Chapter 21 postpartum complications

The nurse is assessing a patient with postpartum hemorrhage (PPH). During the physical assessment, the nurse finds that there are deep lacerations in the cervix. Which observation allows the nurse to conclude that the PPH is caused by cervical lacerations?

Bright Red blood

The nurse suspects that a postpartum patient has deep vein thrombosis (DVT). Which diagnostic test should the nurse expect the health care provider to prescribe to confirm DVT?

Venous ultrasonography

Which intrapartal factors can contribute to a postpartum infection?

C-births Prolonged rupture of membranes Chorioamnionitis prolonged labor bladder catheterization Internal fetal/uterine pressure monitoring Mutiple vaginal exams after rupture of membranes Epidural anesthesia Retained placental fragments postpartum hemorrhage Episiotomy or lacerations Hematomas

What are the characteristics of a deep vein thrombosis?

Calf tenderness Pain Warmth Redness

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding?

Mastitis

A 28-year-old multipara delivered a 9-pound, 3-ounce baby girl an hour ago after a 22-hour labor with a forceps-assisted birth. As the patient is holding her daughter, she keeps shifting position and is becoming increasingly irritable and annoyed with everyone in the room. What action should the nurse initially take?

Check her perineum (The patient is exhibiting increasing anxiety, which can signal the presence of postpartum hemorrhage. Risk factors for postpartum hemorrhage include a large fetus, prolonged labor, and a forceps-assisted birth)

Bleeding caused by varices or superficial lacerations of the birth canal is characterized by what color blood?

Dark Red blood

During the assessment of a postpartum patient, the nurse finds the patient has endometritis. Which medication should be administered in the treatment plan for this patient?

Endometritis is usually managed by giving the patient a broad-spectrum antibiotic drug, like Clindamycin (Cleocin).

A postpartum patient experiencing hemorrhagic shock has been administered an intravenous (IV) infusion of crystalloid solution. Upon reviewing the patient's laboratory reports, the nurse finds that platelet count and clotting factor levels have not improved. What is the best treatment option in this situation?

Fresh frozen plasma contains all of the coagulation factors, and it helps restore platelet counts.

A patient who has postpartum bleeding caused by uterine subinvolution has not recovered with drug therapy. Moreover, the patient is not willing to undergo surgery for this condition. Which procedure would be helpful in managing the bleeding in this patient?

Inserting a fist into the vagina (notice the question says helpful to manage bleeding?)

Which postpartum conditions are considered medical emergencies that require immediate treatment?

Inversion of the uterus and hypovolemic shock are considered medical emergencies.

The nurse is caring for a patient during labor. Despite a firm and contracted uterine fundus, the patient has frank vaginal bleeding. Which action should the nurse take first?

Lacerations must be identified and sutured immediately after the birth of the baby to prevent heavy blood loss, which otherwise may result in hypovolemic shock.

Which are characteristics of postpartum venous thrombosis?

Pain Warmth Redness

While caring for a postpartum patient, the nurse finds that the patient has spurts of blood with clots. What does the nurse infer about the patient's clinical condition from this sign?

Partial separation of the placenta

A patient who has undergone cesarean surgery reports to the nurse persistent perineal pain and feeling pressure in the vagina. The nurse finds that the patient is in shock. What clinical condition should the nurse suspect based on this assessment?

Retroperitoneal hematoma is the accumulation of blood in the retroperitoneal space. It is caused by the rupture of the cesarean scar during labor.

Which are considered signs of the postpartum blues?

Sad, anxious, overwhelmed Crying spells Loss of appetite Difficulty sleeping Should go away in few days or a week

What are the signs of postpartum depression?

Same signs as baby blues but last longer and more severe -Sad, anxious, overwhelmed -Crying spells -Loss of appetite -Difficulty sleeping -Thoughts of harming self or baby -Not having interest in baby

Which are considered signs of the postpartum psychosis?

Seeing or hearing things Confusion Rapid mood swings Trying to hurt self or baby

When a nurse observes profuse postpartum bleeding, what is the first and most important nursing intervention?

The initial management of excessive postpartum bleeding is firm massage of the uterine fundus

For which symptoms does the nurse monitor the postpartum patient with bipolar disorder?

The nurse monitors the postpartum patient with bipolar disorder for increased energy, changes in mood, and increased activity. Women with bipolar disorder are at high risk for relapse during the postpartum period.

Postpartum women experience an increased risk for urinary tract infection. What is a prevention measure the nurse could teach the postpartum woman?

Urine is acidified with cranberry juice. Drink at least 3 L of fluid each day. Empty her bladder every 2 hours to prevent stasis of urine. Keep perineum clean

During an assessment the nurse finds that a patient is multiparous, has multifetal gestation, and has polyhydramnios. What does the nurse expect the patient to be at risk for after the delivery?

Uterine atony

The nurse is caring for a postpartum patient with venous thrombosis. What instructions related to precautions to take with anticoagulant therapy should the nurse give to the patient at the time of discharge?

When anticoagulants are prescribed to administer SC, the patient must be educated not to inject the drug at the same site repeatedly, because this may cause tissue necrosis.

After physical assessment of a patient during labor, the nurse finds that the fetal head is exerting pressure on the patient's vaginal mucosa. Which postpartum complication does the nurse expect in the patient?

When the fetal head exerts prolonged pressure on the vaginal mucosa during labor, it reduces the flow of blood to the vaginal tissue and causes ischemia. Because of the reduced oxygen supply and tissue damage, the patient may have necrosis of the vaginal mucosa. This leads to deep vaginal lacerations and vaginal hematomas.

The nurse is caring for a patient whose placenta was removed manually. The nurse finds that the patient has developed an infection. Which category of medication does the nurse expect to be prescribed for the patient?

antipyretics are prescribed for the patient to reduce the body temperature from infection

The nurse caring for a patient finds excessive postpartum bleeding caused by uterine atony. Upon further assessment, the nurse finds no improvement in the bleeding after administration of oxytocin (Pitocin). What does the primary health care provider prescribe to the patient?

misoprostol (Cytotec) ergonovine (Ergotrate) or methylergonovine (Methergine)

A postpartum patient has uterine atony. What medication does the nurse expect the primary health care provider to prescribe to the patient?

oxytocin (Pitocin)