NRS 240 TBL 2: postpartum complications

clinical manifestations of superficial venous thrombosis

(most common form) characterized by pain and tenderness in the lower extremity

when is ergonovine or methlyergonovine contrainidcated?

(uterotonic for severe bleeding) presence of hypertension or cardiovascular disease. Prostaglandin F2α should not be given to women with a history of asthma as it can cause bronchoconstriction

managment of endometritis

-IV broad-spectrum antibiotic therapy (cephalosporins, penicillins, or clindamycin and gentamicin) -supportive care, including hydration, rest, and pain relief. -Assessments of lochia, vital signs, and changes in the woman's condition continue during treatment

hypovolemic shock s/s

-RR rapid and shallow -pulse weak, thready, irregular -BP decrease (late sign) -skin is cool, calmy -LOC is lethargy

what are postpartum infections

-also called puerperal infection -any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion or birth

postpartrum hemorrhage care management

-early recognition and treatment critical -initial intervention is firm massage of the uterine fundus -expression of any clots -elimination of bladder distention -continuous Iv infusion of 10 to 40 units of oxytcoin and IV fluid -additional uterotonic medications

causes of postpartum hemorrhage: retained placenta

-either nonadherent or adherent retained placenta -

postpartum hemorrhage causes: uterine atony

-marked hypotonia of uterus -leading cause -associated with high parity, hydramnios, macrosomic fetus and multifetal gestation

hemorrhagic (hypovolemic) shock interventions

-restore circulating blood -moniotr pulse and BP -fluid or blood replacement therapy -give O2

treatment of inversion of the uterus

-toxolytics to relax uterus -oxytocin once uterus is back in place -antiobitoics -monitor for fluid overload or shock

degree of attachment of the placenta to the myometrium

1. Placenta accreta—Slight penetration of myometrium 2. Placenta increta—Deep penetration of myometrium 3. Placenta percreta—Perforation of uterus

how is post partum hemorrhage classified

1. early: acute or primary occurs within 24 hours of birth 2. late: secondary occurs more than 24 hours after birth but less than 6 weeks after the birth

client has DIC (disseminated intravasuclar coagulation) which complication should the nurse note as a risk factor a. preeclampsia b. thrombophlebitis c. placenta previa d. hypermesis gravidarum

A

nurse caring for a client who is postpartum. which of the following findings is an early indicator of hypovolemia caused by hemorrhage? a. increasing pulse and decrease BP b. dizziness and increase RR c. cool, clammy skin and pale mucous membranes d. altered mental status

A

client is admitted for DVT. which of the following findings should the nurse expect? a. calf tenderness to palpation b. mottling of the extremitiy c. increase temp d. area of warmth e. report of nausea

A, C, D

nurse is reviewing risk factors for postpartum hemorrhage which ones should she include? a. precipitous delivey b. obesity c.inversion of the uterus d. oligohydramnios e. retained placental fragments

A, C, E

physician orders methylergonovine for a client. what intervention should the nurse take before administering. a. obtain BP b. determine blood glucose c. client empty bladder

A; do not give if BP greater than 140/90

describe how uterine atony causes bleeding

Bleeding is controlled by the contraction of smooth muscle in the uterus. If the uterus is flaccid after detachment of all or part of the placenta, brisk venous bleeding occurs, and normal coagulation of the open vasculature is impaired and continues until the uterine muscle is contracted. This marked hypotonia of the uterus is called uterine atony.

nurse is planning care for a thrombophlebitis. which of the following interventions should she do. a. apply cold compress b. massage the affected extremity c. allow client to ambulate d. measure leg circumference

D

can fragments of the placenta remain after placental expulsion?

Fragments of the placenta can remain in the uterus after spontaneous separation of the placenta during the third stage of labor. In this case the woman will have excessive bleeding and the uterus feels boggy (soft) due to uterine atony. puts women at risk for infection or PPH

lacerations of the genital tract and PPH

Hemorrhage related to lacerations should be suspected if bleeding continues despite a firm, contracted uterine fundus. This bleeding can be a slow trickle, an oozing, or frank hemorrhage. Factors that influence the causes and incidence of obstetric lacerations of the lower genital tract include operative birth, precipitous birth or baby size/malpresentation

urinary tract infections postpartum risk factors

Risk factors include urinary catheterization, frequent pelvic examinations, regional (epidural or spinal) anesthesia, genital tract injury, history of UTI, and cesarean birth.

