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Questions and Answers
What is the first step in controlling postpartum hemorrhage?
What is the first step in controlling postpartum hemorrhage?
Attempt uterine massage to encourage contraction
What are some predisposing factors for cervical and perineal lacerations?
What are some predisposing factors for cervical and perineal lacerations?
Retained placental fragments can lead to uterine bleeding.
Retained placental fragments can lead to uterine bleeding.
True
_______ is a condition where the placenta does not completely deliver after birth.
_______ is a condition where the placenta does not completely deliver after birth.
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What is a hematoma related to in assisted vaginal delivery?
What is a hematoma related to in assisted vaginal delivery?
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What are common signs of localized perineum, vulva, and vagina infections?
What are common signs of localized perineum, vulva, and vagina infections?
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A hematoma in assisted vaginal delivery usually occurs in the area of the lateral wall.
A hematoma in assisted vaginal delivery usually occurs in the area of the lateral wall.
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Late postpartal hemorrhage occurs most often within postpartum day 6 to __ days.
Late postpartal hemorrhage occurs most often within postpartum day 6 to __ days.
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Match the bacterial causative agents with their respective names:
Match the bacterial causative agents with their respective names:
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What is a common symptom of postpartum depression?
What is a common symptom of postpartum depression?
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Which of the following are risk factors for thromboembolic disorders postpartum?
Which of the following are risk factors for thromboembolic disorders postpartum?
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Postpartum thrombocytosis leads to decreased platelet adhesiveness.
Postpartum thrombocytosis leads to decreased platelet adhesiveness.
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Thrombophlebitis is inflammation of the lining of a blood vessel, commonly occurring in the ______ period.
Thrombophlebitis is inflammation of the lining of a blood vessel, commonly occurring in the ______ period.
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Match the thromboembolic disorder with its description:
Match the thromboembolic disorder with its description:
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What is a priority nursing diagnosis related to thromboembolic disorders postpartum?
What is a priority nursing diagnosis related to thromboembolic disorders postpartum?
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What is the single most significant risk factor for a Caesarian delivery?
What is the single most significant risk factor for a Caesarian delivery?
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Which invasive procedures contribute to the risk of postpartal infections? (Select all that apply)
Which invasive procedures contribute to the risk of postpartal infections? (Select all that apply)
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Post-delivery urinary tract infections are usually caused by E. Coli bacteria. (True/False)
Post-delivery urinary tract infections are usually caused by E. Coli bacteria. (True/False)
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Breast mas@@s is an infection primarily in women who are ________.
Breast mas@@s is an infection primarily in women who are ________.
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What are common causative organisms for breast infections like mas@@s? (Select all that apply)
What are common causative organisms for breast infections like mas@@s? (Select all that apply)
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What is another term for Postpartum Major Mood Disorder?
What is another term for Postpartum Major Mood Disorder?
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What percentage of pregnancies experience Postpartum Depression?
What percentage of pregnancies experience Postpartum Depression?
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Postpartum Psychosis occurs in 1-2 of every 1000 births.
Postpartum Psychosis occurs in 1-2 of every 1000 births.
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What is the primary treatment for Postpartum Psychosis?
What is the primary treatment for Postpartum Psychosis?
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Match the following counseling types with their descriptions:
Match the following counseling types with their descriptions:
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What is one of the potential complications that preterm infants are particularly susceptible to?
What is one of the potential complications that preterm infants are particularly susceptible to?
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What medication is often given to preterm infants to replace the natural surfactant in their lungs?
What medication is often given to preterm infants to replace the natural surfactant in their lungs?
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Preterm infants lack ____, making their lungs prone to respiratory distress syndrome.
Preterm infants lack ____, making their lungs prone to respiratory distress syndrome.
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Preterm infants are more susceptible to indirect bilirubin effects than full-term infants.
Preterm infants are more susceptible to indirect bilirubin effects than full-term infants.
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What is a possible test that may be done for a premature infant to check the brain for bleeding or fluid buildup?
What is a possible test that may be done for a premature infant to check the brain for bleeding or fluid buildup?
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What factors predispose infants to respiratory difficulty in the first few days of life?
What factors predispose infants to respiratory difficulty in the first few days of life?
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Premature infants should be breastfed if possible because of the same signs as term infants, such as roothing and crying and sucking motions, to establish ____________.
Premature infants should be breastfed if possible because of the same signs as term infants, such as roothing and crying and sucking motions, to establish ____________.
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Preterm birth occurs in approximately 7% of live births of white infants.
Preterm birth occurs in approximately 7% of live births of white infants.
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How is a preterm infant traditionally defined based on gestation or weight?
How is a preterm infant traditionally defined based on gestation or weight?
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What does PVL stand for in relation to preterm infants?
What does PVL stand for in relation to preterm infants?
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What is a possible outcome evaluation for a preterm infant in terms of maintaining temperature?
