chp 18 Postpartum Maternal Complications
what is the antidote for a woman receiving heparin therapy?
protamine sulfate
what is the number 1 and 2 drugs given for as prophylaxis for postpartum hemorrhage?
#1 oxytocin #2 Methergine (methylergovine) if oxytocin not effective [do not give if bp >136/90
To treat a woman with a urinary tract infection (UTI), the nurse should encourage her to drink____?
fluids such as apricot, prune, or cranberry juice.
what are the complications on trying to expel clots of a uterus (by pushing) before the uterus contracts?
inversion of the uterus, and massive hemorrhage and rapid shock
Assessment for: Bleeding (steady trickle, dribble, oozing, seeping, or profuse flow); heavy: saturation of 1 pad/hr; excessive: 1 pad/15 min
-Assess for trauma; -save and weigh pads, linen savers, and bed linens so estimation of blood loss will be more accurate. -Notify health care provider.
Assessment for: Soft, boggy, displaced fundus
-Massage, - express clots - assist to void or catheterize - notify primary health care provider if measures are ineffective.
The best position for a woman who has postpartum endometritis is___?
Fowler's position aids in the drainage of the uterine cavity.
Clinical Manisfestations of uterine atony
•Uterine fundus that is difficult to locate •A soft or boggy feel when uterus is located •A uterus that becomes firm with massage but loses its tone when massage is stopped •A fundus located above the expected level •Excessive lochia, bright red •Excessive clots expelled, with or without massage
signs of subinvolution of the uterus
•Uterine tenderness •Increases fundal height •Fundal height unchanged •Pelvic pain •Pelvic heaviness *•Backache •Lochia changes •Fatigue •Malaise*
Sign of hematoma
-deep severe unrelieved pain -*feelings of pressure* -severe pelvic or rectal pain.
management of thrombophlebitis
-encourage rest -bed rest and elevation of extremities -warm moist compresses intermittently -measure leg circumferences -do NOT massage affected limb (dislodgment may occur) -thigh-high antiembolism stockings -analgesics -antibiotic therapy -anticoagulants for DVT (heparin and warfarin)
therapeutic management of DVT
1. *administer O2* 2. elevate pts head 3. monitor VS 4. IV fluids 5. prophylactic heparin ex) enoxaparin (lovenox) does not cross placenta
A woman in labor with no known complications rings the call bell to say she has had a "gush" from her vagina. The nurse identifies a large amount of bright-red blood. In which order would the nurse perform the necessary interventions?
1.Call for help 2.Check fetal heart tones 3. Increase the maintenance intravenous (IV) infusion rate 4.Start oxygen at 8 L via mask 5.Call the primary health care provide
thrombophlebitis what is it? -Why does it occur?
A thrombus is a collection of blood factors on a vessel wall. -Thrombophlebitis occurs when the vessel wall develops an *inflammatory response* to the thrombus. •*Venous stasis* •*Hypercoagulation* •*Injury to intima *(innermost layer of the vessel)
cervical lacerations
Cervical lacerations occur frequently when the cervix dilates rapidly during the first stage of labor. ex) 1 hour labor and 10 minute pushing stage
Pulmonary Embolism is a complication of___?
DVT
thrombus vs embolus
Thrombus = clot in arteries embolus = dislodged traveling clot in arteries
When checking the fundus on a mother who delivered 1 hour ago, the nurse notices that it is 3 cm above the umbilicus, displaced to the right, and slightly boggy. The nurse should massage the fundus until firm and then________?
assist the mother to empty her bladder.
The postpartum woman has a blood pressure of 150/90 mm Hg, pulse of 72 bpm, and respirations of 14 breaths per minute. She continues to bleed heavily. The order states she may have methylergonovine (Methergine), 0.2 mg IM, or oxytocin (Pitocin), 10 units IM for heavy bleeding. The nurse should administer which medication? a) Methylergonovine b)oxytocin
b)oxytocin Methylergonovine is contraindicated if the woman has an elevated blood pressure >136/90
signs of laceration when does it occur
bleeding with a firmly contracted uterus. bleeding is bright red (vs dark red of lochia) -occur at 2nd stage of labor, when fetal head descends rapidly, or forceps/vacuum is used for birth.
hemorrhage
cumulative blood loss >1000ml accompanied by sx of hypovolemia w/in 24 of birth.
