Postpartum Shock in Childbearing
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Questions and Answers

What is the definition of postpartum shock?

  • A condition where the body tolerates excessive blood loss effectively
  • A condition where there is an increase in blood volume after pregnancy
  • A condition where the cardiovascular system provides adequate oxygen and nutrients to the cells
  • A condition where the cardiovascular system fails to provide essential oxygen and nutrients to the cells (correct)

    • What is a common cause of hypovolemic shock related to childbearing?

  • Pulmonary embolism (correct)
  • Anemia
  • Puerperal infection
  • Preeclampsia

    • When does late postpartum hemorrhage occur?

  • Immediately after birth
  • Between 24 hours and 6 weeks after birth (correct)
  • Within 6 weeks after birth
  • Within 24 hours of birth

    • What is the major risk associated with postpartum hemorrhage?

    <p>Hypovolemic shock</p> Signup and view all the answers

    How much blood loss defines postpartum hemorrhage traditionally?

    <p>Greater than 500 mL after vaginal birth or 1000 mL after cesarean birth</p> Signup and view all the answers

    Which type of shock can be caused by an allergic reaction to drugs administered during childbearing?

    <p>Anaphylactic shock</p> Signup and view all the answers

    What is the leading cause of postpartum death around the world?

    <p>Postpartum hemorrhage</p> Signup and view all the answers

    Which of the following is the first sign of inadequate blood volume (hypovolemia)?

    <p>Increased heart rate</p> Signup and view all the answers

    What action is taken to assess oxygen saturation of the blood?

    <p>Using a pulse oximeter</p> Signup and view all the answers

    What may indicate a blood clotting problem?

    <p>Bleeding from venipuncture sites</p> Signup and view all the answers

    Which sign may indicate that a large hematoma is the cause of hypovolemia despite normal lochia and firm uterus?

    <p>Tachycardia</p> Signup and view all the answers

    How should intake and output be monitored in early postpartum hemorrhage care?

    <p>Weighing the perineal pad</p> Signup and view all the answers

    What is a key nursing role in providing care for postpartum hemorrhage?

    <p>Maintaining emotional support for the mother</p> Signup and view all the answers

    What is the first blood pressure change seen in hypovolemic shock?

    <p>Narrow pulse pressure</p> Signup and view all the answers

    What is used to assess urine output and kidney function in patients with postpartum hemorrhage?

    <p>Indwelling catheter</p> Signup and view all the answers

    What may be required for high-risk patients with postpartum hemorrhage to allow invasive hemodynamic monitoring?

    <p>Intensive care</p> Signup and view all the answers

    What is the most common cause of early postpartum hemorrhage?

    <p>Uterine atony</p> Signup and view all the answers

    Which drug is commonly used to control uterine atony?

    <p>Methylergonovine</p> Signup and view all the answers

    What can cause uterine atony according to the text?

    <p>Full bladder</p> Signup and view all the answers

    How should the uterus feel when a woman is experiencing uterine atony?

    <p>Boggy (soft)</p> Signup and view all the answers

    What is the expected fundal height after the expulsion of the placenta?

    <p>At the umbilicus level</p> Signup and view all the answers

    What may worsen uterine atony and postpartum hemorrhage according to the text?

    <p>Collection of blood in the uterus</p> Signup and view all the answers

    How is a woman with uterine atony usually positioned?

    <p>Left lateral position</p> Signup and view all the answers

    'Lochia rubra' should be of what color?

    <p>Dark red</p> Signup and view all the answers

    What may lead to uterine atony if not corrected according to the text?

    <p>Full bladder</p> Signup and view all the answers

    What can help stimulate uterine contraction postpartum?

    <p>Infant suckling at the breast</p> Signup and view all the answers

    What is the treatment for retained placental fragments?

    <p>Pharmacological drugs to contract the uterus</p> Signup and view all the answers

    What is subinvolution of the uterus?

    <p>Delayed return of the uterus to its nonpregnant condition</p> Signup and view all the answers

    What is a common sign of subinvolution?

    <p>Pelvic pain and heaviness</p> Signup and view all the answers

    How does involution prevent postpartum bleeding?

    <p>By contracting and constricting blood vessels at the placental site</p> Signup and view all the answers

    What may increase the risk of venous thrombosis in pregnant women?

    <p>Compression of blood vessels by the heavy uterus</p> Signup and view all the answers

    What may cause subinvolution of the uterus?

    <p>Infection and retained placental fragments</p> Signup and view all the answers

    What might be a sign that a woman is experiencing subinvolution?

    <p>&quot;Fundal height greater than expected&quot;</p> Signup and view all the answers

    How does ultrasonography assist in postpartum care?

    <p>&quot;Identifying remaining placental fragments&quot;</p> Signup and view all the answers

    Why do pregnant women face an increased risk of venous thrombosis?

