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98 Cards in this Set
- Front
- Back
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What are some postpartum complications?
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1. Postpartum hemorrhage
2. Hypovolemic shock 3. Coagulopathy 4. Thromboembolic disease 5. Postpartum infections |
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What is postpartum hemorrhage?
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Blood loss of more than 500 mL after vaginal birth or 1000 mL after cesarean birth
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What is acute postpartum hemorrhage?
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Hemorrhage that occurs within 24 hours after birth
(also called PRIMARY POSTPARTUM HEMORRHAGE) |
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What is late postpartum hemorrhage?
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Hemorrhage that occurs more than 24 hours but less than 6 weeks postpartum
(also called SECONDARY POSTPARTUM HEMORRHAGE) |
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What are the types of blood that may be observed during hemorrhage?
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1. Dark blood
2. Bright blood 3. Spurts of blood with clots 4. Failure of blood to clot or clotted blood |
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What is the origin of dark blood?
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Venous blood
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What is the origin of bright blood?
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Arterial blood
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What is the origin of spurts of blood with clots?
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Partial placental separation
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What is the cause of failure of blood to clot or clotted blood?
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Pathologic condition or coagulopathy
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What are the risk factors and causes of postpartum hemorrhage?
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1. Uterine atony
2. Lacerations of the birth canal 3. Retained placental fragments 4. Ruptured uterus 5. Inversion of the uterus 6. Placenta accreta, increta, percreta 7. Coagulation disorders 8. Placenta abruption 9. Placenta previa 10. Manual removal of a retained placenta 11. Magnesium sulfate administration during labor or postpartum period 12. Chorioamnionitis 13. Uterine subinvolution |
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What is the leading cause of postpartum hemorrhage?
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Uterine atony
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What is uterine atony?
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Marked hypotonia of the uterus
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What causes uterine atony?
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1. Overdistended uterus
2. Anesthesia and analgesia 3. Previous history of uterine atony 4. High parity 5. Prolonged labor; oxytocin-induced labor 6. Trauma during labor and birth |
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What is associated with overdistended uterus?
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1. Large fetus
2. Multiple fetuses 3. Hydramnios 4. Distention with clots |
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What can cause trauma to the uterus during labor and birth?
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1. Forceps-assisted birth
2. Vacuum-assisted birth 3. Cesarean birth |
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Where can lacerations originate?
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1. Cervix
2. Vagina 3. Perineum |
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What factors influence the causes and incidence of obstetric lacerations?
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1. Operative birth
2. Precipitate birth 3. Congenital abnormalities of maternal soft parts 4. Contracted pelvis 5. Size, presentation, and position of fetus 6. Relative size of presenting part and the birth canal 7. Previous scarring 8. Vulvar, perineal, or vaginal varicosities |
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What is a first degree laceration?
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Laceration that extends through the skin and structures superficial to the muscles
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What is a second degree laceration?
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Laceration that extends through muscles of the perineal body
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What is a third degree laceration?
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Laceration that continues through the anal sphincter muscle
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What is a fourth degree laceration?
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Laceration that also involves the anterior rectal wall
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What is placenta accreta?
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Slight penetration of the myometrium by placental trophoblast
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What is placenta increta?
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Deep penetration of the myometrium by placenta
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What is placenta percreta?
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Perforation of uterus by placenta
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What is inversion of the uterus?
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Condition in which the uterus is turned inside out so the fundus protrudes into the cervix or vagina
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What causes inversion of the uterus?
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Too vigorous removal of the placenta before it is detached by the natural process of labor
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What is subinvolution?
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Failure of the uterus to return to normal size and condition
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What causes subinvolution?
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1. Retained placental fragments
2. Pelvic infection |
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What vital signs are related to blood loss?
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1. Tachycardia
2. Tachypnea 3. Decreasing BP |
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What is assessment of the bladder important?
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A distended bladder can displace the uterus and prevent contraction, thereby leading to hemorrhage
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What are the other assessments regarding hemorrhage?
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1. Skin for warmth and dryness
2. Nail beds for color and capillary refill 3. H&H lab results |
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What are the noninvasive assessments of cardiac output in clients experiencing postpartum hemorrhage?
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1. Palpation of pulses
2. Measure BP 3. Auscultation of heart sounds 4. Auscultation of breath sounds 5. Inspection of skin, LOC, cap refill, urinary output, neck veins, O2 sat, mucous membranes 6. Observation for anxiety, apprehension, restlessness, disorientation |
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What are the nursing diagnoses for women experiencing PPH?
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1. Deficient fluid volume
2. Risk for imbalance fluid volume 3. Risk for infection 4. Risk for injury 5. Fear or anxiety 6. Risk for impaired parenting 7. Ineffective (peripheral) tissue perfusion |
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What are the expected outcomes of care for women experiencing PPH?
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1. Maintain normal vital signs and lab values
2. Develop no complications r/t excessive bleeding 3. Express understanding of condition, its management, and discharge instruction 4. Identify and use available support systems |
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What is the initial management of excessive postpartum bleeding?
