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59 Cards in this Set
- Front
- Back
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BUBBLEEE |
Breasts soft filling Nipples
Uterus Fundus Firm Boggy Bladder retention anesthesia Bowels sounds ambulate early Loche 1st Red to pink brownish Episiotomy medial/medial lateral Extremities no Homan’s Sign Emotional Status baby Blues 1 in 5 |
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REEDA Scale
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used for Episiotomy Healing
Redness Ecchymosis Edema Discharge, Drainage Approximation |
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Uterine Atony
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uterus is not clamped down and lacking tone
Drug Pitocin = more susceptible |
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Postpartum Hemorrhage after
vaginal birth |
> 500 mL of blood loss
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Postpartum Hemorrhage after
cesarean birth |
> 1000mL of blood loss
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Causes of Postpartum Hemorrhage
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1. Uterine Atony
2. Lacerations of Genital tract 3. Episiotomy 4. Retained placenta Fragments |
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most common cause of EARLY Postpartum Hemorrhage
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uterine atony
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Amount of blood loss before the signs of Postpartum Hemmorhage of BP down pulse up occur
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1,800 to 2,100 mL of Blood loss due to the preg women's extra blood volume
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Pathophysiology 4T’s of Postpartum Hemorrhage
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Tone (Overdistension)
Tissue (Uterine involution, subinvolution) Trauma (spontaneous lacerations or caused by manipulation, hematoma Thrombosis (coagulation issues interfere with clot formation |
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Therapeutic management of uterine atony
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Uterine massage
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Therapeutic management retained placental fragments
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fragments are usually manually separated and removed and a uterine stimulant is given to promote the uterus to expel fragments & antibiotics are administered to prevent infection.
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Therapeutic management of Lacerations
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sutured or repaired
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Therapeutic management of Coagulation disorders
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platelet transfusions may be given
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splenectomy
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spleen removal may be necessary if the bleeding tissues do not respond to medical management
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most common cause of late Postpartum Hemorrhage
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placental fragments
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Uterine rupture
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can cause damage to genital tract; more common in women with previous cesarean incisions or those who had undergone any procedure resulting in disruption of the uterine wall, (myomectomy, perforation of the uterus during a dilation and curettage (D&C), biopsy, or intrauterine device (IUD) insertion
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Cervical lacerations
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commonly occur during forceps delivery or in mothers who have not been able to resist bearing down before the cervix is fully dilated.
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Signs of late Postpartum Hemorrhage
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Boggy Fundus
Saturation 1 pad an hour (call doctor) |
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Lacerations
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should always be suspected in the face of a contracted uterus with bright-red blood continuing to trickle out of the vagina. Needs immediate attention
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DIC
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Decimated Intravascular Coagulation always a secondary diagnosis that occurs as a complication of abruptio placentae, amniotic fluid embolism, intrauterine fetal death with prolonged retention of the fetus, severe preeclampsia, septicemia, and hemorrhage
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Decimated Intravascular Coagulation aka DIC
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bleed out of everywhere mouth ears clotting factors not available
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Placental Abruption causes
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not a lot of prenatal care history of crack contains and smoking
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Placental Abruption signs and symptoms
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placental detaches early lot of bleeding may be concealed or obvious have underling in blood clotting disorder may have DIC
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Signs of Thrombophlebitis
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Localized tenderness/pain
Redness Warmth Palpable cord |
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Leading cause of Pregnancy related Death
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Pulmonary Embolism
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Factors Placing a Women at Risk for Postpartum Hemorrage (PPH)
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Prolonged labor
Previoss history of PPH Multiple gestation Fetal macrosomia Uterine infection Manual extraction of the placenta Arrest of descent Maternal exhaustion,malnutrition,or anemia Mediolateral episiotomy Preeclampsia Precipitous birth Maternal hypotention use of forceps or vacuum Previous placenta previa Augmented labor with meds Coagulation abnormalities Birth Canal lacerations Grand multiparity Polyhydramnios |
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A soft boggy uterus that deviates from the midline suggests
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a full bladder is interfering with uterine involution
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How to massage the Fundus to promote Uterine Contraction
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1. explain the procedure then place your dominant hand on the fundus
2. Place the other gloved hand on the area to support the symphsis pubis 3.With the hand on the fundus gently massage the fundus in a circular manner 4.Assess for uterine firmness 5. If firm, apply gental yet firm pressure dowards toward the vagina to express clots DO NOT attempt to express clots until the fundus is firm this could lead to uterine inversion,leading to a massive hemorrhage. 7. Assis the woman with perineal care and apply a new perineal pad. 8. Remove gloves and wash hands |
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Weighing perineal pads to deterine blood loss
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1g = 1 mL of blood loss
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Drugs used to control Postpartum Hemorrage
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1. Oxytocin (Pitocin) stimulates the uterus to contract to control the bleeding from the placental site
2. Methylergonovine maleate (Methergine) Stimulates the uterus to prevent & treat PPH due to atony or subinvolution 3. Prostaglandin (PGF-2 Carboprost, Hemabate stimulates uterine contractions to treat PPH due to uterine atony when not controlled by other methods |
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Nusing Implications for Oxytocin (Pitocin)
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Assess the fundus for evidence of contraction & bleeding every 15 mis or as ordered
Montitor VS every 15 mins Monitor uterine tone to prevent hyperstimulation Offer explanation to pt and family about what is happening and what the meds purpose provide nonpharmacolgic comfort measures to assist with pain managemen Set up IV infusion to be piggybacked into a primary IV line (this ensures that the med can be stopped quickly incase of hyperstimulation or adverse affects, while maintaining the IV site and primary infusion |
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Nusing Implications for
Methylergonovine |
Assess baseline bleeding, uterine tone, and VS every 15 mins or according to protocol.
