Postpartum complications
Carboprost
Which medication is contraindicated in asthma? Oxytocin Carboprost Methylergonovine Mistopertol
Mistopertol
Which medication is contraindicated in cardiovascular disease, hepatic, pulmonary disease? Oxytocin Carboprost Methylergonovine Mistopertol
Methylergonovine
Which medication is contraindicated in hypertension? Oxytocin Carboprost Methylergonovine Mistopertol
impaired urinary elimation
Which nursing diagnosis would be most appropriate for a client with a postpartum hematoma?
1. fundal massage 2. replace fluid 3. administration uteriotic medications (helps pieces of hemorrhage to come out)
What is the management for hemorrhage?
uterine atony inability of the uterus to contract lacerations of uterus, cervix retained placenta
What are the causes of hemorrhage
Inability to concentrate Decreased interest in life Loss of confidence Lack of pleasure Change in appetite, sleep, weight Lack of interest in baby
What are signs of postpartum depression?
Monitor vital signs Pad count Assess uterine tone
A nurse is assessing a client with postpartal hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply.
Impaired tissue integrity Risk for injury Ineffective tissue perfusion
A nurse is caring for a client with a postpartum laceration. Which nursing diagnoses would be most appropriate? Select all that apply. Ineffective tissue perfusion Ineffective thermoregulation Risk for injury Risk for disuse syndrome Impaired tissue integrity
Oxytocin
What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage?
symphysis pubis uterus and prevent possible uterine inversion.
Before initiating fundal massage, the nurse must first place a hand over the ______________ to anchor the ____________________________________
Subinvolution
What is the most common cause of late postpartum hemorrhage?
uterine atony
What is the most common cause of postpartum hemorrhage?
24 hours 1000 mL 500 mL
Early postpartum hemorrhage happens in the first ____________ hours and cumulative blood loss of ____________ or greater in a c section and ____________ in a vaginal birth.
1. antibiotics therapy 2. Continue empty of breast 3. Continue breastfeeding
Intervention for Mastitis
psychotherapy social support medication ( prozac, paxil, zoloft, lexapro)
Intervention for baby blues?
Oxytocin
Medication Stimulates the uterus to contract/to contract the uterus to control bleeding from the placental site
Yes. while taking her antibiotics, it will not harm the infant
Should the mother still breastfeed with mastitis?
breastfeed or Empty the breast every 1 to 2 hours
What is the most important self care when having mastitis?
The client has a history of epidural anesthesia. If a client has an epidural, her sensation of pain is decreased, so nurses cannot rely on client reports of pain as a symptom of a perineal hematoma.
Upon examination of a postpartal client's perineum, the nurse notes a large hematoma. The client does not report any pain, and lochia is dark red and moderate in amount. Which factor would most likely contribute to the nurse not discovering the perineal hematoma prior to the examination? The client is receiving oral pain medications. The client had an episiotomy. The client has a distended bladder. The client has a history of epidural anesthesia.
Consistency Shape Location
What should you assess the fundus for?
pad count.
What should you monitor every hour for hemorrhage?
Uterine massage Check bladder for distension Lab studies Provide fluids and medication
What to collobarate with the provider about hemorrhage?
Elevated BP (do not give if hypertension)
Why do we give methylergonovine (methergine) for uterine atony?
.b) Her blood pressure is below 140/90. Methylergonovine elevates blood pressure. It is important to assess that it is not already elevated before administration.
You administer methylergonovine (Methergine) 0.2 mg to a postpartal woman with uterine subinvolution. Which of the following assessments should you make prior to administering the medication? a) She can walk without experiencing dizziness .b) Her blood pressure is below 140/90. c) Her hematocrit level is over 45%. d) Her urine output is over 50 mL/h.
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.
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? a) Early postpartum hemorrhage b) Late postpartum hemorrhage c) Pelvic hematoma d) Uterine laceration
Hypovolemic shock
_________________ occurs when excessive blood loss.
mastitis
inflammation of the breast
1. Fundal massage (massage until firm and express clots) 2. Empty Bladder 3. Provide fluid replacement' 4. Medication (oxytocin, Methergine, Misoprostol) 5. Bimanual compression 6. Balloons to apply pressure to uterine wall 7. Hysterectomy (Measures to contract the uterus)
Interventions for uterine atony?
24 hrs up to 12 weeks
How long is late postpartum hemorrhage
Estimate the size of the hematoma and report it • Administer a mild analgesic as prescribed • Apply an ice pack to the site
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? (Select all that apply.) a) Administer an antibiotic b) Administer a mild analgesic as prescribed c) Apply an ice pack to the site d) Administer methotrexate e) Perform fundal massage f) Estimate the size of the hematoma and report it
d) Uterine protrusion into the vagina To determine if the uterine prolapse in the client is mild or severe, the nurse should assess for uterine protrusion of the cervix and uterus into the vagina.
