ch 22 PP management/complications

clinical risk factors of PPH

-over distention of uterus -uterine muscle exhaustion -uterine infection -products of conception (placenta) -retained blood clots -lacerations/extension -uterine inversion -preexisting clotting disorders -traction on UC

uterine inversion

turning of the uterus inside out after birth of the fetus by pulling on umbilical cord

management of metritis

-place in semi fowlers to encourage drainage -adm pain meds -monitor IV site and response to abx -monitor response to tx -assess VS Q2hr while fever is present -warm blankets, cool compresses, cold/warm drinks -encourage foods high in vit C and protein for healing

Every postpartum client has the potential of hemorrhage. While assessing a client's status, which finding would be of little benefit in identifying the possibility of hemorrhage? A. signs of shock B. estimated amount of blood loss C. vital signs D. uterine tone

signs of shock -do not appear until the hemorrhage is far advanced due to the increased fluid and blood volume of pregnancy

Pitocin (oxytocin)

used for PPH -labor induction is a risk for PPH

signs and symptoms of PPD

-sadness -guilty -panic/anxiety -frequent crying -insomnia/excessive sleeping -appetite changes -difficulty concentrating or making decisions -lack of interest in activities -lack of concern about appearance -hostility towards self and others including the newborn

nursing management thromboembolic conditions

-prevention -adequate circulation -NSAID's -BR -stockings -anticoag therapy (heparin) -emergency measure for PE

Which instruction would the nurse include in the teaching plan for a postpartum woman with mastitis? A. "Try applying warm compresses to your breast to encourage the milk to be released." B. " You'll need to take this medication to stop the milk from being produced." C. "Limit the amount of fluid you drink so your breasts don't get much fuller." D. "Stop breastfeeding until the pain and swelling subside."

"try applying warm compresses to your breasts to encourage the milk to be released."

cause of metritis

- prolonged rupture of membranes (over 24 hours) -C/S, instruments, long labors, diabetics, low socioeconomic status -internal monitoring -multiple vaginal exams during labor -soft tissue damage -preexisting bacterial vaginosis -compromised health status

risk factors of thromboembolic conditions

-C/S -prolonged immobility/standing -use of oral contraceptives -obesity -cigarrete smoking -varicose veins -trauma -diabetes -multiparity -advanced maternal age (over 35)

misoprostol (cytotec)

-contracts uterus -given rectally -C/I: allergy, pulmonary disease and hepatic disease -not FDA approved for PPH

PP infection

-fever of 100.4 or greater -organisms (vaginal flora) -metritis -wound infection -UTI -mastitis

s/s of mastitis

-flu like symptoms (malaise, chills, body aches) -breasts- red, tender, hot to touch

nursing management PPH

-fundal massage and pad count -administration of oxytocic medications -fluid administration -monitor for signs and symptoms of shock -emergency if DIC occurs

risks for developing a PP mood disorder

-hormonal changes -unresolved feelings about pregnancy -fatigue -inadequate assistance from partner -little social support -hx of abuse -financial insecurity -doubts about being a good mother -stress -loss of freedom and identity

UTIs are caused by

-laceration (especially of the urethra) -catheterizing -manipulation of perineum -BM during pushing -use of instruments

PP psychosis symptoms

-mood lability -delusional beliefs -hallucinations -disorganized thinking

Saturation of peripad within 60 minutes is

considered excessive

Methergine (Methylergonovine)