    <p>Compression of blood vessels by heavy uterus in pregnancy</p> Signup and view all the answers

    What is an appropriate medical treatment for subinvolution?

    <p>Selecting treatment based on the cause like methylergonovine for firm contractions, antibiotics for infection, and dilation for removing fragments</p> Signup and view all the answers

    What is the fourth leading cause of maternal mortality in the United States?

    <p>Puerperal sepsis</p> Signup and view all the answers

    Which of the following is a risk factor for postpartum infection?

    <p>Presence of retained placenta</p> Signup and view all the answers

    How is puerperal fever defined after childbirth?

    <p>Temperature of 38°C (100.4°F) or higher for at least 2 days during the first 10 days after birth</p> Signup and view all the answers

    What is the estimated normal range of white blood cells during the early postpartum period?

    <p>20,000 to 30,000 cells/mm3</p> Signup and view all the answers

    Why should the nurse promptly report and document any hardening of a C-section or episiotomy wound?

    <p>To ensure timely treatment of infection</p> Signup and view all the answers

    What can happen if a localized infection in the perineum ascends the reproductive tract?

    <p>Spread to the fallopian tubes and peritoneum</p> Signup and view all the answers

    What medication can be used to inhibit the breakup of clots that form, supporting the developing blood clot necessary to control hemorrhage?

    <p>Tranexamic acid</p> Signup and view all the answers

    In what timeframe must tranexamic acid be administered for postpartum hemorrhage?

    <p>Within 3 hours of delivery</p> Signup and view all the answers

    Which intervention is typically sufficient for most small perineal hematomas?

    <p>Ice pack to the perineum</p> Signup and view all the answers

    What long-term effects can genital trauma after childbirth cause?

    <p>Cystocele</p> Signup and view all the answers

    What is the primary purpose of intravenous calcium gluconate in the context of postpartum hemorrhage?

    <p>To counteract a tocolytic drug</p> Signup and view all the answers

    What might be the cause of late postpartum hemorrhage (occurs 24 hours to 6 weeks after childbirth)?

    <p>Retention of placental fragments</p> Signup and view all the answers

    What is the main reason pregnant women are at an increased risk of blood clot formation?

    <p>Increased levels of clot-dissolving factors</p> Signup and view all the answers

    Which symptom characterizes Deep Venous Thrombosis (DVT)?

    <p>Redness and tenderness in the calf</p> Signup and view all the answers

    What is the appropriate treatment for Superficial Venous Thrombosis?

    <p>Elevation of the legs</p> Signup and view all the answers

    Which practice should pregnant women avoid to prevent thrombus formation?

    <p>Crossing their legs</p> Signup and view all the answers

    What should pregnant women be taught regarding antiembolic stockings?

    <p>To put them on properly to prevent blood flow impedance</p> Signup and view all the answers

    What is the main sign of possible Pulmonary Embolism (PE)?

    <p>Sudden chest pain and dyspnea</p> Signup and view all the answers

    Which scenario may necessitate prophylactic heparin use for pregnant women?

    <p>Undergoing cesarean section</p> Signup and view all the answers

    What should be reported promptly when looking for signs of Deep Venous Thrombosis?

    <p>Increased leg circumference with redness and tenderness</p> Signup and view all the answers

    Which practice should be continued both during and after birth to prevent thrombus formation?

    <p>Measures to promote venous flow</p> Signup and view all the answers

    What is important when using stirrups during birth or episiotomy repair?

    <p>Padded stirrups to prevent popliteal pressure</p> Signup and view all the answers

    Postpartum shock is a condition in which the cardiovascular system fails to provide essential oxygen and nutrients to the cells due to ________

    <p>childbearing</p> Signup and view all the answers

    Hypovolemic shock is caused by postpartum hemorrhage or blood clotting disorders, leading to low blood volume or ________

    <p>hypovolemia</p> Signup and view all the answers

    Anaphylactic shock is caused by allergic responses to drugs administered during childbearing, resulting in an ________ reaction

    <p>allergic</p> Signup and view all the answers

    Septic shock is caused by puerperal infection, which leads to a systemic ________ response

    <p>infection</p> Signup and view all the answers

    Postpartum hemorrhage is traditionally defined as blood loss greater than 500 mL after vaginal birth or 1000 mL after cesarean birth, resulting in signs or symptoms of ________

    <p>hypovolemia</p> Signup and view all the answers

    Early (primary) postpartum hemorrhage occurs within 24 hours of birth, while late postpartum hemorrhage occurs after 24 hours and within 6 weeks after birth, posing a risk of ________ shock

    <p>hypovolemic</p> Signup and view all the answers

    Uterine atony is characterized by a lack of normal ______ tone

    <p>muscle</p> Signup and view all the answers

    After the placenta detaches, the uterus normally ______ to compress bleeding vessels

