Postpartum complications

Causes of PPH

4 T's Tone- atony (uterus is not contracted by exam) Trauma- lacerations (e.g. from forceps, by exam too) Tissue- accessory lobe or invasive placenta Thrombin- coagulopathies

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

Answer B

Which sign of thrombophlebitis should the nurse include instruct the postpartal client to look for when at home after discharge from the hospital? A. Muscle soreness in her legs after exercise. B. Enlarging varicose veins in her legs. C. Localized posterior leg tenderness, heat, and swelling D. New areas of ecchymosis

C

General Management of PPH

Uterine massage and ABC

postpartum hemorrhage definition

>500 normal deliver or >1000 ml in c-section occurring after deliver (can be delayed but within 6 weeks)

A client delivered a 9 pound, 10 ounce infant assisted by forceps. When the nurse performs the second 15-minute assessment, the client reports increasing perineal pain and a lot of pressure. What action should the nurse take? A. Apply ice to the client's perineum, reassuring the client that this is normal. B. Call for assistance from another nurse. C. Assess the fundus for firmness. D. Check the perineum for a hematoma.

A

The client is a 36-year-old woman, gravida 6 and para 6, who delivered a 7 pound, 14 ounce baby girl at term after an eight-hour labor. The client's vital signs are stable, and her lochia is bright red, heavy, and contains various clots; some are half dollar size. The nurse would consider the client to be at high risk for uterine atony for which reason? A. Grandmultiparity. B. Large for gestational age baby. C. Labor of long duration. D. Advancing maternal age.

A

The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma? A. Changes in vital signs B. Signs of heavy bruising C. Complaints of intense pain D. Complaints of a tearing sensation

A

The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. A. Wear a supportive bra B. Rest during the acute phase C. Maintain a fluid instate 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

A nurse is providing care to multiple clients on the postpartum unit. Which of the following clients is at the greatest risk for developing a puerperal infection? A. A client who has an episiotomy that is erythematous and has extended into a 3rd degree laceration B. A client who does not wash her hands between perineal care and breastfeeding C. A client who is not breastfeeding and is using measures to suppress lactation D. A client who has a cesarean incision that is well-approximated with no discharge

B

A postpartum client is diagnosed with cystitis. The nurse should plan for which priority nursing action in the care of the client? A. Providing sitz baths B. encouraging fluid intake C. placing ice on the perineum D. monitoring hemoglobin & hematocrit levels

B

If the nurse suspects a uterine infection in the postpartum client, the nurse should make which priority assessment? A. Pulse and blood pressure. B. Odor of the lochia. C. Episiotomy site. D. The abdomen for distention.

B

A new mother with mastitis is concerned about breastfeeding while she has an active infection. How should the nurse respond to the client's concern? 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 passes in the milk. D. The organisms will be inactivated by gastric acid.

C

A nurse is providing discharge instructions for a client. At 4 weeks postpartum, the client should contact her provider for which of the following client findings? A. Scant nonodorous white vaginal discharge B. Uterine cramping during breastfeeding C. Sore nipples with cracks and fissures D. Decreased response with sexual activity

C

On assessment of a postpartum client, the nurse notes that the uterus feels soft & boggy. The nurse should take which initial action? A. elevate the client's legs B. Document the findings C. massage the fundus firm D. Push on the uterus to assist in expressing cloths

C

On the client's third postpartum day, the nurse enters the room and finds the client crying. The client states that she does not know why she is crying and she cannot stop. What is the most appropriate reply by the nurse? A. "There is no need to cry, you have a healthy baby." B. "Are you dissatisfied with your care? I will see that any issues are addressed." C. "Many new mothers have shared with us their same confusion of feelings, would you like to talk about them?" D. "This happens to lots of mothers, and be reassured that it will pass with time."

