Chp 18 PP maternal complicationsOB

Upon assessment the nurse finds that the patient who has undergone a cesarean delivery is at risk of postpartum hemorrhage (PPH). What would be the most likely cause of PPH in this patient? 1 Anesthesia 2 Coagulopathy 3 Placenta previa 4 Chorioamnionitis

1 Anesthesia blocks the neurologic impulses that stimulate uterine contractions. This causes uterine atony and can lead to PPH. Chorioamnionitis is a serious condition in which the fetal membranes are infected and is associated with other signs, such as fever. Coagulopathy is a clotting disorder, which occurs due to protein defects in the plasma that interrupt the coagulation cascade and cause blood coagulation. Placenta previa is an obstetric complication in which the placenta penetrates partially in the lower uterine segment. This is a common complication in pregnant women who smoke and consume cocaine.

A postpartum woman with hypovolemic shock is given an intravenous infusion of crystalloids. Upon assessing the reports of the blood tests done after the infusion, the nurse finds that the patient has decreased clotting factors and platelet count. Which intervention would help in restoring the normal levels of platelets and clotting factors in the patient? 1 Administration of fresh-frozen plasma 2 Administration of packed red blood cells 3 Administration of normal saline solution 4 Administration of lactated Ringer's solution

1 Hypovolemic shock is initially treated by restoring blood volume and eliminating the underlying cause of the shock. The patient is initially treated by administering crystalloids in order to perform fluid resuscitation. Because the fresh frozen plasma is rich in clotting factors and platelets, administration of fresh-frozen plasma restores the normal levels of platelets and clotting factors in the patient. Packed red blood cells are administered if the patient is actively bleeding. Normal saline solution and lactated Ringer's solution are both crystalline solutions that are administered to restore the circulating blood volume in the condition of hypovolemic shock. However, these solutions are not helpful in restoring normal levels of platelets and clotting factors.

While assessing a postpartum patient the nurse finds that the patient has excessive foul-smelling lochia. What medication would be helpful in treating the condition? 1 A broad-spectrum antibiotic 2 A diuretic to induce urination 3 Intravenous oxytocin agents 4 Intravenous fluids

1 Profuse lochia with a foul smell indicates that the patient has a bacterial infection, such as endometritis. Therefore, the nurse anticipates that the primary health care provider will prescribe a broad-spectrum antibiotic. Diuretics are prescribed when the patient shows urinary retention, characterized by decreased urinary output. Intravenous oxytocin agents are prescribed to induce uterine contractions in case of uterine inversion. The nurse should ensure adequate fluid intake; however, administration of intravenous fluids is likely not necessary.

The nurse is completing an assessment on a 42-year-old primipara, who has just delivered a healthy infant weighing 9 lb, 2 oz. The mother's labor lasted approximately 8 hours and was augmented with oxytocin. Which factor would increase the mother's risk for postpartum hemorrhage? 1 Size of the infant 2 Age of the mother 3 Length of labor 4 Augmentation with oxytocin

1 The use of oxytocin to augment labor increases the risk for postpartum hemorrhage. The size of the infant, age of the mother, and length of labor in this situation are not risk factors.

The nurse completes a history on a patient admitted in active labor. Which risk factor noted in the patient's history indicates an increased risk for a thromboembolic disorder? 1 History of smoking 2 Age older than 30 years 3 Hypercholesterolemia 4 Low level of physical activity

1 A history of smoking increases the risk for thromboembolic disorders. Age older than 35 years, not 30 years, increases the risk of thromboembolic disorders. Hypercholesterolemia and levels of physical activity are not indicated as risk factors.

Upon assessment of a patient who delivered 1 hour prior, the nurse notes a soft boggy uterus. Which action should the nurse complete first? 1 Massage the fundus until it is firm. 2 Catheterize the mother to drain the bladder. 3 Complete bimanual compression of the uterus. 4 Administer methylergonovine per unit protocol.