What is a possible outcome evaluation for a preterm infant in terms of maintaining temperature?
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Post-term infants are susceptible to hypoglycemia.
Post-term infants are susceptible to hypoglycemia.
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A post-term infant is one born after the __ week of gestation.
A post-term infant is one born after the __ week of gestation.
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Study Notes
Postpartal Hemorrhage
- Postpartal hemorrhage is excessive bleeding (> 500 ml in vaginal delivery) following delivery.
- Types of postpartal hemorrhage:
- Early (primary): Blood loss during the first 24 hours after delivery.
- Late (secondary): Blood loss between 24 hours and 6 weeks after delivery.
- Conditions that increase the risk of postpartal hemorrhage:
- Prolonged third stage of labor
- Deep anesthesia or analgesia
- Retained placental fragments
- Maternal age > 35 years
- Previous uterine surgery
- Prolonged and difficult labor
- Secondary maternal illness (e.g., anemia)
- Prior history of postpartum hemorrhage
Causes of Postpartal Hemorrhage
- Uterine atony (lack of uterine muscle tone)
- Lacerations (cervical, vaginal, or perineal)
- Retained placental fragments
- Uterine inversion
- Disseminated intravascular coagulation
Uterine Atony
- The lack of uterine muscle tone, leading to excessive bleeding.
- Causes:
- Conditions that overdistend the uterus (e.g., multiple gestation, hydramnios)
- Conditions that affect uterine contractility (e.g., prolonged labor, precipitous labor)
- Therapeutic management:
- Attempt uterine massage to encourage contraction
- Remain with the woman after massaging her fundus to ensure it is not relaxing again
- Observe fundic height and consistency and lochia carefully
Retained Placental Fragments
- A condition where the placenta does not deliver entirely, leaving fragments behind.
- Causes:
- Prolonged labor
- Opera@ve delivery (forceps or vacuum extraction)
- Prolonged second stage of labor
- Therapeutic management:
- Removal of the retained placental fragment
- Dilation and curettage (D & C) may be performed to remove the placental fragment
Lacerations
- Either cervical, vaginal, or perineal lacerations may occur.
- Predisposing factors:
- Primiparous state
- Epidural anesthesia
- Precipitous childbirth
- Macrosomia
- Forceps or vacuum-assisted birth
- Mediolateral episiotomy
Disseminated Intravascular Coagulation
- A complex disorder caused by overs@imulation of clotting and anti-clotting mechanisms.
- Predisposing factors:
- Pre-eclampsia or eclampsia
- Amniotic fluid embolism
- Sepsis
- Abruptio placenta
- Prolonged intrauterine fetal demise
Late Postpartal Hemorrhage
- Bleeding after 24 hours until the sixth week postpartum.
- Subinvolution (failure of the uterus to return to normal size after pregnancy)
- Lochia may not progress from rubra to serosa to alba normally.### Postpartal Infections
- Postpartal infections can occur within the first 6 weeks after childbirth or 4 weeks after abortion.
- The uterus may feel larger and softer, and the client may experience pain or tenderness over the uterus.
- Predisposing factors include:
- Caesarian delivery
- Anemia
- Prolonged rupture of membranes
- Invasive procedures such as internal fetal monitoring
- Multiple vaginal examinations
- Retention of placental fragments
- Chorioamnionitis
- Preexisting bacterial vaginosis
- Manual removal of placenta
- Nursing assessment:
- Temperature greater than 100.4°F on any 2 of the first 10 days postpartum, excluding the first 24 hours
- Abnormal lochia
- Foul odor
- Scant or profuse lochia in amount
- Tachycardia
- Delayed involution
- Fundal height does not descend as expected
- Pain, tenderness, or inflammation of the perineum
- Backache
- Malaise
- Fatigue
- Chills
- Abnormal laboratory results
- Priority nursing diagnosis:
- Hyperthermia
- Risk for altered parenting
- Risk for impaired parent/infant attachment
Wound Infection
- Wound infection can occur in the abdominal incision for Caesarian delivery or the episiotomy site.
- Infection rate following Caesarian births is 3-5%, with the highest rate occurring after emergency Caesarian.
- Culture of wound drainage frequently reveals mixed pathogens.
- Nursing assessment:
- REEDA assessment:
- Redness
- Edema
- Ecchymosis
- Discharge
- Body temperature
- Localized tissue warmth
- Tenderness
- Generalized fever
- REEDA assessment:
- Priority nursing diagnosis:
- Hyperthermia
- Acute pain
- Deficient knowledge
MASTITIS or Breast Infection
- Mastitis is an infection of the breast connective tissue, primarily in women who are lactating.
- Causative organisms include Staphylococcus aureus, Escherichia coli, Haemophilus parainfluenzae, and Streptococcus species.