A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? a) Uterine bleeding present b) Foul smelling lochia c) Pain in the lower abdomen d) Uterine protrusion into the vagina
d) Semi-Fowler's. A semi-Fowler's position encourages lochia to drain so it will not become stagnant and cause further infection. Placing the woman flat in bed, on her left side, or in the Trendelenburg position would be contraindicated.
A postpartum woman is diagnosed as having endometritis. Which position would you expect to place her in based on this diagnosis? a) On her left side. b) Flat in bed. c) Trendelenburg. d) Semi-Fowler's.
a) Endometritis
A woman is two weeks postpartum when she calls the clinic and tells the nurse that she has a fever of 101°F. She complains of abdominal pain and a "bad smell" to her lochia. The nurse recognizes that these symptoms are associated with which condition? a) Endometritis b) Episiotomy infection c) Mastitis d) Subinvolution
Encourage an oral intake of 2 to 3 liters per day.
A woman who gave birth to an infant 3 days ago has developed a uterine infection. She will be on antibiotics for 2 weeks. What is the priority education for this client?
Check for bladder distension while encouraging the client to void
The nurse notes that a client's uterus, which was firm after the fundal massage, has become "boggy." Which intervention would the nurse do next?
postpartum hemorrhage
This remains a major cause of maternal mortality and mobidity
Assess for uterine contractions. The nurse needs to identify whether the bleeding is from lacerations or uterine atony. This can be done by looking for a well contracted uterus with bright-red vaginal bleeding.
Upon assessment, the nurse notes a postpartum client has increased vaginal bleeding. The client had a forceps birth that resulted in lacerations 4 hours ago. What should the nurse do next?
loss of interest in usual activity emotional responses to family shame anxiety unable to feel pleasure of love
What are some signs of baby blues?
Fever chills malaise breast tender/ pain redness
What are symptoms of mastitis?
report the finding to provider administer a mild analgesics' Apply ice pack (cover with towel) - prevents bleeding Estimate size of hematoma and report it
What are the intervention you will provide for hematoma?
Fundus is difficult to locate Boggy or soft fundus Firm Excessive lochia and clots
What happens when a patient has uterine atony?
b) Obtain a clean-catch urine specimen The client in this scenario shows classic signs of a urinary tract infection. The priority nursing action at this point is to obtain a clean-catch urine specimen to confirm the infection
A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action? a) Administer amoxicillin, as prescribed b) Obtain a clean-catch urine specimen c) Encourage her to drink large amounts of fluid d) Suggest that she take an oral analgesic
length of labor
An Rh positive client vaginally gives birth to a 6 lb, 10 oz (3,005 g) neonate after 17 hours of labor. Which condition puts this client at risk for infection?
1. Antibiotics 2. phenazopyridine
Intervention for urinary tract infection
seizures Seizures, hypertension, uterine cramping, nausea, vomiting, and palpitations are adverse effects of methylergonovine. Uterine hyperstimulation is an adverse effect of oxytocin. Flushing and headache are adverse effects of carboprost.
Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? uterine hyperstimulation seizures flushing headache
Unable to recognize reality, communicate, and relate to others
What are signs of postpartum psychosis?
prolonged discharge of lochia irregular/excessive bleeding low back pain fatigue profuse hemorrhage (nurses should teach the parents about the signs to be reported)
What are signs of subinvolution?
type 1 diabetes prolonged labor cesarean birth
What is a risk factor for developing a postpartum infection? Select all that apply. type 1 diabetes thin build prolonged labor cesarean birth rupture of membranes at time of birth
adequate rest
What is the most important intervention for postpartum depression?
removal of milk in the breast as often as possible
What is the treatment for mastitis?
b) Massaging the fundus firmly Initial management of excessive postpartum bleeding is firm massage of the fundus and administration of oxytocin (Pitocin).
When monitoring a postpartum client 2 hours after delivery, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially? a) Performing bimanual compressions b) Massaging the fundus firmly c) Notifying the primary health care provider d) Administering ergonovine (Ergotrate)
in the reproductive tract
When planning care for a postpartum client, the nurse is aware that which site is the most common for postpartum infection? in the milk ducts in the reproductive tract in the urinary bladder within the blood stream
c) Her uterus is at the level of the umbilicus.
Which assessment on the third postpartal day would make you evaluate a woman as having uterine subinvolution? a) Her uterus is three finger widths under the umbilicus. b) She experiences "pulling" pain while breastfeeding. c) Her uterus is at the level of the umbilicus. d) Her uterus is 2 cm above the symphysis pubis.
Baby blues
a disability disorder that affects the entire family