C

The nurse is assessing a client in the fourth stage of labor & notes that the fundus is firm, but that bleeding is excessive. Which should be the initial nursing action? A. record the findings B. massage the fundus C. notify the health care provider D. Place the client in the Trendelenburg's position

C

The nurse is developing a plan of care for a postpartum client with a small vulvar hematoma. The nurse should include which specific action during the first 12 hours after delivery? A. assess vital signs every 4 hours B. measure fundal height every 4 hours C. prepare an ice pack for application to the area D. inform the health care provider of assessment findings

C

The postpartum nurse is assessing a client who delivered a healthy infant by cesarean section for signs & symptoms of superficial venous thrombosis. Which sign would the nurse note if superficial venous thrombosis were present? A. Paleness of the calf area B. Coolness of the calf ares C. Enlarged, hardened veins D. Palpable dorsalis pedis pulses

C

A client in a postpartum unit complains of sudden sharp chest pain & dyspnea. The nurse notes that the client is tachycardic & the respiratory rate is elevated. The nurse suspects a pulmonary embolism. Which should be the initial nursing action? A. Initiate an intravenous line. B. Assess the client's blood pressure. C. Prepare to administer morphine sulfate D. Administer oxygen 8 to 10L/min by face mask.

D

A nurse is conducting a home visit with a client who is 3 mos postpartum and breastfeeding. Menses has not yet resumed. The client is discussing contraception with the nurse, stating that she does not want to have another child for a couple of years. The nurse understands that this client needs further instruction if the client makes which of the following statements? A. "I have already started using the mini pill for protection." B."Because of our beliefs, we are going to use the rhythm method." C. "I am being refitted for a diaphragm by my doctor next week." D. "I will begin using birth control when I stop breastfeeding."

D

A postpartum client develops a temperature during her postpartum course. Which temperature measurement indicates to the nurse the presence of postpartum infection? A. 99.0 F at 12 hours postdelivery that decreases after 18 hours B. 100.2 F at 24 hours postdelivery that decreases the second postpartum day C. 100.4 F at 24 hours postdelivery that remains until the second postpartum day D. 100.6 at 48 hours post delivery that continues into the third postpartum day

D

Despite the nurse's attempt to massage a boggy fundus, a postpartum client continues to pass several large clots in the presence of bright red lochia. The uterine fundus remains boggy and fundal massage and oxytocin (Pitocin) are not successful. What medication does the nurse expect to be prescribed next? A. Dinoprostone (Cervidil) B. Terbutaline sulfate (Brethine) C. Magnesium sulfate D. Carboprost (Prostin 15-M or Hemabate)

D

The nurse is preparing to care for four assigned clients. Which client is at highest risk for hemorrhage? A. A primiparous client who delivered 4 hours ago B. A multiparous client who delivered 6 hrs ago C. A primiparous client who delivered 6 hrs ago & had an epidural D. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction

D

The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breast-feeding her newborn. Which client statement would indicate a need for further instructions? A. "I should breast-feed every 2-3 hours" B. "I should change the breast pads frequently" C. "I should wash my hands well before breast-feeding" D. "I should wash my nipples daily with soap & water"

D

Which instruction should the nurse include in the discharge teaching plan to assist the postpartal client to recognize early signs of complications? A. Expect to pass clots, which occasionally can be the size of a golf ball. B. Report a decrease in the amount of brownish-red lochia. C. Palpate the fundus daily to make sure it is soft. D. Notify the health care provider of increased lochia or bright red bleeding.

D

Because postpartum depression occurs in 3 to 30% of postpartal women, the prenatal nurse assesses clients for risk factors for postpartum depression during the prenatal period. Which clients would the nurse consider to be at risk for postpartum depression? SELECT ALL THAT APPLY. A. A client who is an unmarried primipara with family support. B. A client who has previously had postpartum blues. C. A client who is a primipara with documented ambivalence about her pregnancy in the first trimester. D. A client who is a primipara with a history of depression and lack of a supportive relationship. E. A client who is primipara living alone and was consistently ambivalent about pregancy.

D, E

Management from trauma

OR for repair

Prevention of PPH

Oxytocin upon delivery of baby Early cod cutting and clamping Brandt-Andrews maneuver (gentle cord traction with contraction)

Tx from retained tissue

Oxytocin/manual removal Not successful--> suspect invasive placenta and then hysterectomy (can wait and give methotrexate which is sometimes helpful)

Management of PPH from atony

massage, and uterotonic drugs (oxytocin, carboprost tromethamine, methylergonovine, misoprostol) If drugs not effective/available--> Tamponade balloon and then OR/interventional radiology