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166 Cards in this Set
- Front
- Back
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Absence of prompt & sustained contractions (relaxation of the uterus) is called:
a) uterine metritis b) sub-involution c) uterine parametritis d) uterine atony |
d) uterine atony
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The 4 most common complications of the postpartal period are (PHIT):
1- Psy_ _ _ _ _ _ _ _ disorders 2- H _ _ _ h _ _ _ _ _ 3- I_ _ _ _ _ _ _ _ 4- Thr_ _ _ _ _ _ _ _ _ _ _ disease |
1- psychiatric disorders
2- hemorrhage 3- infection 4- thromboembolic disease |
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A cause of significant maternal mortality which accounts for 11% of maternal deaths is attributed to:
a) infection b) endometritis c) thromboembolic disease d) hemorrhage |
d) hemorrhage
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The traditional definition of PP hemorrhage is a blood loss after childbirth of more than:
a) 200 ml b) 400 ml c) 500 ml d) 1000 ml |
c) 500 ml
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Given the increased blood volume of pregnancy, the clinical signs of hemorrhage are:
a) decreasing blood pressure, increasing pulse, increasing urinary output b) decreasing blood pressure, decreasing pulse, decreasing urinary output c) decreasing blood pressure, decreasing pulse, increasing urinary output d) decreasing blood pressure, increasing pulse, decreasing urinary output |
d) decreasing blood pressure, increasing pulse, decreasing urinary output
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The clinical signs of hemorrhage, decreasing blood pressure, increasing pulse, decreasing urinary output, do not usually appear until as much as:
a) 500-1000 mL blood has been lost b) 1000-1500 mL blood has been lost c) 1500-1800 mL blood has been lost d) 1800-2100 mL blood has been lost |
d) 1800-2100 mL blood has been lost
"hemodynamically unstable" |
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At term, blood volume & cardiac output have increased so that 20% of cardiac output perfuses the:
a) maternal circulatory system b) pregnant uterus c) developing fetus d) placenta |
b) pregnant uterus
to support the developing fetus |
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When the placenta separates uterine vessels that carried blood to & from the placenta are severed abruptly. The normal mechanism for hemostasis after expulsion of the placenta is contraction of the interlacing uterine muscles to occulude the open sinuses that previously brought blood into the placenta. The absence of prompt & sustained uterine contractions which can result in significant blood loss is termed?
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uterine atony
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Causes for significant PP blood loss (hemorrhage)include retained placental fragments, vulvar, vaginal, or subperitoneal hematomas, uterine involution and 3 other conditions. Name these other 3 conditions.
1- 2- 3- |
1- laceration of the genital tract
2- episiotomy 3- coagulation disorders |
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If the uterine cavity is distended while the perineal pad and linen protectors remain dry the nurse would suspect:
a) uterine inversion b) subinvolution c) late PP hemmorage d) uterine atony |
d) uterine atony
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With uterine atony, blood may escape the vagina or collect in the uterus, evident as large clots. The uterine cavity may distend with up to 1000 mL blood or more while perineal pads & linens remain dry. Because of the increased blood volume associated with pregnancy, changes in maternal blood pressure & pulse may not occur until blood loss has been significant. The exception to this would be the woman with:
a) hypervolemia b) general anesthesia c) insulin dependent mothers d) preeclampsia |
d) preeclampsia
She does not have the normal hypervolemia of pregnancy & cannot tolerate even normal post-childbirth blood loss. |
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ANy woman at risk for a PP hemorrhage should be typed & crossmatched for blood & have:
a) rhogam b) pitocin c) IV in place w/18 guage needles d) IV in place w/20 guage needles |
c) IV in place w/18 guage needles
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After expulsion of the placenta, the fundus is palpated to ensure it is:
a) 2 fingerbreadths above umbilicus b) 2 fingerbreadths below umbilicus c) firmly contracted d) not distended |
c) firmly contracted
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Bogginess indicates the uterus is not contracting well which results in:
a) increased heme b) hypervolemia c) eclampsia d) increasd bleeding |
d) increasd bleeding
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If the fundus is not firm with palpation (after the placenta is expulsed) and bleeding is excessive, the nurse will:
a) continue fundal massage b) anticipate IV oxytocin w/rapid infusion c) anticipate emergency blood transfusion d) wait 1-3 hours before resuming fundal massage |
b) anticipate IV oxytocin w/rapid infusion
clinician may also elect to do a bimanual massage |
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The woman with this condition does not have the normal hypervolemia of pregnancy & cannot tolerate even normal post-childbirth blood loss.
a) ceasarian delivery b) preeclampsia c) insulin dependent d) parametritis |
b) preeclampsia
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What lab studies are used to determine the need for intravenous fluid replacement & blood transfusion?
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Hb & Hct
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All of the following are risk factors for uterine atony except:
a) large baby b) mutiples c) short labor d) 3rd stage of labor over 30 minutes |
c) short labor
prolonged labor is a risk factor for uterine atony a major cause for PP hemmorrhage |
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In treating uterine atony, (fundus not shrinking; relaxation of uterus)an 18-guage IV line is in place, fundal massage is performed until it is firmly contracted, & the nurse may anticipate a rapid infusion of oxytocin in addition to a bimanual massage. In the event of sever uncontrolled hemorrhage there are 3 other TX's.