    <p>contracts</p> Signup and view all the answers

    Excessive bleeding in postpartum hemorrhage may be managed by providing a uterine ______

    <p>tamponade</p> Signup and view all the answers

    The woman's uterus is difficult to feel and feels boggy (soft) in cases of uterine ______

    <p>atony</p> Signup and view all the answers

    The infant suckling at the breast stimulates the woman’s posterior pituitary gland to secrete ______, which causes uterine contraction

    <p>oxytocin</p> Signup and view all the answers

    A dilute oxytocin (Pitocin) IV infusion is commonly ordered to control uterine ______

    <p>atony</p> Signup and view all the answers

    Methylergonovine increases blood pressure and should not be given to a woman with ______

    <p>hypertension</p> Signup and view all the answers

    Lochia rubra should be of a dark ______ color

    <p>red</p> Signup and view all the answers

    Pressing towards the vagina should expel any clots or blood pooled in the vagina after the uterus is ______

    <p>firm</p> Signup and view all the answers

    A full bladder interferes with the ability of the uterus to contract and may eventually lead to uterine ______

    <p>atony</p> Signup and view all the answers

    Treatment for retention of placental fragments may include the administration of drugs such as oxytocin, methylergonovine, or prostaglandins to contract the ______

    <p>uterus</p> Signup and view all the answers

    If bleeding continues after ultrasonography is used to identify placental fragments, curettage (scraping or vacuuming of the inner surface of the uterus) is performed to remove small blood clots and placental fragments. This procedure is known as dilation and ______

    <p>curettage</p> Signup and view all the answers

    Subinvolution is a slower than expected return of the uterus to its nonpregnant condition. Infection and retained fragments of the placenta are the most common causes. Typical signs of subinvolution include fundal height greater than expected for the amount of time since birth, persistence of lochia rubra or a slowed progression through the three phases, pelvic pain, heaviness, and ______

    <p>fatigue</p> Signup and view all the answers

    Medical treatment for subinvolution may include methylergonovine (Methergine) to maintain firm uterine contraction, antibiotics for infection, and dilation of the cervix and curettage to remove fragments of the placenta from the uterine ______

    <p>wall</p> Signup and view all the answers

    Puerperal sepsis is an infection or septicemia after ______ and is the fourth leading cause of maternal mortality in the United States

    <p>childbirth</p> Signup and view all the answers

    A venous thrombosis is a blood clot within a ______

    <p>vein</p> Signup and view all the answers

    Tissue trauma during labor, the open wound of the placental insertion site, surgical incisions, cracks in the nipples of the breasts, and the increased pH of the vagina after ______ are all risk factors for the postpartum woman

    <p>birth</p> Signup and view all the answers

    Blood vessel injury during cesarean section can cause a ______

    <p>thrombus</p> Signup and view all the answers

    The fever is most often caused by ______, an inflammation of the inner lining of the uterus

    <p>endometritis</p> Signup and view all the answers

    Blockage of the lochial flow because of retained placenta or clots increases susceptibility to ______

    <p>infection</p> Signup and view all the answers

    The pregnant woman is at increased risk for venous thrombosis because of the venous stasis that can occur from compression of the blood vessels by the heavy uterus or by pressure behind the knees when the legs are placed in stirrup leg supports for episiotomy ______

    <p>repair</p> Signup and view all the answers

    A venous thrombosis occurs in 1 in 1500 pregnancies. The size of the clot can increase as circulating blood passes over it and deposits more platelets, fibrin, and ______

    <p>cells</p> Signup and view all the answers

    Fever, pain, a foul odor, or abnormal findings on routine postpartum assessment must be reported to the health care ______

    <p>provider</p> Signup and view all the answers

    Women should report fever, persistent pain, persistent red lochia, or return of bleeding after it has changed. The woman should be taught how to palpate the fundus and what normal changes to ______

    <p>expect</p> Signup and view all the answers

    Leukocyte counts in the upper limits are more likely to be associated with infection than lower ______

    <p>counts</p> Signup and view all the answers

    Nursing care for subinvolution involves assisting with medical therapy, providing analgesics, and other comfort measures. Specific nursing care depends on whether the subinvolution results from infection or ______

    <p>another cause</p> Signup and view all the answers

    The body responds to a reduction in blood volume with increased heart and respiratory rates to increase the oxygen content of each ____________.

    <p>erythrocyte</p> Signup and view all the answers

    Tachycardia is usually the first sign of inadequate blood volume in ____________ shock.

    <p>hypovolemic</p> Signup and view all the answers

    The first blood pressure change in hypovolemic shock is a narrow pulse pressure with a falling systolic pressure and a rising diastolic pressure as the blood pressure continues falling and eventually cannot be ____________.

