Podcast
Questions and Answers
Which of the following is the most common cause of postpartum hemorrhage (PPH)?
Which of the following is the most common cause of postpartum hemorrhage (PPH)?
- Retained placental fragments
- Coagulopathy
- Uterine atony (correct)
- Vaginal lacerations
A postpartum woman is suspected of having a retained placenta. Which assessment finding would most strongly support this suspicion?
A postpartum woman is suspected of having a retained placenta. Which assessment finding would most strongly support this suspicion?
- Firmly contracted uterus with minimal bleeding.
- Elevated white blood cell count and fever.
- Complaints of intense perineal pain.
- Continuous trickle of bright red blood despite a firm uterus. (correct)
Which of the following conditions in a postpartum woman increases the risk of postpartum hemorrhage?
Which of the following conditions in a postpartum woman increases the risk of postpartum hemorrhage?
- Diagnosis of polyhydramnios (correct)
- Singleton pregnancy carried to term
- History of short labor and delivery
- Spontaneous vaginal delivery without complications
A postpartum patient who had a prolonged labor is at an increased risk for postpartum hemorrhage. What is the most likely reason for this?
A postpartum patient who had a prolonged labor is at an increased risk for postpartum hemorrhage. What is the most likely reason for this?
When assessing a postpartum patient, which finding would be most concerning and warrant immediate intervention?
When assessing a postpartum patient, which finding would be most concerning and warrant immediate intervention?
A postpartum patient is receiving oxytocin (Pitocin) for the management of postpartum hemorrhage. What should the nurse carefully monitor to prevent adverse effects?
A postpartum patient is receiving oxytocin (Pitocin) for the management of postpartum hemorrhage. What should the nurse carefully monitor to prevent adverse effects?
A physician orders methylergonovine (Methergine) for a postpartum patient experiencing uterine atony. Which pre-existing condition would contraindicate the administration of this medication?
A physician orders methylergonovine (Methergine) for a postpartum patient experiencing uterine atony. Which pre-existing condition would contraindicate the administration of this medication?
A patient with a known coagulation disorder experiences a postpartum hemorrhage. What is the priority nursing intervention beyond the standard PPH protocol?
A patient with a known coagulation disorder experiences a postpartum hemorrhage. What is the priority nursing intervention beyond the standard PPH protocol?
What is the primary nursing intervention for a postpartum patient experiencing uterine atony?
What is the primary nursing intervention for a postpartum patient experiencing uterine atony?
A postpartum patient reports severe perineal pain and difficulty voiding. Assessment reveals a localized, bluish bulging area in the perineum. Which condition is most likely?
A postpartum patient reports severe perineal pain and difficulty voiding. Assessment reveals a localized, bluish bulging area in the perineum. Which condition is most likely?
Which of the following medications would be the least appropriate initial choice for managing uterine atony?
Which of the following medications would be the least appropriate initial choice for managing uterine atony?
A postpartum patient is diagnosed with a deep vein thrombosis (DVT). Besides bed rest and elevation, which medication is most likely to be prescribed initially?
A postpartum patient is diagnosed with a deep vein thrombosis (DVT). Besides bed rest and elevation, which medication is most likely to be prescribed initially?
Which of the following signs or symptoms should prompt the most immediate concern for a postpartum patient?
Which of the following signs or symptoms should prompt the most immediate concern for a postpartum patient?
A postpartum patient with a history of varicose veins is at increased risk for which of the following?
A postpartum patient with a history of varicose veins is at increased risk for which of the following?
Which of the following best describes the underlying cause of thromboembolic conditions in the postpartum period?
Which of the following best describes the underlying cause of thromboembolic conditions in the postpartum period?
A postpartum client develops a fever of 38.5°C on the third postpartum day. Which of the following infections is MOST likely, given organisms of normal vaginal flora are usually the cause?
A postpartum client develops a fever of 38.5°C on the third postpartum day. Which of the following infections is MOST likely, given organisms of normal vaginal flora are usually the cause?
A postpartum woman is diagnosed with superficial thrombophlebitis. Which nursing intervention is most appropriate?
A postpartum woman is diagnosed with superficial thrombophlebitis. Which nursing intervention is most appropriate?
