post partum maternal complications
Terms
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- in post partum hemorrage blood loss is
- > 500 ml (vag delivery) >1000 ml (c/s)
- uterine atony is what
- a boggy uterus
- uterine atony (boggy) is from what
- -uterus is unable to contract
- what are the s/s of uterine atony
- -the uterus will be difficult to palpate -soft or boggy feel when palpated -uterus will firm up when palpated, but relaxes when massage is stopped
- why will use of tocolytic drugs cause post partum hemmorrage
- they will stop contractions
- what tocolytic drug would be used to stop contractions
- mag sulfate
- what can the overuse of oxytocic drugs cause
- post partum hemorrhage
- what oxytocic drug would be used to induce labor
- pitocin
- why would pitocin cause post partum hemorrhage
- -will tire out the uterus, not allowing it to contract after delivery
- what kind of labor could cause post partum hemorrhage
- - precipitate labor (fast) - prolonged labor
- what are some predisposing factors for post partum hemorrhage
- -previous event -use of forceps -general anesthesia -placenta previa -placenta acreta (placenta grows into the uterus) -clotting disorders -manual removal of placenta
- what actions would the nurse take for a post partum hemorrhage
- -message fundus first -empty bladder -rapid iv infusion of pitocin -parental administration of methergine / hemabate
- what is hemabate
- a medication that will cause uterine contractions
- what type of medication is hemabate
- -prostaglandin -oxytocic
- what should you monitor when giving hemabate and why
- -bp - will make bp go up
- what is methergine
- a medication that causes uterine contractions
- what drug should you never use during pregnancy, why
- -methergine -will shut off perfusion to the baby
- what is the only type of birth that a hematoma is seen in
- vag birth
- what is a uterin inversion
- the uterus completely or partially turns inside out
- what would cause a uterine inversion
- -pulling on the umbilical cord before seperation -fundal pressure before or after birth -congenital weakness of uterine wall
- what are the s/s of a uterine inversion
- -interior of the uterus may be seen through the cervix -interior of the uterus may be protruding into the vagina -massive hemorrhage
- what is the treatment for a uterine inversion
- -rapidly replace the uterus through the vagina
- when can pitocin be given for a uterine inversion
- -only after the uterus is replaced
- define sub involution of the uterus
- a slower than normal return of the uterus to its nonpregnancy size
- what is the most common cause of sub involution of the uterus
- -retained placental fragments -pelvic infection
- prolonged lochial discharge, excessive bleeding, pelvic pain, and the uterus feeling large and soft are signs of what
- sub involution of the uterus
- what treatment is given for a sub involution of the uterus
- -methergine (causes uterine contractions) -antibiotics for infection
- a thombus is
- -a clot -collection of clotting factors, platelets and fibrin on a vessel wall
- thrombophlebitis is
- -inflamation -inflammatory process in the vessel wall
- what are the main causes of thomboembolic disorders
- -venous stasis -hypercoagulable blood -injury to the lining of the blood vessel
- what intervention would the nurse do to prevent thrombosis
- -get the patient up and ambulating
- what interventions would the nurse do to prevent thrombosis
- -identify pt at risk -early ambulation -rom exercise if cant ambulate -scd device
- what treatment would you give for a dvt
- -bed rest with gradual ambulation -anticoagulant therapy, iv heparin -analgesics -moist heat
- what medication would you not give during pregnancy for a dvt
- -coumadin
- a puerperal infection is
- -a post partum infection -temp will be 100.4 after 1st 24 h and less than 10 days
- metritis is
- an infection in the uterus
- wha are the s/s of metritis (infection of the uterus)
- -fever, chills, malaise, lethargy, anorexia, abdominal pain, foul smelling lochia
- what would the wbc count be for metritis
- 20000
- what is the best prevention for wound infection
- good hand washing
- what are s/s of infection in a wound
- -edema -warmth -redness -tenderness -malaise -pain -edges of wound seperated -fever
- what is mastitis
- infection in the lactating breast
- what signs would you see in mastitis
- -feels like the flu -cant raise arm -fever of 101.1
- what can a woman do to prevent mastitis
- -keep nipple intact -wash hands -lanolin on nipple -change positions when feeding -change sides when feeding -break seal before baby removal
- wha are the normal post partum stages
- -taking in -taking hold -letting go
- how would you describe the taking in stage
- - the "its all about me stage" -may talk a great deal about delivery -may ask many questions
- what stage does the mother start to focus on the needs of the infant
- -phase 2 -taking hold stage
- what happens in phase 2 (maternal)
- -transfers from dependant to independant -begins to focus on needs of the infant -relinquishes pregnant role -takes on maternal role
- what phase is a good stage for teaching
- phase 2 (taking hold )
- when does the mom refocus on relationship with partner
- phase 3 (letting go)
- what s/s would you see in post partum blues
- -irritability -crying spells -sleeplesness -moodiness -anger
- what are the risk factors for post partum depression
- -hormaonal fluctuation -medical problems during pregnancy -hx of depression -low self asteem -marital problems -lack of social support -fatigue / sleep deprivation
- what are the s/s of post partum depression
- -exaggerated and prolonged irritability -withdrawal -shows less interest in surroundings -unable to feel love or pleasure -fatigue -difficulty in concentration -little interest in food
- when a patient is out of touch with reality they are suffering from
- post partum psychosis
- what are the symptoms of post partum psychosis
- -psychotic -hallucinations -phobias