Name them. 1- _____-_____ _____ of the pelvis vessels 2- ____ ligation 3- _____ (last resort) |
1- radio-guided embolization of pelvic vessels
2_ vessel ligation to slow blood loss & allow normal clotting mechanisms to occur 3_ hysterectomy is a last resort (uterine packing is no longer advocated) |
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Anesthesia, magnesium sulfate, and terbutaline (Brethine), in addition to oxytocin augmentation, are all:
a) drugs used to control hemorrhage b) drugs used to manage prolonged labor c) risk factors causing uterine atony d) drugs used in TX for PIH |
c) risk factors causing uterine atony
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Ethnic group at highest risk for uterine atony:
a) northern europians b) african american c) asians or hispanics d) white women over 30 yrs |
c) asians or hispanics
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Bogginess indicates the uterus is not contracting well which results in increased uterine bleeding from which blood may remain in the uterus and form clots or result in increased flow. In assessing the amount of blood loss, you must first:
a) geta Hb & Hct study b) administer rapid oxytocin infusion c) massage uterus until firm & then express clots d) perform manual removal of the placenta |
c) massage uterus until firm & then express clots
manual removal & manual compression are only performed by the medical clinician Hb & Hct studies are performed to determine need for IV fluid replacement & blood transfusion Rapid infusion of oxytocin is administered when bleeding is excessive |
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These women tend to experience heavier bleeding after childbirth & should be observed frequently for potential PP hemorrhage & hypovolemia:
a) green eyed b) brown eyed c) blondes d) redheads |
d) redheads
(natural redheads) |
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Associated with early postpartal hemorrhage:
a) subinvolution b) puerpural infection c) metritis d) lacerations |
d) lacerations
*lacerations=effects of lacerations causing hemorrhage usually occur immediatly (also present mode for infection which usually can not be identified immediatly) *subinvolution= 1-2 weeks PP(failure to return to normal size 1-2 WEEKS PP due to retained placnetal fragments) *puerperal infection=generally occurs anytime up to 6 weeks PP *metritis=usually 24-36 hours PP (GBS) |
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Should be suspected when vaginal bleeding persists in the presence of a firmly contracted uterus:
a) subinvolution b) puerpural infection c) metritis d) genital tract lacerations |
d) genital tract lacerations
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This is often an underappreciated source of blood loss because of slow and steady bleeding:
a) subinvolution b) puerpural infection c) metritis d) episiotomy |
d) episiotomy
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Episiotomy is often an underappreciated source of blood loss because of slow and steady bleeding. The risk for bleeding is increased with:
a) translateral episiotomies b) obtusemediolateral episiotomies c) mediolateral episiotomies d) precipitous episiotomy |
c) mediolateral episiotomies
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Most deaths from PP hemorrhage are due to:
a) excessive & uncontrollable bleeding b) ineffective management of slow steady blood loss c) uterine atony c) boggy uterus |
b) ineffective management of slow steady blood loss
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Macrosomia is:
a) infants born to insulin dependent moms b) infants born to mothers with gestational diabetes c) mothers predisposed to preeclampsia d) large babies (4000 g or more) |
d) large babies (4000 g or more)
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Nulliparity, epidural anesthesia, precipitous childbirth, use of foreceps or vaccume assisted birth & macrosomia are all risk factors for:
a) retained placental fragments b) subinvolution c) puerpural uterine inversion d) lacerations of reproductive tract |
d) lacerations of reproductive tract
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May cause early PP hemorrhage & are the MOST COMMON cause of LATE hemorrhage:
a) placental fragmants b) uterine atony c) episiotomies d) subinvolution |
a) placental fragmants
"retained placental fragments & retained placental lobe" |
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The most common cause for partial separation of the placenta with retention of fragments is:
a) prolonged labor b) massage of fundus prior to spontaneous placental separation c) macrosomia d) puerpural involution |
b) massage of fundus prior to spontaneous placental separation
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What would you suspect if PP bleeding persisted and no lacerations were noted?
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IMMEDIATELY Suspect retained placental fragments or a retained placental lobe.
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Occurs as a result of injury to a blood vessel from birth trauma, often without noticeable trauma to superficial tissue, or from inadequate hemostasis at the site of incision or laceration repair:
a) hematomas b) uterine atony c) lacerations of reproductive tract d) puerperal involution |
a) hematomas
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Used to diagnose retained placental fragments:
a) Hb & Hct lab studies b) cutterage c) uterine ligation d) sonography |
d) sonography
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Tx for retained placental fragments is:
a) rapid infusion of oxytocin b) cutterage c) manual compression & removal d) administration of ergotrate maleate |
c) manual compression & removal
Cutterage was formerly the standard Tx, but is now thought to increase bleeding. Nevertheless, it may still be indicated depending on the by the degree of hemmorrhage. |
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A RARE type of HEMATOMA but are the MOST DANGEROUS because of the amount of blood loss that can occur without clinical symptoms until the woman becomes hemodynamically unstable:
a) vulvar b) vaginal c) subperitoneal (pelvic) |
c) subperitoneal (pelvic)
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The most COMMON HEMATOMAS are:
a) vulvar b) vaginal c) subperitoneal (pelvic) |
vulvar AND vaginal
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Hematomas that are managed with ice packs & anesthesia:
a) nonexpanding <2 cm b) expanding & non exanding <2cm c) nonexpanding <5cm d) expanding & nonexpanding <5cm |
c) nonexpanding <5cm
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Large hematomas (>5cm) are generally managed with:
a) cutterage b) laser c) surgery d) thrombin |
c) surgery
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Hematoma sites are an ideal medium for the growth of flora that is normally present in the genital tract. Therefore, broad spectrum antibiotics are usually ordered. The nurse can decrease the risk of vulvar or vaginal hematoma by all of the following except:
a) alternate ice packs & heat packs to perineum after the 1st hour after birth & intermittantly for up to 24 hours b) apply ice packs to perineum after the 1st 4 hours after birth & intermittantly for up to 24 hours c) apply ice packs & heat aternately to perineum during the 1st hour after birth & intermittantly for up to 24 hours d) apply ice packs to the perineum during the 1st hour after birth & intermittantly for up to 24 hours |
d) apply ice packs to the perineum during the 1st hour after birth & intermittantly for up to 24 hours
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If a hematoma develops despite preventative measures, a sitz bath 4-6 times a day after the 1st 24 hours can promote comfort and aid fluid absorption:
a) when bleeding decreases. b) after analgesic agents have been administered. c) after antibiotics have been administered. d) once bleeding has stopped. |
d) once bleeding has stopped.
