simulation Flashcards
temp
36.5-37.5 C (97.7-99.5 F)
pulse
120-160
respiration s
30-60
intermittent uterine contractions that happen after birth
after pains
If the uterus is contracted but there is excessive lochia, what type of injury is suspected?
laceration of the birth canal
6 hazards of cold stress?
a. Increase oxygen needs
b. Decrease surfactant production
c. Respiratory distress
d. Hypoglycemia
e. Metabolic acidosis
f. Jaundice
postpartum hemorrhage for vaginal birth
loss of 500 ml
postpartum hemorrhage for c section
loss of 1000 ml
when does late postpartum hemorrhage occur
24 hours and 6-12 weeks after birth.
early postpartum hemorrhage occurs
during first hour after birth. Most often caused by uterine atony (a lack of tone)
What is the first intervention in uterine atony?
Massage fundus until firm, and express the clots that may have accumulated in uterus
earliest indication of hypovolemic shock?
Tachycardia, even the smallest increase in pulse should be noted
Acute peripheral circulation failure resulting from loss of circulating blood volume.
hypovolemic shock
Abnormally decreased volume of circulating fluid in the body
hypovolemia
Where is the location of the uterus immediately after delivery?
Midway between the symphysis pubis and the umbilicus and midline of abdomen
Within 12 hours after birth?
Fundus rises to level of umbilicus
Each day thereafter until the 14th day?
Descends into abdominal cavity and cannot be palpated abdominally
Why do some women have severe afterpains?
Most cases have multipara (multiple children) have more severe because of repeated stretching of uterus, primipara remains contract but may feel some afterpain – due to over distention of uterus or blood clots
8 risk factors for post-partum hemorrhage.
a. Trauma to birth canal
b. Hematoma
c. Retention of placental fragment
d. Abnormalities of coagulation
e. DIC
f. Placenta prevera
g. Placenta accreta
h. Inversion of uterus
i. Someone who has multiple babies, LIKE MULTIPLE
When assessing bladder elimination, explain the concern if a woman has frequent voids of less than 150 cc after birth?
This is known as urinary retention, mother is not emptying bladder all the way, mother’s fundus should be palpated to know how full bladder is
Explain the procedure and risks of expressing clots from the uterus after birth.
Apply firm and gentle pressure on fundus in the direction of the vagina. Very important that the uterus is contracted firmly before attempt to express clots
Risk : pushing on uterus that is not contracted can invert the uterus and cause massive hemorrhage and shock
If the uterus does not remain contracted or is displaced, what is the next step in dealing with uterine atony?
Assist the mother to urinate or put in catheter.
Explain the procedure in replacing intravascular fluid volume.
Administer hall blood, packed RBC, normal saline and other plasma extenders are used, enough fluid should be given to maintain urinary output of 30 mL per hour, lactated ringers, whole blood
When should lacerations of the birth canal be suspected?
If excessive uterine bleeding continued when the fundus is contracted firmly and is at expected location
What is the most common cause of late post-partum hemorrhage?
subinvolution – delayed return of uterus to its not pregnant size and consistency
How much blood loss can a pregnant or newly delivered woman tolerate
1500 – 2000 mL
How does anemia impact the effect of blood loss in the pregnant or newly delivered woman?
Has less of a reserve for blood
How is amount of blood loss estimated?
Weigh peri pads, linen savers, weigh linens
Why would a woman who is hemorrhaging be temporarily rolled on her side?
Check underneath legs butt and back for lochia drainage
Explain the differences in effacement in the parous woman and the woman who has not previously given birth.
Parous woman – thicker at point of time compared to nullipara, nullipara completes most cervical effacement early in the process of dilation
Why are intermittent rather than continuous contractions in the laboring woman important to the fetus?
To allow fetal exchange of oxygen, nutrients, and waste products in the placenta during the period between the end of one contraction to the beginning of the next one.
BP FOR prec
look up
stimulates sustained contraction of the uterus and causes vasoconstriction
methylergonovine
prevents hemorrhaging after labor
meth
who do you not want to give the meth drug to
mom with hypertension, thrombophlebitis, CAD
stimulates contractions of the uterus; used for treatment of postpartum hemorrhage caused by uterine atony
carboprost trome
dont want to give carboprost trome to what patients
asthma, hypertension/hypotension, anemia, jaundice
POST PARTUM hemorrhage
carboprost trome
route for carboprost trome
IM ONLY
route for Oxytocin/Pitocin
IV or IM
route for meth
IM or PO
side effects of carboprost Tromethamine/Hemabate
tachycardia, vomiting, diarrhea
Occurs when bleeding into loose connective tissue occurs, while over lying tissue remains intact. Development as result of blood vessel injury and spontaneous deliveries, and deliveries where vacuum and forceps were used.
