MB 4 Postpartum Sellers

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mthompson17
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213274
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MB 4 Postpartum Sellers
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2013-04-14 15:13:53
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Postpartum nursing
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postpartum nursing for test 4
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  1. Postpartum period?

    AKA?
    first 6 weeks folowing birth

    AKA puerperium
  2. 5 things that occur during the postpartum period?
    • 1. involution
    • 2. wound healing
    • 3. return to normal circulating volume
    • 4. return to normal endocrine function
    • 5. weight loss
  3. Involution?
    process of shrinking of uterus to prepregnancy
  4. What happens to blood volume during pregnancy?
    almost doubled
  5. What happens to hormones during pregnancy & postpartum?
    during pregnancy have high levels of pregesterone and estrogen to sustain pregnancy then goes away PP
  6. 3 process that occur and cause involution?
    • 1. contraction of uterine muscle fibers
    • 2. catabolism of enlarged uterine muscle cells
    • 3. epithelial regeneration
  7. What is the result of involution?
    shedding of the other portion of the endometrium and healing of the placental insertion site
  8. Why does uterus need to contract during involution?
    pinches off vessels and prevents bleeding and causes uterus to get smaller
  9. Where is epithelial regeneration occuring during involution?
    at the placental attachment site
  10. What will the healed uterine lining be like?
    will heal without scarring so that it does not interfere with future pregnancy implantations
  11. Total healing time postpartum?
    ~6 weeks
  12. Where will the placenta be located immediately PP?

    Where will it be 12 h PP?
    fundus will be midway b/t the pubic symphysis and the umbilicus

    will rise to umbilical level due to inflammatory process and swelling
  13. How will the fundus change daily?
    each subsequent day will descend by a fingerbreath
  14. When will the fundus cease to be palpable?
    day 14
  15. What can cause fundul height to be higher than normal?
    1. fibroids in the uterus
  16. Biggest concern during PP?
    hemorrhage:  if fundus is a little high but firm and she is not bleeding excessivly that is fine
  17. 2 main S./S uterus is not  contracting down?
    excessive bleeding, boggy uterus
  18. What causes after pains?
    uterine muscle contractions responsible for the descent of the uterus
  19. 2 characteristics of afterpains?
    • 1. feel like cramps
    • 2. usually subside withing 48 hours
  20. Tx of afterpains?
    ibuprofen/NSAIDS
  21. 3 types of lochia and when are they seen?
    • 1. Rubra - through day 3
    • 2. Serosa - days 4 - 10
    • 3. Alba - seen day 11 and then tapers off
  22. Rubra make-up and appearance?
    mostly blood with some decidual tissue and mucus - red
  23. Best drugs for PP afterpains?

    What should you ask first?
    ask them what/where pain is to be sure this is what it is

    NSAIDS are most effective
  24. Make up and appearance of serosa lochia?
    mostly serous with some erythrocytes, leukocytes, and mucus

    pink-brown in color
  25. Make up and appearance of lochia alba?
    made up of leukocytes, bacteria, some dcidual cells and epithelial cells, and mucus

    white to light yellow
  26. 3 characteristics of lochia?
    1. will pool while the pt is in a reclining position

    2. will be less in a post-c section mom b/c more of the lining tissue is removed with the procedure

    3. should not have a foul odor
  27. When should lochia assessments be performed and what should be included?
    should assess q 15 minutes for the first PP hour then q 4 h for the first 24 h

    should assess color, amount, odor
  28. What may occur when a woman stands up after reclining for a while after birth?

    Nursing responsibility?
    may have excess lochia and possible clots from pooling of  blood while reclining

    teach pt that this may occur
  29. Changes that occur in the cervix during PP?
    cervix will immediately be somewhat flaccid and possible edematous

    withing a week will be firm and opening will be diminishing in size

    will end up looking like a slit rather than a pinpoint opening
  30. What is the cervix?
    neck of the uterus
  31. What changes will occur in the vagina during PP?
    may be edematous, bruised, and have multiple small lacerations or episiotomy

    will regain tone, but will always be slightly larger than before pregnancy occurred
  32. Where are cuts for episiotomies done?