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The prolapse of the fundus to or through the cervix so that the uterus is turned inside out:
a) subinvolution b) uterine inversion c) uterine atony d) parametritis |
b) uterine inversion
AKA Puerperal uterine inversion |
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In most cases, this condition occurs after birth and may be worsened by excess traction on the cord before placental separation:
a) subinvolution b) uterine inversion c) uterine atony d) parametritis |
b) uterine inversion
AKA Puerperal uterine inversion |
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Delayed hemorrhage (late PP hemorrhage) usually occurs within:
a) 8-12 hours after birth b) 24-48 hours after birth c) 3-10 days after birth d) 7-14 days after birth |
d) 7-14 days after birth
(1-2 weeks) |
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Failure of the uterus to return to normal size is termed:
a) uterine atony b) uterine inversion c) subinvolution d) succenturation |
c) subinvolution
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Although early PP hemorrhage usually occurs within hours after birth, delayed hemorrhage generally occurs within 1-2 weeks, most frequently as a result of subinvolution (failure to return to normal size) of the placental site due to:
a) uterine hematomas b) uterine atony c) puerpural inversion d) retained placental fragments |
d) retained placental fragments
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One of the main complications of retained placental fragments, secondary to late hemorrhage, is:
a) uterine hematomas b) puerperal uterine inversion c) subinvolution d) endometritis |
c) subinvolution
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Blood loss from late PP hemorrhage may be excessive but rarely poses the same risk as immediate PP hemorrhage.
true/false |
true
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With subinvolution:
a) the PP fundal height is less than expected b) the PP fundal height is greater than expected |
b) greater than expected
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With subinvolution the PP fundal height is greater than expected &:
a) lochial flow rapidly progresses from rubra to serosa to alba b) lochial flow often fails to progress from rubra to serosa to alba |
b) lochial flow often fails to progress from rubra to serosa to alba
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If lochia rubra persists longer than 2 weeks PP, or a woman reports scant brown lochia or irregular heavy bleeding you should suspect:
a) uterine atony b) lacerations of the reproductive tract c) uterine inversion d) subinvolution |
d) subinvolution
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Leukorrhea, backache, & foul lochia may occur if infection is a cause of:
a) uterine atony b) lacerations of the reproductive tract c) uterine inversion d) subinvolution |
d) subinvolution
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Subinvolution is most commonly diagnosed during the routine PP examination at:
a) 1-2 weeks b) 2-4 weeks c) 4-6 weeks d) 6-10 weeks |
c) 4-6 weeks
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An enlarged, softer than normal uterus palpated bi-manually is an objective indication of:
a) puerperal uterine inversion b) subinvolution c) uterine atony d) retained uterine fragments |
b) subinvolution
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TX for subinvolution are:
a) administration of oxytocin IV 1-40 units/500-1000 mL crystilloid fluid b) Methergine 0.2 mg orally q6hrs for at least 48 hours & antibiotics if infection is present |
b) Methergine 0.2 mg orally q6hrs for at least 48 hours & antibiotics if infection is present
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There are 9 signs of PP hemorrhage which include:
1 - Decreased level of consciousness 2 - hematoma formation or bulging/shiny skin in the perineal area 3 - Persistant bleeding in the presence of a firmly contracted uterus 4 - Abnormal clots 5 - excessive or bright red bleeding Can you name the other 4 signs of hemorrhage? |
1- boggy fundus that does not respond to massage
2- any unusual pelvic discomfort or bachache 3- rise in the level of the fundus of the uterus 4- increased pulse or decreased BP |
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There are 2 assessments you should rely on which indicate the possible development or recurrence of hemorrhage. What are they?
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1 - Frequent assessment of fundal height
2- Frequent assessment & evidence of uterine tone & contractility |
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When regional anesthesia is used, this assessment is especially significant:
a) fundal height b) uterine tone c) lochial flow d) perineum |
d) perineum
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Once the effects of anesthesia have subsided, the general cause of perineal pain is:
a) vaginal & vulvar hematomas b) lacerations of the reproductive tract c) parametritis d) puerpural infection |
a) vaginal & vulvar hematomas
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Rather than automatically attributing complaints of perineal pain to an episiotomy the nurse should assess the perineal area for signs of hematomas:
a) extreme tenderness to palpation b) ecchymosis c) edema d) tensness of tissue overlying hematoma fluctuant & bulging mass at the extroitus |
ALL OF THESE !