hematomas
symptoms of hematomas
deep severe unrelieved pains and feelings of pressure that are not relieved by usual methods, tachycardia, decreased BP.
hematoma treatment
small hematomas reabsorb naturally, large hematomas may require incision, evacuation of clots, and location/ligation of bleeding vessels
pharm therapeutic management when late post-partum hemorrhage occurs
oxytocin, methergine, prostaglandins
therapeutic management when late post-partum hemorrhage occurs
If bleeding continues or reoccurs, dilation and stretching of cervical OS2 permits suctioning or scraping of the walls of the uterus may be necessary to remove fragments.
Explain the cause of increased respiratory rate, skin pallor, decreased blood pressure, anxiety and confusion in the hemorrhaging woman.
Decrease in BP due to decrease in circulating blood volume, respiratory rate increases as woman becomes more anxious in attempts to take in more oxygen, vasoconstriction in skin which cause pallor
nursing care during a hemorrhage
vital signs and pulse assessment of fundus and lochia uterine massage oxygen administration iv fluids blood administration meds urine catheter position notify Doc family support
explain the benefit and procedure of modified Trendelenburg positioning
Legs are elevated 10-30 degerees to increase blood return from the legs, head is elevated, trunk is horizontal
most common cause of subinvolution
delay ??
nullipara advice to these laboring women about coming to the hospital
contractions are 5 minutes apart lasting 1 minute for 1 hour
multi para advice to these laboring women about coming to the hospital
contractions are 10 minutes apart lasting one minute for one hour
womans whose bag has possibly broken advice to these laboring women about coming to the hospital
come in; could be trickle or gush of fluid
what other patient should you suggest to come into the hospital
women with bright red bleeding
where does the transducer go
on the fetal back
Continuous headache, drowsiness, mental confusion, blurred/double vision, numbness/tingling in feet, epigastric pain, decreased urine output
hypertension and preclampsia
Impaired liver function, pulmonary edema, renal insufficiency, and death to baby and mom.
complications with preclampsia
cure for preclampsia
deliver the baby
Reduce activity, BP monitoring, go to doctor, monitor weight, urine collection to test for protein, increase kick counts, diet should have proteins and calories.
regular interventions for preclampsia
severe preclampsia
bed rest in lateral position, calm environment, antihypertensive meds.
numbers for preclampsia ??
dont know
treats preeclampsia and hypertension; contraindications include heart block, impaired renal func, respiratory distress, myocardial damage
magnesium sulfate
treats preeclampsia and hypertension; less maternal tachycardia, contraindicated for patients with asthma, CHF, or heart disease, associated with hypoglycemia and small for gestational aged infants
labitol
antidote for magnesium sulfate
calcium gluconate
nursing interventions for patient on magnesium sulfate
monitor lungs for pulmonary edema and respiratory rate
treats preeclampsia and hypertension; higher doses associated with maternal hypotension, headaches and fetal distress
Hydrolizide
prevent eclampsia.
Early and regular prenatal care, close attention to weight, monitor BP, urinary protein analysis, low does aspirin, calcium and magnesium supplements, and a salt restricted diet
BUBBLEHE
breasts uterus bladder bowel lochia EPISITOMY/INCISION HEMMORHOIDS/HOMAN’S SIGN EMOTIONAL STATUS
preeclampsia blood pressure levels
140/90
Where is the Doppler ultrasound transducer placed?
On the fetal back: monitoring the fetal heart rate.
normal is bloody small cloths, earthy odor, fleshly, dark red or red brown
-Abnormal:really large clots, foul odor
Lochia Rubra
day 3-10 Decreased amount of blood- pink or brown tinged
-Abnormal: excessive amount, foul smell, dark deep red color
lochia serosa
day 10-14 white creamy light yellow color
Abnormal: red foul odor, discharge is continuous
lochia albia
What does REEDA mean?
REEDA for someone who has had an episiotomy (cut) or a laceration. Redness Edema Ecchymosis Discharge Approximation
How do we do a bubblehe assessment on a postpartum mother?
Breast - check nipples, wearing supportive bra
Uterus - palpate fundus
Bladder - pain or burning with urination
Bowel - passing gas, bowel movement, listen to bowel sounds
Lochia - how much they have been bleeding, color
Edema - check stitches for REEDA, education on peri bottle
Hommen’s sign/hemorrhoids - hommen’s sign is patient has history of DVT
Education/emotion - overall mood and bonding with infant, signs of baby blues
breast fed infants should have how many stools per day
4 stools
formula fed infants should have how many stools per day
1-3 stools
