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Maternal Newborn

Postpartum Complications

QuestionAnswer
The four areas of postpartum complications are: ____, Infection, Thrombophlebitis, and Psychiatric disorders hemorrhage
Postpartal hemorrhage is more than ____ ml of blood loss over 500ml.
Postpartal hemorrhage is clinically underestimated by ____% because it is difficult to assess due to blood mixing with amniotic fluid and absorbed by linens, ect. 50% underestimated
Since postpartal hemorrhage is underestimated the best way to determine blood loss is to compare post delivery ____ levels to predelivery levles hematocrit levels - If drops 10 points, need for fluid replacement
What are the late signs of postpartal hemorrhage BP drop and pulse increase
What is considered early and late hemorrhage early within first 24 hours. late after first 24 hours and up to 6 weeks
____ is the term for relaxation of the uterus uterine atony
What are some of the causes of postpartal hemorrhage overdistnesion of the uterus, rapid or prolonged labor, oxytocin induction, grand multiparity, anesthesia, prolonged 3rd stage, infection, preeclampsia, operative birth, & retained placental fragments
How does overdistention of the uterus cause hemorrhage The overstretched muscles are more difficult to contract
Why does oxytocin induction increase the risk of hemorrhage the stronger contractions puts pt at risk for hemorrhage
Why is anesthesia a risk factor for hemorrhage anesthesia causes vasodilation
When would weighing perineal pads be necessary after fundal massage and expression of clots plus emptying bladder, there is a slow, steady, free flow of blood (1ml = 1gm)
Pitocin, Methergine, Ergotrate Maleate, & Prostaglandin are all medications used for postpartal hemorrhage
What are the sources of bleeding during postpartal hemorrhage placenta detachment, lacerations, retained placental fragments, hematomas
What are the risks for lacerations Nulliparity (never given brith b4), precipitous labor, prolonged second stage, operative birth, and macrosomia (LGA)
When is retained placental fragments a concern after the pt has left the hospital
How is a hematoma assessed after birth look at vulva when checking pt. Might see fluctuant skin that is shiny with edema, this would be a large blood clot under the skin. Prevention includes cold packs 20 min on and 20 min off
postpartal hemorrhage signs include: excessive bright red bleeding, boggy fundus (not responding to massage), abnormal clots, unusual pelvic or back discomfort, bleeding in the presence of a contracted uterus, rise in level of fundus, increased pulse, decrease in blood pressure, hematoma
____ infection or postpartum infection is an infection of the reproductive tract that occures up to ____ weeks postpartum Puerperal infection up to 6 weeks postpartum
puerperal morbidity includes a temperature over 100.4 (38C) taken 4X/day on any 2 occasions, or the first 10 PP days excluding ____ the first 24 hours
____ is an infection or inflammation of the uterine lining metritis
What is the risk factors for metritis or infection or inflammation of the uterine lining C-section, PPROM (many hrs of ruptured membrane), prolonged labor then C-section, compromised health status, internal EFM, birth trauma, chorioamnionitis (infection of membranes during labor), DM, operative birth, manual placental removel, VB or chlamydia
What is an early cause and late cause of metritis (infection or inflammation of the uterine lining) Early - B-strep. Late - Chlyamidia
What are the signs of metritis (infection of the uterine lining bloody FOUL smelling locia, uterine tenderness, TEMP spikes more than 2 occasions, increased pulse, chills, increase WBC of 30% in 6hr period
What is the tx for metritis (infection of the uterine lining) antibiotics until afrebrile for 48 hrs, prophlactic antibiotics with C-section
overdistention can cause UTI's, why would the bladder overdistend trauma, effects of anesthesia. tx includes straight cath or foley, ice packs to decrease edema around meatus, pain meds, antibiotics, and avoid carbonated beverages and drink cranberry juice (acidic)
____ is an infection of the breast connective tissue (ONE SIDED) due to bacterial invasion following trauma to nipple mastitis
What causes mastitis milk stasis, poor hygine, nipple trauma and duct obstruction
what are the s/s of mastitis usually 2nd to 4th PP week, a warm reddened painful area of the breast (often upper outer quandrant), advancing to include fever chills H/A and FLU LIKE sx
What is the treatment of mastitis bedrest for 24 hours, increase fluids, supportive bra, frequent breastfeeding, warm moist heat packs, analegics and antibiotics
It is important to access the ____ when doing maternal assessment nipples (tx cracks to prevent mastitis)
Let pt know if breast hurts they must continue breastfeeding (empty both breasts) and ____ See their doctor, usually happens 2nd to 4th week after they are home
_____ is thrombus formation in a superficial or deep vein, usually in the ____ and is life threatening Venous thrombosis - usually in ghe legs
Venous thrombosis can cause ____ embolism due to venous stasis pulmonary embolism
causes of thrombopheblitis coagulability of pregnancy and venous statis