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Nursing diagnosis that may apply to a woman experiencing PP hemorrhage include:
1- ____ ____ RT lack of information about signs of delayed PP hemorrhage 2- ____ ____ ____ RT blood loss secondary to uterine atony, lacerations, or retained placental fragments. |
1- Deficient Knowledge
2- Fluid Volume Deficit |
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If the uterus is soft & boggy you should?
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massage until firm
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If the uterus is not contracting firmly & appears larger than anticipated, clots may be . . . ???
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expressed during fundal massage
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If the woman seems to have a slow, steady, free flow of blood, you should?
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begin to weigh the perineal pads (1 mL = 1 g) & monitor vital signs q15 minutes or more frequently if indicated.
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If the fundus is displaced upward or to one side because of a full bladder you should?
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encourage her to void or catheterize her if she is unable to void to allow for sustained uterine contractions
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When physicians & midwives write orders to dc Iv after the present bottle, the astute PP nurse will first?
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assess the consistancy of the fundus & the presence of normal lochia before dc the infusion & contact them if assessments are not reassuring.
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Assessing the woman for anemia includes observing for all of the following except:
a) fatigue b) pallor c) headache d) thirst e) ortostatic changes in pulse f) orthostatic changes in BP g) review Hct determinations |
All of the ABOVE
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The PP nurse will assess the patient for uterine tone, lochia, anemia, & urinary output. Urinary output is assessed to determine adequacy of fluid replacemnet & renal perfusion. The nurse will notify the physician if output is less than:
a) 20 mL/hr b) 30 mL/hr c) 40 mL/hr d) 50 mL/hr |
b) 30 mL/hr
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The woman & family should receive clear, written, explanations of the normal PP course, including changes in lochia & fundus, & signs of abnormal bleeding. Instructions for managing bleeding should include what 3 things?
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1- fundal massage
2- ways to assess the fundal height & consistancy 3- inspection of episiotomy & lacerations, if possible |
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Routine discharge instructions include advise such as you care for baby & let?
Advisng spouse or support persons the importance of foods high in this mineral? Patient should count? Patient should recognize? |
someone else care for you, family & household.
foods high in iron count perineal pads for several days recognize signs of excess blood loss |
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A debilitated condition & anemia associated with hemorrhage increase the womans risk for?
a) uterine atony b) involution c) puerperal infection d) hematomas |
c) puerperal infection
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A sense of emergency often accompanies late postpartal hemorrhage & because it generally occurs 1-2 weeks after birth, the couple is?
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generally at home & involved in day-to-day activities when the unexpected & excessive bleeding begins.
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Lab studies used in diagnosing hemorrhage are Blood type & cross, CBC, platelets and:
1- ______ 2- ______ 3- ______ |
1 - PT
2- PTT 3- fibrinogen |
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Associated with childbirth & occurs anytime up to 6 weeks PP:
a) uterine atony b) hematomas c) puerperal infection d) puerperal inversion |
c) puerperal infection
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The most common puerperal infection is:
a) metritis b) parametritis c) perineal wound infections d) UTI's |
a) metritis
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Metritis AKA endometritis is limited to the:
a) uterus b) fundus c) cervix d) fallopian tubes |
a) uterus
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Although the cause of of PP fever is presumed to be metritis until proven otherwise, infection can spread by way of the:
a) fallopian tubes b) cervix c) urine d) lymphatic |
d) lymphatic
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Puerperal infection is recognized with a temperature of:
a) 36.6 C or higher occuring on any 2 of the 1st 10 PP days b) 37.0 C or higher occuring on any 2 of the 1st 10 PP days c) 37.6 C or higher occuring on any 2 of the 1st 10 PP days d) 38.0 C or higher occuring on any 2 of the 1st 10 PP days |
d) 38.0 C or higher occuring on any 2 of the 1st 10 PP days
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The vagina & cervix of 70% of all healthy women contain pathogenic bacteria that are sufficient to cause excessive infection. However, other factors must be present for infxn to occur such as?
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the change to an alkaline pH of vagina that favors growth of aerobes
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ALthough uterine infections are relatively uncommon following uncomplicated vaginal births they continue to be a major source of morbididty for women who:
a) undergo an epidural b) experience hemorrhage c) deliver via ceasarian d) have chronic anemia |
c) deliver via ceasarian
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PP infections are known by 4 various terms. Name them.
1-Met_ _ _ _ _ 2-En_ _ _ _ _ _ _ _ _ _ 3-En_ _ _ _ _ _ _ _ _ _ _ _ _ 4-En_ _ _ _ _ _ _ _ _ _ _ _ _ _ |
1- Metritis
2- Endometritis 3- Endomyometritis 4- Endoparametritis |
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Inflammation of the endometrium which occurs PP in 1-3% of vaginal births & up to 27% in women who deliver ceasarian:
a) Metritis b) Endometritis c) Endomyometritis d) Endoparametritis |
Metritis aka Endometritis
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Both aerobic & anaerobic organisms cause metritis that is often polymicrobial & clinical findings of metritis in the in the intitial 24-36 hours PP tend to be related to:
a) uterine atony b) retained placental fragments c) group bets strep d) chlamydia trachomatis |
c) group beta strep
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Late onset PP metritis is most commonly associated with:
a) uterine atony b) retained placental fragments c) group bets strep d) chlamydia trachomatis |
d) chlamydia trachomatis
(not consistently eradicated by antibiotics used for early PP infections) |
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In mild cases of metrtis the woman typically has a discharge that is bloody, foul smelling,& either scant or profuse. In severe cases she will also have?
