T3-Post-Partum Complications Flashcards
What is PPH?
Blood loss greater than 500 mL in 24 hours
What is early PPH?
Within 24 hours of delivery
What is late PPH?
After first 24 hours of delivery
What are some common causes of PPH? (6)
- Uterine atony
- Lacerations
- Retained placenta (or fragments)
- DIC
- Inversion of uterus
- Subinvolution of uterus
What is the number one cause of PPH?
Uterine atony
What is uterine atony?
Failure of muscles to contract effectively could be due to overstretched muscle from multiple preg, polyhydraminos, or macrocosmic infant
What are some clinical signs of uterine atony? (3)
- Hypotonic uterus (boggy)
- Excessive blood loss
- Hypotensive shock
What are s/s of hypotensive shock?
- Tachycardia and tachypnea
- BP decreasing
- Skin changes (cool, clammy, pallor)
- Restlessness and dyspnea
What are some drugs used for PPH?
- Pitocin
- Methergine
- Prostin E2 (mom may throw up with this one)
- Prostaglandin
PPH r/t lacerations What are the clinical signs?
- Continuous trickle of blood; firm fundus (this is the big clue…if she is saturating pads but her fundus is firm, check for laceration!)
- Decreasing Hct
- S/s of hypovolemic shock
PPH r/t lacerations…What is treatment?
- Surgical repair if necessary
- Hygiene and sit baths
- Nothing PR
PPH r/t hematoma
What are clinical signs?
- Pressure
- VS or skin color changes
- Hct lower w/o apparent blood loss
- Bulging mass
PPH r/t retained fragments of placenta
What are signs?
- Dark colored bleeding
- Large clots
- Boggy uterus (even past massage)
PPH r/t retained fragments of placenta
What is treatment?
- Control bleeding with drugs (oxytocin)
- Sonogram
- Curretage and antibiotics
Coagulation problem with bleeding and increased clotting occurring at the same time
DIC
What is treatment of DIC?
Correct underlying problem
Uterus soft and boggy causing bladder to be distended and displaced= ?
Uterine atony
A cut above causing bright red bleeding in spite of contracted uterus= ?
Laceration(s)
Left behind so a soft/non-contracted uterus with slow trickle of dark red blood= ?
Retained placenta
If uterine atony, lacerations, and retained placenta have all been ruled out, what may be the problem?
Coagulation problems
What are some objective symptoms of hypovolemic shock? (6)
- Peripad soaked w/in 15 min
- Complaint of light-headed or dizzy
- Appears anxious; air hunger
- Skin cool and clammy; pale
- HR increased
- BP decreased
What are some interventions for PP Hypovolemic shock?
- Stay with client
- Notify physician
- Massage fundus/expel clots
- *LR or NS per primary line
- Oxytoxic med
- Indwelling catheter
- Prep for possible surgery
Collection of platelets and fibrin on a vessel wall
Thrombus
Confined to lower leg involving superficial veins
Superficial thrombosis
Clot dislodges and settles in the pulmonary artery
PE
Veins from lower leg to femoral region
DVT
What is the definition of puerperal infection?
Elevated temp of 100.4 or higher or 2 successive days of the first 10 PP days (not counting first 24 hours)
What are risk factors for PP infection?
- ROM more than 24 hours before delivery
- Placental fragments retained (growth medium for bacteria)
- Anemia
- Difficult labor (suction or forceps)
- C-section
Symptoms of PP infection?
- Fever
- Chills
- Abdominal tenderness; strong afterpains
- Lochia (increased or scant; dk brown in color)
- WBC elevated
Is it ok to obtain a culture from a peripad?
No; culture vagina
Treatment of PP infection: What do we do/give to encourage UC?
Encourage fluids; give oxytoxic agent
Treatment of PP infection: What positioning to do put client in to prevent pooling of secretions?
High fowlers
Breast infection r/t staph
Mastitis
Symptoms of mastitis?
- Fever to 103 or greater and with chills
- Breast reddened, hard (abscess)
- Elevated WBC
What is treatment for mastitis?
- Antibiotics (Pen G 48-72 hours; cephalexin for 10-14 days)
- Warm compresses before feeding
- Pump to empty breasts
- I&D of abscess
*some physicians recommend breastfeeding be discontinued temp–pen does cross into milk but wouldn’t harm baby
