High Risk Postpartum

How many hours should a pad hold for?

3 hours

How much mL is considered a postpartum hemorrhage after vaginal delivery?

500 ml

A second-day postpartum client with diabetes mellitus has scant lochia with a foul odor and a temperature of 101.6 degrees F. The physician suspects infection and writes orders to treat the client. Which of the following orders written by the physician would the nurse complete first? A. Obtain culture and sensitivity of lochia and urine B. Administer Ceftriaxone (Rocephin) C. Check the client's temperature D. Increase the intake of oral fluids.

A! Culture and sensitivity results should be obtained before any antibiotic therapy is begun to avoid masking the microorganisms identified in the culture. Options B and D are standard parts of therapy for this type of infection but are not completed first. Although the client's temperature is monitored, checking the temperature is not the first action.The data in the question indicate that the temperature has already been checked.

A nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which of the following instructions would be included on the list? A. Wear a supportive bra B. Rest during the acute phase C. Maintain a fluid intake of at least 3000 ml D Continue to breast-feed if the breasts are not too sore E. Take the prescribed antibiotics until the soreness subsides. F. Avoid decompression of the breasts by breast-feeding or breast pump.

A, B, C, D Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3000ml/day (if not contraindicated), taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken UNTIL THE COMPLETE PRESCRIBED COURSE IS FINISHED. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. CONTINUED DECOMPRESSION of the breast by breast-feeding or breast pump is important to empty the breast and prevent the formation of an abscess

Medications used to manage postpartum hemorrhage include (choose all that apply): A. Pitocin B. Methergine C. Terbutaline D. Hemabate E. Magnesium sulfate

A,B,D

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? A. Administration of blood B. Preparation of the client for invasive hemodynamic monitoring C. Restriction of intravascular fluids D. Administration of steroids

A. Administration of blood A. Correct: Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. B. Incorrect: Central monitoring would not be ordered initially in a client with DIC, because this can contribute to more areas of bleeding .C. Incorrect: Management of DIC would include volume replacement, not volume restriction. D. Incorrect: Steroids are not indicated for the management of DIC.

The nurse is caring for a postpartum client who experienced a second-degree perineal laceration at delivery 2 hours ago. Which of the following interventions should the nurse perform at this time? A. Apply an ice pack to the perineum. B Advise the woman to use a sitz bath after every voiding C. Advise the woman to sit on a pillow. D. Teach the woman to insert nothing into her rectum.

A. Apply an ice pack to the perineum it is appropriate to apply an ice pack to the area. A second-degree laceration affects the skin, vaginal mucosa, and underlying muscles. (It does not affect the rectum or rectal sphincter.)Because of the injury, the area often swells, causing pain. Ice packs help to reduce the inflammatory response and numb the area.

A 1-day postpartum woman states, "I think I have a urinary tract infection. I have to go to the bathroom all the time." Which of the following actions should the nurse take? A. Assure the woman that frequent urination is normal after delivery. B. Obtain an order for a urine culture C. Assess the urine for cloudiness. D. Ask the woman if she is prone to urinary tract infections

A. Assure the woman that frequent urination is normal after delivery.

It has been 12 hours since the client's delivery of a newborn. The nurse assesses the client for the process of involution and documents that it is progressing normally when palpation of the client's fundus is noted at which level? A. At the umbilicus B. One fingerbreadth below the umbilicus C. Two fingerbreadth above the umbilicus D. Two fingerbreadth below the umbilicus

A. At the umbilicus The term involution is used to describe the rapid reduction in size and the return of the uterus to a normal condition similar to its pre-pregnant state. Immediately following delivery of the placenta the uterus contracts to the size of a large grapefruit The fundus is situated into the midline between the symphysis pubis and the umbilicus. Within 6 to 12 hour after birth the fundus of the uterus rises to the level of the umbilicus. The top of the fundus remains at the level of the umbilicus for about a day and then descends into the pelvis approximately one fingerbreadth on each succeeding day.

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is A. Uterine atony B. Uterine inversion C. Vaginal hematoma D. Vaginal laceration

A. Correct: Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. B. Incorrect: Uterine inversion may lead to hemorrhage, but it is not the most likely source of this client's bleeding. Furthermore, if the woman was experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. C. Incorrect: A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding .D. Incorrect: A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

Which of the following nursing interventions would be appropriate for the nurse to perform in order to achieve the client care goal: The client will not develop postpartum thrombophlebitis? A. Encourage early ambulation. B. Promote oral fluid intake. C. Massage the legs of the client twice daily. D. Provide the client with high fiber foods.