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uterine tenderness, sawtooth temperature spikes between 101 & 104 F, tachycardia & chills.
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The classic sign of metritis is:
a) bloody discharge b) sawtooth temperature c) foul smelling lochia d) tachycardia |
c) foul smelling lochia
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Infection involving the connective tissue of the broad ligament or, in more severe forms, the connective tissue of all the pelvic structures:
a) metritis b) endometritis c) endomyometritis d) endoparametritis |
d) endoparametritis
(parametritis/cellulitis) |
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A pelvic abscess may form in PP:
a) cellulitis b) peritonitis c) endomyometritis d) endoparametritis |
b) peritonitis
cellulitis is parametritis (aka endoparametritis)& involves infection of the broad ligament &/or entire pelvic structure endometritis is metritis & is inflammation & infection of the endometrium most common w/"c" sections |
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An infection that generally ascends up into the pelvis by way of lymphatics in the uterine wall but may also occur if pathogenic organisms invade a cervical laceration that extends upwards into the connective tissue of the broad ligament ( adirect pathway into the pelvis):
a) cellulitis b) peritonitis c) endomyometritis d) endoparametritis |
a) cellulitis
aka: parametritis |
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May be a secondary result of pelvic vein thrombophlebitis:
a) cellulitis b) peritonitis c) endomyometritis d) parametritis |
d) parametritis
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An infection involving the peritoneal cavity most commonly found in the uterine ligaments, the cul-de-sac of Douglas, & the subdiaphragmatic space:
a) cellulitis b) peritonitis c) endomyometritis d) parametritis |
b) peritonitis
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Parametritis may be a secondary result of pelvic vein thrombophlebitis which occurs when the clot of an ovarian vein becomes infected & the wall of the vein breaks down from necrosis thus spilling the infection into the connective tissue of the pelvis. The ovearian vein most commonly affected is the :
a) right ovarian vein b) left ovarian vein c) top ovarian vein d) medial ovarian vein a) cellulitis b) peritonitis c) endomyometritis d) parametritis |
a) right ovarian vein
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S/S of peritonitis is acute illness, severe pain, marked anxiety, & a high fever. Other symptoms are? (name 4)
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1- rapid & shallow respirations
2- pronounced tachycardia 3- excessive thirst 4- abd distention with N&V |
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Perineal wound infection is recognized by these classic signs:
1-redness 2-warmth 3-edema 5-purulent drainage and a later sign would be? |
gaping of the previously approximated wound
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TX of infected purulent wounds are:
a) antibiotic therapy b) sitz baths q4hrs & antibiotic therapy c) drainage, antibiotics, & sitz baths d) drainage, remove sutures, antibiotics & secondary wound intention |
d) drainage, remove sutures, antibiotics & secondary wound intention
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The infection rate following cesarian births is 3-5% with the highest rate occuring:
a) due to general anesthesia b) port of entry into spinal fluid or epidural space c) blood loss d) emergency cesarean due to traumatization of tissue |
d) emergency cesarean due to traumatization of tissue
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Predisposing factors of of cesarean wound infection include metritis, prolonged labor, anemia, steroid therapy, & immunosuppression. There are 4 other predisposing factors. Name them.
1- O_ _ _ _ _ _ 2- D_ _ _ _ _ _ _ M. 3- Pro_ _ _ _ _ _ PP Hospitalization 4- P _ _ M |
1- obesity
2- diabetes mellitus 3- prolonged PP hospitalization 4- PROM |
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TX for a localized infection is?
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antibiotics, sitz baths, & analgesics for pain
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TX for an abscess is?
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drainage, suture removal, packing wound, secondary intention healing, antibiotics
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Broad spectrum antibiotics are used to TX PP wound infections & cephalosporins, pencillinase-resistant penicillin, & vancomycin are commonly used with anaerobic coverage by _____ or _____?
Name |
clindamycin or ampicillin
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Types of infections TX with IV antibiotics & of which oral antibiotics are rarely needed on discharge:
a) metritis & endometritis b) parametritis & peritonitis |
b) parametritis & peritonitis
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AN abscess is frequently manifested by the development of a palpable mass & may be confirmed with?
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ultrasound
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AN abscess frequently requires incision & drainage to prevent rupture into peritoneal cavity thus causing peritonitis. After drainage the cavity may be packed with what kind of guaze to promote drainage & facilitate healing?
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iodoform guaze
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Nursing assessment & diagnosis for reproductive tract or wound infection includes inspection of the womans perineum every:
a) 2-4 hours b) 4-6 hours c) 6-8 hours d) 8-12 hours |
d) 8-12 hours
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The REEDA scale is a good reminder to consider s/s of infection. What does REEDA stand for?
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Redness
Edema Eccyhmosis Discharge Approximation |
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The nurse should IMMEDIATELY report this observation to the clinician:
a) fever b) pain c) induration d) abd pain |
c) induration
(hardening) |
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Due to the normal increase of this cell type during the PP period, this blood cell type cannot be used reliably:
a) RBC b) WBC c) BASO's d) Platelets |
b) WBC
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During the PP period, a WBC count of 14,000 to 16,000 is not an unusual finding. However an increase in WBC of more than 30% in what period of time is indicative of infection?
a) 1 hour b) 2 hour c) 4 hour d) 6 hour |
d) 6 hour
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Nursing care for the woman in the PP period includes teaching self care measures to prevent infection, perineal care, handwashing, adequate fluid intake & a diet high ___ & ___ which are necessary for wound healing & prevent infection?