1 If the uterus is soft and boggy, the nurse should first massage the fundus until it is firm and expresses clots that may have accumulated in the uterus. If this is unsuccessful, the nurse can either assist the mother to void or catheterize the mother to correct atony caused by a full bladder. Bimanual compression is not done unless uterine massage and pharmacological interventions are unsuccessful. Methylergonovine is not administered unless atony continues after prophylactic oxytocin and uterine massage.

Which instruction does the nurse give a postpartum patient to prevent infections? 1 "Wipe from front to back after using the toilet." 2 "Use cold water to cleanse the perineal area." 3 "Change the perineal pad from back to front." 4 "Avoid the use of slippers while in the hospital."

1 The nurse instructs the postpartum patient to wipe from front to back after using the toilet to prevent the spread of bacteria to the vaginal or perineal area. The nurse should ask the patient to clean the perineal area with an antiseptic solution and warm water to prevent infections. The patient should change the perineal pad carefully to avoid the spread of bacteria. The nurse instructs the patient to use slippers while walking around the hospital to prevent contamination of the linens on returning to bed.

The nurse is caring for a postpartum patient who is diagnosed with superficial venous thrombosis. Which interventions will the nurse perform for a patient with this condition? Select all that apply. 1 Change the patient's position frequently. Administer analgesics as needed. 2 Apply moist heat to relieve the patient's pain. Apply elastic support hose. 3 Inspect the affected site by gently palpating it. Elevate the affected lower extremity. 4 Massage the affected area suitably for comfort. Encourage patient to stand for extended periods. 5 Allow the patient to rest with legs in a low position. Apply ice to affected lower extremity.

1,2,3 The patient with superficial venous thrombosis is instructed to elevate the affected lower extremity and gradually increase ambulation. Application of heat packs eases circulation and provides pain relief. Routine inspection of the affected site prevents further complications of the condition. The patient should not rest by placing the legs in a low position, nor should the patient stand for long periods of time, because this causes the pooling of blood in the lower extremities.

What measures will the nurse implement in her postpartum patient to prevent postpartum infection and other possible complications? Select all that apply. 1 Instruct the patient to consume foods that are rich in protein and vitamin C. 2 Instruct the patient to wash hands with soap after urination. 3 Perform fundal massage on the patient continuously. 4 Instruct the patient to pour warm water over the perineum after urinating. 5 Inform the patient to avoid consuming an excess amount of water.

1,2,3,4 While teaching a patient about preventive measures for postpartum infection, the nurse should emphasize diet pattern and hygiene. A protein and vitamin C-rich diet is recommended. Washing one's hands with soap will prevent the spread of infection. Fundal massage is performed during the postpartum period to promote uterine contraction and is only performed when necessary. The perineal pads should be changed from front to back because this prevents postpartum urinary tract infections by preventing the deposit of the microorganisms present in the lochia near the urethra. The postpartum patient is advised to drink plenty of water to maintain hydration and prevent infection in the uterus.

A patient is considered at risk for ineffective tissue perfusion related to excessive postpartum blood loss after delivering twins within the past 6 hours. Which interventions would be appropriate for this nursing diagnosis and patient? Select all that apply. 1 Measure vital signs every 15 to 20 minutes. 2 Weigh peripads and linens before and after use. 3 Ensure the patient remains free of infection for postpartum period. 4 Ensure the patient empties bladder every 2 to 3 hours. 5 Monitor areas under buttocks, legs, and back for lochia. 6 Assess consistency and location of fundus as needed until firmly contracted.

1,2,5,6 The nurse should measure vital signs, including oxygen levels and capillary return, every 15 to 20 minutes to ensure optimal organ function. All pads, linens, and bed liners should be measured before and after use to accurately determine amount of blood loss. Likewise, the areas under the back, buttocks, and legs should be assessed for drainage and pooling of lochia to have an accurate determination of blood loss. The fundus should be firmly contracted and therefore must be monitored to confirm for normal return to this state. Ensuring the patient remains free of infection is an outcome for a postpartum patient, not an intervention. Emptying the bladder is unrelated to postpartum blood loss.