A. Encourage early ambulation

A 3-day-postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, "I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest." Which of the following actions should the nurse take at this time? A. Encourage the woman exclusively to breastfeed her baby. B. Have the woman massage her breasts hourly. C. Obtain an order to culture her expressed breast milk. D. Take the temperature and pulse rate of the woman.

A. Encourage the woman exclusively to breastfeed her baby Clients should be strongly encouraged exclusively to breastfeed their babies to prevent engorgement The lactating breast produces milk in response to being stimulated. When a feeding is skipped, milk is still produced for the baby. When the baby is not fed, breast congestion or engorgement results. Engorgement is not only uncomfortable, but it also gives the body the message to stop producing milk, resulting in an insufficient milk supply

A nurse obtains the vital signs on a mother who delivered a healthy newborn infant 2 hours ago and notes that the mother's temperature is 102 F. The appropriate nursing action would be to: A. Notify the physician B. Remove the blanket from the client's bed C. Document the finding and recheck the temperature in 4 hours. D. Administer Acetaminophen (Tylenol) and recheck the temperature in 4 hours.

A. Notify the physician Vital signs are to return to normal within the first hour postpartum if no complication arise. If the temperature is greater than 2F above normal this may indicate infection, and the physician should be notified. Options B, C, and D are inaccurate nursing interventions for the client's temperature of 102F 2 hours following delivery.

A nurse is teaching a postpartum client about breast-feeding. Which of the following instructions should the nurse include? A. The diet should include additional fluids B. Prenatal vitamins should be discontinued C. Soap should be used to cleanse the breasts .D. Birth control measures are unnecessary while breast-feeding.

A. The diet should include additional fluids

An OB-GYN nurse explains to her nursing student that the number one reason that most women have Cesarean deliveries is which of the following: a. reason to believe the mother or fetus will be compromised with vaginal delivery b. reason to believe only the mother will be compromised with vaginal delivery c. reason to believe only the unborn fetus will be compromised with vaginal delivery

A. reason to believe the mother or fetus will be compromised with vaginal delivery

Symptoms of mastitis

Affected breast show localized pain, swelling and redness, tender Fever Breast milk becomes scant CRACKED NIPPLES tender lymph nodes Painful

After a precipitous delivery, a nurse notes that the new mother is passive and only touches her newborn infant briefly with her fingertips. The nurse should do which of the following to help the woman process what has happened? A. Encourage the mother to breast-feed soon after birth B. Support the mother in her reaction to the newborn infant C. Tell the mother that it is important to hold the newborn infant D. Document a complete account of the mother's reaction on the birth record

B! Precipitous labor is labor that lasts less than 3 hours. Women who have experienced precipitous labor often describe the feelings of disbelief that their labor progressed so rapidly. To assist the client to process what has happened the best option is to support the client in her reaction to the newborn infant. Options A, C, and D do not acknowledge the client's feelings.

The nurse is assessing the lochia on a 1 day PP patient. The nurse notes that the lochia is red and has a foul-smelling odor. The nurse determines that this assessment finding is? A) normal b) indicates the prescence of infection c) indicates the needs for increasing oral fluids d) Indicates the needs for increasing ambulation

B) Indicates the prescence of infection

The nurse knows that a measure for preventing late postpartum hemorrhage is to? a. administer broad-spectrum antibiotic .b. inspect the placenta after delivery. c. manually remove the placenta. d. pull on the umbilical cord to hasten the delivery of the placenta.

B) inspect the placenta after delivery (If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage.)

The visiting nurse must be aware that women who have had a postpartum hemorrhage are subject to a variety of complications after discharge from the hospital. These include: (Select all that apply.) a. dehydration b. anemia c. exhaustion d. failure to attach to her infant e. postpartum infection.

