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61 Cards in this Set
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- Back
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hemorhage that occurs in the first 24 hours PP
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early PPH- causes are usually uterine atony, lacerations and hematomas
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hemorrhage that occurs after the first 24 hours PP?
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late PPH- causes are usually hematomas, subinvolution, and retained placental fragments
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blood loss greater than 500 mL in vaginal birth and 1000 mL in c-section
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PPH
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ASSESSMENT:
boggy uterus saturation of peripad in 15 min bleeding slow and steady OR sudden and massive blood clots may be present pale/clammy skin tachy hypotension |
Uterine Atony- decreased tone of the uterine muscle,is the primary cause of early PPH
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what is the medical management for uterine atony?
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meds- oxytocin, methergine, hemabate
IV therarpy- reduce the risk of hypovolemia blood replacement- reduce risk of hemorrhagic shock surgical interventions- hysterectomy if all else fails |
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what are the nursing actions that should be implimented if uterine atony is suspected
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assess uterine fundus- massage if boggy
assess bladder overdistention- cath if needed assess lochia- amount, color and clots review lab test- H&H notify dr administer meds- oxy, meth or hemabate provide support |
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methylergonovine ( METHERGINE)
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indications: PPH due to uterine atony/ subinvolution
action: stimulates contractions side effects: N/V cramps route/dose: 200mcg IM/IV precaution: check blood pressure, dont use in PHI or if HTN is noted (will increase BP) |
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Carboprost (HEMABATE)
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indications: PPH that has not responed to oxy or methergine
action: contracts uterus side effects: N/V/D and fever route/dose: 205mcg IM not to exceed 2mg |
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ASSESSMENT:
a firm uterus that is midline with heavier than normal bleeding bleeding with a steady stream without clots tachy hypotension |
Lacerations- second most common cause of early PPH. common sites are the cervix, vagina, labia, and perineum
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what are some risk factors for lacerations that can lead to PPH?
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fetal macrosomia
operative vag delivery (forcepts ect.) precipitous labor/birth |
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what are the nursing actions and interventions when PPH is secondary to lacerations?
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monitor v/s
monitor blood loss notify dr administer pain meds as ordered prepare women for vag exam provide support |
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ASSESSMENT:
pain in vag/perineum that cant be controlled with pain meds tachy/hypotension when vag exam is done, women will express intense pain in vag area or a heaviness or fullness or rectal pressure swelling,discoloration, and tenderness in perineum displaced uterus and uterus atony (when large enough) |
Hematomas- occurs when blood collects within the connective tissures or the vagina or perineal areas, related to a vessel that ruptures and continues to bleed (difficult to determine amount of blood so PPH may not be dx until she is in hypovolemic shock)
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risk factors for hematomas?
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episiotomy
use of foreceps prolonged 2 stage of labor |
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what is the medical management of hematomas?
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small- monitored
large- surgery, blood is removed (women will experience instant relief) |
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what is the nursing actions and interventions if a hematoma is suspected?
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review chart for risk factors ( labor)
apply ice to perineum for the first 24 hours assess pain on a pain scale monitor VS (decrease in BP and elevated pulse) admister pain meds review labs- H&H notify dr if labs are abnormal |
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ASSESSMENT:
the uterus is soft and larger than normal for the days postpartum lachia returns to rubra and can be heavy back pain is present |
subinvolution of the uterus- uterus doesnt decrease in size and return to the pelvis, usually occurs late in PP period when uterus and lochia had been undergoing normal invoultion
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what are the risk factors for subinvolution?
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fibroids
endometritis retained placental fragments |
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what is the medical management of subinvolutions?
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depends on type:
D&C methergine PO for fibroids antibiotics for endometritis |
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what are the nursing actions for subinvolution?
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review chart for risk factors
if risk factors are there monitor pt more frequntley subinvolution usually happens after discharge so you must teach the patient about s/s and how to assess fundus for involution teach how to reduced infection (endometritis) |
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ASSESSMENT:
profuse bleeding that occurs suddenly after 1 week PP subinvolution of uterus elevated temp pale skin tachy hypotensive |
retained placental fragments-common cause of LPPH, occurs when small portions of the placent (cotyledons) remain attached to the uterus in 3rd stage of labor, and interferes with involution of the uterus and can lead to endometritis
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what are the risk factors that can lead to retained placental fragments?
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manual removal of the placental
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what is the medical management of retained placental fragments?
