Hemorrhage
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
CCBCMDNursing218
Popular Nursing sets