B, C, D, E (Postpartum hemorrhage often results in anemia, and iron therapy may need to be initiated. Exhaustion is common after hemorrhage. It may take the new mother weeks to feel like herself again. Fatigue may interfere with normal parent-infant bonding and attachment processes. The mother is likely to require assistance with housework and infant care. Excessive blood loss increases the risk for infection

The nurse palpates a distended bladder on a woman who delivered vaginally 2 hours earlier. The woman refuses to go to the bathroom, "I really don't need to go." Which of the following responses by the nurse is appropriate? A. "Okay. I must be palpating your uterus." B. "I understand but I still would like you to try to urinate." C. "You still must be numb from the local anesthesia. D.. "That is a problem. I will have to catheterize you."

B. "I understand but I still would like you to try to urinate."

To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks? A. Apply antibiotic ointment to the perineum daily. B. Change the peripad at each voiding. C. Void at least every two hours. D. Spray the perineum with a povidone-iodine solution after toileting.

B. Change the peripad at each voiding Clients should be advised to change their pads at each voiding Postpartum women should be advised to perform three actions to prevent infections: (1) change their peripads at each toileting because blood is an excellent medium for bacterial growth; (2) spray the perineum, from front to back, with clear water to cleanse the area; and (3) wipe the perineum after toileting from front to back to prevent the rectal flora from contaminating sterile sites

A postpartum client is diagnosed with cystitis .The nurse plans for which priority nursing intervention in the care of the client? A. Providing Sitz baths B. Encouraging fluid intake C. Placing ice on the perineum D. Monitoring hemoglobin and hematocrit levels.

B. Encouraging fluid intake

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with a placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa? A. Infection B. Hemorrhage C. Chronic hypertension D. Disseminated intravascular coagulation

B. Hemorrhage

The surgeon has removed the surgical cesarean section dressing from a post-op day 1 client. Which of the following actions by the nurse is appropriate? A. Irrigate the incision twice daily. B. Monitor the incision for drainage C.. Apply steristrips to the incision line D. Palpate the incision for weaknesses

B. Monitor the incision for drainage

A breastfeeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective? A. She pumps her breasts after each feeding. B. She feeds her baby every 2 to 3 hours. C. She feeds her baby 10 minutes on each side. D. She supplements each feeding with formula.

B. She feeds her baby every 2 to 3 hours This statement is true. The best way to prevent engorgement is to feed the baby every 2 to 3 hours This question is similar to the preceding question except that this question tests the nurse's ability to evaluate a client's response rather than to perform a nursing action

A nurse is assessing the fundus of a client during the immediate postpartum period. Which of the following actions indicates that the nurse is performing the skill correctly? A. The nurse measures the fundal height using a paper centimeter tape. B. The nurse stabilizes the base of the uterus with his or her dependent hand C. The nurse palpates the fundus with the tips of his or her fingers. D. The nurse precedes the assessment with a sterile vaginal exam.

B. The nurse stabilizes the base of the uterus with his or her dependent hand

The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by A. Washing the nipples and breasts with mild soap and water once a day B. Using proper breastfeeding techniques C. Wearing a nipple shield for the first few days of breastfeeding D. Wearing a supportive bra 24 hours a day

B. Using proper breastfeeding techniques A. Incorrect: Washing the nipples and breasts daily is no longer indicated. In fact, this can cause tissue dryness and irritation, which can lead to tissue breakdown and infection. B. Correct: Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples. C. Incorrect: Wearing a nipple shield does not prevent mastitis. D. Incorrect: Wearing a supportive bra 24 hours a day may contribute to mastitis, especially if an underwire bra is worn, because it may put pressure on the upper, outer area of the breast, contributing to blocked ducts and mastitis.

Nurses should first look for the most common cause of PPH, _____, by _____. A. Lacerations of the genital tract; checking for the source of blood B. Uterine atony; evaluating the contractility of the uterus C. Inversion of the uterus; feeling for a smooth mass through the dilated cervix D. Retained placenta; noting the type of bleeding

B. Uterine atony; evaluating the contractility of the uterus

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: A. Establish venous access B. Perform fundal massage C. Prepare the woman for surgical intervention D. Catheterize the bladder

B: Perform fundal massage A. Incorrect: Although this may be a necessary intervention, the initial intervention would be fundal massage. B. Correct: The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. C. Incorrect: The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus. D. Incorrect: After uterine massage, the nurse may want to catheterize the client to eliminate any bladder distension that may be preventing the uterus from contracting properly.

