Ch. 22 PP at risk

Which of the following would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis?

Activated partial thromboplastin time The activated partial thromboplastin time is used to monitor the effectiveness of intravenous anticoagulant therapy, most commonly heparin. Prothrombin time is used to monitor the effectiveness of the oral anticoagulant warfarin. Although platelets and fibrinogen are involved in blood clotting, they are not used to monitor the effectiveness of intravenous anticoagulant therapy.

A nurse is caring for a postpartum client who has a history of thrombosis during pregnancy and is at high risk of developing a pulmonary embolism. For which sign or symptom should the nurse monitor the client to prevent the occurrence of pulmonary embolism?

Calf swelling The nurse should monitor the client for swelling in the calf. Swelling in the calf, erythema, and pedal edema are early manifestations of deep vein thrombosis, which may lead to pulmonary embolism if not prevented at an early stage. Sudden change in the mental status, difficulty in breathing, and sudden chest pain are manifestations of pulmonary embolism, beyond the stage of prevention

A nurse is assigned to care for a client experiencing early postpartum hemorrhage. The nurse is required to administer the prescribed methylergonovine maleate intramuscularly to the client. Which of the following conditions would the nurse identify as necessitating the cautious administration of this drug?

Cardiovascular disease The nurse should know that the client with cardiovascular disease must understand that the drug has to be administered cautiously. Nurses must administer methylergonovine maleate with caution in women who have elevated blood pressure or cardiovascular disease because it causes a sudden increase in blood pressure and could initiate a cerebrovascular accident in women at risk with pre-existing conditions. Low blood pressure, respiratory problems, or mild fever is not known to enforce cautious use of methylergonovine maleate in clients with early postpartum hemorrhage.

The nurse is assisting with a birth, and the client has just delivered the placenta. Suddenly bright red blood gushes from the vagina. The nurse recognizes that which of the following is the most likely cause of this postpartum hemorrhage?

Cervical laceration Lacerations of the cervix are usually found on the sides of the cervix, near the branches of the uterine artery. If the artery is torn, the blood loss may be so great that blood gushes from the vaginal opening. Because this is arterial bleeding, it is brighter red than the venous blood lost with uterine atony. Fortunately, this bleeding ordinarily occurs immediately after detachment of the placenta, when the primary care provider is still in attendance. Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartum hemorrhage; it tends to occur most often in Asian or Hispanic woman. Conditions that contribute to uterine atony include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage. Disseminated intravascular coagulation is typically associated with premature separation of the placenta, a missed early miscarriage, or fetal death, none of which is evident in this scenario. A retained placental fragment is possible, but there is no evidence for this in the scenario

Within 24 hours of delivery, a client reports pain in the pelvic region. Comfort measures and medication fail to eliminate the pain, the pulse is rapid, and blood pressure, hematocrit, and hemoglobin are low. The fundus is firm, however, and the lochia is dark red and flowing in only moderate amounts; no pooling is evident. What complication does the nurse suspect?

Deep pelvic hematoma The assessment data indicate a blood loss in the body, and the lack of active bleeding leads one to believe it may be a hematoma. Retained placental fragments are characterized by late postpartum bleeding. Along with an abrupt onset of bleeding, the woman's uterus is not well-contracted. The woman with DVT may have no symptoms. If the client does exhibit signs, these typically include swelling and calf pain or tenderness in the affected leg. The area may be warm, tender, and red. Lacerations can occur as small tears or cuts in the perineal tissue, vaginal sidewall, or cervix.

A nurse is assessing vital signs for a postpartum patient 48 hours after delivery. The vital signs are: T 101.2°F; (38.4°C) HR 82 beats/min.; RR 18 breaths/min.; BP 125/78 mmHg. How will the nurse interpret the vital signs?

Infection Temperatures elevated above 100.4°F (38°C) 24 hours after delivery are indicative of possible infection.

When teaching a postpartum woman about possible complications during this time, the nurse would include information about which of the following as a possible effect?

Interference with the maternal-newborn attachment process The nurse would include information that maternal postpartum complications affect not only the health status of the woman, but also that of the newborn by potentially interfering with the maternal-newborn attachment process. Furthermore, they can disrupt the dynamics of the entire family, with health-related, fiscal, and emotional effects and costs. Maternal postpartum complications are not known to result in ineffective breast-feeding, delayed development of the newborn, or altered maternal hormonal function

A postpartal woman with a thrombophlebitis tells you that her leg is very painful. Which of the following actions would be most appropriate to relieve this pain?

Keep covers off the leg. Pressure or cold on the leg can interfere with blood circulation. Massaging the leg or urging her to walk could cause a clot to move and become a pulmonary embolus.

Your patient delivered six hours ago. She calls you to her room complaining of pain "deep inside." You medicate her per orders with no relief attained. You check her vital signs and find they are markedly different then when the CNA charted them 30 minutes ago. What would you suspect?

Pelvic hematoma A hematoma also can form deep in the pelvis where it is much more difficult to identify. The primary symptom is deep pain unrelieved by comfort measures or medication and accompanied by vital sign instability.

Samantha delivered her fourth child after protracted and difficult labor during which oxytocin was used to augment her contractions. The next day, her vaginal bleeding continues to be moderately heavy with numerous large clots. Palpating her fundus, you find that it is in the midline but boggy and above the level of the umbilicus. Fundal massage is indicated; what should you do first?

Place one hand over the symphysis pubis A boggy fundus with active bleedings and clots the day after delivery is indicative of uterus atony. The nurse should prepare to initiate fundal massage.The first step in this procedure is to place one had over the symphysis pubis. The first step in fundal massage is not to ensure that the patient's bladder is empty, seek an order for an oxytocic, nor insert uterine packing.

Retention of placental fragments commonly leads to hypertension.

True

A nurse is caring for a client who has had an intrauterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulation?

• Bleeding gums • Tachycardia • Acute renal failure The nurse should monitor for bleeding gums, tachycardia, and acute renal failure to assess for an increased risk of disseminated intravascular coagulation in the client. The other clinical manifestations of this condition include petechiae, ecchymosis, and uncontrolled bleeding during birth. Hypotension and amount of lochia greater than usual are findings that might suggest a coagulopathy or hypovolemic shock.

A nurse discovers a perineal hematoma in a woman who has recently given birth. Which of the following interventions should the nurse make in this case?

• Estimate the size of the hematoma and report it • Administer a mild analgesic as prescribed • Apply an ice pack to the site Report the presence of a perineal hematoma, its estimated size, and the degree of the woman's discomfort to her primary care provider. Administer a mild analgesic as prescribed for pain relief. Applying an ice pack (covered with a towel to prevent thermal injury to the skin) may prevent further bleeding. Usually a hematoma is absorbed over the next 3 or 4 days. An antibiotic is not required, as there is no indication of infection. Fundal massage is indicated for uterine atony, and methotrexate is used to destroy retained placental fragments when removal is not possible.

Which of the following would lead the nurse to suspect that a postpartum woman has developed metritis?

• Pain on both sides of the abdomen • Foul-smelling lochia • Leukocytosis