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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
The clinician places one hand on the abdomen and the other hand inside the vagina then compresses the uterus between the two hands
Bimanual Compression
26
Vaginal packing is inserted during this procedure to stabilize the placement of balloon.
Balloon Catheter/ Tamponade
27
How many mL of sterile water is used in Balloon Catheter/ Tamponade?
500 mL
28
What are the steps of blood replacement/ blood transfusion?
- Blood typing and cross matching - Verify physicians order - identify client properly - record baseline vital sign - monitor blood transfusion reaction
29
What are the considerations of blood replacement?
- Iron Therapy - Activity level, Exertion and Exercise may be restricted
30
It refers to the removal of the uterus.
Hysterectomy
31
What should be considered when doing hysterectomy?
- Provide care and support to patient and support patients - Open lines communication between family and health problem - Referral to grief counselor
32
It refers to the tears of the birth canal.
Lacerations
33
What are the causes of lacerations?
- Precipitate labor - primigravida - Birth of large infant heavy than 9lbs - Lithotomy position and use of instrument (vacuum and forceps)
34
What are the three types of lacerations?
Cervical, Vaginal and Perineal
35
When should you suspect of possible laceration?
I After birth, bleeding persist even if the uterus is firm and contracting well.
36
This type of laceration produces brighter red blood than uterine atony. This may lead to immediate gush of blood after detachment of placenta.
Cervical Dilatation
37
What are the therapeutic management for cervical lacerations?
- suturing - inform the mother of the baby condition - if cervical laceration becomes extensive, may give regional anesthesia
38
This type of Laceration is easily located.
Vaginal Laceration
39
What are the therapeutic management of vaginal laceration?
- Suture - Balloon Catheter - Vaginal pack
40
This type of laceration is common in lithotomy position.
Perineal Laceration
41
What are the therapeutic management of perineal laceration?
- Suturing - Proper documentation of the degree - Diet high in fluid and stool softener
42
This degree of perineal laceration involves tearing of the vaginal mucus membrane and skin of the perineum?
1st degree
43
Involves tearing of the perineal skin, levator ani muscle and perineal body.
2nd degree
44
Involves tearing of entire perineum and external sphincter muscles
3rd degree
45
Involves tearing of entire perineum, sphincter muscles and some of the rectal mucus membrane.
4th degree
46
Placenta does not detach in it's entirety, fragments of it separate and are left attached tot he uterus.
Retained Placental Fragments
47
What are the 2 types of retained placental fragments?
Large placental Fragments Small placental Fragments
48
This type of RPF is a result of immediate post-delivery?
Large Placental Fragments
49
This type of RPF is a observed after 6 days to 10 days post delivery
Small Placental Fragments
50
What are the causes of retained placental fragments?
- succenturiate placenta - placenta accreta - cesarean birth - in vitro fertilization
51
What are the assessments involved in retained placental fragments?
- bleeding apparently - blood serum sample contain human chorionic gonadotrophin
52
What are the therapeutic management for retained placental fragments?
- inspect the placenta for completeness - manual removal of the placenta - methotrexate - ultrasound - Dilatation and Curettage (remove tissue from inside uterus) - Hysterectomy
53
It refers tot he uterus turning inside and out with either birth of fetus or delivery of placenta.
Uterine Inversion
54
What are the causes of uterine inversion?
-excessive traction is applied for the delivery of placenta - placenta is attach to the fundus
55
Can bleeding be stopped during a uterine inversion?
No, bleeding can't halt because uterus can't contract in position
56
What are the 4 degrees of uterine inversion?
- incomplete - complete - prolapse - total
57
Top of the uterus collapse
incomplete
58
Uterus out through cervix
complete
59
uterus out through vagina
prolapse
60
uterus and vagina protrude out
total
61
What are the therapeutic management for uterine inversion?
- 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
What is the meaning of DIC? It is an acquired disorder of blood clotting in which fibrinogen level falls bellow effective limits.
Disseminated Intravascular Coagulation
63
A normal value of fibrinogen is between what?
200 - 400 mg/dL
64
What is usually associated with DIC?
premature separation of the placenta, septic abortion, miscarriages
65
What are the early symptoms of DIC?
easy bruising and bleeding IV sites
66
This two this work together to form clots during bleeding which is involved in DIC?
Platelet and Fibrin
67
What activates the release of fibrinolysis?
Thrombin
68
What is the therapeutic management for Disseminated Intravascular Coagulation?
- 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
It refers to the incomplete return of the uterus to prepregnant size and shape.
Subinvolution
70
What are the assessments included for subinvolution?
- 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
What are the possible causes of subinvolution?
Small retained placental fragments, mild endometritis or uterine myoma
72
What are the therapeutic management for subinvolution?
- 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
It refers to the collection of blood below the epidermis of the vulva.
Vulvar hematoma
74
What are the causes of vulvar hematoma?
- Injury to blood vessels in the penis or vulva during birth - rapid spontaneous birth, and patient who have vulvar varicosities - Punctured during suture
75
What are the assessment included for vulvar hematoma?
- 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
What are the therapeutic management of vulvar hematoma?
- 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
The warm water increases blood flow to your peri area, which promotes faster healing.
Hot Sitz or Sitz Bath
78
What are the symptoms of hypovolemic shock.
- low blood - weak rapid pulse - drifting in and out of consciousness - sweating heavily - feeling cool to the touch - extremely looking pale
79
Give an example of nursing diagnosis related to postpartum hemorrhage?
Fluid volume deficit related to excessive blood loss after birth
80
It refers to the infection of the reproductive tract. This spreads to the peritoneum or the circulatory system.
Puerperal Infections
81
What are the organisms that could cause puerperal infections?
Group B Streptococci, Staphylococci, E. Coli
82
What is the management for a puerperal infection?
Use appropriate antibacterial after culture and sensitivity test
83
What conditions can increase the risk of puerperal infection?
- 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
Give examples of nursing diagnosis related to infection?
- Infection risk related to loss of uterine sterility with child birth - social isolation

NCM 214 A (8 decks)

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