The nurse is caring for a postpartum patient who has undergone a vaginal delivery. Which nursing interventions help to reduce the risk of postpartum hemorrhage? Select all that apply. 1 Encouraging voiding 2 Applying hydrogel pads 3 Determining uterus tone 4 Providing a warm sitz bath 5 Providing uterus massage

1,3,5 Bladder distention and uterus atony cause excessive bleeding and increase the risk of hemorrhage in postpartum patients. Therefore, the nurse should follow interventions that help to reduce bladder distention and uterus atony in the patient. Frequent voiding helps to prevent bladder fullness and reduces bladder distention. The nurse should determine uterine tone and provide massage to promote uterine contraction and reduce the risk of uterine atony. Hydrogel pads are used on the breasts to reduce swelling, but these would not be applied to reduce bladder distention, uterine atony, or to prevent hemorrhage. Warm sitz baths reduce pain and discomfort, but do not promote uterine contraction or prevent uterine atony.

A mother had a cesarean delivery after an unsuccessful rupture of membranes and oxytocin. On the second postpartum day, she reports abdominal pain and anorexia. The patient's lochia is foul-smelling and purulent in nature. Her temperature is 101.6˚F (38.6˚C). Which actions would be important for the nurse to take to provide evidence-based care for this patient? Select all that apply. 1 Place the patient in a Fowler position. 2 Assess the patient's temperature every 4 hours. 3 Medicate the patient as needed for abdominal pain and cramping. 4 Anchor a urinary catheter to decrease bladder distention. 5 Provide foods high in vitamin C and protein, along with oral fluids.

1,3,5 The patient's symptoms indicate endometritis. Nursing considerations for endometritis include placing the patient in a Fowler position, medicating her as needed for abdominal pain and cramping, and encouraging foods high in vitamin C and protein, along with fluids. While the patient has a fever, temperature should be assessed every 2 hours, not every 4. A urinary catheter is not necessarily indicated in this situation.

After removal of the retained placental fragment, the patient is recovering on the mother-baby (postpartum) unit. What should the nurse identify as the priority of care? 1 Monitoring the infant's ability to breastfeed 2 Checking the perineum frequently 3 Assessing vital signs frequently 4 Encouraging the patient to ambulate

2 Although the retained placental fragment has been removed, the patient is still at risk for postpartum hemorrhage. Because vital signs change late, checking the perineum is the best way to assess for postpartum hemorrhage and is the priority. Monitoring the infant's ability to breastfeed is unrelated to removal of retained placental fragments. Assessment of vital signs is a required part of the nursing care plan for this patient. Increasing ambulation is not a priority at this time in the postpartum period.

The postpartum patient who delivered a day ago reports, "I feel tired very often and experience pain in my lower abdomen." Upon further observation, the nurse finds that the patient also has profuse foul-smelling vaginal discharge and an increased pulse. Which medication would be added to the patient's prescription? 1 Warfarin (Coumadin) 2 Clindamycin (Cleocin) 3 Misoprostol (Cytotec) 4 Ergonovine (Ergotrate)

2 Endometrial infection is characterized by tiredness and lower abdominal pain, profuse foul-smelling discharge, and increased pulse. Clindamycin (Cleocin) is an antibiotic used to treat endometrial infections. Warfarin (Coumadin) is prescribed to postpartum patients with thromboembolic disorders. Misoprostol (Cytotec) is prescribed to patients with excessive bleeding caused by uterine atony. Ergonovine (Ergotrate) is prescribed to treat subinvolution of the uter

The ultrasonography report of a pregnant woman reveals the presence of hydramnios. What complication would the nurse expect during the postpartum period? 1 Hematomas 2 Uterine atony 3 Retained placenta 4 Endometrial infections

2 Hydramnios causes the uterine muscles to stretch excessively, which may result in poor uterine contraction after delivery. This results in uterine atony in the patient. Hydramnios does not cause hematomas. Prolonged compression of the fetal head on the vaginal walls causes vaginal hematoma. Polyhydramnios does not cause retained placenta. Hydramnios does not affect placental separation. Presence of hydramnios would not cause endometrial infections.

hat is the primary cause of thromboembolic disease? 1 Viral infection 2 Hypercoagulation 3 Corticosteroid therapy 4 Deficient clotting factors

2 Hypercoagulation and venous state are the primary causes for thromboembolic disease. Thromboembolic disease is characterized by the formation of clots in the blood vessel mainly due to inflammation. Viral infection is not associated with the formation of clots. Administration of corticosteroids does not alter the clotting behavior in a patient. Deficiency of clotting factors results in bleeding; it is not associated with thromboembolic disease.

