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GRCC pn135 OB HRPP
GRCC High Risk postpartum care
| Question | Answer |
|---|---|
| What are the primary physiological disorders postpartum? | Hemorrhage, coagulation disorders and infection. |
| What are the primary psychological disorders? | Postpartum depression and postpartum psychosis. |
| What is a major complication of postpartum hemorrhage? | Hemorrhagic shock related to hypovolemia. |
| What is early postpartum hemorrhage (PPH)? | Defined as blood loss of greater than 500 mL within the first 24 hours. |
| What are causes of early PPH? | Uterine atony, lacerations and hematomas. |
| What are causes of late PPH? | hematomas, subinvolution and retained placental tissue. |
| subinvolution | Failure of the uterus to return to its normal size following childbirth. |
| Risk factors of PPH | Neonatal macrosomia; polyhydraminos; operative vag delivery; induced labor;ineffective uterine contractions;precipitous labor;general anesthesia. |
| Polyhydrminos | presence of excessive amniotic fluidamniotic fluid surrounding the unborn infant. |
| Signs and symptoms of early PPH | 10% increase in hct post birth; saturation of peripad within 15 minutes;fundus that remains boggy after massage;tachycardia; decrease in blood pressure. |
| Thrombosis | A blood clot within the vascular system. women are at risk for forming blood clots during pregnancy through the first 6 weeks of pg |
| Risk factors for thrombosis | Normal physiological changes in coagulation related to pregnancy; c-section (5x greater than vag birth); endometrititis; decreased mobility; obesity; increased parity |
| Signs and symptoms of thrombosis | Positive homans sign, tenderness and heat over the affected area, leg pain with walking, swelling in the affected leg. |
| Medical mgmt of thrombosis | Doppler ultrasonagraphy;compression stockings; coagulation therapy; antibiotic and bed rest. |
| What is the major cause of death for mama's? | Genital tract infection. |
| What is the major cause for endometritis? | Streptococci...it is a local infection of the endometrium- who lining of the uterus can get infected. |
| Signs and symptoms of endometritis | Increased temp, increased pulse, chills and malaise. Decreased appetite, back ache and sever after birth pain. Also, foul smelling lochia..unless streptococcus is present, then lochia is scant and odorless. |
| Risk factors for endometritis | Prolonged rupture of membranes; prolonged labor; c-section;internal fetal and uterine monitoring; anemia;malnutrition; PPH; diabetes |
| Medical mgmt of endometriosis | Antibiotic;UA, CBC, Blood culture; endometrial culture; have mama sit in fowler position |
| Salpingitis | Infection of fallopian tubes transmitted from uterus to venous how tubes infected |
| Signs and symptoms of salpingitis | Increase temp, increase pulse, rigidity ab. |
| Med mgmt of salpingitis | antibiotics and analgesics. |
| Complications of salpingitis | Infertility, usually just one side |
| Nursing actions for endometris | Min fluid intake of 3000 ml/day, change peripads each time they void, proper hand washing techniques, high diet in protein and vitamin C,. |
| Cystitis is an infection of the bladder | This is a common occurence in the postpartum period. If left untreated, could lead to pyelonephritis. |
| Signs and symptoms of cystitis | Low grade fever (<38.5c/101F), burning urination, supapubic pain, urgency to void, small frequent voids (less than 150 ml/voiding) |
| Med mgmt of cystitis | Encourage to void, if not more than 200 ml/void, then you'll have to cath the mom. Give antibiotics and get labs (UA, CBC, urine culture) |
| How many times/day should a woman void if she has cystitis? | Every three to four hours |
| What foods would you recommend for someone with cystitis | cranberry juice, apricots and plums. |
| Thrombolitis | Blood clots in legs due to extra blood; puts pressure on femoral arteries; use support stockings. |
| Treating thrombolitis | Encourage early ambulation to avoid blood pooling. |
| Thromobolitis manifestations | warmth, swelling reddish |
| Med mgmt of thrombolitis | Give heparin |
| Complications of thrombolitis | Pulmonary emboli, filling of lungs, pneumonia. |
| Mastitis | Inflammation/infection of the breast- usually unilaterally w/in first 2 postpartum weeks after milk flow |
| When does infection resolve if mama has mastitis? | Usually within 24 to 48 hours of antibiotic therapy. |
| Risk factors for mastitis | History of it, cracked and or sore nipples, use of antifungal nipple cream (usually applied when NB has thrush) |
| If abscess occurs in breast | encourage mama to continue expressing milk to promote flow and prevent it from plugging up. |
| Treating mastitis | Broad spectrum antibiotics, apply heat and/or cold, breastfeed every 2 to 3 hours |
| Post partum depression | Requires psychiatrtic interventions, occurs within 6 months post partum, unable to safely care for baby or self |
| Post partum blues | Symptoms disappear without medical intervention, occurs within 2 weeks postpartum, able to safely care for baby and self. |
| Post partum psychosis | varian bi-polar disorder; delusional, mood swings, agitation;confused thinking;strange beliefs. |
Created by:
Wends1984
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