    <p>detected</p> Signup and view all the answers

    Blood flow to nonessential organs gradually stops to make more blood available for vital organs, specifically the ____________ and brain.

    <p>heart</p> Signup and view all the answers

    As blood loss continues, flow to the brain decreases, resulting in mental changes such as anxiety, confusion, restlessness, and ____________.

    <p>lethargy</p> Signup and view all the answers

    In the first hours postpartum, the perineal pad should be weighed to determine the output amount: 1 g equals 1 ____________.

    <p>mL</p> Signup and view all the answers

    Decreased blood pressure may be a late sign of ____________ shock.

    <p>hypovolemic</p> Signup and view all the answers

    The body initially responds to a reduction in blood volume with increased heart and respiratory rates to cause faster circulation of the remaining ____________.

    <p>blood</p> Signup and view all the answers

    Medical management of hypovolemic shock resulting from hemorrhage may include giving ____________ to increase the saturation of remaining blood cells.

    <p>oxygen</p> Signup and view all the answers

    Nursing Care Plan 10.1 specifies interventions for the woman at high risk for altered tissue perfusion related to ____________.

    <p>hemorrhage</p> Signup and view all the answers

    Intravenous calcium gluconate may be used to counteract a tocolytic drug that may have been administered to relax the ______ during labor.

    <p>uterus</p> Signup and view all the answers

    The health care provider may examine the woman in the delivery or operating room to determine the source of her bleeding and to correct it. Rarely, a hysterectomy is needed to remove the bleeding ______ that does not respond to any other measures.

    <p>uterus</p> Signup and view all the answers

    Lacerations of the perineum, vagina, cervix, or area around the ______ (periurethral lacerations) can cause postpartum bleeding.

    <p>urethra</p> Signup and view all the answers

    Blood lost in lacerations is usually a brighter red than ______ and flows in a continuous trickle.

    <p>lochia</p> Signup and view all the answers

    The woman with a hematoma usually has severe, unrelenting pain that analgesics do not relieve. Depending on the amount of blood in the tissues, she also may describe pressure in the vulva, pelvis, or ______.

    <p>rectum</p> Signup and view all the answers

    Small hematomas usually resolve without treatment. Larger ones may require incision and drainage of the clots. The bleeding vessel is ligated or the area packed with a ______ material to stop the bleeding.

    <p>hemostatic</p> Signup and view all the answers

    Depending on the amount of blood in the tissues, she also may describe pressure in the vulva, pelvis, or ______. She may be unable to urinate because of the pressure.

    <p>rectum</p> Signup and view all the answers

    The woman does not have unusual amounts of lochia, but she may develop signs of concealed blood loss if the hematoma is large. Her pulse and respiratory rates rise, and her blood pressure falls. She may develop other signs of ______ shock if blood loss into the tissues is substantial.

    <p>hypovolemic</p> Signup and view all the answers

    An ice pack to the perineum is sufficient for most small perineal hematomas and requires no physician prescription. The nurse should observe for and report the classic symptom – excessive, poorly relieved ______.

    <p>pain</p> Signup and view all the answers

    In addition to the specific interventions for specific causes of postpartum hemorrhage, the medication tranexamic acid can be used to inhibit the breakup of clots that form; this supports the developing blood clot that is necessary to control hemorrhage. However, the drug must be administered within 3 hours of ______.

    <p>delivery</p> Signup and view all the answers

    The levels of ______ and other clotting factors normally increase during pregnancy

    <p>fibrinogen</p> Signup and view all the answers

    A state of hypercoagulability results in an increased susceptibility to developing ______

    <p>blood clots</p> Signup and view all the answers

    Preventive measures for thrombus formation include the use of pneumatic compression devices on the lower extremities or prophylactic ______

    <p>heparin</p> Signup and view all the answers

    Superficial venous thrombosis (SVT) involves the ______ vein of the lower leg

    <p>saphenous</p> Signup and view all the answers

    Deep venous thrombosis (DVT) can involve veins from the feet to the ______ area

    <p>femoral</p> Signup and view all the answers

    Pulmonary embolism (PE) occurs when the pulmonary artery is obstructed by a ______ clot

    <p>blood</p> Signup and view all the answers

    Superficial venous thrombosis is treated with administration of analgesics, local application of heat, and elevation of the legs to promote ______ drainage

    <p>venous</p> Signup and view all the answers

    Deep venous thrombosis is treated similarly, with the addition of subcutaneous or IV ______ drugs

    <p>anticoagulation</p> Signup and view all the answers

    Low-molecular-weight heparin (LMWH) may be used to treat thrombosis because it is long acting and requires less frequent doses and lab ______

    <p>testing</p> Signup and view all the answers

    The woman undergoing anticoagulant therapy at home should be taught how to give herself the drug and about signs of excess ______

    <p>anticoagulation</p> Signup and view all the answers

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