ch 22 PP management/complications
clinical risk factors of PPH
-over distention of uterus -uterine muscle exhaustion -uterine infection -products of conception (placenta) -retained blood clots -lacerations/extension -uterine inversion -preexisting clotting disorders -traction on UC
uterine inversion
turning of the uterus inside out after birth of the fetus by pulling on umbilical cord
management of metritis
-place in semi fowlers to encourage drainage -adm pain meds -monitor IV site and response to abx -monitor response to tx -assess VS Q2hr while fever is present -warm blankets, cool compresses, cold/warm drinks -encourage foods high in vit C and protein for healing
Every postpartum client has the potential of hemorrhage. While assessing a client's status, which finding would be of little benefit in identifying the possibility of hemorrhage? A. signs of shock B. estimated amount of blood loss C. vital signs D. uterine tone
signs of shock -do not appear until the hemorrhage is far advanced due to the increased fluid and blood volume of pregnancy
Pitocin (oxytocin)
used for PPH -labor induction is a risk for PPH
signs and symptoms of PPD
-sadness -guilty -panic/anxiety -frequent crying -insomnia/excessive sleeping -appetite changes -difficulty concentrating or making decisions -lack of interest in activities -lack of concern about appearance -hostility towards self and others including the newborn
nursing management thromboembolic conditions
-prevention -adequate circulation -NSAID's -BR -stockings -anticoag therapy (heparin) -emergency measure for PE
Which instruction would the nurse include in the teaching plan for a postpartum woman with mastitis? A. "Try applying warm compresses to your breast to encourage the milk to be released." B. " You'll need to take this medication to stop the milk from being produced." C. "Limit the amount of fluid you drink so your breasts don't get much fuller." D. "Stop breastfeeding until the pain and swelling subside."
"try applying warm compresses to your breasts to encourage the milk to be released."
cause of metritis
- prolonged rupture of membranes (over 24 hours) -C/S, instruments, long labors, diabetics, low socioeconomic status -internal monitoring -multiple vaginal exams during labor -soft tissue damage -preexisting bacterial vaginosis -compromised health status
risk factors of thromboembolic conditions
-C/S -prolonged immobility/standing -use of oral contraceptives -obesity -cigarrete smoking -varicose veins -trauma -diabetes -multiparity -advanced maternal age (over 35)
misoprostol (cytotec)
-contracts uterus -given rectally -C/I: allergy, pulmonary disease and hepatic disease -not FDA approved for PPH
PP infection
-fever of 100.4 or greater -organisms (vaginal flora) -metritis -wound infection -UTI -mastitis
s/s of mastitis
-flu like symptoms (malaise, chills, body aches) -breasts- red, tender, hot to touch
nursing management PPH
-fundal massage and pad count -administration of oxytocic medications -fluid administration -monitor for signs and symptoms of shock -emergency if DIC occurs
risks for developing a PP mood disorder
-hormonal changes -unresolved feelings about pregnancy -fatigue -inadequate assistance from partner -little social support -hx of abuse -financial insecurity -doubts about being a good mother -stress -loss of freedom and identity
UTIs are caused by
-laceration (especially of the urethra) -catheterizing -manipulation of perineum -BM during pushing -use of instruments
PP psychosis symptoms
-mood lability -delusional beliefs -hallucinations -disorganized thinking
Saturation of peripad within 60 minutes is
considered excessive
Methergine (Methylergonovine)
-simulated contraction of uterine smooth muscle -side effects: nausea/vomiting, cramps **use cautiously with hypertensive patients
nursing management for PP depressive diorders
-recognize risk/early identification -monitor mother-infant interactions more closely -be supportive/demonstrate caring -education -screen for excess fatigue*** -provide anticipatory guidance -help mother verbalize feelings -helping family members (if mom has it, dad is 10x more likely to have it as well) -discuss resources -antidepressants
