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High Risk PP


List possible causes of PP atony (7) 1) distended uterus, 2) full bladder, 3) retained placenta, 4) multiparty, 5) prolonged labor, 6) Pit use, 7) MgSO4 use
Why would Pitocin use contribute to uterine atony? When given too much pit, oxytocin receptors are saturated and there's no more room for more oxytocin. Uterus may not contract
What factors contribute to cervical/vaginal/uterine injury? Forceps, birth process
List three common coagulation disorders associated with PP DIC, thrombosis, PE
First step of treatment of pp hemorrhage caused by atony is... Assess!
Treatment of PPH involves: 1) Assess and if needed massage, 2) Calling for help, 3) IVF + Meds, 4) O2 NRB @ 10-15L, 5) 2nd IV, 6) Foley, 7) Labs, 8) Blood products, 9) surgery
Order for PP hemorrhage treatment (4 drugs) 1) Oxytocin, 2) Methergine, 3) Carboprost/Hemabate, 4) Misoprostol/Cytotec
True or False: Methergine is given IV or PO FALSE. Given IM/PO. NEVER IV
_______ is a contraindication for methergine HTN
_____ is a contraindication for hemabate Asthma
Medications for treating uterine atony specifically (list 3) 1) Increased IVF to 500cc/hr with Pit, 2) Methergine, 3) Miso
During PPH crisis _____ is preferred O2 treatment; but after stabilized ____ is preferred Simple mask/non-rebreather; NC
PP injury signs for tears/lacerations and treatment Slow, oozy lochia; repair needed
PP injury signs fr hematomas Increase in pain, sudden ASYMMETRY in swelling of perineum
If a hematoma is small, we can let the body ____ it Reabsorb it
If woman has a hematoma, recommended they have ____ for 24 hours Foley
If hematoma is significant in size and pain is increasing, only management of care is ____ Removal
After PPH, we would do the following (list 5) 1) Labs (Hct/coag panel), 2) VS, 3) Safety issues, 4) Future bleeding (lochia/injury), 5) DOCUMENT
______ is a major risk factor for DIC Retained dead fetus for > 2 wks
Explain how retained dead fetus relates to DIC Abruption -> fetal demise -> body compensates for bleeding -> used up clotting factors -> enter DIC
What are other major risk factors r/t DIC? PIH/HEELP syndrome, sepsis, Hx of hemorrhage
Nursing actions r/t to DIC 1) Observe for petechiae, VS, I/O, check other sites (gums, IV, lochia), monitor NB status if DIC began prenatal/intrapartum (aka do a CBC panel)
In DIC, we will see lab trends such as (list 5) 1) decreased PLT, 2) decreased fibrinogen, 3) prolonged PT/PTT, 4) positive D-dimer, 5) positive fibrin splits
ITP stands for Idiopathic thrombocytopenia
Define ITP Autoimmune disorder where antibodies decrease lifespan of PLTs.
S/sx of ITP Bleeding gums, bleeding from open sites
Nursing care/treatment for ITP Supportive/safety, IV, PLTs, steroids
Risk factors of venous thrombosis (list 4) 1) C-section, 2) obesity, 3) maternal age, 4) Hx of varicosities/thrombosis
S/sx of venous thrombosis Redness, warmth, unilateral enlarged/hardened vein, calf tenderness, swelling
Treatment of venous thrombosis Elevation, compression (maybe), heparin/lovenox
S/sx of PE Anxiety, chest pressure, dyspnea, tachypnea, cough, hemoptysis, low O2 sat, tachycardia, temp changes
Patho related to PE Hypoxia, hypotension, coagulopathy --> death
Treatment for PE O2 as indicated, bedrest, analgesia, CXR, D-dimer, IV heparin/enoxaparin --> Coumadin
What is contraindicated for pts. with PE? ASA and other NSAIDs
Amniotic fluid embolism is Dx as: Sudden onset cardiovascular collapse as result of amniotic fluid entering maternal circulation during first 48 hours PP, sustained tachycardia for 4h, absence of other illnesses
Amniotic fluid embolism is most often accompanied by ____ DIC
Treatment of amniotic fluid embolism ACLS support, intubation
S/sx of endometritis Uterus tender on palpation, pelvic pain, foul lochia, excessive bleeding, chills, fever
Treatment of endometritis Antibiotics + remove cause of infection
UTI s/sx Discomfort when urinating, cloudy urine, difficult to distinguish; test urine if suspect
Placental fragments s/sx Uterus doesn't get smaller (poor involution), foul lochia, constant state of rubra, passing clots
_____ is not uncommon for 25% women to have for first couple months Mastitis
True or false: if woman Dx with mastitis, it is not ok to breastfeed False. Okay unless there is an open abscess
Treatment of mastitis Warm compresses, pain management, antibiotics
Best prevention for mastitis Early recognition (mom knows s/sx, prevents engorgement by putting baby to breast frequently)
Created by: lapio-obgyn