexisting htn or renal disease
previous preeclampsia or eclampsia
DM
54
Q

preeclampsia risks for mother

A 
cerebral edema/hemorrhage/stroke
disseminated intravascular coagulation
pulmonary edema
congestive HF
hepatic failure
renal failure
abruptio placenta
55
Q

preeclampsia risk for newborn

A 
prematurity
IUGR
LBW
stillbirth
fetal intolerance r/t decreased placental perfusion
56
Q

preeclampsia assessment findings

A 
HTN
proteinuria
elevated liver fxn
diminished kidney fxn
altered coagulopathies
57
Q

first-line drugs for preeclampsia

A

hydralazine (vasodilator)
methyldopa (mechanism unknown)
labetalol (beta blocker)

58
Q

second-line drug for preeclampsia

A

nifedapine (Ca channel blocker)

59
Q

mag loading dose

A

4-6 g in 100ml IV fluid over 15-20 min

60
Q

mag continuous infusion

A

2g/hr in 100 ml IV fluid for maintenance

61
Q

mag lab eval

A

measure serum magnesium level at 4-6 hrs

maintain 4-7 mEq/L

62
Q

mag duration

A

IV should continue 24 hrs post delivery

63
Q

mag antidote

A

calcium gluconate or calcium chloride 5-10 mEq IV over 5-10 min

64
Q

eclampsia

A

occurrence of seizure activity in presence of preeclampsia

65
Q

eclampsia triggers

A 
cerebral:
vasospasm
hemorrhage
ischemia
edema
66
Q

eclampsia warning signs

A 
persistent headaches
epigastric pain
N/V
hyperreflexia w/ clonus
restlessness
67
Q

care during eclampsia seizure

A 
stay with pt
call for help
As and Bs
anticipate suction
prevent injury
record time, length, type
notify provider
68
Q

maternal side effects on mag

A 
nausea
flushing
diaphoresis
blurred vision
lethargy
hypocalcemia
depressed reflexes
respiratory distress/arrest
cardiac dysrhythmias
decreased platelet aggregation
circulatory collapse
69
Q

fetal side effects on mag

A 
decreased variability in FHR
respiratory depression
hypotonia
decreased suck reflex
magnesium toxicity
70
Q

nursing actions for patient on mag

A

vital signs before infusion and every 5-15 min during loading dose, then 30-60 min until stable

assess DTRs every 2 hrs
monitor I/Os strictly
monitor mag levels
monitor for mag toxicity

seizure/resuscitation precautions
cardiac monitoring
FHR monitor - continuous
neonatal team

71
Q

post-seizure assessment

A 
maternal and fetal status
assess airway
supplemental oxygen
IV access
mag sulfate
quiet environment
72
Q

HELLP risks for woman

A

abruptio placenta
renal failure
liver hematoma/rupture
death

73
Q

HELLP risk for fetus

A

preterm

death

74
Q

HELLP assessment findings

A

general malaise, nausea, RUQ pain

unexplained bruising, mucosal bleeding, petechiae, bleeding from injection/IV sites

altered lab tests

75
Q

HELLP medical management

A

immediate delivery of fetus and placenta

resolution generally 48 hrs postpartum

platelet replacement

76
Q

HELLP nursing actions

A 
assessment r/t preeclampsia
lab tests
notify physician
platelet replacement
education
emotional support

Nursing of Women (6 decks)

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