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1. Firm massage of the uterine fundus
2. Expression of any clots in the uterus 3. Elimination of any bladder distention 4. Continuous IV infusion of 10 to 40 units of oxytocin added to 1000 mL of LR or NS |
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What medications can be used to facilitate uterine contractions to manage PPH?
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1. Ergonovine
2. Methylergonovine |
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What are the contraindications of ergonovine and methylergonovine?
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1. Hypertension
2. Cardiovascular disease 3. Asthma |
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What medication can be used to facilitate uterine contractions to manage PPH in women with hypertension, CVD, or asthma?
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Prostaglandin F-2-alpha
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What lab tests are done to manage hypotonic uterus?
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1. CBC with platelet count
2. Fibrinogen 3. Fibrin split products 4. Prothrombin time 5. Partial thromboplastin time 6. Blood type 7. Antibody screen |
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What are the surgical management options for hypotonic uterus?
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1. Vessel ligation (uteroovarian, uterine, hypogastric)
2. Selective arterial embolization 3. Hysterectomy |
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What are some herbal remedies for PPH?
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1. Witch hazel
2. Lady's mantle 3. Blue cohosh 4. Motherwort 5. Sherperd's purse 6. Alfalfa leaf 7. Nettle 8. Raspberry leaf 9. Goldenseal |
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What caution must be taken to avoid injury to the suture line in women with 3rd or 4th degree lacerations?
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1. Avoid use of rectal suppositories or enemas
2. Avoid digital rectal examinations |
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What is shock?
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An emergency situation in which the perfusion of body organs may become severely compromised and death may occur
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What are the assessments of hemorrhagic (hypovolemic) shock?
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1. Respirations
2. Pulse 3. BP 4. Skin 5. Urinary output 6. LOC 7. Mental status 8. Central venous pressure |
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What are the characteristics of hemorrhagic (hypovolemic) shock?
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1. Rapid and shallow respirations
2. Rapid, weak, irregular pulse 3. Decreased BP 4. Cool, pale, clammy skin 5. Decreased urinary output 6. Lethargy or coma 7. Anxiety 8. Decreased central venous pressure |
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What is a late sign of hemorrhagic (hypovolemic) shock?
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Hypotension (low BP)
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What are the interventions of hemorrhagic (hypovolemic) shock?
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1. Summon assistance and equipment
2. Start IV infusion per standing orders 3. Ensure patent airways 4. Administer O2 at 10-12 L/min 5. Continue to monitor status |
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How is urinary output measured?
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Hourly using a Foley catheter
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What is the normal rate of urinary output for an adult?
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30 mL/hr
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What is coagulopathy?
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Abnormal or inability of the blood to clot
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What lab results are indicative of coagulopathy?
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1. Increased prothrombin time
2. Increased partial thromboplastin time 3. Decreased platelets 4. Decreased fibrinogen level 5. Increased fibrin degradation products 6. Prolonged bleeding time |
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What are the causes of coagulopathy?
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1. Idiopathic or immune thrombocytopenia purpura (ITP)
2. von Willebrand disease 3. Disseminated intravascular coagulation (DIC) |
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What is idiopathic or immune thrombocytopenia purpura (ITP)?
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An autoimmune disorder in which antiplatelet antibodies decrease the life span of platelets
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What are the diagnostic findings of idiopathic or immune thrombocytopenia purpura (ITP)?
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1. Thrombocytopenia
2. Capillary fragility 3. Increased bleeding time |
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What is von Willebrand disease?
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Type of hemophilia resulting from a factor VIII deficiency and platelet dysfunction
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What are the symptoms of von Willebrand disease?
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1. Familial bleeding tendency
2. Previous bleeding episodes 3. Prolonged bleeding time 4. Factor VIII deficiency 5. Bleeding from mucous membranes |
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What is the most important indicator for von Willebrand disease?
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Prolonged bleeding time
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What is the treatment of choice for von Willebrand disease?
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Desmopressin
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What is disseminated intravascular coagulation (DIC)?
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A pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, including platelets, fibrinogen, prothrombin, and factors V & VII
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What causes disseminated intravascular coagulation (DIC)?
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1. Abruptio placentae
2. Amniotic fluid embolism 3. Dead fetus syndrome 4. Severe preeclampsia 5. Cardiopulmonary arrest 6. Hemorrhage |
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What is dead fetus syndrome?
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Fetus that has died but is retained in utero for at least 6 weeks
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What are the symptoms of disseminated intravascular coagulation (DIC)?
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1. Unusual bleeding
2. Spontaneous bleeding from gums or nose 3. Petechiae 4. Tachycardia 5. Diaphoresis |
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What is the primary medical management of disseminated intravascular coagulation (DIC)?
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Correction of underlying cause
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What is superficial venous thrombosis?
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Clotting with involvement of the superficial saphenous venous system
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What is deep venous thrombosis?
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Clotting with involvement varies but can extend from the foot to the iliofemoral region
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What is pulmonary embolism?
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Complication of deep venous thrombosis occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs
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What is the most frequent form of postpartum thrombophlebitis?
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Superficial venous thrombosis
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What is the most frequent form of thrombophlebitis during pregnancy?
