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Family NRSG > Week 7: Monday, High Risk Newborn > Flashcards

Week 7: Monday, High Risk Newborn Flashcards

1
Q

Postpartum period

A
  • The first 6 weeks after delivery
  • Also called puerperium, 4th trimester (which doesn’t work cause tri means three)
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2
Q

Postpartum hemorrhage definition

A
  • 500 + mL blood loss after vaginal delivery or
  • 1000 + mL blood loss after c-section or
  • > 1000 mL loss within 24 hours after delivery
  • FYI: Most likely to occur in first 24 hours after delivery but can also occur up to 6 weeks postpartum
  • 54 - 93% of maternal deaths due to obstetric hemorrhage may be preventable
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3
Q

Signs of potential complications (case study)

A
  • Vitals: 100.4 Temp, after 1st 24 hours. tachy, brady. Hypo or HTN.
  • Uterus: Not in midline, Boggy, above umbilicus
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4
Q

Signs of potential complications CONT.

A
  • Lochia: heavy, bright red (NOT LOCHIA THEN), foul odor
  • Perineum: Pain, edema, not intact, bad odor (infection)
  • Legs: pain, redness/warmth, edema
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5
Q

Complications: breasts

A
  • Redness
  • warmth
  • pain
  • cracked/bleeding/flat/inverted nipples
  • Engorgement
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6
Q

Complications: Elimination

A
  • Insufficient voiding
  • Urgency/dysuria
  • Constipation
  • Diarrhea
  • Gas pain
  • Epigastric gas pain
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7
Q

Complications: Appetite

A
  • N/V
  • Loss of appetite
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8
Q

Complications: Neuro

A
  • Headache
  • Blurred vision
  • Altered consciousness
  • inability to rest/sleep
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9
Q

Indications of excessive bleeding that require immediate assessment, intervention, and notification of provider

A
  1. A peripad is saturated in 15 min or less, consecutively. Can be caused by uterine atony.
  2. Constant “trickle” of un- clotted blood. Can be a laceration.
  3. Pooling of blood under the buttocks. Most likely uterine atony (70% of PPH)
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10
Q

Precipitating factors for Hemorrhage - The 4 T’s

A
  1. Tone
  2. Trauma
  3. Tissue
  4. Thrombin disorders
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11
Q

Tone (70% of the time). What causes issues with tone? (6 pts)

A
  • Large baby (or multiples)
  • High parity
  • Rapid labor
  • Fever
  • Oxytocin induction
  • Fibroids
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12
Q

Symptoms of uterine atony (5 pts)

A
  • Bleeding may be slow and steady, or profuse
  • Large, boggy uterus
  • Clots!
  • Weigh pads, chux for quantitative blood loss.
  • 1 G = 1 mL
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13
Q

Nursing actions related to postpartum hemorrhage (6 pts)

A
  • Assess lochia (amount, color, clots or not)
  • Fundal massage
  • Pad saturation (time it takes)
  • Saturated within 15 min is heavy bleeding
  • Vital sign indicators of shock
  • Administer uterotonic(s)
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14
Q

Medical intervention for PPH (FYI)

A
  • Bakri balloon inserted into uterus to keep it from “leaking”
  • Also B-lynch sutures to essentially suture the uterus to prevent it from bleeding
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15
Q

Fundal massage “review” (3 pts)

A
  • Fundus should feel firm like a grapefruit
  • Use two hands
  • Immediately after delivery, observe the perineum during fundal check to check for clots, gush of blood, etc
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16
Q

Involution of the uterus (4 pts)

A
  • The height of the uterine fundus decreases approx. 1 cm per day until it is no longer palpable at 1- days’ postpartum
  • At delivery: 1/U
  • Day 1: U/1
  • Day 3: U/3
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17
Q

Meds to control bleeding may be given ____ (1 pt)

A

PO, IV, IM, or directly into uterine muscle

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18
Q

Oxytocin admin details (2 pts)

A
  • 30 units in 500 mL lactated ringers
  • Or 10 - 20 mg IM
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19
Q

Uterotonic detail (this med starts with an “M”)

A
  • Misoprostil 800 mcg per rectum
  • Some providers order it p.o.
20
Q

Uterotonic details (This med starts with a type of street drug)

A
  • Methergine 0.2 mg
  • IM ONLY – NEVER IV
  • Contraindicated for pts with HTN
21
Q

Uterotonic details (starts with an “H”)

A
  • Hemabate
  • 250 mcg (1 vial) IM
  • Often violent G.I. S/E
  • Contraindicated with hx of asthma
22
Q

3 details concerning meds during PPH (3 pts)

A
  • 2nd IV line necessary with pph
  • May need surgical management with hyst possible
  • Serious risk of DIC accompanies severe pph
23
Q

Trauma (the 4 t’s)

A
  • Laceration: perineal, cervical, or vaginal wall
24
Q

4 degrees of lacerations (4 pts)

A
  • 1st degree: vaginal mucosa torn
  • 2nd degree: perineal muscles torn
  • 3rd degree: Anal sphincter torn
  • 4th degree: Rectum torn
25
Q

PPH lacerations Definitions (3 pts)