A postpartum client is diagnosed with metritis. Which intervention would the nurse anticipate?
A postpartum client is diagnosed with metritis. Which intervention would the nurse anticipate?
Which nursing action is MOST important for preventing postpartum infection in a client who had a cesarean birth?
Which nursing action is MOST important for preventing postpartum infection in a client who had a cesarean birth?
A client is experiencing emotional lability, irritability, and insomnia on postpartum day 4. What is the MOST likely cause for the client's symptoms?
A client is experiencing emotional lability, irritability, and insomnia on postpartum day 4. What is the MOST likely cause for the client's symptoms?
A postpartum client reports feelings of hopelessness, worthlessness, and anhedonia 4 weeks after delivery. What should the nurse prioritize?
A postpartum client reports feelings of hopelessness, worthlessness, and anhedonia 4 weeks after delivery. What should the nurse prioritize?
Which of the following is the MOST critical differentiating factor between postpartum depression and postpartum psychosis?
Which of the following is the MOST critical differentiating factor between postpartum depression and postpartum psychosis?
A client with a history of bipolar disorder appears agitated, is experiencing sleep disturbances, and reports hearing voices two weeks after giving birth. Which condition is MOST likely?
A client with a history of bipolar disorder appears agitated, is experiencing sleep disturbances, and reports hearing voices two weeks after giving birth. Which condition is MOST likely?
A postpartum client is diagnosed with mastitis. Besides antibiotics, what other intervention should the nurse include in the plan of care?
A postpartum client is diagnosed with mastitis. Besides antibiotics, what other intervention should the nurse include in the plan of care?
Flashcards
Postpartum Risk Factors
Postpartum Risk Factors
Conditions that increase the risk for a woman after childbirth.
Postpartum Hemorrhage (PPH)
Postpartum Hemorrhage (PPH)
Excessive bleeding after childbirth, either vaginally (>500 mL) or via C-section (>1000 mL), that threatens the mother's health.
The "Five Ts" of PPH
The "Five Ts" of PPH
Uterine atony, retained placental tissue, trauma, thrombin disorders, traction.
Uterine Atony
Uterine Atony
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PPH Risk Factors
PPH Risk Factors
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PPH Management
PPH Management
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Therapeutic Focus for PPH
Therapeutic Focus for PPH
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Uterine Atony
Uterine Atony
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Postpartum Hemorrhage Assessment
Postpartum Hemorrhage Assessment
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Postpartum Hemorrhage Management
Postpartum Hemorrhage Management
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Perineal Hematoma
Perineal Hematoma
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Thromboembolic Conditions
Thromboembolic Conditions
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Thromboembolic Conditions: Pathophysiology
Thromboembolic Conditions: Pathophysiology
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Thromboembolic Conditions: Nursing Management
Thromboembolic Conditions: Nursing Management
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DVT Treatment (Postpartum)
DVT Treatment (Postpartum)
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Postpartum Infection
Postpartum Infection
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Metritis
Metritis
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Baby Blues
Baby Blues
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Postpartum Depression
Postpartum Depression
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Postpartum Psychosis
Postpartum Psychosis
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Signs of Baby Blues
Signs of Baby Blues
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Signs of Postpartum Depression
Signs of Postpartum Depression
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Signs of Postpartum Psychosis
Signs of Postpartum Psychosis
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Study Notes
- Chapter 22 covers the nursing management of postpartum women at risk for complications
Common Postpartum Disorders
- Postpartum hemorrhage (PPH), infection, thromboembolic disease, and postpartum psychiatric disorders are all common
Postpartum Hemorrhage (PPH)
- PPH is a potentially life-threatening complication of both vaginal and cesarean births
- PPH is the leading cause of maternal mortality in the United States
- Blood loss of >500 mL following a vaginal birth and >1,000 mL following a cesarean birth can be considered PPH
