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Maternal Newborn
Postpartum Complications
| Question | Answer |
|---|---|
| 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
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