Offer explanation to pt and family about what is happening and what the meds purpose. Moniter for possisble adverse side effects such as hypertention, seizures, uterine cramping, nausea, vomiting, and palpitations. Report any complaints of chest pain promptly. |
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Nusing Implications for Prostaglandin (PGF-2 Carboprost, Hemabate)
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Assess VS, uterine contractions, client's comfort level & bleeding staus per protocol.
Offer explanation to pt and family about what is happening and what the meds purpose. Monitor for possible adverse effects such as fever chills, headache, nausea, vomiting, diarrhea, flushing, and bronchospasms |
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The 4 causes of Postpartum Hemorrage and the appropriate intervention for each
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1. Uterine atony- fundal massage & oxytocics
2. Retained Placental tissue- evacuation & oxytocics 3. Lacerations or hematoma-surgical repair 4. Thrombosis (bleeding disorder)- blood products |
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Teaching to Prevent Bleeding Related to Anticoagulant Therapy
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Watch for the follow signs of bleeding and call dr if any of these occur
Nosebleeds, Bleeding gums or mouth, Black tarry stools, Brown (coffee gound) vomitus, Red- brown speckled sputum, ozzing at incision, episiotomy site, cut or scrape, Pink, red, or brown tinged urine, Briuses, Increased lochia discharge. Practice measures to reduce risk of bleeding Brush teeth with a soft toothbrush, use electric razor for shaving. Avoid activites that could lead to injury, scrapes, bruising, or cuts. Do not use any OTC products contain asprin or asprin like derivates. Aviod consuming alcohol. Inform healthcare workers about use of anticoagulants, esp dentist. Comply with follow up lab testing. If you cut yourself apply firm direct pressure for 5-10 mins. Do the same after receiving injections of having blood drawn. Wear ID bracelet that indicates you take an anticoagulant. |
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A thrombus can lead to a
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thromboembolism (obstruction of a blood vessel by a blood clot carried by the circulation from the site of origin).
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Superficial venous thrombosis
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usually involves saphenous venous system & is confined to lower leg. Superficial thrombophlebitis may be caused by the use of the lithotomy position during birth.
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Deep venous thrombosis
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can involve deep veins from foot to calf, to thighs, or pelvis. In both locations, thrombi can dislodge and migrate to the lungs, causing a pulmonary embolism (which can be fatal).
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Factors Placing a Woman at Risk for Postpardum Infection
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Prolonged (>18-24 hours) premature rupture of membranes.
Cesarean birth. Urinary Catherization. Regional anesthesia that decreases perception to void. Staff illness (dr nurses techs). Compromised health status ( anemia obesity, drug abuse smoking). Preexisting colonzation of lower genital tract with baterial vaginosis Chlamydia trachomatis, group B strep, Staph Aureus, E. Coli). Retainted placental fragments. Manual removal of retained placenta fragments. Insertion of fetal scalp electrode or intrauterine pressure catheters forinternal fetal monitoring. Instrument-assisted childbirth (forceps or vacuum extraction). Trauma to the genital tract, (episiotomy or lacerations). Prolonged labor with frequent vaginal exams. Poor nutritional status. Gestational diabetes. Break in aseptic technique during surgery or birthing process. |
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Nursing Management to prevent postpartum infections
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Maintain aseptic technique when preforming invasive procedures i.e catheterzation changing dressing etc.
Use good handwaskig technique before and after each client activity Reinforce measures to maintaining good perineal hygiene. Use adequate lighting & turn the client to the side to assess episiotomy sight. Review clients history for preexisting infections or chronic conditions. Montitor VS & lab results for abnormal values. Moniter frequency of vaginal exams & length of labor. Assess for early signs of infection esp fever, lochia. Inspect wouonds frequently for inflammation & drainage. Encourage rest, hydration, & healthy eating. Reinforce preventive measures during client interactions. |
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Nursing focus with Mastitis
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reversing milk stasis, maintaining milk supply, and continuing breastfeeding, provide maternal comfort & prevent reocurrence.