A thrombosis results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation or partial obstruction of the vessel. What are three thromboembolic conditions of concern during the postpartum period? Select all that apply. 1 Amniotic fluid embolism (AFE) 2 Superficial venous thrombosis (SVT) 3 Deep vein thrombosis (DVT) 4 Pulmonary embolism (PE) 5 Idiopathic thrombocytopenic purpura (ITP)

2,3,4 An SVT includes involvement of the superficial saphenous venous system. With DVT the involvement varies but can extend from the foot to the iliofemoral region. A PE is a 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. An AFE occurs during the intrapartum period when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. ITP is not a thromboembolic condition.

The nurse is reviewing the history of a patient admitted at 39 weeks of gestation. The nurse knows the patient is gravida 3, para 2, and has been experiencing labor symptoms over the past 12 hours. While analyzing the patient's data, which information does the nurse look for that may indicate an increased risk for uterine atony? Select all that apply. 1 Size of the uterus 2 Size of the baby 3 Hydramnios 4 Excessive lochia 5 History of multigestation 6 Expelling of excessive clots

2,3,5''Risk factors for uterine atony include a large baby, excessive volume of amniotic fluid (hydramnios), and multigestation. The size of the uterus, excessive lochia, and excessive clot expelling are all clinical manifestations of uterine atony, not risk factors.

A postpartum patient has returned to the hospital and is complaining of fatigue, backache, and a feeling that her uterus is "heavy and full." Based on this information, the nurse plans which actions? Select all that apply. 1 Administering low-molecular weight heparin 2 Conducting a bimanual examination 3 Administering fibrinogen to promote clotting 4 Assessing bleeding amounts reported from pads and linens 5 Checking for discharge of lochia 6 Reviewing history for predisposing factors of hemorrhage

2,4,5,6 Late postpartum hemorrhage is typically seen after a patient has returned home. Patients should be monitored when there are complaints of fatigue, general malaise, backache, pelvic pain, a feeling of heaviness in the pelvic area, and any lingering discharge of lochia. For a patient with potential late postpartum hemorrhage, the nurse would conduct a bimanual examination to obtain more data, assess bleeding amounts in pads and linens, and assess lochia, and review the patient's history for any hemorrhage risk factors. Heparin would dangerously exacerbate bleeding, and lab tests must be performed before the health care provider prescribes fibrinogen and the nurse can administer it.

Excessive blood loss after childbirth can have several causes; however, which is the most common? 1 Vaginal or vulvar hematomas 2 Unrepaired lacerations of the vagina or cervix 3 Failure of the uterine muscle to contract firmly 4 Retained placental fragments

3 Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention. Although vaginal or vulvar hematomas are a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause. Although unrepaired lacerations are a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause. Although a retained placental fragment is a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause.

A postpartum woman with asthma, who had manual repositioning of her uterus into the pelvic cavity after uterine inversion, experiences prolonged lochial discharge and hemorrhage. Upon examination, the nurse finds a large, boggy uterus. Which nursing intervention may pose the most risk to the patient? 1 Removal of retained placental fragments 2 Administration of carboprost (Hemabate) 3 Aggressive massage of the uterine fundus 4 Administration of intravenous oxytocin (Pitocin)

3 Aggressive fundal massage should be avoided in a patient who underwent a manual repositioning of the uterus because this may increase the risk of bleeding. Subinvolution of the uterus is the delayed return of the uterus to its normal size and function. Subinvolution of the uterus is characterized by prolonged lochial discharge, excessive bleeding, hemorrhage, and a large, boggy uterus. Retained placental fragments should be removed by performing dilation and curettage. This may reduce excessive bleeding. Carboprost (Hemabate), a uterotonic medication, is used if the uterus is nonresponsive to the continuous oxytocin (Pitocin) infusion. Carboprost (Hemabate) is contraindicated in patients with asthma. Because the patient has asthma, carboprost (Hemabate) should not be administered to the patient. Administration of intravenous oxytocin (Pitocin) along with normal saline promotes restoration of normal uterine tone and size.

