Podcast
Questions and Answers
What is the primary nursing intervention for a postpartum client experiencing uterine atony?
What is the primary nursing intervention for a postpartum client experiencing uterine atony?
- Inserting a Foley catheter.
- Performing fundal massage. (correct)
- Initiating a blood transfusion.
- Administering a high dose of antibiotics.
A postpartum patient reports severe perineal pain and difficulty voiding. Assessment reveals a localized, bluish bulging area in the perineum. What condition does this suggest?
A postpartum patient reports severe perineal pain and difficulty voiding. Assessment reveals a localized, bluish bulging area in the perineum. What condition does this suggest?
- Uterine atony
- Deep vein thrombosis.
- Perineal hematoma. (correct)
- Pulmonary embolism.
Which of the following factors contributes to the increased risk of thromboembolic conditions in postpartum women?
Which of the following factors contributes to the increased risk of thromboembolic conditions in postpartum women?
- Venous stasis. (correct)
- Decreased levels of clotting factors.
- Decreased blood volume.
- Increased venous return from the legs.
A postpartum woman is diagnosed with superficial thrombosis. What nursing intervention is most appropriate for this condition initially?
A postpartum woman is diagnosed with superficial thrombosis. What nursing intervention is most appropriate for this condition initially?
Which medication is contraindicated for a postpartum woman with hypertension?
Which medication is contraindicated for a postpartum woman with hypertension?
A postpartum patient is receiving heparin therapy for a deep vein thrombosis. Which laboratory value is most important for the nurse to monitor?
A postpartum patient is receiving heparin therapy for a deep vein thrombosis. Which laboratory value is most important for the nurse to monitor?
What is the initial nursing action when a postpartum patient exhibits signs and symptoms of hypovolemic shock?
What is the initial nursing action when a postpartum patient exhibits signs and symptoms of hypovolemic shock?
A postpartum patient is being discharged home on anticoagulant therapy. What key teaching point should the nurse emphasize regarding the medication?
A postpartum patient is being discharged home on anticoagulant therapy. What key teaching point should the nurse emphasize regarding the medication?
A postpartum patient is experiencing excessive bleeding. Initial assessment reveals a boggy uterus and heavy lochia. Which of the following nursing interventions is the MOST appropriate FIRST action?
A postpartum patient is experiencing excessive bleeding. Initial assessment reveals a boggy uterus and heavy lochia. Which of the following nursing interventions is the MOST appropriate FIRST action?
A client who delivered vaginally 24 hours ago is suspected of having a retained placental fragment. Which assessment finding would be MOST indicative of this complication?
A client who delivered vaginally 24 hours ago is suspected of having a retained placental fragment. Which assessment finding would be MOST indicative of this complication?
During the assessment of a postpartum woman, the nurse notes a distended bladder. What is the MOST significant risk associated with a distended bladder in the early postpartum period?
During the assessment of a postpartum woman, the nurse notes a distended bladder. What is the MOST significant risk associated with a distended bladder in the early postpartum period?
A postpartum patient is receiving IV fluids and oxygen due to postpartum hemorrhage. Which assessment finding would indicate the patient is responding positively to the interventions?
A postpartum patient is receiving IV fluids and oxygen due to postpartum hemorrhage. Which assessment finding would indicate the patient is responding positively to the interventions?
A postpartum woman develops a fever of 101.4°F (38.6°C) on her third postpartum day, along with complaints of lower abdominal pain. Which condition is MOST likely the cause of these symptoms?
A postpartum woman develops a fever of 101.4°F (38.6°C) on her third postpartum day, along with complaints of lower abdominal pain. Which condition is MOST likely the cause of these symptoms?
A nurse is caring for a postpartum woman at risk for thromboembolic disease. Which nursing intervention is MOST important to prevent this complication?
A nurse is caring for a postpartum woman at risk for thromboembolic disease. Which nursing intervention is MOST important to prevent this complication?
A postpartum client is diagnosed with postpartum depression. Which of the following symptoms is MOST indicative of this condition rather than transient 'baby blues'?
A postpartum client is diagnosed with postpartum depression. Which of the following symptoms is MOST indicative of this condition rather than transient 'baby blues'?
A postpartum woman with a history of bipolar disorder exhibits rapid mood swings, disorganized thoughts, and delusional beliefs. What is the MOST likely diagnosis?
A postpartum woman with a history of bipolar disorder exhibits rapid mood swings, disorganized thoughts, and delusional beliefs. What is the MOST likely diagnosis?
A postpartum client has a fever of 100.8°F (38.2°C) on the second postpartum day. Which of the following actions is most appropriate, assuming this is the only symptom?
A postpartum client has a fever of 100.8°F (38.2°C) on the second postpartum day. Which of the following actions is most appropriate, assuming this is the only symptom?
Which of the following nursing interventions is most important in preventing postpartum infection?
Which of the following nursing interventions is most important in preventing postpartum infection?