    How long does it take for them to heal?
    cut in the perineal area

    can take up to 6 months to heal
  33. What heals better:  a tear or an episiotomy?
    a tear will have a stronger heal r/t more fibers in diff areas
  34. What is the main reasons episiotomies are performed?
    to prevent tearing of the rectal mucosa
  35. REEDA?
    redness, edema, ecchymosis, discharge, approximation
  36. Teaching for women when leave hospital?
    nothing in vagina until have next check-up in 6 weeks

    no tampon, no sex, etc
  37. Normal blood loss during a vaginal and C-section?
    vag - 500 mL

    C-section - 1000mL
  38. Why is the normal blood loss during delivery tolerated by the woman?
    because of the increase in volume that occurred during the pregnancy
  39. When do you need to do a REEDA assessment if a person had a C section?
    if they tried to push but didn't deliver the baby or if the delivered one twin then had the other Csection
  40. What changes occur in the circulatory section during PP?
    1. blood to the uterus and placenta is shifted back into central circulation and causes increase in CO temporarily

    2. decrease in pressure on the vessels b/c the heavy uterus is not longer compressing them
  41. CO + ____ X ____.
  42. CBC of women that is normal PP?

    TX?
    will be anemic by CBC b/c blood is dilute in pregnancy and will be even more anemic PP

    almost all PP will be getting FE
  43. What does increased CO cause to occur during PP?
    increase CO -> increased SV -> body compensates by dropping HR -> temp bradycardia (50-60 BPM) in early PP
  44. What will occur in BP during first few days PP?
    may temp increase r/t increased CO & increased volume r/t uterus getting less BF
  45. High heart rate and low BP in PP?

    What is first assessment to make?
    hypovolemia

    check pad
  46. 2 ways that the body gets rid of excess fluid during PP?

    Nursing consideration?
    increased urination brought on by hormonal changes

    perspiration

    Need to teach the pt that these will occur
  47. Why is a PP pt at risk for thrombus formation?
    during PP period there is an increase in fibrinogen and clotting factors and decrease in fibrinolysis to prevent excess bleeding
  48. Fibrinolysis?
    break down of clots
  49. Important preventative measure to prevent thrombus formation during PP?
    early ambulation and mobility are important
  50. Four things to assess for circulatory function?
    • 1. vital signs: tachycardia and low BP = bad
    • 2. fundus and lochia:  want firm fundus level with umbilicus and scant-moderate lochia
    • 3. Homan's sign and exam of BLE (bilateral lower extremities) for color, temp, edema, pain, and pulses
    • 4. DTR- deep tendon reflexes - for PP pre-eclampsia and will not have reflexes if no blood flow
  51. DTR in pt with pre-eclampsia?
    will be hyper-reflexive
  52. Teaching for pt who is being discharged PP?
    • 1. normal lochia - rubra, change colors in a couple days, should not be soaking pads q hour
    • 2. should teach them that their circulatory system is changing and to change positions slowly, hot shower can cause vasodilation and lower BP
    • 3. need to know they are at risk for falls and fainting
  53. GI changes PP?
    constipation and associated gas pain
  54. Why does constipation occur during PP?
    • 1. decrese in motility
    • 2. pain meds
    • 3. pain from perineal trauma
    • 4. manipulation of the gut during C-section
    • 5. Fe supplements
  55. Why is flatulence a good sign during PP?

    What should we be doing?
    positive sign of a return to normal function

    nurses need to ask if they have been having any gas
  56. Tx for constipation PP?
    stool softeners
  57. Main priority r/t urination during PP?

    Intervention?
    full bladder can displace the fundus to the upper right quadrant - interferes with ability to contract and may lead to excessive bleeding

    ask p to void or cath if necessary then massage the fundus
  58. Factors that contribute to difficulty urinating during PP?
    • 1. trauma to areas
    • 2. epidural decreases sensation & reduces bladder control
    • 3. if had Foley may have decreased bladder control or decreased ability to void
  59. What urination probs may occur PP?
    1. may have incontinence/ stress incontinence caused by displacement caused during pregnancy

    2. may have difficulty voiding
  60. What may occur in muscles and joints during PP? 

    One of the causes of this?
    muscle aches and pains

    hormone relaxin diminishes as ligaments resume their pre-pregnant condition (tightens up)
  61. Diastasis recti?

    Assessment?

