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NCM 214 A > Unit 3: Nursing Care of Postpartal Client > Flashcards

Unit 3: Nursing Care of Postpartal Client Flashcards

1
Q

In 2020, everyday, how many women die from preventable causes of pregnancy and child birth?

A

800

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2
Q

Maternal death occur every _____ minutes.

A

2

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3
Q

In 2000-2020, maternal mortality rate, drop by _____ %?

A

34

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4
Q

______ % of maternal death are in low income countries?

A

95

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5
Q

______ % of maternal death are due to care of skilled profession.

A

75

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6
Q

What are the five main causes of maternal death?

A
  • severe bleeding
  • infections
  • high blood pressure
  • complication from delivery
  • unsafe abortion
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7
Q

What are the factors that prevent seeking intervention?

A
  • Health System Failure
  • Social Determinants
  • Harmful gender norms and inequalities
  • External factors
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8
Q

What is the rate of utilization of maternal health care services in the country?

A

Moderate

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9
Q

What stage of pregnancy is services greatly availed?

A

Intrapartum

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10
Q

What stage of pregnancy is services least availed?

A

Postpartum

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11
Q

What is the target of SDG by 2030?

A

Reducing global maternal mortality rate less than 70 per 100,000 birth, with no country having a maternal death rate more than 2 times of the global case.

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12
Q

Can a postpartum complication be preventable, or can be treated without long term complication? True or False

A

True

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13
Q

During post partum hemorrhage how much blood loss is there following a vaginal birth or cesarean delivery.

A

1000

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14
Q

When does early hemorrhage occur?

A

24 hours

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15
Q

When does late hemorrhage occur?

A

24 weeks to 6 weeks

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16
Q

What factors increase the risks for hemorrhage?

A
  • conditions that distend the uterus beyond capacity
  • conditions that caused cervical and uterine lacerations
  • open birth, rapid birth
    -varied placental site attachment
  • conditions that leave the uterus unable to contract readily (Deep Anesthesia, History of Postpartum Hemorrhage)
  • inadequate blood coagulation
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17
Q

What are the 4 T’s of Postpartum Hemorrhage?

A
  • Tone: Uterine Atony
  • Tissue: Retained Placental Fragments
  • Trauma: Lacerations
  • Thrombin - Disseminated Intravascular coagulation
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18
Q

It refers to the relaxation of the uterus? It is the most common cause of post partum hemorrhage.

A

Uterine Atony

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19
Q

What should be the first intervention to be given to someone with uterine Atony?

A

Fundal Massage

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20
Q

What are the correct steps of Fundal Massage?

A
  • Drain the bladder
  • lie supine and knees flexed
  • be careful not to over massage
  • continue to asses for the next 4 hours
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21
Q

What are other interventions that should be given to someone with uterine atony?

A
  • Start IVF
  • Administer a bolus or incorporate to IV infusion of oxytocin
  • Med administration
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22
Q

What are the medications used for uterine atony?

A
  • Carboprost Tromethamine
  • Methylergonovinve Maleate
  • Misoprostol
  • Oxytoxin
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23
Q

What are other interventions for uterine atony?

A
  • elevate lower extremities
  • Offer bedpan or assist to bathroom
  • administer oxygen by facemask 10-12 L/min
  • obtain vital signs frequently
  • allow sucking for breastfeeding
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24
Q

What are the therapeutic management of Uterine Atony?

A
  • Bimanual Compression
  • Balloon Catheter
  • Blood Transfusion
  • Hysterectomy
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25
Q

The clinician places one hand on the abdomen and the other hand inside the vagina then compresses the uterus between the two hands

A

Bimanual Compression

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26
Q

Vaginal packing is inserted during this procedure to stabilize the placement of balloon.

A

Balloon Catheter/ Tamponade

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27
Q

How many mL of sterile water is used in Balloon Catheter/ Tamponade?

A

500 mL

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28
Q

What are the steps of blood replacement/ blood transfusion?

A
  • Blood typing and cross matching
  • Verify physicians order
  • identify client properly
  • record baseline vital sign
  • monitor blood transfusion reaction
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29
Q

What are the considerations of blood replacement?

