VN 34 Test 5 Postpartum

Question 1

1. Postpartum hemorrhage manifestations(ch.12pp slide 6, ch.19 pp slide 2)

Answer 1

 Greater than 500ml (after vaginal delivery)
 Greater than 1000ml (after cesarean delivery)
 Saturated Pads
 Clots
 Steady flow
 Decreased H&H
 Palpitations
 Restlessness
 Changes in LOC
 Hemorrhagic shock (Hypotension & tachycardia, pallor, weakness, diaphoresis, light- headedness)

Question 2

1. Postpartum hemorrhage Nursing considerations: (CH.12 slide 6 & CH.19 PP slide 4)

Answer 2

 GOAL TO CORRECT UNDERLYING CAUSE WHILE CONTROLLING HEMORRHAGE & REDUCE EFFECTS (#1 reason for maternal morbidity)
 Massage uterine fundus every 15 mins for 1-2hrs (PRIORITY)
 Monitor VS (BP, HR, O2 sat)
 Palpate fundus for height, firmness & location
 Monitor lochia for color, quantity & clots (check for pooled blood under buttocks)
 Empty & Palpate bladder for distention
 Elevate legs
 If no change, meds: (misoprostol, oxytocin, surgery)

Question 3

1. Postpartum hemorrhage Risk Factors: (CH. 19 pp slide 2)

Answer 3

 Multiparity
 Precipitous birth
 Previous uterine surgery
 Tocolytics
 LGA- macrosomia
 Polyhydramnios

Question 4

2. Expected findings during the postpartum period (CH.12 pp slide 5)

Answer 4

 Temperature may be slightly elevated for the first 24hrs (100.4F)
 Blood pressure should remain at level it was during labor.
 Mild bradycardia (50-60bpm) in the early postpartum period is normal
 Shaking & chills due to excess epinephrine could occur
 Woman is at risk for DVT & her legs should be monitored for edema & excess heat or redness
 When assessing pad, look under buttocks for pooling

Question 5

3. Vitamin K administration client education (CH.12 PP slide 12, ATI pg.133)

Answer 5

 Not produced in the GI tract of newborn until around day 7
 Is produced in the colon by bacteria once formula or breastmilk is introduced
 Administer 0.5 -1mg IM into the vastus lateralis (side of the thigh) w/in 1hr of newborns birth to stimulate appropriate clotting
-decreases risk of infant hemorrhagic disorder

Question 6

4. Mastitis Manifestations: (PP slide 10)

Answer 6

 General flu like sx
 Fever of 101F (38.3c) or greater
 Malaise
 Possibly chills
 Tenderness, pain & heaviness in the breast
 Erythema & edema in area localized to one breast (often pie-shaped wedge)

Question 7

4. Mastitis Nursing actions: (CH.19 PP slide 12)

Answer 7

 Support continued breast-feeding, preventing milk stasis, administering ordered antibiotics (10 days if at home), complete emptying of breast
 If not breastfeeding encourage manually expressing milk/using breast pump
 Warm compresses/warm shower
 Analgesics
 Support & encouragement, liberal fluid intake
 Refer to lactation specialist

Question 8

5. Breastfeeding nursing considerations (CH.12 PP slide 8)

Answer 8

 Encourage early feeding/helps prevent hemorrhage/will help w/infant stools (2-3 a day)
 Engage lactation consultant for proper latching
 Each feeding around 30 mins
 Assess nipples
 Apply milk on nipple prior to feeding to breasts
 Change infant position
 Rotate breasts at beginning

Question 9

6. Difference between PP blues; PP depression; PP psychosis and nursing actions (Flashcard)

Answer 9

PP BLUES:
 Most common, least serious
 mild sadness & crying
 Starts about 2- 3 days after delivery, resolves about 2 weeks postpartum

PP DEPRESSION:
 Severe sadness, guilt, anxiety
 Anytime w/in the 1st year
 If untreated : difficulty w/normal maternal infant attachment , marital discord, maternal suicide

PP PSYCHOSIS:
 Hallucinations
 Delusions
 Can be danger to self or others (baby)
 More likely in woman w/hx of bipolar disorder
 Medical emergency requiring inpatient treatment in mental health facility

ACTIONS:
Utilize screening tools to assess the type

Question 10

7. RhoGAM criteria(CH.12 PP slide 12)

Answer 10

 Rh negative mom
 Provide education to mom about reason Rhogam is administered (helps prevent formation of antibodies)
 Should be administered w/in 72 hrs of delivery