Which complication should the nurse assess before planning care for the patient who has undergone a forceps-assisted delivery? 1 Decreased vaginal secretions 2 Decreased urinary frequency 3 Presence of vaginal lacerations 4 Increased pelvic muscles tone

3 Forceps-assisted delivery may result in cervical or vaginal lacerations in most patients. This increases the risk of postpartum infection in patients. Therefore, the nurse should assess the patient for presence of vaginal lacerations to prevent infection. Postpartum vaginal dryness or a decrease in vaginal secretions occurs in all patients due to low levels of estrogen in the blood. A postpartum increase in urinary frequency and diuresis of excess extracellular fluid accumulated during pregnancy are also common. There will be a decrease, not an increase, in the pelvic muscular tone postpartum.

A patient who is within 24 hours of a vaginal delivery begins to exhibit symptoms of hypovolemic shock, and the nurse quickly realizes the patient is experiencing postpartum hemorrhage. Which error by the health care team would most likely result in this life-threatening condition? 1 Failing to accurately deliver postpartum care after manual removal of placenta 2 Not accounting for overdistention of the uterus 3 Underestimating blood loss during the birthing process 4 Not administering adequate fluids during and after delivery

3 Most cases of postpartum hemorrhage are due to miscalculation of blood loss during and directly after delivery and are often estimated at one-half the true amount of blood volume lost. Failing to provide postpartum care after manual removal of the placenta can increase the risk of postpartum hemorrhage, as will overdistention of the uterus, but these are not direct causes based on clinical judgment of care. Failure to administer fluids may contribute to hypovolemia, but this only adds to the risk, it is not the direct cause.

When a nurse observes profuse postpartum bleeding, the first and most important nursing intervention is to what? 1 Call the woman's primary health care provider. 2 Administer the standing order for an oxytocic. 3 Palpate the uterus and massage it if it is boggy. 4 Assess maternal blood pressure and pulse for signs of hypovolemic shock.

3 The most important nursing intervention is to stop the bleeding. Once the nurse has applied firm massage of the uterine fundus, the primary health care provider should be notified or the nurse can delegate this task to another staff member. This intervention is appropriate after assessment and immediate steps have been taken to control the bleeding. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Vital signs will need to be ascertained after fundal massage has been applied.

After reviewing the medical reports of a patient, the nurse finds that the patient has multiparity. What could be the most likely complication associated with this? 1 Vaginal hematomas 2 Von Willebrand disease (vWD) 3 Postpartum hemorrhage (PPH) 4 Abnormal development of limbs

3 The uterine walls are overstretched due to multiparity (five or more), so the uterus contracts poorly after birth. This may cause uterine atony, leading to PPH. Multifetal gestation does not cause vaginal hematomas, vWD, or abnormal limb development of the fetus. Vaginal hematomas occur more commonly in association with a forceps-assisted birth. vWD is a type of hemophilia, which is a hereditary bleeding disorder. Abnormal development of fetal limbs is usually a complication associated with teratogenic drugs.

A postpartum patient who underwent a cesarean delivery complains of minor perineal and rectal pain. Further assessment shows the presence of peritoneal hematomas. Which primary nursing interventions should be performed after surgically removing the hematomas and minimizing the bleeding? Select all that apply. 1 Prepare for hysterectomy. 2 Administer pain relief medication. 3 Initiate fluid replacement therapy. 4 Monitor serum hemoglobin levels. 5 Monitor the amount of blood loss.