A postpartum client reports feeling overwhelmed, intensely sad, and hopeless 3 weeks after delivery. Which condition is most likely?
A postpartum client reports feeling overwhelmed, intensely sad, and hopeless 3 weeks after delivery. Which condition is most likely?
Which of the following symptoms is most indicative of postpartum psychosis rather than postpartum depression?
Which of the following symptoms is most indicative of postpartum psychosis rather than postpartum depression?
A client is diagnosed with metritis after a cesarean birth. What class of medications would you anticipate the provider to prescribe?
A client is diagnosed with metritis after a cesarean birth. What class of medications would you anticipate the provider to prescribe?
A postpartum client is experiencing mastitis. Besides antibiotics, which intervention is most important for the nurse to recommend?
A postpartum client is experiencing mastitis. Besides antibiotics, which intervention is most important for the nurse to recommend?
A postpartum client is being discharged home. Which of the following instructions should the nurse include regarding signs of potential complications?
A postpartum client is being discharged home. Which of the following instructions should the nurse include regarding signs of potential complications?
A nurse is assessing a postpartum client's perineal laceration. What does the acronym REEDA stand for in this assessment?
A nurse is assessing a postpartum client's perineal laceration. What does the acronym REEDA stand for in this assessment?
Flashcards
Postpartum Infection Fever
Postpartum Infection Fever
Fever greater than 38°C (100.4°F) after the first 24 hours postpartum.
Metritis
Metritis
Infection of the endometrium, decidua, and adjacent myometrium.
Metritis Treatment
Metritis Treatment
Broad-spectrum antibiotics are used to treat metritis.
Baby Blues Symptoms
Baby Blues Symptoms
Emotional lability, irritability, and insomnia after childbirth.
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Postpartum Depression
Postpartum Depression
Major depressive episode associated with childbirth, lasting beyond 2-6 weeks.
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Postpartum Depression Symptoms
Postpartum Depression Symptoms
Feelings of hopelessness, worthlessness and guilt. Also, loss of libido
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Postpartum Psychosis
Postpartum Psychosis
Surfaces within 3 weeks of giving birth, increased risk with history of mental illness.
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Postpartum Psychosis Symptoms
Postpartum Psychosis Symptoms
Sleep disturbances, fatigue, depression, hallucinations and delusions, hypomania.
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Postpartum Risks
Postpartum Risks
Conditions that put a postpartum woman at risk, including hemorrhage, infection, thromboembolic disease, and psychiatric disorders.
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Postpartum Hemorrhage (PPH)
Postpartum Hemorrhage (PPH)
Excessive bleeding after childbirth, >500 mL after vaginal birth or >1,000 mL after C-section, or any amount causing hemodynamic instability.
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Five Ts of PPH Causes
Five Ts of PPH Causes
Uterine atony, retained placenta and clots, trauma, thrombin disorders, and traction causing uterine inversion.
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Uterine Atony
Uterine Atony
The uterus fails to contract adequately after delivery.
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PPH Risk Factors
PPH Risk Factors
Multiparity, multiple gestation, polyhydramnios, macrosomic newborn, coagulation disorders, prolonged labor, induction, general anesthesia.
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PPH Management
PPH Management
Focus on underlying cause, uterine massage, removal of retained fragments, antibiotics for infection, and repair of lacerations.
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First-line PPH treatment
First-line PPH treatment
Uterine massage
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Common cause of PPH
Common cause of PPH
The most common is uterine atony.
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Postpartum Hemorrhage: Nursing Management
Postpartum Hemorrhage: Nursing Management
Massage the fundus, count pads, administer uterotonics, manage fluids, and monitor for shock.
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Perineal Hematoma
Perineal Hematoma
Localized collection of blood underneath the skin, often in the perineum.
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Thrombophlebitis
Thrombophlebitis
Inflammation of the blood vessel lining.
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Most Common Thromboembolic Conditions
Most Common Thromboembolic Conditions
Superficial thrombosis, deep vein thrombosis, and pulmonary embolism.
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Thromboembolic Conditions: Pathophysiology
Thromboembolic Conditions: Pathophysiology
Venous stasis, injury to blood vessel layer and hypercoagulation.
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Thromboembolic Conditions: Nursing Management
Thromboembolic Conditions: Nursing Management
Prevention, adequate circulation, education, and emergency measures for PE.
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DVT Drug
DVT Drug
Heparin helps prevent further clot formation in DVT
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- Major conditions can put a postpartum woman at risk.
- Risk factors, assessment, preventative measures, and nursing management are used for common postpartum complications.
- Postpartum hemorrhage causes are based on underlying pathophysiologic measures.
- Signs and symptoms and management of PPH.
- Assessing and managing the care of a woman with a thromboembolic condition is part of a nurse's role.
- Nursing management for a woman who develops a postpartum infection.
- Postpartum depression and psychosis are compared and contrasted, describing specific therapeutic management of each.
Common Postpartum Disorders
- Postpartum hemorrhage can occur.