A
  • A tear anywhere in the genital tract
  • Can be the result of operative delivery, rapid labor, or normal labor
  • Perineal lacerations are classified by degrees with the 4th being the worst (p. 407 in text gives more details)
26
Q

PPH lacerations, S&S and Interventions (5 pts)

A
  • Signs and symptoms: Firm uterus with continued bleeding
  • Steady trickle of unclotted bright red blood
  • Interventions: Monitor VS’s and lochia, measure QBL
  • Maintain fluid balance
  • Call provider to evaluate, locate and repair laceration
27
Q

PPH: Hematoma (2 pts)

A
  • Definition: Collection of blood in the pelvic tissue due to trauma to a vessel (without laceration)
  • Location may be vulvar, vaginal, cervical or retroperitoneal
28
Q

PPH: Hematoma S&S (4 pts)

A
  • Firm uterus
  • Sudden onset of painful perineum (pressure)
  • Bulging area just under the skin
  • Extreme difficulty voiding or sitting
29
Q

Hematoma Interventions (6 pts)

A
  • Assess for visible hematoma
  • Call provider to assess
  • May need to be excised and ligated
  • May insert bladder catheter
  • Continue to assess VS, EBL, fluid maintenance
  • Pain management, ice to area
30
Q

Tissue (4 T’s) 10% of the time (1 pt)

A

Retained or abnormal placenta

31
Q

Retained placental fragments (6 pts)

A
  • Most late PPH is caused by retained placental fragments
  • S&S: Uterus is atonic and remains larger than normal
  • Strings of tissue in the blood
  • Interventions: Call provider to assess – D&C may be needed
  • Monitor for signs of shock
  • Administer oxygen if indicated
32
Q

Thrombin disorders (1% of the 4 T’s)

A
  • Pre-eclampsia
  • Stillbirth
33
Q

Disseminated intravascular coagulation (DIC) (3 PTS)

A
  • Not a separate cause of PPH, but a result of rapid and excessive blood loss
  • DIC is a disturbance in normal coagluation
  • Pregnant and PP women are at greater physiologic risk to develop DIC
34
Q

Predisposing conditions for DIC (1 pt)

A

Severe pre-eclampsia, HELLP syndrome, missed or incomplete abortion, abruptio placentae, severe trauma or infection

35
Q

Signs of potential psychosocial complications (4 pts)

A
  • Unwilling to hold baby
  • Refuses to care for baby
  • Markedly depressed
  • Lacks support system
36
Q

Postpartum depressive disorders (3 pts)

A
  1. Postpartum blues
  2. Postpartum depression
  3. Postpartum psychosis
37
Q

Postpartum blues (4 pts)

A
  • Occur in about 50% or more of women within the 1st few weeks after delivery
  • Onset often around 3 days postpartum, resolves on its own within 2 weeks
  • Low mood and mild depressive symptoms, transient and self-limited
  • Sadness, crying, irritability, anxiety, exhaustion, feeling overwhelmed, difficulty sleeping
38
Q

Postpartum depression (3 pts)

A
  • Similar to postpartum blues, but more intense
  • Usually develops within the first few weeks after giving birth, but may occur after a year
  • Psychotherapy and antidepressants can be helpful
39
Q

Postpartum depression S&S (8 pts)

A
  • Crying too much
  • Difficulty bonding with the baby
  • Withdrawing from family and friends
  • Less interest and pleasure in activities once enjoyed
  • Intense irritability and anger
  • Fear that shes not a good mother
  • Thoughts of harming one’s self or the baby, thoughts of suicide or death
  • Untreated, may last for many months
40
Q

Postpartum psychosis (4 pts)

A
  • a rare condition that usually develops within the first week after delivery
  • The symptoms are severe
  • May lead to life-threatening thoughts or behaviors and requires immediate treatment
  • Generally requires hospitalization and therapy
41
Q

Postpartum psychosis S&S (7 pts)

A
  • Feeling confused and lost
  • having obsessive thoughts about your baby
  • hallucinating and having delusions
  • Having sleep problems
  • Mania
  • Feeling paranoid
  • Making attempts to harm yourself or your baby
42
Q

ABO incompatibility (3 pts)

A
  • During pregnancy, some of the mother’s antibodies are transported across the placenta and enter fetal circulation
  • This is necessary because by the time of birth, newborns have only a primitive immune system, and the continuing presence of maternal antibodies helps ensure that they survive while their immune system matures
  • A downside to this protection is that by targeting fetal RBCs, maternal antibodies can also cause hemolytic disease of the fetus and newborn (HDFN)
43
Q

Two main signs that a newborn has an ABO incompatibility

A
  • Jaundice
  • Anemia (generally mild)
44
Q

FYI: ABO incompatibility and HDFN (5 pts)

A
  1. A congenital, inherent mismatch between maternal and fetal blood types, causing immune-mediated red blood cell (RBC) disorder
  2. Occurs in 15 to 25% of pregnancies
  3. Maternal antibodies attack fetal or newborn RBCs
  4. Effects on fetus : Mild anemia or hyrops fetalis
  5. Effects on newborn: Hyperbilirubinemia and Kernicterus
45
Q

Bookmark at slide 57

A

Family NRSG (8 decks)

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