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PP Ch 28

Study guide- PP maternal complications

Less than normal muscle tone Atony
A clot or amniotic fluid material forced into smaller vessels by the vlood circulation Embolism
A blood cloth withing a vessel Thrombus
Tiny purplish-red spots onthe skin caused by intradermal /submucosal hemorrhage Petechiae
Placenta that adheres abnormally to the uterine wall Placenta accreta
Difference between systolic & diasystolic BP pulse pressure
Failure of the uterus to return to its prepregnant state in the time expected subinvolution
Thrombus formation with inflammation Thrombophelbitis
What is time difference between early & late PP hemorrhage? Early occurs within 24h of birth, Late occurs after 24h up to 6-12wks after birth
How is hemorrhage defined? loss of more than 500mL blood after vaginal birth, more than 1000mL after C/S, or decrease in Hct of 10% or more, or need for blood transfusion
What is most common cause of early PPH? Describe patho of this cause. Uterine atony. Occurs when muscle fibers of uterus do not contract firmly to compress bleeding endometerial vessels at placental site
How will RN recognize uterine atony? Uterus difficult to locate & when found it is soft rather than firm & higher than the expected level near umbilicus. May become firm with massage, but fails to remain. lochia & clots may be excessive.
What is correct nursing action if uterine atony is discovered? Support lower uterus with one hand while gently massaging with other. After firm, press down on fundus toward vagina to express clots.
What S/S typically distinguish PPH caused by uterine atony from hemorrhage caused by lacerations of birth canal? excess, usually brighter red, bleeding that may be heavy or slow but steady in the presence of a firmly contracted uterus that is in the expected location suggests laceration
How do S/S of hematoma differ from those of uterine atony of a bleeding laceration? With hematoma, pain is greatest distinction, bc confined bleeding exerts pressure on sensory nerves. uterus is firm, excluding atony as cause. Lochia is normal bc bleeding is concealed, excluding laceration. buldging, discolored mass may be visible, Risin
What D/C teaching r/t PPH is essential? Normal sequence, amt & duration of lochia. should be taught assessment & expected descent of fundus. provide guidelines for reporting deviations from normal
Why are pregnant & PP women prone to developp venous thrombosis? Stasis of blood inthe veins of lower extremities & have higher levels of clotting factors & suppression of factors that prevent clot formation. injur to vessels may occur during birth.
S/S, interventions & preventative measures for venous thrombosis See pgs 740-743
What lab studies should RN expect if woman is undergoing Heparin therapy? Warfarin therapy? Heparin- APTT & platelets; Warfarin-INR
List pt teaching r/t long-term anticoagulation teach injection technique to pt & family, report unusual bruising/petechiae, nosebleeds, blood in urine/stools, bleeding gums, increased vaginal bleeding. use soft bristle toothbrush & do not go barefoot. explain SE, drug interactions & avoid ETOH, vit K
What is definition of puerperal infection? an infection that is associated with childbirth, in which the woman have a fever 100.4 or higher after the first 24hr, occuring on at least 2days during the first 10 days following birth
What anatomic features of the woman's reproductive tract make infection ther potential serious? all parts of reproductive tract are connected to each other & to the perioneal cavity. Area is richly supplied with blood vessels & lymphatics, providing a well-nourished, dark, warm, environment that favors bacterial growth.
What changes of uncomplicted childbirth further increase a woman's risk for reproductive tract infection? What are her protective factors? Amniotic fluis, blood & lochia make normally acidic vagina more alkaline, fostering growth of organisms. Necrotic endometrial lining & lochia promote growth of anaerobic organisms. Small areas of trauma allow microorganisms to enter the tissues. However,
What signs suggest that a mother may be developing endometritis? Fever, lochia with a foul odor, chills, anorexia, cramping, uterine tenderness, malaise, tachycardia, subinvolution
List S/S of wound infection. Edema, warmth, redness, pain, separation of edges, seropurulent drainage
What liquids can help acidify urine? What is this acidity helpful in preventing/treating UTI? Apricot, plum, prune & cranberry juices help acidify urine, which makes it less friendly to microorganisms
Why is it important that breastfeeding mother with mastitis avoid engorgement? Engorgement causes stasis of milk, which promotes growth of infecting microorganisms, possibly leading to abcess.
What is key difference between PP blues & PP depression? PP depression symptoms are more intense & persistent(lasting at least 2wks) than those of PP blues, which is temporary & mild. Symptoms of PP depression include changes in appetite, wt, sleep & psychomotor activity, decreased energy, feelings of worthless
What RN interventions are appropriate for the woman with PP depression? Help express her feelings & ID stressors, discuss methods to relieve stress, such as relaxation techniques, model ways to respond to the infant, teach family what to expect & how to hlep mom, refer to MD for psychotherapy & meds, also refer to support gro
Created by: L.moore