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Maternal-Newborn (Josh) > T3 - Postpartum Complications (Josh) > Flashcards

T3 - Postpartum Complications (Josh) Flashcards

1
Q

What constitutes a postpartum hemorrhage?

A

blood loss greater than 500 mL in 24 hrs

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2
Q

When is an early postpartum hemorrhage?

When is a late postpartum hemorrhage?

A

Early = within 24 hrs

Late = after 24 hrs

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3
Q

Common causes of Postpartum hemorrhage.

A

Uterine atony

Lacerations

Retained placenta (or fragments)

Disseminated Intravascular Coagulation (DIC)

Inversion of uterus

Subinvolution of uterus

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4
Q

What is the #1 cause of postpartum hemorrhage?

A

Uterine atony

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5
Q

What are predisposing factors to uterine atony?

A

Multiple pregs

Polyhydramnios

Macrosomic infant

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6
Q

What are clinical signs of uterine atony?

A

Boggy uterus

Excessive blood loss (hypotensive shock)

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7
Q

What are s/s of hypotensive shock?

A

Tachycardia

Tachypnea

Blood pressure decreasing

Skin changes (cool and clammy, pallor)

Restlessness and dyspnea

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8
Q

What is nursing actions for Uterine Atony?

A

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

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9
Q

How much does 1 mL of blood way?

A

1 g

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10
Q

What are some drugs used in Postpartum Hemorrhage mgmt?

A

Pitocin

Methylergonovine (Methergine)

Prostin E2

Prostaglandins

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11
Q

How much pitocin would be used to treat postpartum hemorrhage?

A

10-40 U/1000 mL LR or NS

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12
Q

What should we be aware of when using Methylergonovine (Methergine) for treating postpartum hemorrhage?

A

BP

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13
Q

What are the prostaglandins used to treat postpartum hemorrhage?

A

Misoprostol (Cytotec) - SL, PO or per rectum

Carbopost or Hemabate - IM
- (C/Section intramyomtreially)

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14
Q

Clinical signs of postpartum hemorrhage r/t lacerations.

A

Continuous trickle of blood/ firm fundus*

Decreasing Hct

S/S of hypovolemic shock

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15
Q

Treatment for postpartum hemorrhage r/t lacerations.

A

Surgical repair If necessary

Encourage hygiene and Sitz baths

Nothing per rectum

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16
Q

What is the major clue that a postpartum hemorrhage r/t lacerations is happening?

A

continuous trickle of blood/firm fundus

17
Q

Clinical signs of a postpartum hemorrhage r/t hematoma

A

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

18
Q

Treatment for postpartum hemorrhage r/t hematoma

A

Ice – reduce swelling

Heat – discomfort

Allowed to reabsorb/or evacuated and vessel ligated

19
Q

Would the nurse see symptoms of shock if the client develops a slow, continuous bleed (like a hematoma)?

A

Yes

20
Q

Clinical signs of postpartum hemorrhage r/t placental fragments remaining in uterus.

A

DARK COLORED bleeding

Large clots

Boggy uterus (even past massage)

21
Q

Treatment for postpartum hemorrhage r/t placental fragments remaining in uterus.

A

Oxytocin

Sonogrom (to rule out other causes)

Curretage and Antbiotics

22
Q

What is a postpartum problem that can kill client?

A

DIC

  • Coagulation problem with bleeding and increased clotting occurring at same time
23
Q

What is the treatment for DIC?

A

correct the underlying problem

***FAST

***have blood available

24
Q

Postpartum hemorrhage:

Soft boggy uterus =

Bright red bleeding =

Slow trickle of dark red blood =

A

Soft boggy uterus = UTERINE ATONY

Bright red bleeding = LACERATIONS

Slow trickle of dark red blood = RETAINED PLACENTA

25
Q

What are objective signs of Hypovolemic Shock?

A

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

26
Q

Nursing interventions for postpartum hypovolemic shock?

A

Stay with client

Notify physician

Massage fundus/expel clots

LR or NS per primary line

Oxytoxic medication

Insert indwelling catheter

Prepare for possible surgery

27
Q

What are the risk factors for a postpartum thromboembolism?

A

Maternal age > 35

Multiparity

Venous stasis r/t immobility (legs in stirrups long time)

Smoking

History of Cardiac Disease or Diabetes

28
Q

How many types of Thrombosis are there?

A

Three

  • Superficial
  • PE (Pulmonary Embolism)
  • DVT
29
Q

What is a Puerperal Infection?

A

Elevated temp of 100.4 or higher on 2 successive days of the first 10 PP days

(NOT counting the first 24 hours)

30
Q

Why do we disregard the elevated temp of first 24 hours post pregnancy?

A

thermoregulation may cause a temp of 100.4 unrelated to infection

31
Q

What increases risk of postpartum infection?

A

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

32
Q

Symptoms of a postpartum infection

A

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

33
Q

Treatment for a postpartum infection

A

Culture from vaginal vault (not pad)

Fluids and oxytoxic agent to encourage UC

Antibiotics

High Fowlers positioning to prevent pooling of secretions

34
Q

Which organism is mastitis usually caused by?

A

staphylococcus

  • from infants’ nose and mouth
  • from cracks in nipples
  • from infected hand of mom or nurse
35
Q

Symptoms of Mastitis

A

Fever to 103 or > with chills

Breast reddened, hard (Abscess)

Elevated WBC > >

36
Q

Treatment for Mastitis

A

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

37
Q

How long would you take Pen G for mastitis?

How long would you take Cephalexin for mastitis?

A

48-72 hrs

10-14 days

***PCN does cross breast milk but won’t harm baby

***still pump and dump, though

Maternal-Newborn (Josh) (29 decks)

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