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Deep venous thrombosis
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What are the causes of thromboembolic disease?
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1. Venous stasis
2. Hypercoagulation |
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What are the risk factors associated with thromboembolic disease?
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1. Pregnancy
2. Cesarean birth 3. History of venous thrombosis or varicosities 4. Obesity 5. Maternal age > 35 years 6. Multiparity 7. Smoking 8. Genetics |
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What are the clinical manifestations of superficial venous thrombosis?
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1. Pain and tenderness in the lower extremity
2. Warmth 3. Redness 4. Enlarged, hardened vein over the site of the thrombosis |
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What are the clinical manifestations of deep venous thrombosis?
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1. Unilateral leg pain
2. Calf tenderness 3. Swelling 4. Redness 5. Warmth 6. Positive Homan's sign 7. Cough 8. Apprehension 9. Tachycardia 10. Hemoptysis 11. Elevated temperature 12. Pleuritic chest pain |
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What are the clinical manifestations of pulmonary embolism?
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1. Dyspnea
2. Tachypnea |
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What is the treatment of superficial venous thrombosis?
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Analgesia (NSAIDs)
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What is the treatment of deep venous thrombosis?
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1. Anticoagulant therapy (usually IV heparin)
2. Bed rest with affected leg elevated 3. Analgesia |
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What is the treatment of pulmonary embolism?
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Continuous IV heparin therapy
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What must nurses teach clients who are discharged home with oral anticoagulants?
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DO NOT take aspirin while on anticoagulant therapy because aspirin inhibits the synthesis of clotting factors and can lead to prolonged clotting time and increase risk of bleeding
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What is the most common postpartum complication?
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Postpartum or puerperal infection
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What is postpartum or puerperal infection?
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1. Presence of a fever of 38 degrees C (100 degrees F) or more on two successive days of the first 10 postpartum days
2. Any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth |
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What are the types of postpartum or puerperal infection?
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1. Endometritis
2. Wound infections 3. Mastitis 4. UTIs 5. Respiratory tract infections |
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What are the most common infecting organisms?
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Streptococcal and anaerobic organisms
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What are the preconception or antepartal predisposing factors for postpartum infection?
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1. Hx of previous venous thrombosis, UTI, mastitis, pneumonia
2. Diabetes mellitus 3. Alcoholism 4. Drug abuse 5. Immunosuppression 6. Anemia 7. Malnutrition |
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What are the intrapartal predisposing factors for postpartum infection?
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1. Cesarean birth
2. Prolonged rupture of membranes 3. Chorioamnionitis 4. Prolonged labor 5. Bladder catheterization 6. Internal fetal/uterine pressure monitoring 7. Multiple vaginal examinations after rupture of membranes 8. Epidural analgesia/anesthesia 9. Retained placental fragments 10. Postpartum hemorrhage 11. Episiotomy or lacerations 12. Hematomas |
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What is the most common type of postpartum or puerperal infection?
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Endometritis
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What is endometritis?
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Postpartum uterine infection, often beginning at the site of the placental implantation
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What are the signs of endometritis?
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1. Fever > 38 degrees C (100 degrees F)
2. Increased pulse 3. Chills 4. Anorexia 5. Nausea 6. Fatigue and lethargy 7. Pelvic pain 8. Uterine tenderness 9. Foul-smelling, profuse lochia 10. Leukocytosis 11. Markedly increased RBC sedimentation rate |
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What are the sites of wound infection?
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1. Cesarean incision
2. Episiotomy or repaired laceration site |
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What are the signs of wound infection?
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1. Erythema
2. Edema 3. Warmth 4. Tenderness 5. Seropurulent drainage 6. Wound separation 7. Fever 8. Pain |
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What are the risk factors for wound infection?
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Same as those for endometritis
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What are the risk factors for UTIs?
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1. Urinary catheterization
2. Frequent pelvic examinations 3. Epidural anesthesia 4. Genital tract injury 5. History of UTI 6. Cesarean birth |
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What are the signs and symptoms of UTI?
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1. Dysuria
2. Frequency and urgency of urination 3. Low-grade fever 4. Urinary retention 5. Hematuria 6. Pyuria 7. Costoverterbral angle tenderness 8. Flank pain |
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What organism is the common cause of UTIs?
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E. coli
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How does mastitis usually present?
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Unilaterally, but can affect both breasts
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What organism is the common cause of mastitis?
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S. aureus
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What are the signs and symptoms of mastitis?
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1. Chills
2. Fever 3. Malaise 4. Local breast tenderness 5. Pain 6. Swelling 7. Redness 8. Axillary adenopathy |
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What are the nursing diagnoses of postpartum infections?
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1. Deficient knowledge
2. Impaired tissue integrity 3. Acute pain 4. Interrupted family processes 5. Risk for impaired parenting |
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What is the most effective and least expensive treatment of postpartum infection?
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Prevention
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What are some other treatments for postpartum infections?
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1. Antibiotic therapy
2. Pain medications 3. Wound debridement 4. Rest 5. Hydration 6. Warm compresses 7. Ice pack |
