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Module 5 - Hemorrhag
Hemorrhage
| Question | Answer |
|---|---|
| What is the #1 cause of maternal mortality worldwide? | Postpartum Hemorrhage |
| Past definition of postpartum hemorrhage | blood loss >500 cc vaginally;blood loss > 1000cc C/S |
| Current definition of postpartum hemorrhage | Any amount causing hemodynamic instability Drop in Hct by > 10% Loss of > 15% total blood volume |
| Excessive blood loss in first 24 hours post birth is _________ hemorrhage. Evidenced by _______ _______,___________,____________ and _______ _________ | Early. Uterine atony, lacerations, hematomas and placental fragments. |
| Excessive blood loss after the first 24 hours post birth (up to 6 wks post birth)is ________ hemorrhage. Evidenced by _________ ________ ________ & ____________. | Late. Retained placental fragments & subinvolution. |
| Causes of postpartum hemorrhage are the 4 "T's" - name them. | 1. Tone - uterine muscle atony (50%) 2. Tissue placental or endometrial. 3. Trauma - C/S or genital tract 4. Thrombosis - coagulation |
| Pathophysiology of postpartum hemorrhage is determined by the __________ of blood loss. | amount |
| Moderate blood loss may result in _____________. Lab test would show a ______ ___________ | anemia lowered hct/hgb |
| Severe blood loss may result in __________ __________ or ____________. Pulse would be __________&_______. BP would be_________, Respirations would be _________&_____ , Skin would be ________, urine output would ________ and LOC would ____________. | hypovolemic shock or death. tachycardic &weak pulse. hypotensive BP, rapid & shallow respirations. clammy skin,decreased urine output (oliguria) LOC would change. |
| True or False. A woman with no identifiable risk factors may hemorrhage after child birth. | True |
| Predisposing factors for Atony include : | overdistention of uterus, bladder distention, prolonged labor, oxytocin use, Multiparity, anesthesia or tocolysis, prolonged 3rd stage, preeclampsia, operative birth, retained placenta, placenta priva |
| How does the nurse manage Atony? | Massage fundus, express clots AFTER fundus is firm. Pad count, increase IV, O2 at 2-3 liter, reposition. |
| Once bleeding stops how often should the nurse reassess ? | q 5-15 minutes if bleeding stopps |
| Who performs a bimanual compression? | Medical doctor |
| What is needed for Atony management ? | 1. Bloodwork for Hct/Hgb 2. Uterine stimulants 3. IV fluids / possibly blood 4. Catheterization to monitor U/O 5. Provide adequate rest. 6. Hysterectomy as last resort. |
| _________ is an IV Med for Atony of uterus. It may cause ___________. | Oxytocin @ 50 mu/min rapid IV infusion will cause hypotension. |
| Name 3 IM meds for Atony of uterus | Methergine (contraindicated with HTN) Ergotrate Hemabate |
| Cytotec(rectal)and Prostin E2(vaginal) are suppository for _______________ | uterine atony Prostin E2 is contraindicated if woman is hypotensive |
| Which Atony Medication should not be used if the woman is hypertensive ? | Methergine |
| A side effect of prostaglandins is __,____&____ | nausea, vomit, diarrhea. |
| A pp Laceration is a tear that involves the _______, _____,______,_____,or ______. | cervix, vagina, perineum, rectum or urethra |
| name 5 Predisposing factors for a laceration | Nulliparity Epidural anesthesia Precipitous birth Macrosomia Instrumental delivery |
| S&S of laceration | Persistent, excessive bright red bleeding in presence of firmly contracted uterus. |
| A 4th degree perineal tear in volves the ______. | rectum |
| Management of laceration may include what 3 things? | Return to OR for surgical repair or ligation. Fluid and/or blood replacement. Antibiotics. |
| Bleeding into soft tissue due to injury to blood vessel is called a _____________ | Hematoma |
| Name the predisposing factors for a hematoma | Preeclampsia Pudendal anesthesia First full-term birth Precipitous labor Prolonged 2nd stage Macrosomia Instrumental delivery Hx vulvar varicosities |
| if you see Discolored bulging, tense, shiny mass Complaints of severe pain, pressure Firm fundus Normal lochia May see S&S hypovolemic shock if severe - you should think of what ? | Hematoma |
| True or False Hematoma's are always visable | false -May be visible or hidden |
| Treatment for small hematoma | Ice x 12 hours sitz bath |
| Treatment for large hematoma | Surgical incision and evacuation of clots Ligation bleeding vessels Fluid/blood replacement Antibiotics may be prescribed |
| Causes Early PP Hemorrhage | Retained placental fragments Uterine inversion Uterine rupture Abnormal placental implantation Accreta Increta Percreta Coagulation disorders |
| When Pieces of placenta fail to separate Become necrosed and get Slough off causing sudden bleeding it results in ________________ due to ______________. | Late PP Hemorrhage due to Retained Placental Fragments |
| How do we avoid Late PP Hemorrhage due to Retained Fragments- | Placenta carefully examined after birth Manual removal if necessary |
| If bleeding occurs, Late PP Hemorrhage what actions does the nurse support? | administer IV oxytocin, IM methergine, IM prostaglandins Replace fluid/blood if needed Request Ultrasound to check for remaining fragments Request Exploration of uterus and removal of fragments Administer Antibiotics to prevent infection |
Created by:
CCBCMDNursing218
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