Question 11

8. Know Uterine fundus location at PP intervals (CH.12 PP slide 3 )

Answer 11

 Immediately after birth: midline about 2cm below umbilicus
 1hr after fundus will rise to the umbilicus
 At or near 12hrs: near the level of the umbilicus or 1cm above
 Then descend about 1-2 cm everyday
 If deviated check for full bladder, if no change after empty notify physician: PRIORITY!! (if deviated get client to bathroom, risk for hemorrhage)

Question 12

9. Episiotomy, laceration manifestations and nursing actions (CH.19 PP slide 9)

Answer 12

 Bright red bleeding can be steady or a trickle

Nursing Actions:
 Episiotomy discomfort w/out infection: ice packs, witch hazel w/order
 Handwashing priority teaching

Question 13

10. Endometritis Manifestations: (pp slide 6)

Answer 13

 Chills
 Fever 100.4F (38c) or higher
 Anorexia & malaise
 Uterine subinvolution & tenderness
 Lochia typically increases in amount & is dark, purulent & foul smelling
 Tachycardia

Question 14

10. Endometritis Nursing Actions (PP slide 7)

Answer 14

 Managing antibiotic therapy
 Alleviating anxiety
 Providing comfort measures (pain control)
 Providing client education (hygiene)
 Semi-fowler position to promote uterine drainage & possible spreading of infection

Question 15

11. DVT complications and manifestations

Answer 15

Complications: (CH.19 pp slide 18)
 PE
 Cardiovascular collapse (fatal)

Manifestations: (CH.19 pp slide 16)
 Edema
 Warmth
 Redness
 Calf pain/tenderness (Homans sign)
 Avoid putting weight on affected leg when walking
 Leg may appear visibly pale or white w/diminished pedal pulses

Question 16

12. Nursing considerations for hemorrhoids (CH.12 PP slide 17)

Answer 16

 Ice
 Witch hazel
 Sitz bath

Question 17

13. Pulmonary embolism manifestations (CH.19 pp slide 17)

Answer 17

 Pleuritic chest pain, abdominal pain
 Sudden onset of dyspnea
 Must be reported immediately
 FOID (fear of impending doom)
 Tachypnea & Tachycardia
 Hypotension
 Hemoptysis (coughing w/blood)
Cyanosis
Changes in LOC

Question 18

14. Client education for breast care (CH.12 PP slide 14)

Answer 18

 Cleanse w/plain water, use of lanolin cream, rub drop of breast milk into each nipple & allow to dry
 Alternate breasts & empty completely
 Reposition the baby
 If bottle feeding, DON’T express milk, will gradually stop producing

Question 19

15. Client education for perineum & vaginal care (CH.12 pp slide 14)

Answer 19

 Teach how to use peri bottle, handle peri pads
 Avoid using tampons/douches
 Ice-packs
 Handwashing
 Avoid sexual intercourse (use birth control)
 Sitz bath (can be delegated to AP)

Question 20

16. Lochia NTK (ch.19 pp slide 5)

Answer 20

 Filling every 15 mins could indicate hemorrhage
 Dark red first few days
 Evidence of clots
 Assess color, amounts & odor
 Assess fundus first
 Look under buttocks for any pooling blood
 Should not fill more than a pad in an hr

Question 21

17. Causes of hemorrhage : The Four T’s (CH.12 PP slide 5 & CH.19 pp slide 3)—TONE—

Answer 21

(Early postpartum hemorrhage occurs w/in the 1st 24hrs)

 TONE: Uterine Atony (most frequent reason for hemorrhage):
-fundus difficult to palpate: soft, spongy & boggy (assess location- displaced)
-Treat w/fundal massage
-Empty bladder
-vaginal bleeding (lochia) typically is moderate w/heavy clots (look underneath buttocks for pooling)
-Meds, surgery
-Big baby 8lbs, 13oz

Question 22

17. Causes of hemorrhage : The Four T’s (CH.12 PP slide 5 & CH.19 pp slide 3)—TRAUMA—

Answer 22

 TRAUMA: Hemorrhage caused by hematoma:
-to any genital structures
-Persistent bright red bleeding w/firm uterus but bleeding may also not be apparent
-Most commonly on one side of the perineum
-deep pelvic hematoma (primary sx is deep pain unrelieved by comfort measures/meds & is accompanied by VS instability, HGB & HCT low
-severe pain

 Hemorrhage caused by laceration:
-Fundus is firm on palpation
-bleeding is bright red in color (can be steady or trickle)

Question 23

17. Causes of hemorrhage : The Four T’s (CH.12 PP slide 5 & CH.19 pp slide 3) —TISSUE & THROMBIN—-

Answer 23

 TISSUE: retained placental tissue
-Assess for intact placenta

 THROMBIN: genetic clotting disorders
-eclampsia
-abruption