    Exercises to strengthen in bood?
    abd muscles that are longitudinal - split during pregnancy

    have pt do a crunch in bed and can feel muscles surrounding your hand
  62. Hormonal changes PP?
    1. dramatic drop in estrogen and progesterone

    2. prolactin increases

    3. oxytoncin triggers letdown
  63. What causes dramatic drop in estrogen and progesterone during PP?
    delivery of the placenta triggers it
  64. What causes increase in prolactin PP?
    prolactin increases during preg but is inhibited by the presence of progesterone and estrogen 

    after the placenta is delivered -> progesterone and estrogen decrease -> increased prolactin -> milk production
  65. Function of prolactin and oxytoncin PP?
    prolactin - milk production

    oxytocin - milk letdown
  66. What will occur due to the decrease in progesterone and estrogen?
    • 1. return of menstruation
    • 2. prolactin increase and lactation
  67. Important factors to teach pt about return of menstruation and ovulation?
    1. lactation may delay menstruation but not necessarily ovulation

    2. ovulatin may occur prior to the first menstruation

    3. discuss conception and desire for contraception before they leave the hospital
  68. Contraception during breast feeding?
    cannot take the combo BC pills but there are some that they can take
  69. 8 things that need to be done before pt leaves from PP?
    • 1. initially, REEDA & circulatory assessments
    • 2. assessment of bowel and bladder function
    • 3. newborn care and teaching about complications
    • 4. self-care and teaching and complications, S/S of infection, too much bleeding, avoiding per vagina, comfort measures
    • 5. contraception and her options
    • 6. assessment of bonding with the baby
    • 7. pain management
    • 8. any special considerations: Rhogam, rubella vaccine
  70. Special consideration for moms in PP who are Rh neg?
    need Rhogam shot within 72 hours of delivery
  71. Nursing consideration for mom PP who is getting a MMR for rubella vaccine?

    What other vaccine is offered?
    should not get pregnant again for at least 3 months

    pertussis vaccine b/c keeps her from passing it to her baby
  72. When may a PP mom get a rubella vaccine?
    if test shows that she is not immune to rubella she will be given MMR before leaving
  73. 6 basic comfort measures during PP?
    • 1. ice packs to the perineum
    • 2. squirt bottles with warm water for use after voiding and BM
    • 3. topical anesthetic sprays
    • 4. warm water perineal soaks
    • 5. pain meds
    • 6. oral narcotic pain meds
  74. How are ice packs used during PP?
    may have pads with ice pack already inside or can pull out some stuffing from a pad and insert an ice pack

    leave ice pack on until ice melts

    remove for at least 10 minutes before replacing
  75. Nursing consideration for a pt using topical anesthetic sprays?
    watch out for -caine allergies
  76. Nursing consideration for pt using warm water perineal soaks?
    be sure to clean tub soaking in b/t soaks
  77. What pain meds are often first choice after vag delivery?

    2 EX?
    NSAIDs r/t their anti-inflammatory action

    ibuprofen, toradol
  78. What type of pain med is often used post-csection?
    PCA
  79. Common narcotic pain med used PP?
    hydrocodone
  80. 3 phases that occur in becoming a mother PP?
    • 1. taking in
    • 2. taking hold
    • 3. letting go
  81. When using squirt bottle to cleanse after urinating or defecation what to teach pt?
    squirt off then pat dry

    pat dry instead of wiping
  82. Pt teaching for topical anesthetic sprays?
    will make the area numb
  83. What occur during the taking in phase of PP?
    • 1. mother is focused on her own need for rest, food, etc
    • 2. takes in every detail of her baby but is content to allow others to take the lead in caring for the child
    • 3. char by reliving the details of the labor and birth
  84. What occurs during the taking hold phase of PP?
    • 1. begins to reclaim responsibility for her own care
    • 2. begins to focus on the baby and is eager to learn
  85. What occurs during the letting go phase of PP?
    • 1. change in family structure (no matter how many babies they have had) - mother will accept this in this stage
    • 2.  may be a loss of child they imagined
  86. When is the best time to teach mother PP?
    when she is in the taking hold phase
  87. Important teaching when pt is going thru mothering phases of PP?
    1. teach pt that these feelings and stages occur

    2. teach them that it is normal for them to feel some disappointment about the baby if it is different from their dream baby - allow them to talk about these feelings and accept their feelings
  88. 3 bonding behaviors the mother may exhibit during PP?
    • 1. fingertipping - exploring baby with fingertips then whole hand then by embracing the baby close to her body
    • 2. binding in - begins relating child's features and behaviors to the family - (brother's hair)
    • 3. use of personal pronouns and the baby's name rather than it or the baby
  89. 4 ways the nurse can facilitate attachment?
    1. model behaviors such as fingertipping and use of baby's name

    2. ask questions such as "Whose nose do you think he has?"