Nursing interventions for Mastitis

Broad-spectrum antibiotics (penicillin/cephalosporins) Breastfeeding continued or pumping (every 2-3 hours) Cold or ice compresses, supportive bra until the pain subsides (15 minutes on, 45 minutes off, 15 minutes on) Warm compresses Analgesics, ibuprofen, rest

A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following? A) ask the client to turn on her side B) ask the client to lie flat on her back with the knees and legs flat and straight C) Ask the mother to urinate and empty her bladder D) Massage the fundus gently before determining the level of the fundus

C

On assessment of a client who is 30 minutes into the fourth stage of labor, the nurse finds the client's perineal pad saturated with blood and blood soaked into the bed linen under the client's buttocks. The nurse's initial action is which of the following A. Call the physician B. Assess the client's vital signs C. Gently massage the uterine fundus D. Administer a 300ml bolus of a 20 units/L Oxytocin(Pitocin) solution

C The most frequent cause of excessive bleeding or hemorrhage after childbirth is uterine atony. A major intervention to restore adequate tone is stimulation of the uterine muscle via gently massaging the uterine fundus. Options A, B and D may be necessary eventually but are not initial actions. The initial action is to alleviate the problem.

What woman is at greatest risk for early postpartum hemorrhage? A. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress B. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced C. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor D. A primigravida in spontaneous labor with preterm twins

C! A. Incorrect: This intervention is appropriate. However, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of PPH. B. Incorrect: This intervention is appropriate. However, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of PPH. C. Correct: The initial management of excessive postpartum bleeding is a firm massage of the uterine fundus. D. Incorrect: This intervention is appropriate. However, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of PPH.

A nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which of the following signs, if noted, would be an early sign of excessive blood loss? A. A temperature of 100.4 F B. A blood pressure change from 130/88 to 124/80mmHg C. An increase in the pulse rate from 88 to 102 D. An increase in the RR from 18 to 22 breaths/min

C!! During the fourth stage of labor vitals should be checked every 15 min during the first hour. An increasing in pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. The blood pressure decreases as the blood volume diminishes but a decreased blood pressure would not be the earliest sign of hemorrhage. A slight increase in temperature is normal immediately postpartum. The RR is slightly increased from normal but not significant in this case.

Methylergonovine (Methergine) is prescribed for a woman who has just delivered a healthy newborn infant. The priority assessment before administering the medication is to check the clients: A. Lochia B. Uterine tone C. Blood pressure D. Deep tendon reflexes

C. Blood pressure

What infection is contracted mostly by first-time mothers who are breastfeeding? A. Endometritis B. Wound infections C. Mastitis D. Urinary tract infections

C. Mastitis

A woman who has recently given birth complains of pain and tenderness in her leg. Upon physical examination, the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect _____ and should confirm the diagnosis by _____. A. Disseminated intravascular coagulation; asking for laboratory tests B. von Willebrand disease; noting whether bleeding times have been extended C. Thrombophlebitis; using real time and Doppler ultrasound D. Coagulopathies; drawing blood for laboratory analysis

C. Thrombophlebitis; using real time and Doppler ultrasound

A discharge nurse is discussing mastitis with a postpartum client. Which of the following statements by the client would indicate a need for further instruction? A. "If I develop a hot, reddened, triangle-shaped area on my breast, I should contact my healthcare provider." B. " I may develop mastitis if I wear underwire bras, experience excessive fatigue, or suddenly decrease the number of feedings." C."If I develop a fever, chills, or body aches at any time after discharge I should stop breast feeding immediately." D. "Antibiotics, rest, warm compresses, and adequate fluid intake are all important for the treatment of mastitis."

C."If I develop a fever, chills, or body aches at any time after discharge I should stop breast feeding immediately."

Which temperature indicates the presence of postpartum infection? a. 99.6° F in the first 48 hours b. 100° F for 2 days postpartum c. 100.4° F in the first 24 hours d. 100.8° F on the second and third postpartum days

D. 100.8° F on the second and third postpartum days (A temperature elevation to greater than 100.4° F on 2 postpartum days not including the first 24 hours indicates infection.)

A client, G1P1001, 1-hour postpartum from a spontaneous vaginal delivery with local anesthesia, states that she needs to urinate. Which of the following actions by the nurse is appropriate at this time? A. Provide the woman with a bedpan. B. Advise the woman that the feeling is likely related to the trauma of delivery. C. Remind the woman that she still has a catheter in place from the delivery. D. Assist the woman to the bathroom.