3,4,5 Early manifestations of retroperitoneal hematoma include shock, which is caused by excessive bleeding. After the surgical removal of the hematomas, the priority nursing intervention is to initiate fluid replacement therapy to treat the shock. Along with fluid replacement, the nurse should monitor the patient's hemoglobin levels until they are restored to normal values. Monitoring blood loss helps the nurse assess the patient's condition. Hysterectomy is performed when there is excessive bleeding that is not responsive to conservative measures. Retroperitoneal hematoma is associated with minimal pain, so administering pain relief medication is not a priority nursing intervention.

The nurse is caring for a patient during the fourth stage of labor during a vaginal birth. After assessment, the nurse finds that the patient has lost 600 mL of blood within 24 hours. The nurse also finds that the patient's uterus is soft and relaxed. Which postpartum complication has the patient developed? 1 Mastitis 2 Puerperal infection 3 Venous thromboembolism 4 Postpartum hemorrhage

4 A loss of 600 mL of blood within 24 hours indicates that the patient has postpartum hemorrhage. Because the patient's uterus feels soft and relaxed, it indicates that the patient has uterine atony, which leads to excessive blood loss. Mastitis is inflammation of the mammary glands, which disrupts normal lactation and usually develops 1 to 4 weeks after labor. Puerperal infection is characterized by fever. Venous thromboembolism is caused by deep vein thrombosis. It occurs later in the postpartum period, 10 to 14 days after delivery.

A patient who has undergone cesarean surgery reports to the nurse about having persistent perineal pain and feels pressure in the vagina. The nurse finds that the patient is in shock. What clinical condition should the nurse suspect based on this assessment? 1 Rectocele 2 Endometritis 3 Impaired lactation 4 Retroperitoneal hematoma

4 Accumulation of blood in the retroperitoneal space is called retroperitoneal hematoma. It is caused by the rupture of the cesarean scar during labor. Retroperitoneal hematoma is characterized by such symptoms as persistent perineal pain, a feeling of pressure in the vagina, and shock. Therefore it is evident that the patient has this condition. Persistent perineal pain, a feeling of pressure in the vagina, and shock are not associated with rectocele, endometritis, and impaired lactation. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. Endometritis is characterized by fever, increased pulse rate, chills, anorexia, nausea, fatigue, pelvic pain, uterine tenderness, and foul-smelling lochia. Because the patient did not report these symptoms, the patient does not have endometritis. Perineal pain, a feeling of pressure in the vagina, and shock do not affect lactation, so the patient does not have impaired lactation.

A postpartum patient with hemorrhagic shock is administered intravascular colloids. The nurse monitors the patient carefully throughout the colloid administration. What risk factor in the patient should the nurse be aware of? 1 Excessive hemorrhage 2 Von Willebrand disease 3 Deep venous thrombosis 4 Intravascular fluid overload

4 Patients who are given intravascular colloids are at a higher risk for intravascular fluid overload. Therefore, the nurse should monitor the patient for symptoms of intravascular fluid overload. Intravascular colloid therapy does not cause excessive hemorrhage. Von Willebrand disease, a hereditary disease condition, is a type of hemophilia. Von Willebrand disease is caused by the deficiency of a blood clotting protein called Von Willebrand factor. Deep venous thrombosis is a venous thromboembolic disorder that is most commonly seen in the lower extremities. It is unrelated to intravascular colloid therapy.

The nurse is assessing a postpartum patient 4 hours after delivery. The nurse observes that the patient has cool, pale, and clammy skin with severe restlessness and thirst. What should the immediate nursing intervention be? 1 Begin fundal massage and start oxygen therapy. 2 Begin an hourly pad count and reassure the patient. 3 Elevate the head of the bed and assess vital signs. 4 Assess for hypovolemia and notify the primary health care provider.

4 The presence of cool, pale, and clammy skin with severe restlessness and thirst are the diagnostic signs of hypovolemia. If the nurse observes these signs it should be immediately reported to the primary health care provider. Fundal massage will only be effective for patients with postpartum hemorrhage due to uterine bleeding. Pad count is associated with postpartum hemorrhage and is unrelated to cold and clammy skin. Elevating the head of the bed may affect the patient's vital signs. However, it is not associated with hypovolemia.