causes of subinvolution
-retained placental fragments -distended bladder -uterine myoma -infection
risk factors of mastitis
-stasis of milk (clogged duct, baby sleeps longer @ night, weaning baby off) -nipple trauma -most common organism (s. aureus; from baby sucking)
signs of metritis
-temp greater than 100.4 36 hours prior to delivery -purulent, foul smelling lochia -chills, anorexia, malaise -tachycardia -delayed involution -uterine/abdominal tenderness -abnormal lab results -increasing WBC -increased sedimentation rate
five t's of hemorrhage
-tone (uterine atony -tissue (retained placenta/clots) -trauma (vaginal, cervical, uterine injury) -thrombin (coagulopathy) -traction (pulling of UC)
cause of PPH
-uterine atony ** -lacerations of genital tract - episiotomy -retained placental fragments -uterine inversion -coagulation disorders -hematoma of vulva, vagina or subperitoneal areas
A client arrives in the emergency department accompanied by her husband and new 10 week old infant, crying, confused and with possible hallucinations. The nurse recognizes this could possibly be postpartum psychosis as it can appear within which time frame after birth ? A. 2 months B. 4 months C. 3 months D. 5 months
3 months
carboprost tromethamine (hemabate)
PPH that does not respond to pitocin or methergine -last resort, very potent -pregnant women cannot handle this; can cause loss of pregnancy side effects: n/v/d, fever -C/I if client has asthma
nursing assessment of wound
REEDA -redness -edema (swelling of tissues) -ecchymosis (skin discoloration) -drainage/discharge (purulent from drainage site) -approximation (gaping wound edges) generalized fever tenderness
baby blues
characterized by mild depression interspersed with happy feelings -does not affect the woman's ability to function or care for the baby -begins with 4 to 5 days PP and usually resolves by day 10 -may feel overwhelmed, unable to cope, fatigued, irritable, and oversensitive -episodic tearfulness and rapid mood swings without an identifiable reason
A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first? A. STI status B. coagulation studies C. HIV studies D. urinalysis results
coagulation studies
sub involution
failure of the uterus to return to a non-pregnant size (contract down)
Which findings would lead the nurse to suspect that a postpartum woman has developed endometritis? SATA. A. hematuria B. foul-smelling lochia C. leukocytosis D. pain on both sides of abdomen E. flank pain
foul-smelling lochia, leukocytosis, pain on both sides of abdomen
complications of subinvolution
hemorrhage, pelvic peritonitis, salpingitis, abscess formation
signs and symptoms of shock
hypotension, tachycardia, diaphoretic, pallor, losing consciousness
mastitis
inflammation of the breast -often in the upper outer quadrant -unilateral -very common infection in PP women (5% of women)
metritis
inflammation of the uterus -localized infection of the lining of the uterine wall beginning at the placental site
A client presents to her PP appointment with vague reports. The nurse suspects PPD based on which assessment findings? A. lack of pleasure B. extreme periods of elation C. feels like eating all the time D. over interest in her baby
lack of pleasure
PPH C/S delivery
more than 1000mL of blood loss
PPH vaginal delivery
more than 500 mL of blood loss
A woman presents to her first PP visit reporting she does not feel well. Which findings would lead the nurse to suspect that she has developed endometritis? SATA. A. flank pain B. pain on both sides of abdomen C. odorless lochia D. leukocytosis E. heamaturia
pain on both sides of abdomen and leukocytosis
postpartum psychosis
psychiatric emergency -increased risk of suicide and infanticide -usually occurs with 3 months of giving birth
Methylergonovine is prescribed for a woman experiencing PPH. The nurse monitors the woman closely for which adverse effects? A. headache B. uterine hyperstimulation C. flushing D. seizures
seizures
Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions ? SATA. A. septicemia B. isoimmunization C. abruptio placenta D. ectopic pregnancy E. severe preeclampsia
septicemia, abruptio placenta, and severe preeclampsia