D. Assist the woman to the bathroom.

A patient, G2 P1, who delivered her baby 8 hours ago, now has a temperature of 100.2ºF. Which of the following is the appropriate nursing intervention at this time? A. Notify the doctor to get an order for acetaminophen B. Request an infectious disease consult from the doctor. C. Provide the woman with cool compresses. D. Encourage intake of water and other fluids.

D. Encourage intake of water and other fluids. It is likely that this client is dehydrated. She should be advised to drink fluids In the early postpartum period, up to 24 hours after delivery, the most common reason for clients to have slight temperature elevations is dehydration. During labor, clients work very hard, often utilizing breathing techniques as a form of pain control. As a result, the clients lose fluids through insensible loss via the respiratory system

The nurse is evaluating the involution of a woman who is 3 days postpartum. Which of the following findings would the nurse evaluate as normal? A. Fundus 1 cm above the umbilicus, lochia rosa. B Fundus 2 cm above the umbilicus, lochia alba. C. Fundus 2 cm below the umbilicus, lochia rubra. D. Fundus 3 cm below the umbilicus, lochia serosa.

D. Fundus 3 cm below the umbilicus, lochia serosa. Although each client'spostpartum course is slightly different, on day 3 postpartum, the nurse would expect the fundus of most clients to be 3 cm below the umbilicus and the lochia to have become serosa.

A nurse is assessing a 1-day postpartum woman who had her baby by cesarean section. Which of the following should the nurse report to the surgeon? A. Fundus at the umbilicus B. Nodular breasts. C. Pulse rate 60 bpm. D. Pad saturation every 30 minutes.

D. Pad saturation every 30 minutes.

Causes of a UTI

Decreased bladder sensitivity Increased bladder capacity Bladder trauma at birth Increased diuresis Poor hygiene (front to back) Frequent pelvic exams

Subinvolution

Delayed return of the uterus to its nonpregnant size and consistency.

Initial treatment for a DVT

Drink lots of fluids! Early ambulation Continuous IV Heparin (3-5 days) NSAID Bedrest with affected leg elevated

Symptoms of deep vein thrombosis

Edema of ankle and leg Low grade fever followed by chills and high fever Pain Peripheral pulses decreased Dyspnea and chest pain Chain in LOC Hypotension

What is the most common cause of postpartum infection?

Endometritis

True or false: If mom is hypertensive would you give methergine

FALSE - do not give it, GET blood pressure before giving this medication. If they are hypotensive give this medication

Nursing interventions for a postpartum hemorrhage

Fundal massage Measure fundal height Assess Lochia Offer a bedpan - empty the bladder, might need to straight-cath V/S Oxygen by face mask

What kind of patients are more at risk for uterine atony?

HYPTONIA patients, patients who had an infection

When a mom is walking and all of a sudden feels dizzy what should the nurse do?

Have her sit and MASSAGE THE FUNDUS, look for that blood clot

Nursing interventions for DVT

IV heparin using infusion pump - to prevent clotting, doesn't cure --> progress to warfarin Assess the pain Call and get a doppler for her* strict bedrest until symptoms subside, elevation of leg monitor signs of early PE prevent with early ambulation, regular leg exercises also provide support stockings

Methergine

Improves muscle tone, shocks the uterus to make it involute

Bimanual compression

Insert the fist in the vaginal canal, pressing the knuckles on the uterus and the other hand abdomen. Pushing to make sure the uterus realizes that it needs to contract then release

pylonephritis

Is an infection in the upper urinary tract that causes damage to the kidney and impairs function

What is mastitis?

Is an infection of the breast connective tissue, primarily in women who are lactating Usual causative organisms are: Staph A., E. Coli, Strep can occur at any time (maybe 2 to 3 weeks postpartum)

Cystitis

Is an infection of the lower urinary tract caused by E Coli.

Symptoms of involution

Late postpartum hemorrhage (1-2 weeks -> childbirth) excessive blood loss Lochia fails to progress from Rubra-Serosa-Alba Lochia Rubra persists after 2 weeks

What kind of assessment is important when it comes to a postpartum hemorrhage?

Lochia assessment - want to know mom's baseline!

