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High Risk PP
Postpartum
| Term | Definition |
|---|---|
| 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
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