UTI s/s

Signs and symptoms include dysuria, frequency and urgency, low-grade fever, urinary retention, hematuria, and pyuria.

s/s of wound infection

Signs of wound infection include fever, erythema, edema, warmth, tenderness, pain, seropurulent drainage, and wound separation.

mastitis

breast infection, should also be considered as a possible diagnosis among breastfeeding mothers, with symptoms such as fever, malaise, flulike symptoms, and a sore area in a breast

DVT

deep venous thrombosis, occurs most often in lower extremities; involvement varies but can extend from the foot to the iliofemoral region

s/s of inversion of the uterus

The primary presenting signs of uterine inversion are sudden and include hemorrhage, shock, and pain. The uterus is not palpable abdominally. The uterus must be replaced into its proper position

hematomas and PPH

Vulvar hematomas are the most common. Pain is the most common symptom, and most vulvar hematomas are visible. Vaginal hematomas occur more commonly in association with a forceps-assisted birth, an episiotomy, or primigravidity

what is retained placenta

When the placenta has not been delivered within 30 minutes after birth despite gentle traction on the umbilical cord and uterine massage, it is described as "retained." Initial management of a retained placenta consists of manual separation and removal by the physician or nurse-midwife

What is subinvolution of the uterus

When the uterus remains enlarged with continued lochial discharge and may result in postpartum hemorrhage. this causes a late postpartum bleed

treatment of superficial venous thrmobosis

analgesia/ NSAIDs, rest with elevation of the affected leg, and elastic compression stockings. Heat may also be applied locally.

UTI treatment

antibiotic therapy, analgesia, and hydration. cranberry juice not recommended because little evidence to support. patient teaching on s/s of further complications and proper treatment

treatment for DVT

anticoagulant therapy (usually continuous IV heparin), bed rest with the affected leg elevated, and analgesia. After the symptoms have decreased, the woman may be fitted with elastic compression stockings to wear when she is allowed to ambulate and warfarin may be started and last about 3 months

what are retroperitoneal hematomas

are the least common but life threatening. They are caused by laceration of one of the vessels attached to the hypogastric artery, usually associated with rupture of a cesarean scar during labor. minimal pain and the initial symptoms can be signs of shock

how are postpartum infections defined

as presence of a fever (100.4) or more on 2 successive days of the first 10 postpartum days

idiopathic thrombocytopenic purpura (ITP)

autoimmune disorder in which antiplatelet antibodies decrease the life span of platelets. Thrombocytopenia, capillary fragility, and increased bleeding time are diagnostic findings. ITP can cause severe hemorrhage after birth

PE s/s

dyspnea and tachypnea (more than 20 breaths/minute). tachycardia, apprehension, pleuritic chest pain, cough, hemoptysis, elevated temperature, and syncope

PE treatment

emergent situation. immediate treatment of PE is anticoagulant therapy. Continuous IV heparin therapy is used for PE until symptoms have resolved. Intermittent subcutaneous heparin or oral anticoagulant therapy is often continued for up to 6 month

nursing interventions for venous thromboembolic disorders.

inspecting and palpating the affected area; palpating the peripheral pulses; checking Homans sign; and measuring and comparing leg circumferences (this is what michelle did with our patient when her BP increased)

endometritis

is infection of the lining of the uterus, most common postpartum infection.

Define post partum hemorrhage

loss of 500 ml of blood after vaginal birth and loss of 1000 ml after cesarean birth, or a 10% change in Hct between labor and postpartum. this is the leading cause of maternal morbidity and mortality

wound infections

often develop after mothers are discharged for home. typically c-section incision, repaired laceration or episiotomy site

s/s of subinvolution of the uterus

prolonged lochial discharge, irregular or excessive bleeding, and sometimes hemorrhage. A pelvic examination usually reveals a larger-than-normal uterus that can be boggy.

PE

pulmonary embolism. complication of DVT occurring when part of a blood clot dislodges and is carried to the pulmonary artery where it occludes the vessel and obstructs blood flow to the lungs.

what is a venous thromboembolism (VTE)

results from formation of blood clot or clots inside a blood vessel. caused by inflammation or partial obstruction of vessel. superficial venous thrombosis is involvement of the superficial saphenous

hemorrhage (hypovolemic) shock

results from hemorrhage; emergency situation in which perfusion of organs may become severely compromised.

endometritis s/s

temperature 101-102; HR >100; malaise, anorexia; excess fundal tenderness long after it is expected; uterine subinvolution; lochia returning to rubra from serosa; foul smell lochia

von willenbrand disease (vWD)

type of hemophilia, deficiency or defect in blood clotting protein. Symptoms include recurrent bleeding episodes such as nosebleeds or after tooth extraction, bruising easily, prolonged bleeding time (the most important test), factor VIII deficiency (mild to moderate),

causes of inversion of the uterus

undal implantation of the placenta, vigorous fundal pressure, excessive traction applied to the cord, fetal macrosomia, short umbilical cord, tocolysis, prolonged labor, uterine atony, nulliparity, and abnormally adherent placental tissue

what is inversion of the uterus

uterus turning inside out, its rare but life threatening. it can be incomplete, complete or prolapsed.