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35 Cards in this Set
- Front
- Back
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Postpartal hemorrhage defined as:
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as any blood loss from the uterus > 500ml within a 24 hour period.
Newer thinking is that a Postpartum hemorrhage is a decrease in Hct of 10 points between time of admission & postbirth |
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The most common cause of postpartal hemorrhage
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uterine atony; May be seen as bleeding or as lg. clots in the uterus
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5 risk factors of uterine atony:
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Overdistention of uterus
Dysfunctional labor Oxytocin use during labor Drugs that produce uterine relaxation Maternal factors |
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management of uterine atony
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Fundal Massage
Bimanual uterine compression O2 by mask Drugs=IM Methergine, Dilute IV pitocin, IM Prostaglandin, & Hysterectomy if unable to control |
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Hemorrhage: Lacerations
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Characterized by bright, red bleeding in presence of a firmly contracted uterus
Treatment is immediate suturing to repair |
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HEMORRHAGE: RETAINED PLACENTA PARTS
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Retained fragments do not allow full contraction of uterus and Treatment may involve a D&C to remove fragments
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Nursing care for hemorrhage
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Stay with woman
Fundal massage Notify Dr. Monitor VS Elevate legs and keep head on pillow Side rails up Anticipate: Pad count, Fluid/blood replacement, Drug therapy |
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Signs and symptoms of a hematoma
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Pain in perineal area
Tense, firm & sensitive swelling Discolored skin Unable or difficulty in voiding |
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nursing care of a hematoma
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Observe
Report Ice Sitz bath after 1st 24 hr to aid fluid absorption Monitor vital signs Pad count ANALGESIA |
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treatment of a hematoma
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Evacuation and ligation - surgery
Smaller ones resolve over several days |
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Puerperal Infection
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Infection of the reproductive tract associated with childbirth and Can occur immediately or any time in the postpartal period
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Signs and symptoms of infection (9)
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Fever/ chills, Pain or redness of wounds, Purulent wound drainage, Tachycardia, Foul odor of lochia, Elevated WBC,
Body aches- general malaise, Urinary sym., Breast sym. |
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treatment of infection
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Good handwashing
Private room - according to site plus cultures of lochia, wound, blood, and urine, Antibiotics after cultures obtained Force fluids Breast care - maintain lactation Emotional support Rest Monitor VS q2 - 4 hr Potential for reduced or no contact with infant |
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Venous thrombosis
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thrombus formation in either a superficial or deep vein
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Thrombophlebitis
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a clot is formed in response to inflammation in the vein wall
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Noninflammatory venous thrombosis
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factor responsible is not inflammation, but usually venous stasis
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THROMBOEMBOLIC DISEASE risk factors
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Hypercoagulability of pregnancy
Inactivity increased estrogen Obesity Prolonged labor Family history, |
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THROMBOEMBOLIC DISEASE signs and symptoms
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Pain, often sudden
Tenderness & turgidity along vein Redness + Homan’s (not always present ) increased skin temp. |
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nurising care for Thromboembolic disease
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Facilitate measures to prevent
Careful positioning in stirrups Early ambulation Support hose ( esp. with C-section ) Bed rest Elevate affected leg Application of heat ( warm, moist ) Administration of analgesics Administration of anticoagulant Bed cradle to lift weight of bedcovers off legs Anticipate an increase in lochia R/T anticoagulant |
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Pulmonary embolus
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A foreign object - air, gas, fat, etc that floats in bloodstream until it becomes lodged in a vessel ( Pulmonary artery )
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signs and symptoms of pulmonary embolus
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SUDDEN onset of dyspnea
Sweating Confusion Pallor decrease BP Cyanosis Cough SOB JVD increase Pulse |
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What is a major complication of deep venous thrombosis?
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Pulmonary embolism
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treatment for pulmonary embolus
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Heparin
IV pain medication decrease pain decrease work of breathing decrease apprehension Drugs to decrease vessel spasms Drugs to correct arrhythmias O2 |
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Subinvolution
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Occurs when uterus fails to follow Normal pattern of involution of 1 cm/day & remains enlarged
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2 Most frequent causes of subinvolution
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Retained placental fragments and
Infection |
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Signs and Symptoms of subinvolution
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Prolonged lochia discharge
Irregular or excessive bleeding Lochia may remain or return to rubra Fundus higher in abd. than expected |
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treatment of subinvolution
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PO adm of oxytoxic drug
D&C Antibiotic if infection |
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3 stages of lochia
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rubra- dark red, 1-3days, composed of blood, fragments and mucus, small clots ok, r/t pooling in vagina
serosa-pink or brown, 3-10 days, composed of blood, mucus, and leukocytes alba- creamy or yellowish, 10-14 days, composed of mucus and leukocytes |
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Pattern of Involution
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(return of uterus in size/prepregnant state.)
-total process takes 6 weeks -immediately after birth uterus is in midline and 1/2 way btwn umbilicus and symphysis pubis -with in 6-12 hrs fundus at level of umbilicus -on 1st pp day fundus is 1cm below the umbilicus -fundus goes down 1cm/day -by day 10 fundus descends into the pelvis |
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Mastitis
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-An infection primarily of the lactating breast
-Occurs most often during 2 - 3 wks after birth -Usually affects only 1 breast |
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Signs and symptoms of Mastitis
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Localized area of redness & inflammation
Flu-like sym. Fever Firm breast mass Pain |
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Mastitis- enters through
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Crack , blister or fissures
Overdistention Manipulation |
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Signs and symptoms of a UTI
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Dysuria
Distended bladder Voids sm. amts <100 ml Urgency with voiding Costovertebral angle tenderness Fever |
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UTI risk factors
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Overdistended bladder
Incomplete emptying of bladder Trauma to bladder Caudal or epidural anesthesia with sensation of need to void Perineal pain & discomfort Inappropriate wiping technique Introduction of a catheter |
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how do you assess the uterus?
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-assess for position, tone, measure in relation to umbilicus.
-assess for consistency (firm, soft, boggy) -measure in finger breaths -always assess with bed flat, and never palpate with out supporting |