A
  • Iron Therapy
  • Activity level, Exertion and Exercise may be restricted
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30
Q

It refers to the removal of the uterus.

A

Hysterectomy

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31
Q

What should be considered when doing hysterectomy?

A
  • Provide care and support to patient and support patients
  • Open lines communication between family and health problem
  • Referral to grief counselor
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32
Q

It refers to the tears of the birth canal.

A

Lacerations

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33
Q

What are the causes of lacerations?

A
  • Precipitate labor
  • primigravida
  • Birth of large infant heavy than 9lbs
  • Lithotomy position and use of instrument (vacuum and forceps)
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34
Q

What are the three types of lacerations?

A

Cervical, Vaginal and Perineal

35
Q

When should you suspect of possible laceration?

A

I After birth, bleeding persist even if the uterus is firm and contracting well.

36
Q

This type of laceration produces brighter red blood than uterine atony. This may lead to immediate gush of blood after detachment of placenta.

A

Cervical Dilatation

37
Q

What are the therapeutic management for cervical lacerations?

A
  • suturing
  • inform the mother of the baby condition
  • if cervical laceration becomes extensive, may give regional anesthesia
38
Q

This type of Laceration is easily located.

A

Vaginal Laceration

39
Q

What are the therapeutic management of vaginal laceration?

A
  • Suture
  • Balloon Catheter
  • Vaginal pack
40
Q

This type of laceration is common in lithotomy position.

A

Perineal Laceration

41
Q

What are the therapeutic management of perineal laceration?

A
  • Suturing
  • Proper documentation of the degree
  • Diet high in fluid and stool softener
42
Q

This degree of perineal laceration involves tearing of the vaginal mucus membrane and skin of the perineum?

A

1st degree

43
Q

Involves tearing of the perineal skin, levator ani muscle and perineal body.

A

2nd degree

44
Q

Involves tearing of entire perineum and external sphincter muscles

A

3rd degree

45
Q

Involves tearing of entire perineum, sphincter muscles and some of the rectal mucus membrane.

A

4th degree

46
Q

Placenta does not detach in it’s entirety, fragments of it separate and are left attached tot he uterus.

A

Retained Placental Fragments

47
Q

What are the 2 types of retained placental fragments?

A

Large placental Fragments
Small placental Fragments

48
Q

This type of RPF is a result of immediate post-delivery?

A

Large Placental Fragments

49
Q

This type of RPF is a observed after 6 days to 10 days post delivery

A

Small Placental Fragments

50
Q

What are the causes of retained placental fragments?

A
  • succenturiate placenta
  • placenta accreta
  • cesarean birth
  • in vitro fertilization
51
Q

What are the assessments involved in retained placental fragments?

A
  • bleeding apparently
  • blood serum sample contain human chorionic gonadotrophin
52
Q

What are the therapeutic management for retained placental fragments?

A
  • inspect the placenta for completeness
  • manual removal of the placenta
  • methotrexate
  • ultrasound
  • Dilatation and Curettage (remove tissue from inside uterus)
  • Hysterectomy
53
Q

It refers tot he uterus turning inside and out with either birth of fetus or delivery of placenta.

A

Uterine Inversion

54
Q

What are the causes of uterine inversion?

A

-excessive traction is applied for the delivery of placenta
- placenta is attach to the fundus

55
Q

Can bleeding be stopped during a uterine inversion?

A

No, bleeding can’t halt because uterus can’t contract in position

56
Q

What are the 4 degrees of uterine inversion?

A
  • incomplete
  • complete
  • prolapse
  • total
57
Q

Top of the uterus collapse

A

incomplete

58
Q

Uterus out through cervix

A

complete

59
Q

uterus out through vagina

A

prolapse

60
Q

uterus and vagina protrude out

A

total

61
Q

What are the therapeutic management for uterine inversion?

A
  • IV fluid line should be inserted
  • never attempt to remove placenta
  • With oxytocin infusion, it should be discontinued
  • administer oxygen mask and assess vital signs
  • be prepared for CPR
  • use of general anesthesia (nitroglycerin or tocolytic)
  • antibiotic therapy
  • cesarean birth necessary
  • If manual replacement fail, hysterectomy is necessary
62
Q

What is the meaning of DIC? It is an acquired disorder of blood clotting in which fibrinogen level falls bellow effective limits.