Symptoms of a UTI

Overdistension of the bladder Frequent urination, burning, dysuria Hematuria Elevated temp Flank + back pain pain/CVT (costovetebral tenderness) - CANNOT TOUCH THE AREA IT WILL HURT Chills, N&V Usually treat with antibiotics

Medical management for a postpartum hemorrhage

Pitocin Bimanual compression Methergine/Hemabate Blood replacement - vessel might need to be ligated Hysterectomy MASSAGE THE FUNDUS (15 second every minute)

Retained placental fragments

Placental fragments occasionally adhere to the uterine wall and prevent the uterus from contracting fully CLEAN OUT THE UTERUS - make sure there is no retained placental fragments

Causes of Endometritis

Prolonged rupture of membrane, c-section, retained placental fragments, multiple SVE to lead prolonged rupture of membranes, prolonged labor

Involution

Shrinking of the uterus (womb) to its normal size after childbirth.

Three types of deep vein thrombosis

Superficial thrombophlebitis Femoral Pelvic

True or False: If mom has an infection then they should not breast feed because they still need to pump because they need to get rid of the abscess! (don't want to give milk to the baby)

TRUE

True or false: Continue to breast feed or pump if the mom has mastitis?

TRUE

True or false: Postpartum hemorrhage is a medical emergency

True!

If mom has a postpartum infection there an increase for what??/

UTI/endometritis

Is Mastitis unilateral or bilateral?

Unilateral but sometimes bilateral

What is the number one cause of postpartum hemorrhage?!

Uterine atony = uterus is calm & relaxed

Symptoms of Endometritis

WBC's 20,000-30,000 A rise in temperature 24 hours postpartum Abdominal tenderness Strong afterpains Lochia foul odor - brown color

Nursing interventions for Endometritis

antibiotics (penicillin/cephalosporins, gentamycin/clindamycin, analgesics, antipyretics, fluids increase) Frequent perineal care Vital signs Fundus checks Check lochia Semi-fowlers/fowlers make the drainage a little better, promote the fluids of lochia

A nurse is monitoring a new mother in the PP period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss? a) A temperature of 100.4 b) an increase in the pulse from 88 to 102 BPM C) an increase in the respiratory rate from 18 to 22 beats per minute D) a blood pressure changes from 130/88 to 124/80 mmHg

b) an increase in the pulse from 88 to 102 BPM During the 4th stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. A rising pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. The blood pressure will fall as the blood volume diminishes, but a decreased blood pressure would not be the earliest sign of hemorrhage. A slight rise in temperature is normal. The respiratory rate is increased slightly.

Deep vein thrombosis

blood clot forms in a large vein (thrombus forms) usually in a lower limb

What vital sign is important to take before giving Methergine?

blood pressure

The mother-baby nurse must be able to recognize what sign of thrombophlebitis? a. Visible varicose veins b. Positive Homans' sign c. Local tenderness, heat, and swelling d. Pedal edema in the affected leg

c. Local tenderness, heat, and swelling

A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that? a. the infant is protected from infection by immunoglobulins in the breast milk b. the infant is not susceptible to the organisms that cause mastitis c. the organisms that cause mastitis are not passed to the milk d. the organisms will be inactivated by gastric acid.

c. the organisms that cause mastitis are not passed to the milk

Femoral deep vein thrombosis signs

decreased pedal pulses pain stiffness swelling in the affected leg

What is a postpartum hemorrhage?

defined as a loss of >500mL of blood for vaginal delivery OR >1000 mL for C-section occurring before, during, or after delivery of the placenta

Pelvic deep vein thrombosis signs

high temperature (101/102) chills/shivering

Teaching points when giving Methergine?

importance of why she needs to void, can't have a full bladder, best thing to do to enhance involution is breast feeding - released natural Pitocin (oxytocin) make the uterine contract

Endometritis

inflammation of the inner lining of the uterus Bacteria gains access to the uterus through the vagina and enters the uterus either at the time of birth or during the postpartum period

Risks for mastitis

milk stasis from block duck, mom had nipple trauma, cracked nipple, poor latching on, poor hygiene (inadequate hand washing)

Causes of a postpartum hemorrhage

uterine atony, lacerations, retained placental fragments, DIC

Symptoms of postpartum hemorrhage

-Decreased blood pressure -Increased shallow respirations -Pale clammy skin -Increasing anxiety -Uterus is boggy/doughy

How much ml is considered a postpartum hemorrhage after a C-section?

1000 ml