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Normal physiologic changes of childbirth increase risk of
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infection by decreasing vaginal acidity due to the presence of amniotic fluid, blood, and lochia, all of which are alkaline (alkaline environment encourages the growth of bacteria).
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Mastitis
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associated with milk stasis: insufficient drainage of the breast, rapid weaning, oversupply of milk, pressure on the breast from a poorly fitting bra, a blocked duct, missed feedings, and breakdown of the nipple via fissures, cracks, or blisters
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Mastitis most common infecting organism is
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S. aureus which comes from the breastfeeding infant's mouth or throat
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Treatment of mastitis
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emptying the breasts (Breast can be emptied either by infant sucking or by manual expression. Increasing the frequency of nursing is advised)
& controlling the infection (Broad Spectrum Antibiotics to control infection & ice or warm packs and analgesics may be needed for pain). |
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Additional Signs & Symptoms of infections
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In addition to elevated temp, other generalized s/s infection may include: chills, foul-smelling vaginal discharge, headache, malaise, restlessness, anxiety, tachycardia & there may be additional s/s specific to location & type of infection
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Therapeutic Management of UTI
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fluids & antibiotics
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Common Assessment Findings Associated With Postpartum Depression
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Loss of pleasure or interest in life
Low mood, sadness, tearfulness Exhaustion that is not relieved by sleep Feelings of guilt Irritability Inability to concentrate Anxiety Despair Compulsive thoughts Loss of libido Loss of confidence Sleep difficulties (insomnia) Loss of appetite Feelings of failure as a mother |
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S/S of pulmonary embolism
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unexplained sudden onset of shortness of breath & severe chest pain. Apprehension & diaphoresis may be present. Additional manifestations may include tachypnea, tachycardia, hypotension, syncope, distention of the jugular vein, decreased oxygen saturation (shown by pulse oximetry), cardiac arrhythmias, hemoptysis, & sudden change in mental status as a result of hypoxemia
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Normal physiologic changes of childbirth increase risk of infection
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by decreasing vaginal acidity due to the presence of amniotic fluid, blood, and lochia, all of which are alkaline (alkaline environment encourages the growth of bacteria).
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S/S of Metritis
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Lower abdominal tenderness, pain on 1 or both sides
Temperature Elevation > 100.4 degrees Fahrenheit Foul-smelling lochia Anorexia Nausea Fatigue and lethargy Leukocytes & elevated sedimentation rate |
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S/S Wound Infection
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Weeping serosanguineous or purulent drainage
Separation or unapproximated wound edges Edema Erythema Tenderness Discomfort at the site Maternal fever > 100.4 Elevated WBC count |
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S/S UTI
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Urgency
Frequency Dysuria Flank Pain Low Grade fever Urinary retention Hematuria Urine + for nitrates Cloudy urine with strong odor |
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S/S Mastitis
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Flulike symptoms including malaise, fever, & chills
Tender, hot, red, painful area on 1 breast Inflammation of breast area Breast tenderness Cracking of skin or around nipple or areola Beast distention with milk |
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Teaching for the Women with a Postpartum Infection
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Take all of your antibiotic medication as ordered until it is finished even if you are feeling better.
Check your temperature everyday and call dr if it is > 100.4 Watch for other signs of infection including chills, increased abdominal pain, change in color or odor of lochia, increased redness, warmth, swelling, or drainage from a wound i.e. C-section or episiotomy. Report any of these to your dr. Practice good infection prevention: Always wash hand before before/after eating, going to bathroom, touching perennial area caring for newborn. Wipe front to back. Remove perennial pad front to back and discard in tissue paper. Apply new perennial pad front to back. When providing perennial care, angle spray front to back. Drink plenty of fluids and vitamin iron and protein rich foods. Get adequate rest at night and throughout the day. |
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Greatest Hazard of postpartum psychosis is
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suicide. Infanticide and child abuse are also risks if the women is left alone with the infant. Early recognition and proper treatment of this disorder are imperative.
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Risk factors for postpardum psychosis
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Poor coping skills
Low self-esteem Numerous life stressors Mood swings and emotional stress Previous psychological problems or a family history of psychiatric disorders Substance Abuse Limited or lack of social support network |
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“Baby Blues”:
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symptoms peek on postpartum days 4-5 and resolve by day 10 mild depressive symptoms of anxiety, irritability, mood swings, tearfulness, increased sensitivity, feelings of being overwhelmed, and fatigue
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Postpardum Depression
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feel worse over time, and changes in mood and behavior do not go away on their own.
Combination of antidepressant medication, antianxiety medication, and psychotherapy in an outpatient or inpatient setting; support groups helpful to decrease sense of isolation Based on the woman's history of prior depression, prophylactic antidepressant therapy may be needed during third trimester or immediately after giving birth. |