    3.Point out reciprocal attachment behaviors by the baby, such as grasping the mother's finger or gazing at the mother's face

    4. provide ample opportunities to held the baby, but allow time for rest, eating, and show concern for mother's comfort
  90. S/S that mother is not bonding with baby?
    • 1. flat affect in general
    • 2. baby always in the bassinet
    • 3. not making eye contact with baby or doing bonding behaviors
  91. 3 degrees of PP depression?
    • 1. PP blues
    • 2. PP depression
    • 3. PP psychosis
  92. PP blues occurs in ____ % of mothers. 

    Characteristics of PP blues?
    70-80%

    transient and self-limiting
  93. Why does PP blues occur?
    b/c hormones drop due to loss of placenta producing them
  94. PP depression occurs in _____% of mothers.

    When can it occur?
    10-15%

    can occur anytime in first year of birth but usually occurs in 2 wks-3 months

    won't be seen in hospital usually
  95. PP psychosis occurs in ______ births.

    When can it occur?

    Nursing consideration?
    occurs in 1-2/1000 births

    can occur as early as PP day 2

    is an emergency
  96. Risk factors for PP depression?
    • 1. Hx of depression of other mental illness
    • 2. first pregnancy
    • 3. low self-esteem
    • 4. teen pregnancy
    • 5. family stressors
    • 6. multiple gestations
    • 7. health problems with the infant
  97. 4 characteristics of PP depression?

    8 other S/S of PP depression?
    • 1. depressed affect
    • 2. loss of interest in usual activities
    • 3. feelings of incompetency as a mother
    • 4. symptoms persist more than 2 weeks

    1anxiety, irritability, guilt, loss of sense of self, difficulty concentyrating, failure to eat, sleep disturbances, & suicidal thoughts
  98. Tx of PP depression?
    • 1. counseling for pt and family
    • 2. medication
    • 3. some cases require electroconvulsive therapy
  99. When should Tx of depression be started?
    do not wait to see if it lasts for 2 weeks - Tx if the S/S for depression are present
  100. Biggest risk factor for PP pregnancy?
    if they had it with previous pregnancies
  101. Meds used for PP depressin?
    1. selective seratonin reuptake inhibitors/SSRIs - EX:  effexor & zoloft

    2. tricyclic antidepressants (TCAs)- EX:  elavil/amitriptyline
  102. 5 characteristic S/S of PP psychosis?
    • 1. bizarre behavior
    • 2. agitation
    • 3. delusions
    • 4. confusion
    • 5. hallucinations
  103. Tx of PP psychosis?
    1. requires hospitalization to prevent suicide of infanticide

    2. medical Tx with antipsychotics and antidepressants
  104. Psychosis?
    break with reality
  105. How does ovulation occur?
    varying levels of estrogen and progestoerone during the ovulatory cycle trigger other hormonal changes that cause ovulation to occur
  106. How does hormonal contraceptive work?
    provides a consistant level of estrogen and progesterone which interupts the cycling of hormones in ovulatory cycle
  107. 5 forms of hormonal contraception?
    • 1. pill
    • 2. patch
    • 3. ring
    • 4. implants
    • 5. depo provera injection
  108. What is birth control patch called?
    ortho evra
  109. Contraceptive ring is called?
    nuvaring
  110. When is depo provera injection given?
    q 3 months
  111. 13 contraindications for oral contraceptives and the patch?
    • 1. Hx of thrombosis
    • 2. CVA
    • 3. CAD
    • 4. estrogen dependent cancer
    • 5. breast cancer
    • 6. poorly controlled HTN
    • 7. DM with vascular compromise
    • 8. some migraines (aura)
    • 9. impaired liver function
    • 10. undiagnosed vaginal bleeding
    • 11. smoking >15 cigs/day or any smoking if over 35 years old
    • 12. prolonged immobility
    • 13. current pregnancy
  112. What is in hormonal contraceptives?
    most are diff combos of estrogen and progesterone or may be progesterone alone
  113. Emergency contraceptive?