- Infection is considered a common postpartum disorder.
- Thromboembolic disease is a potential postpartum disorder.
- Postpartum Psychiatric disorders are included in the list
Postpartum Hemorrhage (PPH)
- Postpartum hemorrhage is a potentially life-threatening complication of both vaginal and cesarean births.
- It is the leading cause of maternal mortality in the United States.
- Blood loss of >500 mL following a vaginal birth indicates PPH.
- Blood loss of >1,000 mL following a cesarean birth indicates PPH.
- Any amount of bleeding that places the mother in hemodynamic jeopardy (10% drop in hematocrit, shock) is considered PPH.
Causes of Postpartum Hemorrhage: "Five Ts"
- Tone relates to uterine atony and distended bladder.
- Tissue means retained placenta and clots.
- Trauma can be vaginal, cervical, or uterine injury.
- Thrombin indicates coagulopathy (pre-existing or acquired).
- Traction occurs when causing uterine inversion.
- Uterine atony is the most common cause of postpartum hemorrhage.
Postpartum Hemorrhage: Risk Factors
- Multiparity
- Multiple gestation
- Polyhydramnios
- Macrosomic Newborn
- Chronic Coagulation Disorders
- Prolonged Labor
- Induction of Labor
- General Anesthesia
Postpartum Hemorrhage: Therapeutic Management
- Focus should be on the underlying cause.
- Uterine massage
- Removal of retained placental fragments
- Antibiotics for infection
- Repair of lacerations
Postpartum Hemorrhage: Assessment and Nursing Management
- Risk factors
- Uterine tone; vaginal bleeding
- Fundal massage; pad count
- Administration of uterotonics
- Pitocin (oxytocin)
- Cytotec (misoprostol)
- Hemabate (carboprost)
- Methergine (methylergonovine)
- Fluid administration
- Monitoring for signs and symptoms of shock
Perineal Hematoma
- Collection of blood underneath the skin
- Localized, bluish bulging area in the perineum
- May report severe perineal pain and difficulty voiding
- May exhibit hypotension, tachycardia, and anemia
- Requires surgical management
- Hematoma evacuated with incision
- Pressure bandage applied to prevent reformation
Thromboembolic Conditions
- Inflammation of blood vessel lining
- The three most common types are:
- Superficial Thrombosis: Usually confined to the saphenous vein in the lower leg
- Deep Vein Thrombosis: May cause pulmonary embolism
- Pulmonary Embolism: Considered the most serious complication
Thromboembolic Conditions: Pathophysiology
- Venous stasis
- Injury to innermost layer of blood vessel
- Hypercoagulation (Increased clotting factors in pregnancy)
Thromboembolic Conditions: Nursing
- Assessment
- Risk factors
- Signs and symptoms
- Management
- Prevention
- Adequate circulation: NSAIDs, bed rest, antiembolism stockings, anticoagulant therapy (heparin); emergency measures for pulmonary embolism
- Education
Postpartum Infections
- Fever of >38°C or 100.4°F after first 24 hours
- Organisms usually those of normal vaginal flora (aerobic and anaerobic)
- Metritis: infection of endometrium, decidua, and adjacent myometrium
- Wound infections
- Urinary tract infections
- Mastitis: infection of the breast
Postpartum Infections: Therapeutic Management
- Broad-spectrum antibiotics are used for metritis.
- Wound care is important for wound infections.
- Fluids and antibiotics for UTIs
- Breast emptying and antibiotics for mastitis
- Nursing assessment includes:
- Risk factors
- Signs and symptoms
- REEDA
Postpartum Infections: Nursing Management
- Infection prevention includes:
- Aseptic technique; handwashing; perineal hygiene
- Screening of visitors
- Administration of antibiotics; wound care
- Client teaching
Postpartum Affective Disorders
- These include
- Baby Blues
- Postpartum Depression
- Postpartum Psychosis
Signs of Postpartum or Baby Blues
- Emotional lability
- Irritability
- Insomnia
- Typically resolves within 2 weeks (by postpartum day 10)
- Usually self-limiting
Signs of Postpartum Depression
- Major depressive episode associated with childbirth
- Symptoms lasting beyond 2-6 weeks and worsening
Symptoms include
- Hopelessness
- Worthlessness
- Guilt
- Anhedonia
- Loss of Libido
- Feeling sad
Signs of Postpartum Psychosis
- Surfaces within 3 weeks of giving birth
- Increased risk with history of mental illness
- Symptoms may include
- Sleep disturbances
- Fatigue
- Depression
- Hypomania
- Hallucinations
- Delusions
Postpartum Affective Disorders: Management
- Baby Blues: Recommend social support; reassure that baby blues are normal
- Postpartum Depression
- Lifestyle Changes
- Medication
- Cognitive Behavioral Therapy
- Postpartum Psychosis
- Do not leave infant alone with mother
- Hospitalization
- Psychotropic drug treatment
- Individual and group therapy
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