T3 - Postpartum Complications (Josh) Flashcards
What constitutes a postpartum hemorrhage?
blood loss greater than 500 mL in 24 hrs
When is an early postpartum hemorrhage?
When is a late postpartum hemorrhage?
Early = within 24 hrs
Late = after 24 hrs
Common causes of Postpartum hemorrhage.
Uterine atony
Lacerations
Retained placenta (or fragments)
Disseminated Intravascular Coagulation (DIC)
Inversion of uterus
Subinvolution of uterus
What is the #1 cause of postpartum hemorrhage?
Uterine atony
What are predisposing factors to uterine atony?
Multiple pregs
Polyhydramnios
Macrosomic infant
What are clinical signs of uterine atony?
Boggy uterus
Excessive blood loss (hypotensive shock)
What are s/s of hypotensive shock?
Tachycardia
Tachypnea
Blood pressure decreasing
Skin changes (cool and clammy, pallor)
Restlessness and dyspnea
What is nursing actions for Uterine Atony?
Assess for bladder distention
Massage fundus and express clots
Accurate pad count (1 g of pad wt = 1 mL)
Maintain primary IV infusion
Type & Culture for blood
Meds
How much does 1 mL of blood way?
1 g
What are some drugs used in Postpartum Hemorrhage mgmt?
Pitocin
Methylergonovine (Methergine)
Prostin E2
Prostaglandins
How much pitocin would be used to treat postpartum hemorrhage?
10-40 U/1000 mL LR or NS
What should we be aware of when using Methylergonovine (Methergine) for treating postpartum hemorrhage?
BP
What are the prostaglandins used to treat postpartum hemorrhage?
Misoprostol (Cytotec) - SL, PO or per rectum
Carbopost or Hemabate - IM
- (C/Section intramyomtreially)
Clinical signs of postpartum hemorrhage r/t lacerations.
Continuous trickle of blood/ firm fundus*
Decreasing Hct
S/S of hypovolemic shock
Treatment for postpartum hemorrhage r/t lacerations.
Surgical repair If necessary
Encourage hygiene and Sitz baths
Nothing per rectum
What is the major clue that a postpartum hemorrhage r/t lacerations is happening?
continuous trickle of blood/firm fundus
Clinical signs of a postpartum hemorrhage r/t hematoma
Pressure (complaint of episiotomy pain)
VS or skin color changes
Hct lower without apparent blood loss
Bulging mass at introitus (may rapidly collect 250-500 mL blood)
Ice – reduce swelling
Heat – discomfort
Allowed to reabsorb/or evacuated and vessel ligated
Treatment for postpartum hemorrhage r/t hematoma
Ice – reduce swelling
Heat – discomfort
Allowed to reabsorb/or evacuated and vessel ligated
Would the nurse see symptoms of shock if the client develops a slow, continuous bleed (like a hematoma)?
Yes
Clinical signs of postpartum hemorrhage r/t placental fragments remaining in uterus.
DARK COLORED bleeding
Large clots
Boggy uterus (even past massage)
Treatment for postpartum hemorrhage r/t placental fragments remaining in uterus.
Oxytocin
Sonogrom (to rule out other causes)
Curretage and Antbiotics
What is a postpartum problem that can kill client?
DIC
- Coagulation problem with bleeding and increased clotting occurring at same time
What is the treatment for DIC?
correct the underlying problem
***FAST
***have blood available
Postpartum hemorrhage:
Soft boggy uterus =
Bright red bleeding =
Slow trickle of dark red blood =
Soft boggy uterus = UTERINE ATONY
Bright red bleeding = LACERATIONS
Slow trickle of dark red blood = RETAINED PLACENTA
What are objective signs of Hypovolemic Shock?
Peripad soaked within 15 minutes
Complaint of light-headed or dizzy
Appears anxious; air hunger
Skin cool and clammy; color pale
HR increased/BP decreased
Nursing interventions for postpartum hypovolemic shock?
Stay with client
Notify physician
Massage fundus/expel clots
LR or NS per primary line
Oxytoxic medication
Insert indwelling catheter
Prepare for possible surgery
What are the risk factors for a postpartum thromboembolism?
Maternal age > 35
Multiparity
Venous stasis r/t immobility (legs in stirrups long time)
Smoking
History of Cardiac Disease or Diabetes
How many types of Thrombosis are there?
Three
- Superficial
- PE (Pulmonary Embolism)
- DVT
What is a Puerperal Infection?
Elevated temp of 100.4 or higher on 2 successive days of the first 10 PP days
(NOT counting the first 24 hours)
Why do we disregard the elevated temp of first 24 hours post pregnancy?
thermoregulation may cause a temp of 100.4 unrelated to infection
What increases risk of postpartum infection?
ROM > 24 hours before delivery
Placental fragments retained (tissue necroses and serves as medium for bacterial growth)
Anemia – lowered defenses against infection
Difficult labor – many invasive procedures
Cesarean
Symptoms of a postpartum infection
Fever
Chills
Abdominal tenderness or strong afterpains
Lochia – increased OR scant –> dark brown in color
WBC’s elevated – more than the 20,000 or so normally elevated in PP
Treatment for a postpartum infection
Culture from vaginal vault (not pad)
Fluids and oxytoxic agent to encourage UC
Antibiotics
High Fowlers positioning to prevent pooling of secretions
Which organism is mastitis usually caused by?
staphylococcus
- from infants’ nose and mouth
- from cracks in nipples
- from infected hand of mom or nurse
Symptoms of Mastitis
Fever to 103 or > with chills
Breast reddened, hard (Abscess)
Elevated WBC > >
Treatment for Mastitis
Antibiotics (Pen G X 48-72 hours) (Cephalexin for 10-14 days)
Warm compresses before feeding
Pump to empty breasts/continue breastfeeding
I&D of abscess
How long would you take Pen G for mastitis?
How long would you take Cephalexin for mastitis?
48-72 hrs
10-14 days
***PCN does cross breast milk but won’t harm baby
***still pump and dump, though