- Any amount of bleeding that places the mother in hemodynamic jeopardy is considered PPH, specifically a 10% drop in hematocrit or shock
Causes of Postpartum Hemorrhage: "Five Ts"
- Tone is a major cause referring to uterine atony and a distended bladder
- Tissue such as retained placental fragments and clots is another cause
- Trauma like vaginal, cervical, or uterine injury may lead to hemorrhage
- Thrombin relating to coagulopathy, either pre-existing or acquired, represents the fourth cause
- Traction may cause uterine inversion and lead to hemorrhage
Postpartum Hemorrhage: Risk Factors
- Multiparity, multiple gestation, polyhydramnios, and macrosomic newborn increase PPH risks
- Chronic coagulation disorders, prolonged labor, induction of labor, and general anesthesia are also risk factors
Postpartum Hemorrhage: Therapeutic Management
- Focus on addressing the underlying cause
- Uterine massage, removal of retained placental fragments, antibiotics for infection, and repair of lacerations are therapeutic measures
Postpartum Hemorrhage: Assessment and Nursing Management
- In nursing assessment, identifying risk factors, assessing uterine tone, and monitoring vaginal bleeding are important
- Nursing management includes fundal massage, pad count, uterotonic administration (Pitocin, Cytotec, Hemabate, Methergine), fluid administration, and monitoring for shock signs and symptoms
Perineal Hematoma
- Accumulation of blood underneath the skin
- It presents as a localized, bluish bulging area in the perineum
- Could cause severe perineal pain and difficulty voiding
- Can lead to hypotension, tachycardia, and anemia
- Surgical management includes hematoma evacuation with an incision, followed by a pressure bandage
Thromboembolic Conditions
- Inflammation of the blood vessel lining occurs
- Three common types include superficial thrombosis, deep vein thrombosis, and pulmonary embolism
Thromboembolic Conditions: Types
- Superficial thrombosis is typically confined to the saphenous vein in the lower leg
- Deep vein thrombosis may lead to pulmonary embolism
- Pulmonary embolism is the most serious complication
Thromboembolic Conditions: Pathophysiology
- Venous stasis, injury to the innermost layer of the blood vessel, and hypercoagulation are factors
- Hypercoagulation refers to increased clotting factors that occur during pregnancy
Thromboembolic Conditions: Assessment and Management
- The nursing assessment includes identifying risk factors and recognizing signs/symptoms for Thromboembolic Conditions
- Nursing management involves prevention, adequate circulation (NSAIDs, bed rest, antiembolism stockings, anticoagulant therapy such as heparin), and education
Postpartum Infections
- Fever of greater than 38°C or 100.4°F after the first 24 hours is indicative of infections
- Organisms typically those of normal vaginal flora (aerobic and anaerobic) are the common cause
- Metritis represents an infection of the endometrium, decidua, and adjacent myometrium
Postpartum Infections: Types
- This can include wound infections, urinary tract infections, and mastitis (breast infection)
Postpartum Infections (cont.): Therapeutic Management
- Broad-spectrum antibiotics are used for metritis
- Wound care is essential for wound infections
- Fluids and antibiotics are given for UTIs
- Breast emptying and antibiotics are the treatment for mastitis
Postpartum Infections nursing assessment
- assessing risk factors and recognizing signs such as REEDA (redness, edema, ecchymosis, drainage, approximation)
Postpartum Infections: Nursing Management
- Prevention involves aseptic technique, handwashing, and perineal hygiene
- Additional measures include screening of visitors, administration of antibiotics, wound care, and client teaching
Postpartum Affective Disorders
- Baby Blues, postpartum depression, and postpartum psychosis are included
Signs of Postpartum or Baby Blues
- Emotional lability, irritability, and insomnia are a result of Baby Blues
- Usually resolves within 2 weeks (by postpartum day 10) and is self-limiting
Signs of Postpartum Depression
- A major depressive episode associated with childbirth
- Symptoms lasting beyond 2-6 weeks and worsening
- Examples are hopelessness, worthlessness, guilt, anhedonia, loss of libido, and feeling sad
Signs of Postpartum Psychosis
- Surfaces within 3 weeks of giving birth
- Symptoms are sleep disturbances, fatigue, depression, hypomania, hallucinations, and delusions
- There is an increased risk with a history of mental illness
Postpartum Affective Disorders: Management
- For Baby Blues, recommend social support and reassure that baby blues are normal
- Postpartum depression lifestyle changes, medication, and cognitive behavioral therapy
- Postpartum psychosis management always ensures to not leave the infant alone with the mother, hospitalization, psychotropic drug treatment, and individual/group therapy
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