Early postpartum hemorrhage is mostly due to? late postpartum hemorrhage is mostly due to?
early: uterine atony, trauma to birth canal late: subinvolution of uterus, placental fragment.
Early postpartum hemorrhage late postpartum hemorrhage
early:occurs within 24 hours of birth late: after 24 hrs (6-12w) after birth
Clinical Manifestations of Pulmonary Embolism
•*Dyspnea*, chest pain, *tachycardia*, and tachypnea •*Hemoptysis* (expectoration of blood or bloody sputum) •Pulmonary rales, cough •Abdominal pain •Low-grade fever •low o2 sat •Feelings of "doom"
Mastitis management
•Antibiotics, 7 - 10 days •decompression of the breast •ice packs or moist heat •breast support •bedrest •analgesics •fluid intake of at least 3000 cc's •massage over the affected area before and after feeding
puerperal infection
•Bacterial infection after childbirth •Temperature of 38°C (100.4°F) or higher *after the first 24 hours* and occurring on at least 2 of the first 10 days following childbirth
postpartum psychosis symptoms
•Failure to be able to identify reality •Confusion •Auditory and visual hallucinations •Insomnia •Hyperactivity •Suicide •Homicide •Infanticide
Mastitis symptoms
•Feelings of the flu, muscle aches and fatigue •Symptoms progress to fever 102.2 or higher, chills, malaise, and headache •Characterized by localized lump, redness, heat, and inflammation •If untreated may progress to abscess
degree of lacerations
•First degree - involves the superficial vaginal mucosa or perineal skin •Second degree - involves the vaginal mucosa, perineal skin, and deeper tissue (*muscle of the perineum*) •Third degree - same as 2nd degree but invloves the *anal sphincter* •Fourth degree - Extends through the anal sphincter into the *rectal mucosa*
postpartum psychosis
•Generally peaks from 48 hours to 2 weeks postpartum •Must have major depressive disorder with psychotic traits, bipolar I, bipolar II, unspecified functional psychosis, schizoaffective disorder, or short term psychotic disorder
management of endometritis
•IV antibiotics •Placed in Fowler's position •Medicate for pain
what are risk factors for Puerperal infection?
•Operative procedures •multiple cervical examinations •prolonged labor (>24hr) •manual extraction of placenta •diabetes •indwelling catheter •anemia
Predisposing factors for postpartum hemorrhage
•Overdistention of the uterus (twin, hydramnios, large baby) •multiparity (>5) •precipitate labor or delivery •prolonged labor •use of forceps, vacuum •cesarean birth •manual removal of placenta •previous postpartum hemorrhage •general anesthesia
deep vein thrombosis (DVT)
•Pain in the leg, groin, lower back, right lower quadrant •Swelling, erythema, heat, tenderness •Make become *pale, cool to touch* with decreased peripheral pulses •Pain on ambulation, chills, malaise, stiffness of the affected leg
postpartum depression
•Presents in the *first 3 months* postpartum and has the potential to last up to a year. •Postpartum depression is the most common complication of childbirth, with 20% experiencing it.
signs and symptoms of thrombophlebitis
•Swelling of involved extremity •*Redness* •Tenderness •Warmth •May be able to palpate an enlarged, hardened cordlike vein •Pain when she walks
Endometritis infection
•Temperature 100.4 or higher •Chills •Malaise •Anorexia •Abdominal pain and cramping •Uterine tenderness •Purulent, foul smelling lochia •Tachycardia and subinvolution
postpartum blues
•Transient, self limiting •early onset - begins in first week, peaks around day 5, and *ends within 2 weeks*