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protein & vit C
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Breastfeeding mothers receiving antibiotics should be instructed to observe:
a) for s/s of vaginal yeast infections b) for constipation or diarrhea c) infants mouth for signs of thrush d) mastitis |
c) infants mouth for signs of thrush
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The overdistended bladder appears as a large mass sometimes reaching to the unbilicus & displacing the uterine fundus:
a) downward b) to the left c) to the right d) upward |
d) upward
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The overdistended bladder appears as a large mass sometimes reaching to the unbilicus & displacing the uterine fundus upward causing increased vaginal bleeding & a boggy fundus. What complaints might the patient have in addition to these s&s?
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uterine crampin
bachache restlessness |
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When a woman is catheterized in the PP, the cath is clamped & taped firmly to the womans leg if the amount of urine drained from the bladder reaches:
a) 300-500 mL b) 400-800 mL c) 500-100 mL d) 900-1000 mL |
d) 900-1000 mL
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Retention of residual urine, bacteria introduced at the time of catheterization, & a bladder traumatized by birth combine to provide an excellent environment for the development of:
a) peritonitis b) metritis c) cystitis d) parametritis |
c) cystitis
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When cystitis is suspected what type of method is used to collect a urine sample?
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clean catch midstream
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If the amount of urine drained from the bladder with a cath in a PP woman reaches 900-1000 mL the cath is clamped, taped to her leg, & vitals are taken before & after the procedure. After an hour the cath may be unclamped & placed on gravity drainage. WHy is this done?
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This technique protects the bladder & prevents rapid intra-abdominal decompression.
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Cystitis (infection) is generally present when bacterial concentrations is greater than ___ ___ of the same organism per millimeter of fresh urine:
a) 1,000 colonies b) 10,000 colonies c) 100,000 colonies d) 1,000,000 colonies |
c) 100,000 colonies
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Cystitis (infection)is suggested particuarly if clinical symptoms are noted when bacterial counts are between:
a) 1,000-10,000 b) 10,000-100,000 c) 100,000-1,000,000 |
b) 10,000-100,000
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Frequently used antibiotics used for TX of cystitis are all of the following except:
a) clindamycin b) Bactrim c) Septra d) short acting sulfonamides e) Macrodantin f) ampicillin g) amoxicillin |
a) clindamycin
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Can you name an antispasmodic or urinary analgesic that may be given to relieve discomfort of cystitis?
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Pyridium
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After childbirth, symptoms of cystitis often appear in:
a) 1-2 days b) 2-3 days c) 3-10 days d) 10-14 days |
b) 2-3 days
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The nurse should encourage a woman to empty her bladder frequently during labor & PP to avoid overdistention & trauma to the bladder, use cath techniques to prevent distention, teach importance of follow up care & drink 8-10 80z glasses of water daily. The nurse also teaches the patient to empty bladder whenever she feels the urge but at leat every 2-4 hours while awake. what else will the nurse teach the patient?
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void before & after intercourse
wear underwear with a cotton crotch avoid carbonated beverages (increase alkalinity of urine when acidification is thought to prevent & manage UTI's. drink unsweetened cranberry juice, plum, apricot & prune juices Take vit c (increases acidity of urine) |
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What are the 3 catagories of PP infection"
1- R_ _ _ _ _ _ _ _ _ _ _ or G_ _ _ _ _ _ tract 2- U_ _ _ _ _ _ tract 3- The _ _ _ _ _ _ _ |
1- Reproductive or genital tract
2- urinary tract 3- the breasts |
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Genital tract infections involve all of the following except:
a) muscle of uterus b) placentall site c) tubes d) ovaries |
All of THESE
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The number 1 cause of PP infection is:
a) epidural b) hematomas c) general anesthesia d) cesarean section |
d) cesarean section
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Endometritis is inflammation of the endometrium & occurs:
a) in the placenta b) in the fundus c) at the placental site d) in the cervix |
c) at the placental site
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Your patient had a pertoneal infection healing by secondary intention & asks how long it will take to heal?
a) 10 days b) 2 weeks c) 4 weeks d) 6 weeks |
d) 6 weeks
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a WBC of 14,000 to 16,000 in PP women is:
a) ok b) suggests infection c) confirms infection is present d) an indication for emergency care |
a) ok
However, an increase of more than 30% in 6 hrs is indicative of infection |
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Infection of the breasts connective tissue occuring primarily in women who are lactating:
a) metritis b) puerperal infection c) lymphedema d) mastitis |
d) mastitis
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The causative organisms for mastitis are generally one of the of the following except:
a) trachomatis b) Haemophilus parainfluenza c) H. influenza d) Staph Aureus e) E. coli f) Strep g) candida albicans |
a) trachomatis
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The most common pathogens associated with lactational mastitis are from:
a) breast milk b) circulating blood c) infants nose & throat d) breast hygiene |
c) infants nose & throat
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Infectious mastitis is a more severe form of mastitis causing fever, headache, flulike symptoms & a warm, reddened, painfull area of the breast. This usually occurs in the upper outer quadrant. Although all of the following are common pathogens causing mastitis, a woman with late-onset nipple pain followed by shooting pain during & between feedings is usually due to which of the following pathogens:
a) Staph b) H. parainflunzae c) H. influenza d) E. coli e) Strep f) candida albicans |
f) candida albicans
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Which of the following pathogens affecting the breastfeeding mother causes thrush in the infants mouth?