    Will it harm implanted pregnancy?
    usually involves taking high levels of progestin

    does not harm implanted pregnancy
  114. How do emergency contraceptives work?
    thickens cervical mucus to prevent sperm getting to the egg

    may also delay or prevent ovulation
  115. Biggest contraindication for hormonal contraceptives?
    smoking
  116. If a person is prolonged immobile why no hormonal contraceptive?
    greater risk for thrombosis
  117. 5 types of barrier contraception?
    • 1. condoms
    • 2. spermicides
    • 3. sponge
    • 4. diaphrag/cervical cap
    • 5. intrauterine device - some of these release hormones
  118. Who can get emergency contraceptive?

    Problem with this?

    Nursing consideration?
    ppl 17 and over can get OTC

    pharmacies may be unwilling to sell it

    teach pt do not need Rx
  119. 3 factors in natural family planning?
    • 1. usually require monitoring signs of ovulation
    • 2. some are strictly based on the number of days in the menstrual cycle
    • 3. abstain from intercourse during the period just prior to and immediately following ovulation
  120. Teaching for barrier contraceptives?
    better if combine barrier types:  spermicide and barrier
  121. How long are ova susceptible to fertilization?

    How long do sperm survive in vagina?
    ova susceptible for ~ 24 h

    sperm survive up to 80 hours
  122. Important for teaching adol?

    What about older ppl?
    • 1. pull out doesn't work
    • 2. do not douche after sex

    • 1. contraindications may occur if health probs
    • 2. smoking?
  123. S/S of ovulation that are use in family planning?
    • 1. take temp
    • 2. assessing discharge
  124. 2 permenant methods of contraception?
    1. bilateral tubal ligation

    2. vasectomy
  125. What is required for family planning contraception?
    a lot of motivation and dedication

    a lot of work involved
  126. Teaching for vasectomy and tubal ligation?
    1. should know that this is considered permenant - if they are not sure don't do it
  127. 6 considerations when picking contraceptive method?
    • 1. effectiveness
    • 2. acceptibility - messiness, self-touch, religious beliefs, cultural norms
    • 3. convenience and effect on spontaneity
    • 4. side benefits - amenorrhea, acne & migraine reduction (1 contraceptive helps)
    • 5. expense
    • 6. involvement of others - partner, parent/guardian
  128. 2 considerations with effectiveness of contraception?
    how effective is it and how important is it for them to not get pregnant
  129. What age will find self-touch contraceptives most aversive?
    younger ppl / adolescents
  130. EX of contraceptive that causes amenorrhea?
    depo provera
  131. How can partner effect contraceptive?
    • 1. how committed is partner
    • 2. are there various partners
  132. large factor in adol contraceptive?
    parent support and how much will they need parent help
  133. IUD functioning?
    inserted into the uterus - work by triggering inflammatory response & creating a hostile env for sperm

    some (mirena) release low levels of progestin to thicken cervical mucus & sometimes prevent ovulation
  134. Can women who can't take oral contraceptives use mirena?
    can usually use mirena b/c low levels
  135. Who is a good candidate for IUD?

    Who shouldn't use IUD?  When is it OK for them to use it?
    a person who cannot take oral contraceptives can usually use IUD

    person at high risk for STD's should not use IUDs due to increased risk of PID - if they regularly use condoms a person with mult sex partners can still use IUD
  136. Who is at high risk for STDs?
    multiple partners and don't use condoms
  137. What may occur with repeated STD infections?
    PID & infertility
  138. How is an IUD inserted?
    office procedure - through an introduction cannula -> through cervical opening -> pull out cannula and it opens up and stays in uterus (soft and flexible)- there are strings that will hang out (can be cut out if it is bothersome)
  139. What are strings on IUD for?
    check placement of IUD
  140. How long can mirena stay in place and be effective?
    5 years and will not effect fertility long-term after taken out
  141. How long may paraguard stay in place and be effective?