s/s of thrombophelitis tenderness, local heat and redness, edema, low grade fever, positive Homan's sign (not always diagnostic)
What is the dx of thrombophelitis venography or doppler ultrasonography
what is the tx for thrombophelitis IV heparin, bed rest, elevation of leg, analesics, and possible antibotics
prevention of thrombophelitis early ambulation and avoid leg trauma
T/F postpartum blues is normal True - it comes and goes and it will pass (adjustment rx and depressed mood)
postpartum blues occures in ____% - ____% , postpartum depression occures ___% - ____% and postpartum psychosis occures ____% - ____% postpartum blues - 50-80% self limiting (a few hours to 10 days, mild depression intersprersed with happiness. postpartum depression 7-30% (change in hormones in 4th week), postpartum psychosis .1-.2% (evident in first 3 months)
s/s of postpartum blues feeling overwhelmed, unable to cope, fatigued, anxious, irritable, oversensitive, episodic tearfulness without cause
tx of postpartum blues reassurance, and have them ask for assistance with self and infant care
s/s of postpartum depression not seen in postpartum blues forgetfulness, speep difficulies, & appetite change,
What are the s/s seen in postpartum psychosis not seen in postpartum depression agitation, hyperactivity, mood lability, confusion, irrationality, poor judgement, delusions and halucinations
What is the treatment for postpartum depression and postpartum psychosis referral to mental helath professional, if antidepressants are prescribed, caution with breastfeeding
Risk factors for postpartum depression primiparity, pregnancy ambivalence, hx of depression, lack of social support/ partner/family, and poor body image
____ can occure after delivery due to a lot of interventions, stressful due to fetal distress, forcepts or vacuum use, trauma, lacerations. PTSD post traumatic stress disorder - problems with sleeping, body image and similar to other stressful events.
Ms. Vargus complains to the nurse that fundal massage is painful. Explain to Ms. Vargus why this procedure is necessary. Ms. Vargus, I know this is uncomfortable for you, but it is important that I massage your uterus, so that it becomes firm so your bleeding will stop."
Debra Vargus delivered a 9-lbs, 3-oz baby girl. Her labor was 22hrs long & augmented w/ oxytocin & prostin gel. initial post assessment reveals a firm fundus at level of umbilicus. Lochia is heavy w/ several sm quarter-sized clots. Risk for? Ms. Vargus is at risk for postpartum hemorrhage related to possible uterine atony.
Debra Vargus delivered a 9-lbs, 3-oz baby girl. Her labor was 22hrs long & augmented w/ oxytocin. initial post assessment reveals a firm fundus at level of umbilicus. Lochia is heavy w/ several sm quarter-sized clots. Contributing risk factors? Ms. Vargus is a multipara (5), she has had a large baby, her labor was augmented with oxytocin (pitocin), she had a prolonged labor, and she is of Hispanic heritage.
What are the nursing implications when caring for Ms. Vargus in the immediate postpartum period? Ms vargus is at risk for atony. The nurse should increase the frequency of her assessments of the fundus, lochia, vital signs, and skin temperature and color.
What would the priority nursing diagnosis for Ms. Vargus be? Ms vargus is at risk for atony Risk for fluid volume deficit related to blood loss secondary to uterine atony.
A nurse is caring for a postpartum client with a diagnosis of superficial thrombophlebitis. What is the most appropriate treatment? Elevation of legs is most appropriateanticoagulants is appropriate treatment for septic pelvic thrombophlebitis.
A nurse is caring for four postpartum clients who each have an order for Methergine (methylergonovine malaeate). In which of the following clients' cases would the nurse hold this medication? client C with a blood pressure of 156/92
A nurse is reviewing the lab reports of a 24-hour postpartum client. The admission hematocrit was 41% and the current hematocrit is 30%. What should the initial nursing intervention be? Report to the physician or nurse-midwife
A nurse has assessed a 4-cm vaginal hematoma on a 6-hour postpartum client. What would be the most appropriate nursing action? apply ice packs q4hrs
A 4-week postpartum client is diagnosed with subinvolution. What medication would the nurse anticipate the physician or nurse-midwife to order? Methergine (methylergonovine malaeate)
A nurse is assessing four postpartum clients with vaginal births. Which one of the following clients is most at risk for uterine atony? cl A, who had epidural anesthesia; cl B, who had an oxytocin induction; cl C, who had a cerclage client B, who had an oxytocin induction
A nurse is catheterizing a 12-hour postpartum client for bladder distention and urinary retention. After draining 900 mL of urine, the nurse clamps the catheter. What is the rationale for this procedure? The catheter is clamped after removing 900 mL to protect the bladder and prevent rapid intra-abdominal decompression.
A nurse is caring for a 48-hour postpartum client who complains of urinary frequency and dysuria. Her temperature is 100.2DEGREE SIGN F, blood pressure 108/72, pulse 72, and respirations 18. What is the most appropriate nursing intervention? Obtain a clean catch urine specimen from the client for culture and sensitivity.
Created by: cgwayland