a) Staph b) H. parainflunzae c) H. influenza d) E. coli e) Strep f) candida albicans |
f) candida albicans
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Diagnosis of mastitis is usually based on history & physical exam and a culture & sensitivity testing of breast milk. Which of the following collection techniques is appropriate:
a) wash nipple, collect 3 ml milk midstream. refridgerate immediatly b) wash nipple, collect 1 ml milk midstream, discard, express 3 mL, refridgerate immediatly c) wash nipple, collect 3 ml milk midstream, discard, express 3 mL for sample d) wash nipple, collect 3 ml milk midstream, discard, express 3 mL for sample, refriderate immediately |
c) wash nipple, collect 3 ml milk midstream, discard, express 3 mL for sample
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Lab study result that is diagnostic for mastitis:
a) Leuk count of 1 million/mL & bacterial colony count > 10,000/ml b) Leuk count of 100,000/mL & bacterial colony count > 10,000/ml c) Leuk count of 10,000/mL & bacterial colony count > 10,000/ml d) Leuk count of 10,000/mL & bacterial colony count > 100,000/ml |
a) Leuk count of 1 million/mL & bacterial colony count > 10,000/ml
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TX for mastitis includes increased fluid intake of at least 2-3 Liters per day & local application of warm moist heat compresses in addition to analgesics that are compatible w/breatfeeding. Nonsteriodal anti-inflamm agents are recommended to TX fever & inflammation and antibiotics. What other information will you provide your patient with?
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wear a supportive bra!!!
frequent breastfeeding!!! |
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Antibiotic therapy for women with mastitis usually includes which 2 og the following antibiotics?
a) vancomycin b) Bactrim c) penicillinase-restistant penicillin d) cephalosporin |
c) penicillinase-restistant penicillin
d) cephalosporin |
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Initial TX for stubborn candidal infections responsible for causing mastitis usually involves antifungal creams or ointments BID. Oral Difulcan is excreted in milk & is:
a) considered toxic to the infant b) not considered toxic to the infant |
b) not considered toxic to the infant
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An alternative TX for women who prefer to avoid medications for mastitis:
a) cleanse nipple w/ivory soap & warm water, air dry b) cleanse nipple w/ivory soap & warm water, air dry, apply hydrocortisone between feedings c) cleanse nipple with warm water, air dry d) 1 tbl vinegar in 1c water, air dry e) 1 tsp baking soda in 1c water, air dry |
d) 1 tbl vinegar in 1c water, air dry
and . . . e) 1 tsp baking soda in 1c |
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Breastfeeding should be continued by women with mastitis.
true/false |
true
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Contributing factors of mastitis:
1- _____ nipples 2- poor ____ 3- en_ _ _ _ _ _ _ _ _ 4- _____ feedings 5- change in _____ 6- change in infant ____ ____ 7- abrubt ____ 8- lack of proper ____ support |
1- craked nipples
2- poor hygiene 3- engorgement 4- supplemental feedings 5- change in routine 6- change in infant feeding pattern 7- abrupt weaning 8- lack opf proper breast support |
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Nursing diagnosis that may apply to women with mastitis:
1- Health seeking behaviors RT lack of ____ about appropriate ____ practices. 2- Ineffective breastfeeding RT ___ secondary to development of ____. |
1- Health seeking behaviors RT lack of INFORMATION about appropriate BREASTFEEDING practices.
2- Ineffective breastfeeding RT PAIN secondary to development of MASTITIS. |
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Failure to change infant position to allow emptying all lobes of the breast & failure to alternate breasts at feedings are activities that predispose a woman to one of the following conditions associated with causing mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
a) milk stasis
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Failure to air dry breasts is an activity that predisposes a woman to one of the following conditions associated with the developement of mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
b) actions that promote access/multilication of bacteria
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Wearing an underwire bra is an activity that predisposes a woman to one of the following conditions associated with the developement of mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
d) obstruction of ducts
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Prolonged sleeping & sleeping through the night is an activity that predisposes a woman to one of the following conditions associated with the developement of mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
e) change in number of feedings/failure to empty breasts
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Stress & fatige are activities that predisposes a woman to one of the following conditions associated with the developement of mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
f) lowered maternal defenses
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Failure to suck & poor letdown are activities that predisposes a woman to one of the following conditions associated with the developement of mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
a) milk stasis
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Incorrect or aggressive breast pumping technique are activities that predisposes a woman to one of the following conditions associated with the developement of mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
c) breast/nipple trauma
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A missed feeding or favoring one breast over another due to soreness are activities that predisposes a woman to one of the following conditions associated with the developement of mastitis:
a) milk stasis b) actions that promote access/multilication of bacteria c) breast/nipple trauma d) obstruction of ducts e) change in number of feedings/failure to empty breasts f) lowered maternal defenses |
e) change in number of feedings/failure to empty breasts
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This is a primary measure in preventing epidemic nursery infections & subsequent maternal mastitis:
a) lazy janitors b) ineffective cleaning products c) eradicatin of mosquitoes d) meticulous _____ |
d) meticulous handwashing
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If the mother finds that one area of her breast feels distended she can do all of the following except:
a) avoid breastfeeding on that side until distention subsides b) rotate the position of her infant for breastfeeding c) manually express the milk remaining in breast after feeding d) massage the caked area toward the nipple as the infant nurses |
a) avoid breastfeeding on that side until distention subsides
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Encourage mothers with mastitis to breastfeed frequently starting with:
a) the affected breast until let down occurs in the unaffected breast b) the unaffected breast until letdown occurs in the affected breast & nurse from it until breast is completely emptied |
b) the unaffected breast until letdown occurs in the affected breast & nurse from it until breast is completely emptied
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The nurse should encourage the mother after breatfeeding to leave a small amount of milk on each nipple to prevent cracking & allow to air dry.