    What is it?
    10 years

    form of IUD
  142. Can you use tampons with IUD?
    yes
  143. How is IUD taken out?
    Pull string and it collapses in on itself and comes out
  144. Contraindications for placement of an IUD?
    • 1. leek procedure for abnormal pap smear can cause scar tissue that prevents penetration
    • 2. congenital anamaly that prevents insertion
    • 3. ppl who have not had vaginal deliveries it can be difficult to insert and cause more cramping
  145. Diaphragms are ____ contraceptives.

    What are they like?

    How are they used?

    Disadvantage?
    barrier

    soft and pliable

    put spermacidal gel in cup and insert into cervix

    must be fitted:  will need refitted after delivery or weight gain/loss, if don't feel comfortable touching themselves will not like it
  146. When should diaphragm be removed?
    leave in 8 hours after intercourse

    do not leave in longer than 24 hours
  147. How does nuvaring work?

    It is a ____ contraceptive.
    impregnated with hormones, does not cover cervix

    inserted into vagina and it expands, placement not critical, releases hormones

    hormonal
  148. Ortho evra is a _____ contraceptive.

    What locations can it be used on?
    hormonal

    hip, butt, shoulder blades, upper arm
  149. How is ortho evra delivered?
    transdermal
  150. Depo provera drug?

    Route of admin?
    medroxyprogesterone

    IM injection q 90 days
  151. Should not miss depo shot for more than ____ days or need to use a backup contraceptive.
    7
  152. What contraceptive is known to cause amenorrhea?

    Other advantage of this?
    depo provera

    shot q 3 months
  153. 2 categories of birth control pills?
    1. some change strength as go through cycle

    2. some have same dose throughout cycle
  154. Contraceptive that you can take indefinitely and not have a period?
    lybrel
  155. Is it necessary to have a period every month?
    no, it cannot harm you to not have a period every month
  156. Seasonique?
    have a period 4 times per year q 3 months
  157. Prob with seasonique and lybrel?
    they can cause breakthrough breathing
  158. 4 categories of PP complications?
    • 1. hemorrhage
    • 2. infection
    • 3. thrombosis
    • 4. depression and psychosis
  159. Primary and secondary hemorrhage PP?
    primary - occurs within the first 24 hrs following birth

    secondary - after first 24 hours
  160. Hct & HgB in PP?
    fluctuating so may be difficult to interpret
  161. What causes 90% of primary hemorrhage?

    Other causes?
    uterine atony

    trauma to birth canal, retained placenta, coagulation defects
  162. Atony?
    without tone
  163. Why are HgB and Hct not accurate indicator in PP?
    blood changes due to dilution during pregnancy and diuretic effects of PP period makes it fluctuate too much
  164. Uterine atony?
    uterine muscle does not contract prn in order to compress the blood vessels and stop bleeding
  165. 8 predisposing factors to uterine atony?
    • 1. multiparity
    • 2. multiple gestation
    • 3. polyhydramnios
    • 4. prolonged labor or precipitate labor
    • 5. C/S
    • 6. use of oxytocin in labor
    • 7. manual placenta removal
    • 8. uterine masses/fibroids
  166. What are predisposing factors to uterine atony r/t?
    fatigue of the uterine muscle
  167. What to do if hemorrhage occurs PP?
    • 1.massage the fundus
    • 2. assess for bladder distention & treat
    • 3. rapid infusion of dilute pitocin
    • 4. methergine
    • 5. various prostaglandins
    • 6. push IV fluids - lactated ringers
    • 7. transfuse with whole blood or packed RBC
    • 8. last resort = historectomy
  168. Route of admin of methergine?

    Action of methergine?
    IM ONLY!!

    potent vasoconstrictor
  169. Why massage the fundus if suspect hemorrhage PP?
    • 1. contracts uterus
    • 2. expel clots to allow uterus to be able to contract
  170. First thing to do if hemorrhage in PP?
    massage the fundus!!!
  171. What to do if bladder is full and displacing uterus?
    have then void or in and out cath
  172. 3 EX of prostaglandins used for PP hemorrhage?