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D&C
IV antibiotic therapy because risk of endometritis |
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what are the nursing actions taken if retained placental fragments is suspected
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review records for risk factors
monitor if there is risk factors review labs- H&H teach pt about s/s because usually happens after discharge (temp, bright red blood, uterine tenderness) |
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ASSESSMENT:
prolonged uncontrolled uterine bleeding bleeding from IV, gums, bladder anxiety shock-pale/clammy, tachy, hypotensive,SOA |
dissminated intravascular cogaulation- coagulation pathways are hyperstimulated and you break down clots faster than you make clots, quickly leading to hemorrhage and death
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what are the risk factors for DIC?
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abruptio placenta
PIH HELLP prolonge PPH AFE sepsis |
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what is the medical management of DIC
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lab test- fibrogen levels, pt, ptt
iv therapy- fluids blood replacement identify primary cause of bleeding o2 thrapy transfer to ICU with perinatologis |
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what are the nursing actions if DIC is suspected?
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review for risk factors, if at risk monitor frequently
monitor vs- they will change quickly iv therapy blood replacement o2 therapy transfer to ICU with perinatologist |
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ASSESSMENT:
hypotension dyspena cyanosis pulmonary edma- on xray cardiac/resp arrest |
amniotic fluid embolism- rare but fatal that can occur during pregnancy, labor and PP. the fluid contains fetal cells, lanugo, and vernix, if it enters the maternal circulation will lead to embolism.
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what are the risk factors for AFE?
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induction of labor- risk 2x greater
maternal age >35 c-section, forceps, vacuum assisted delivery placental previa abruptio placenta polyhydraminos eclampsia fetal intolerance of labor cervical/uterine lacs |
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what is the medical management of AFE?
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focus on RESP/CARDIAC function
do labs- CBC, platelet count, arterial gases, fibrogen, and PT type and screen chest x-ray blood replacement- ICU have a heart and lung bypass machine ready |
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what are the nursing interventions that need to be done if you suspect AFE?
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review chart for risk factors
notify dr if suspected o2 at 8 L IV access get labs administer blood per orders support the pt call a code- preform CPR |
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ASSESSMENT:
positive homans sign tenderness and heat over affected area leg pain when walking swelling in leg |
thrombosis- a blood clot within the vascular system, at risk during and 6 weeks PP. this is related to normal physiological changes that occur in pregnancy (state of hypercoagulation due to an increase in clotting factors and fibrinogen) usually occurs in the leg (DVT) major concern is that the clot will detach and become an embolism and travel to a vital organ (lungs=PE)
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what is the medical management for a suspected thrombosis?
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doppler US to confrim
compression socks- reduce venous stasis coagulation therapy- iv heprin antibiotic therapy- if related to infection bed rest with effected area elevated |
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what is the nursing interventions that you will do if you suspect a thrombosis?
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review chart for risk factors- if there is risk factors monitor more frequently
apply compression stockings assist with ambulation call dr if you suspect thrombosis administer meds per order- heprin |
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ASSESSMENT:
elevated temp- 39.5 C or 101 F (w/ or w/o chills) tachy uterine tenderness subinvolution malasie lower abd pain lochia flow heavy and foul smell |
Endometritis- most common PP infection, its an infection of the endometrium that usually starts at the placental site and then spreads to the entire endometrium
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what type of infectious organism creates a foul smell lochia?
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anaerobic organism- it is a later sign that occurs when the entire endometrium is involved
lochia is scant and odorless when a beta-hemolytic (streptococcus) is present |
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what is the medical management when endometritis is suspected?
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CBC- WBC above 20,000
endometrial cultures blood cultures UA to rule out UTI antibiotic |
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what antibiotic is used when the infection is mild to moderate?
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a broad spectrum cephalosporin or PCN
IV antibiotics are given then changed to PO 24 hours after the temp is normal |
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what is the nursing intervention done when endometritis is suspected?
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review chart
obtain and review labs- WBC encourage fluids- adequate hydration can decrease risk for infection instruct pt to wipe front to back change peripads after each void/defication hand washing diet high in protien and vit C administer meds per order provide support |
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ASSESSMENT:
low grade fever (<38.5 C and 101 F) burning on urination suprapubic pain urgency to void small freqent voids ( less than 150 ml per void) |
Cystitis- infection of the bladder, can be treated but if left untreated the women is at risk for pyelonephritis
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what is the medical management for cystitis?
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antibiotics- PO (started before culture results are back)
UA, CBC, culture and sensitivity |
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what are the nursing interventions if cystitis is suspected?