A

Disseminated Intravascular Coagulation

63
Q

A normal value of fibrinogen is between what?

A

200 - 400 mg/dL

64
Q

What is usually associated with DIC?

A

premature separation of the placenta, septic abortion, miscarriages

65
Q

What are the early symptoms of DIC?

A

easy bruising and bleeding IV sites

66
Q

This two this work together to form clots during bleeding which is involved in DIC?

A

Platelet and Fibrin

67
Q

What activates the release of fibrinolysis?

A

Thrombin

68
Q

What is the therapeutic management for Disseminated Intravascular Coagulation?

A
  • heparin coagulation factors can be freed and normal clot factors can restore
  • blood or platelet transfusion
  • laboratories
  • monitoring urine output and maintain it at more than 30 mL/hr
69
Q

It refers to the incomplete return of the uterus to prepregnant size and shape.

A

Subinvolution

70
Q

What are the assessments included for subinvolution?

A
  • uterus is still enlarged and soft at 4 or 6 week of post partum visit
  • fundal height greater than expected for the amount of time since birth
  • Persistence of Lochia rubra or slowed progression through the three phases
  • Pelvic pain, heaviness
71
Q

What are the possible causes of subinvolution?

A

Small retained placental fragments, mild endometritis or uterine myoma

72
Q

What are the therapeutic management for subinvolution?

A
  • Ultrasound
  • D and C
  • Oral administration of methylergonovine
  • oral antibiotic
  • patient recognize normal process of involution
  • inform patient that it can lead to infection which may interfere with infant bonding
73
Q

It refers to the collection of blood below the epidermis of the vulva.

A

Vulvar hematoma

74
Q

What are the causes of vulvar hematoma?

A
  • Injury to blood vessels in the penis or vulva during birth
  • rapid spontaneous birth, and patient who have vulvar varicosities
  • Punctured during suture
75
Q

What are the assessment included for vulvar hematoma?

A
  • a patient report severe pain in the perineal area or a feeling of pressure in between legs
  • it appears as an area of purplish discoloration with obvious swelling
  • it could be as small as 2 cm. or as large as 8 cm.
  • it could appear as a firm globe and feels tender when palpated
76
Q

What are the therapeutic management of vulvar hematoma?

A
  • report presence of hematoma, estimate size and degree if pain to physician
  • administer analgesic as ordered
  • apply ice pack (cover with towel) to prevent farther bleeding
  • if hematoma continues to increase size, it will be incised and blood vessel ligated under anesthesia
  • if an episiotomy incision line was open to drain hematoma, it may be left open and packed with gauze instead of suture
  • home instruction: suture line care and site bath once or twice a day
77
Q

The warm water increases blood flow to your peri area, which promotes faster healing.

A

Hot Sitz or Sitz Bath

78
Q

What are the symptoms of hypovolemic shock.

A
  • low blood
  • weak rapid pulse
  • drifting in and out of consciousness
  • sweating heavily
  • feeling cool to the touch
  • extremely looking pale
79
Q

Give an example of nursing diagnosis related to postpartum hemorrhage?

A

Fluid volume deficit related to excessive blood loss after birth

80
Q

It refers to the infection of the reproductive tract. This spreads to the peritoneum or the circulatory system.

A

Puerperal Infections

81
Q

What are the organisms that could cause puerperal infections?

A

Group B Streptococci, Staphylococci, E. Coli

82
Q

What is the management for a puerperal infection?

A

Use appropriate antibacterial after culture and sensitivity test

83
Q

What conditions can increase the risk of puerperal infection?

A
  • Rupture of the membranes 2 hours before birth
  • retained placenta
  • pre-existing anemia
  • prolonged difficult labor using instrument at birth
  • internal fetal heart monitoring electrodes
  • local vaginal infection of tissue of birth
  • uterus explode after birth for retained placenta or abnormal bleeding
84
Q

Give examples of nursing diagnosis related to infection?

A
  • Infection risk related to loss of uterine sterility with child birth
  • social isolation

NCM 214 A (8 decks)

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