    Their action?
    hemabate, prostin, cytotec

    stimulate uterine contractions
  173. What type of fluids will be pushed during PP hemorrhage?
    lactated ringers
  174. When delivery trauma be suspected as the cause of PP hemorrhage?
    any time the fundus is firm but excessive bleeding is present
  175. Tx for delivery trauma causing hemorrhage?
    often require surgery for repair
  176. 3 most common causes of secondary hemorrhage?
    • 1. delayed involution
    • 2. retained placental fragments
    • 3. infection
  177. When does secondary hemorrhage most commonly occur?

    Nursing consideration?
    6 - 14 days PP

    need to teach pt S/S b/c will usually occur after left hospital
  178. Tx of secondary hemorrhage?
    1. similar to primary hemorrhage:  oxytocin, prostaglandins

    2. ultrasound eval of the utrus for placental fragments or clots may be done

    3. dilation and curettage for fragment removal

    4. antibiotics for infection
  179. 4 Tx that may be done if immediate Tx are not effective for PP hemorrhage?
    • 1. bimanual uterine massage by MD
    • 2. use of a ballooon tamponade for direct compression within the uterus
    • 3. ligation of uterine arteries
    • 4. hysterectomy
  180. Body's compensatory response to hemorrhage?
    constricting peripheral vessels to shunt blood to vital organs & releasing catecholemines
  181. What occur if hemorrhage is not reversed after compensatory mechanisms have been stimulated?
    compensatory mechanisms will fail ->  organs fail due to blood shunted away from them-> lactic acid builds up = metabolic acidosis
  182. Effect of acidosis?
    vasodilation that can increase bleeding
  183. What will the bleeding be like in PP hemorrhage?

    Nursing consideration?
    may be gushing or cont. trickle

    make sure you look under them for pooling blood
  184. What may be occuring if there is no obvious bleeding but there are s/s of hemorrhage?

    Nursing consideration?
    may be forming a hematoma somewhere - need to inspect the perineum for hematoma

    REEDA
  185. What will happen to VS initially when hemorrhage occurs PP?

    Then what will occur?

    Other s/s
    may initially remain stable

    tachycardia, narrowing pulse pressure, tachypnea

    • 1. pallor
    • 2. coolness
    • 3. decrease in UOP b/c of blood shunted away from kidneys
    • 4. anxiety & sense of dread
    • 5. confustion
    • 6. lethargy
  186. Pulse pressure?
    difference b/t systolic and diastolic pressures
  187. 7 Tx for hypvolemic shock?
    • emergency!!
    • 1. v/s q 3 to 5 minutes
    • 2. fundal and lochia assessment and massage
    • 3. o2 sats
    • 4. foley for I& O recording
    • 5. O2 by nonrebreather facemask 8 to 10 L/min
    • 6. IV access and rapid infusion
    • 7. transfusion - will need large IV
  188. Where does superficial vein thrombosis usually occur?
    usually occurs in a varicosity (varicose vein)
  189. 2 char of superficial vein thrombosis?
    • 1. little risk of pulm embolus
    • 2. vein may be hardened
  190. Pain with superficial vein thrombosis?
    may complain of leg pain during ambulation
  191. Tx of superficial vein thrombosis?
    • 1. rest
    • 2. compression support - TEDS
    • 3. elevation
    • 4. heat therapy
    • 5. antiinflammatory meds
    • 6. ambulate gradually when s/s have resolved
  192. Purpose of TEDs?
    venous return
  193. Where does DVT occur?
    occur in deeper and often larger vessels
  194. Priority complication with DVT?
    significant risk of pulm embolus
  195. S/S of DVT?
    • 1. may be asymptomatic
    • 2. edema
    • 3. erythema
    • 4. change in temp:  warmer or cooler
    • 5. tenderness
    • 6. + Homan's sign
    • 7. pallor of the limb
    • 8. decreased pulses
    • 9. pain with ambulation
    • 10. malaise
  196. 3 Dx tests for DVT?
    • 1. doppler flow studies
    • 2. CT scan or MRI
    • 3. D-dimer blood test
  197. D-dimer test with DVT?
    helpful to rule it out

    if it is negetive means there isn't a DVT

    if it is positive can be # of conditions but could have a DVT
  198. Care of pt with a DVT?
    • 1. bedrest with limb elevation
    • 2. no massage of the limb
    • 3. pain control
    • 4. anticoagulant therapy
  199. Anticoagulant therapy with DVT?
    1. initially cont IV heparin