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review chart
assist pt to bathroom to void within a few hours after birth cath if she is unable to void within 12 hours post birth as per orders remind her to void every 3-4 hours measure voids for the first 24 hrs, each void should equal 150 ml or more change peripads drink a min of 3000 ml/day encourage foods that have high acidity obtain labs and report if they are abnormal teach proper use of meds teach s/s of cystitis |
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ASSESSMENT:
hard tender palpable mass redness around the area of the mass acute pain in breast temp elevated tachy malaise purulent drainage |
mastitis- inflammation/infection of the breast that is common amoung lactating women, usually occurs in one breast within 2 weeks PP the infection resolves within 24-48 hours after antibiotics are started, abscess can occur if there is a delay in treatment
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what are the risk factors for mastitis?
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hx of mastitis
cracked or sore nipples use of antifungal nipple creams- used when the baby has thrush |
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what is the medical management of a pt with mastitis?
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oral antibiotics that are safe to use when lactating.
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what are the nursing actions that are to be done with a pt with mastitis
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palpate for signs of mastitis
teach correct latching on methods let nipples air dry after feedings proper hand washing use a supportive bra administer analgesia/antibiotics per orders teach adequate fluid intake teach to continue breastfeeding and express milk from the affected breast to promote circulation of milk flow |
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ASSESSMENT:
erythema redness heat swelling tenderness purulent drainage low grade fever increased pain at site |
wound infection- can occur at the episitomy site, cesarean site, and laceration site
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what are the risk factors for developing a wound infection?
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obesity
diabetes malnutrition long labor PROM preexisting infection immunodeficiency disorders corticosteroid therapy poor suturing technique |
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what is the medical management for a wound infection?
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obtain a wound culture
Mild/moderate infection without purulent drainage- PO antibiotics and warm compress to area infection with purulent drainage- open and drain wound and begin IV antibiotics |
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what is the nursing interventions that need to be done if there is a wound infection?
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review chart
use proper handwashing tech proper diet use hot packs for abd wound or sitz bath for perineal wound obtain labs- wound culture and CBC administer antibiotics/analgesia per order teach at discharge s/s |
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ASSESSMENT:
sleep and appetite distrubances despondency uncontrolled crying anxiety feelings of guilt |
postpartum depression- depression that occurs the first 6-12 months PP and is disabling- unable to care for herself or the baby
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what are the risk factors for PPD?
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hx of depression
anxiety/depression during pregnancy inadequate support poor relationship with partner life and child care stresses |
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what is the medical management for PPD?
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mild/moderate PPD- antidepressant, psychotherapy, cognitive therapy
severe PPD- intense psychiatric care, crisis intervention, meds |
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what are the nursing actions if PPD is suspected?
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review chart for risk factors
monitor mother-child relationship teach s/s of PPD provide info on support groups and community resources provide support |
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ASSESSMENT:
delusion, hallucinations, paranoia mood swings extreme agitation depressed/ elated mood confused thinking disorganized behavior |
postpartum psychosis- is a varian of bipolar disorder and is serious can occur as soon as the 3rd PP day, require immediate hospitalization
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what are the risk factors for PPP?
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women with known bipolar disorder
personal/family hx of bipolar disorder |
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what is the medical and nursing management of PPP?
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hospitalization to psych unit
evalutaion antidepressant/antipsychotic meds therapy ECT review chart for risk factors |
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ASSESSMENT:
protrusion of uterus into vaginal area low back pain sensation of heaviness in vagina/pelvis difficult/painful intercourse |
uterine prolapse-occurs when there is a weakening of the pelvic connective tissue, pubococcygeus muscle and uterine ligaments, allowing the uterus to desend into the vagina
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ASSESSMENT:
leakage of urine or fecal material from the vagina foul vaginal odor irritation of the vaginal mucosa |
genital fistula- abnormal connection between the vagina, bladder, rectum and or urethra, the fistula provides a pathway for fecal material or urine to enter the vagina
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ASSESSMENT:
sense of fullness or pressure in the vag/pelvis discomfort when straining, coughing, bearing down or lifting stress incontinence bladder infection pain/leakage of urine during sex |
Cystocele- bulging of the bladder in the vagina, which occurs when the wall between the vagina and bladder weakens and stretches
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ASSESSMENT:
sense of fullness in vag/pelvis low back pain that is relieved when layin down constipation difficulty in controlling/passing stool |
Rectoceles- occurs when the front walll of rectum bulges into the vagina
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