- Predisposing factors:
- Traumatized tissue, fissured or cracked nipples
- Engorgement, milk stasis, or poor drainage of milk
- Missed feedings
- Lowered maternal defenses caused by fatigue or stress
- Poor hygiene practices
- Tight clothing or poor support of pendulous breasts
- Nursing assessment:
- Breast consistency
- Nipple condition
- Flu-like symptoms
- Generalized fever
- Body temperature
- Priority nursing diagnosis:
- Hyperthermia
- Acute pain
- Deficient knowledge
Urinary Tract Infections
- Urinary tract infections occur in 5% of postpartal women who have one catheterization and 50% of those with intermittent catheterizations.
- Infection can occur as cystitis (lower urinary tract infection) or pyelonephritis (upper urinary tract infection).
- Predisposing factors:
- Normal postpartal diuresis
- Increased bladder capacity
- Decreased bladder sensitivity from stretching or trauma
- Possible inhibited neural control of the bladder following the use of general or regional anesthesia
- Contamination from catheterization
- Nursing assessment:
- Frequency of urination
- Burning or urgency
- Hematuria
- Elevated temperature
- Flank pain
- Costovertebral angle tenderness
- Priority nursing diagnosis:
- Hyperthermia
- Acute pain
- Deficient knowledge
Thromboembolic Disorders
- Thromboembolic disorders may occur antepartally but are usually considered a postpartum complication.
- Types of thromboembolic disorders:
- Superficial thrombophlebitis (more common in the postpartum)
- Deep vein thrombosis (DVT)
- Septic pelvic thrombophlebitis
- Septic pelvic thrombophlebitis:
- Infection ascends upward along the venous system and develops in the uterine, ovarian, or hypogastric veins
- Usually unresponsive to antibiotics
- Characterized by abdominal or flank pain, present with guarding
- Occurs on the 2nd to 3rd postpartal day with fever and tachycardia
- Intermittent fever and chills may persist### Complications of Thrombophlebitis
- Thrombophlebitis can lead to inflammation, formation of blood clots, and pulmonary embolism
- Pulmonary embolism is a catastrophic event with a high mortality rate, often occurring within 30 minutes
- Contributing factors to pulmonary embolism include:
- Proximal VT and recurrent thromboembolic disease
- Increased risk with proximal VT and recurrent thromboembolic disease
- Nursing assessment for pulmonary embolism:
- Dyspnea and chest pain
- Diagnosis may be verified by V/Q scan, blood gas studies, or x-ray
Predisposing Factors for Thrombophlebitis
- Obesity
- Increased maternal age
- High parity
- Anesthesia or surgery resulting in vessel trauma or venous stasis
- Prolonged bedrest
- Caesarian birth
- Maternal anemia or diabetes
- Heart disease
- Endometriosis
- Varicosities, injury, or trauma to the leg
- History of deep vein thrombosis
- Cigarette smoking
Nursing Interventions for Thrombophlebitis
- Implementing support hose during labor and postpartum period
- Early ambulation following birth
- Performing regular leg exercises to promote venous return
- Monitoring for signs of pulmonary embolism
- Administering anticoagulant therapy and monitoring for signs of bleeding
- Maintaining bedrest and elevation of legs to decrease venous aching
- Promoting comfort and pain management
Postpartum Psychiatric Disorders
- Postpartum blues:
- Occurs in 50-70% of mothers
- Characterized by mild depression, tearfulness, and feelings of overwhelm
- Resolves spontaneously within 10 days
- Postpartum depression:
- Develops in 7-30% of postpartum women
- May occur anytime in the first postpartum year
- Characterized by feelings of guilt, crying, and overwhelm
- Treatment includes selective serotonin reuptake inhibitors (SSRIs), individual or group psychotherapy, and practical assistance with child care and daily life
- Postpartum psychosis:
- Occurs in 1-2 per 1000 births
- Characterized by severe mental illness, delusions, and hallucinations
- Requires hospitalization and treatment with antipsychotic medications, sedatives, and electroconvulsive therapy
Types of Psychotherapy
- Cognitive-behavioral therapy (CBT):
- Helps people identify and change negative thought patterns and behaviors
- Focuses on current problems and how to solve them
- Interpersonal therapy (IPT):
- Helps people understand and change underlying interpersonal issues
- Focuses on improving communication and relationships
- Psychodynamic therapy:
- Focuses on unconscious thoughts and feelings
- Helps people understand and change underlying psychological dynamics
- Supportive therapy:
- Provides guidance and encouragement to help people develop their own resources
- Focuses on building self-esteem, reducing anxiety, and improving social and community functioning
Risk Factors for Postpartum Psychiatric Disorders
- Previous postpartum psychosis
- History of bipolar disorder
- Prenatal stressors
- Obsessive personality
- Family history of mood disorder
- 10-25% reoccurrence rate in subsequent pregnancies
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Description
This quiz covers the conditions that lead to postpartum hemorrhage, a serious complication that occurs after delivery. It also explores the factors that increase the risk of postpartum hemorrhage.