    2. prior to discontinuation of heparin will also begin warfarin

    3. will remain on warfarin for up to 6 months
  200. What are aPTT & PT/INR used for in anticoagulant therapy?
    used to det the app. dosing for the pt and may vary widely from pt to pt
  201. Nursing care of the client on anticoagulant therapy?
    1. monitor aPTT on heparin

    2. monitor PT/INR on warfarin

    3. Monitor for S/S of toxicity:  bruising, bleeding gums or nose, blood in urine, stool, petechiae, signs of blood loss
  202. Can PT/INR tell heparin levels or aPTT tell coumadin levels needed?
    no
  203. _____ is the leading cause of maternal death worldwide.
    infection
  204. 5 types of infection that may occur PP?
    • 1. endometritis
    • 2. wound infections
    • 3. UTI
    • 4. mastitis
    • 5. septic pelvic thrombophlebitis
  205. How often should labs for clotting be checked during anticoagulant therapy?
    q 6 h until get to therapeutic level then qd
  206. Endometritis?
    infection of the uterus
  207. Who is esp. at risk for endometritis?
    person with prolonged rupture of membranes or long period of time before delivery, post C-section, colonization of reproductive tract (GBS), DM
  208. What can cause mastitis PP?
    if baby doesn't latch on properly can crack nipples and get infected
  209. What organisms may cause endometritis?
    group A&B strep, E.coli, chlamydia is ass. with late endometritis
  210. Early rupture of membranes most important PP consideration?
    huge risk for infection
  211. 2 probs that can be caused by GBS (group B strep) infection?
    1. risk for endometritis

    2. risk for baby getting infection
  212. S/S of endometritis?
    • 1. fever - primary sign
    • 2. subinvolution - uterus larger than should be
    • 3. abd pain and tenderness - really sensitive during fundal massage
    • 4. purulent/foul smelling lochia
    • 5. elevated WBC
  213. When does endometritis usually occur?
    usually within first 2 days PP
  214. Tx of endometritis?
    • 1. IV antibiotics
    • 2. promote drainage - elevate HOB
    • 3. pain management
    • 4. monitor VS & WBC count
  215. How do you know if an antibiotic is effective?
    monitor WBC count
  216. Why elevate HOB for endometritis?
    to promote drainage
  217. Wound infections PP?

    Nursing consideration?
    episiotomy/tear

    C-section incision

    make sure follow MD orders for dressings etc
  218. Mastitis S/S?
    cone/wedge-shaped redness, edema, heat, pain, systemic symptoms (fever, malaise, may be very nauseated)
  219. Tx of mastitis?
    antibiotics and pump, pump, pump or cont to breastfeed
  220. Best thing to do to treat mastitis?
    continue to nurse - will not harm the baby
  221. If there is a broken area of skin on breast/absess what should be done?

    When is this a concern?
    do not nurse- must pump until healed

    only when it is close to the areaola and will be where the baby's mouth will be
  222. Teaching for breastfeeding with mastitis?
    begin by nursing on the unaffected side - will stim the let-down so minimal nursing is required on the painful breast to achieve emptying
  223. 4 nursing interventions/teaching for mastitis?
    • 1. may use ice or heat - heat before nursing
    • 2. breast support but not compression
    • 3. breast massage
    • 4. increase fluids
  224. Intervention that can stimulate let down in breast?
    heat therapy
  225. Septic pelvic thrombophlebitis? (SPT)
    infection that courses through the venous sytem of the pelvis and causes thrombophlebitis of these vessels

    2 probs:  infection -> triggers thrombus formation
  226. S/S of SPT?
    will have s/s of infection and thrombophlebitis: 

    • 1. s/s of infection
    • 2. groin pain
    • 3. abd pain
    • 4. if GI involved will have hypoactive bowel sounds
    • 5. N/V
    • 6. cramping
  227. Diff b/t S/S of endometritis and SPT?
    will be more GI s/s such as N/V along with s/s infection
  228. Key sign of SPT?  ***
    fever that does not respond to antibiotics
  229. Tx of SPT?
    ABX & anticoagulants
  230. Why does fever with SPT not respond to ABX?
    there is inflammation ass. with thrombophlebitis that contributes to fever and does not respond to ABX

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