-simulated contraction of uterine smooth muscle -side effects: nausea/vomiting, cramps **use cautiously with hypertensive patients

nursing management for PP depressive diorders

-recognize risk/early identification -monitor mother-infant interactions more closely -be supportive/demonstrate caring -education -screen for excess fatigue*** -provide anticipatory guidance -help mother verbalize feelings -helping family members (if mom has it, dad is 10x more likely to have it as well) -discuss resources -antidepressants

causes of subinvolution

-retained placental fragments -distended bladder -uterine myoma -infection

risk factors of mastitis

-stasis of milk (clogged duct, baby sleeps longer @ night, weaning baby off) -nipple trauma -most common organism (s. aureus; from baby sucking)

signs of metritis

-temp greater than 100.4 36 hours prior to delivery -purulent, foul smelling lochia -chills, anorexia, malaise -tachycardia -delayed involution -uterine/abdominal tenderness -abnormal lab results -increasing WBC -increased sedimentation rate

five t's of hemorrhage

-tone (uterine atony -tissue (retained placenta/clots) -trauma (vaginal, cervical, uterine injury) -thrombin (coagulopathy) -traction (pulling of UC)

cause of PPH

-uterine atony ** -lacerations of genital tract - episiotomy -retained placental fragments -uterine inversion -coagulation disorders -hematoma of vulva, vagina or subperitoneal areas

A client arrives in the emergency department accompanied by her husband and new 10 week old infant, crying, confused and with possible hallucinations. The nurse recognizes this could possibly be postpartum psychosis as it can appear within which time frame after birth ? A. 2 months B. 4 months C. 3 months D. 5 months

3 months

carboprost tromethamine (hemabate)

PPH that does not respond to pitocin or methergine -last resort, very potent -pregnant women cannot handle this; can cause loss of pregnancy side effects: n/v/d, fever -C/I if client has asthma

nursing assessment of wound

REEDA -redness -edema (swelling of tissues) -ecchymosis (skin discoloration) -drainage/discharge (purulent from drainage site) -approximation (gaping wound edges) generalized fever tenderness

baby blues

characterized by mild depression interspersed with happy feelings -does not affect the woman's ability to function or care for the baby -begins with 4 to 5 days PP and usually resolves by day 10 -may feel overwhelmed, unable to cope, fatigued, irritable, and oversensitive -episodic tearfulness and rapid mood swings without an identifiable reason

A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first? A. STI status B. coagulation studies C. HIV studies D. urinalysis results

coagulation studies

sub involution

failure of the uterus to return to a non-pregnant size (contract down)

Which findings would lead the nurse to suspect that a postpartum woman has developed endometritis? SATA. A. hematuria B. foul-smelling lochia C. leukocytosis D. pain on both sides of abdomen E. flank pain

foul-smelling lochia, leukocytosis, pain on both sides of abdomen

complications of subinvolution

hemorrhage, pelvic peritonitis, salpingitis, abscess formation

signs and symptoms of shock

hypotension, tachycardia, diaphoretic, pallor, losing consciousness

mastitis

inflammation of the breast -often in the upper outer quadrant -unilateral -very common infection in PP women (5% of women)

metritis

inflammation of the uterus -localized infection of the lining of the uterine wall beginning at the placental site

A client presents to her PP appointment with vague reports. The nurse suspects PPD based on which assessment findings? A. lack of pleasure B. extreme periods of elation C. feels like eating all the time D. over interest in her baby

lack of pleasure

PPH C/S delivery

more than 1000mL of blood loss

PPH vaginal delivery

more than 500 mL of blood loss

A woman presents to her first PP visit reporting she does not feel well. Which findings would lead the nurse to suspect that she has developed endometritis? SATA. A. flank pain B. pain on both sides of abdomen C. odorless lochia D. leukocytosis E. heamaturia

pain on both sides of abdomen and leukocytosis

postpartum psychosis

psychiatric emergency -increased risk of suicide and infanticide -usually occurs with 3 months of giving birth

Methylergonovine is prescribed for a woman experiencing PPH. The nurse monitors the woman closely for which adverse effects? A. headache B. uterine hyperstimulation C. flushing D. seizures

seizures

Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions ? SATA. A. septicemia B. isoimmunization C. abruptio placenta D. ectopic pregnancy E. severe preeclampsia

septicemia, abruptio placenta, and severe preeclampsia