true/false |
true
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Name 4 of the main causes for PP hemorrhage.
1- 2- 3- 4- |
1- uterine atony
2- laceration of vagina & cervix 3- retained placenatl fragments 4- subinvolution |
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A nurse is assessing a 2 hr PP client. Her BP is 98/60, pulse is 90, & she has saturated 2 pads in the last hour. What should the immediate nursing action be?
a) assess & massage fundus until firm, if needed b) increase the rate of the IV infusion c) notify the physician or nurse-midwife d) obtain an order for antihypertensive medication |
a) assess & massage fundus until firm, if needed
this client is showing early signs of hemorrhage & possi ble shock the FIRST initial action ALWAYS is to assess the uterus & massage until firm & then increase infusion rate & call physician |
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A nurse is caring for 4 PP clients who each have an order for Methergine. Inwhich of the following cases would she hold the medication:
a) client A with temp of 101 b) client B with Hct of 33% c) client C with BP of 156/92 d) client D with WBC count of 22,000 |
c) client C with BP of 156/92
THE MOST significant side effect of methergine is HYPERtension & therfore contraindicated in clients w/HTN |
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A nurse has assessed a 4cm vaginal hematoma on a 6hr PP client. What would be the most appropriate nursing action:
a) administer anti-inflammatory meds b) apply hot packs q4h c) insert indwelling Fley cath d) apply ice packs q4h |
d) apply ice packs q4h
ice causes vasoconstriction heat may increase size of hematoma Foley is inserted only if there is urinary retention Analgesics might be needed but not anti-inflammatories |
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A 4 week PP client is diagnosed with subinvolution. What med would the nurse anticipate an order for?
a) methergine b) percodan c) motrin d) hemabate |
a) methergine
subinvolution is when the uterus fails to contract & return to normal size. Methergine allows the uterus to have a sustained contraction. Percodan & Motrin would help w/pain Hemabate would be needed if there was hemorrhaging |
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A nurse is caring for a 4 hr PP client with PP hemorhage. What is the priority nursing diagnosis:
a) knowlede deficit RT lack of knowledge about signs of PP hemorrhage b) Fluid Vol Deficit RT blood loss secondary to uterine atony c) Fatigue RT anemia from PP bleeding d) Activity intolerance RT enforced bedrest to control PP bleeding |
a) knowlede deficit RT lack of knowledge about signs of PP hemorrhage
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The nurse is reviewing the lab reports of a 24-hr PP client. The admission Hct was 41% & the current is 30%. What should the initial nursing intervention be?
a) notify lab for another draw b) increase IV infusion rate c) report to physician or midwife d) administer 2 units of typed & cross-matched blood |
c) report to physician or midwife
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A nurse is catheterizing a 12 hr PP client for bladder distention & urinary retention. After draining 900 mL of urine, the nurse clamps the cath. What does the nurse explain to the client as the rationale for this procedure?
a) the cath is clamped after draining 900 mL to protect & prevent rapid intr-abdominal decompression b) this enables the nurse to collect a clean-catch urine specimen for culture & sensitivity c) the nurs drains the clients bladder of all urine to prevent stasis of urine d) clamping the cath facilitates administration of prphilactic antibiotics to prevent a UTI |
a) the cath is clamped after draining 900 mL to protect & prevent rapid intr-abdominal decompression
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The nurse is caring for a 48-hr PP client who complains of urinary frequency & dysuria. Her temp is 100.2, BP is 108/72, & respirations are 18. What is the most appropriate nursing intervention?
a) administer anti-inflammatory meds for discomfort b) obtain a cath urine specimen for culture & sensitivity c) admin antibiotics to client for puerperal infxn d) obtain a clean-catch urine specimen from client for culture & sensitivity |
d) obtain a clean-catch urine specimen from client for culture & sensitivity
Client exhibits signs of a UTI |
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The nurse is caring for PP patient w/superficial thrombophlebitis. What is the most appropriate TX for the nurse to plan to do for this client? Select all that apply.
a) admin anticoagulants b) elevate affected limb c) admin antibiotics d) apply heat packs |
a) admin anticoagulants
b) elevate affected limb d) apply heat packs |
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The PP patient is eager for discharge & on assessment the nurse notes the uterus is boggy & midline. The bladder is not distended & on massage, the nurse notes that there are several large clots on the saturated peripad. What would the nurse suspect as the problem:
a) uterine atony b) vaginal lacerations c) retained placental fragments d) hematoma eruption |
c) retained placental fragments
Because of the late stage of bleeding & the large clots the nurse would suspect retained placental fragments Uterine atony would have occured earlier. Lacerations would have produced a trickling of blood |
