Podcast Beta
Questions and Answers
What is defined as blood loss greater than 500 mL after vaginal birth?
Which type of shock is caused by postpartum hemorrhage or blood clotting disorders?
Which of the following complications occurs within 24 hours of birth?
What does the condition of shock generally result from?
Signup and view all the answers
Which of the following is NOT a category of complications related to childbirth?
Signup and view all the answers
What is the initial cardiovascular response of the body to hypovolemia?
Signup and view all the answers
What change in blood pressure is typically observed first in hypovolemia?
Signup and view all the answers
Which nursing care action is essential for monitoring early signs of postpartum hemorrhage?
Signup and view all the answers
Which characteristic is associated with uterine atony during early postpartum hemorrhage?
Signup and view all the answers
What is a common sign indicating a decrease in kidney function due to hypovolemic shock?
Signup and view all the answers
What factor is NOT associated with the risk of uterine atony?
Signup and view all the answers
What is defined as a temperature of 38° C (100.4° F) or higher after the first 24 hours postpartum?
Signup and view all the answers
Which of the following is NOT a risk factor for puerperal sepsis?
Signup and view all the answers
When a woman has a fever, elevated pulse, and localized pain after childbirth, what should be the nurse's first action?
Signup and view all the answers
What is the primary goal of medical treatment for puerperal sepsis?
Signup and view all the answers
Which is an appropriate nursing instruction to prevent urinary tract infections (UTIs) postpartum?
Signup and view all the answers
What is the expected size and feel of the uterus immediately after a full-term birth?
Signup and view all the answers
What indicates the presence of uterine atony after childbirth?
Signup and view all the answers
What is the primary action to take when the uterus is found to be boggy?
Signup and view all the answers
What characteristic of lochia is considered normal in the first few hours postpartum?
Signup and view all the answers
What can occur if a woman has a full bladder after childbirth?
Signup and view all the answers
What type of laceration typically presents with continuous bleeding while the uterus remains contracted?
Signup and view all the answers
Which medication is commonly administered to help control uterine atony?
Signup and view all the answers
What symptom is often associated with a hematoma after childbirth?
Signup and view all the answers
Which medication can inhibit the breakup of clots to help control postpartum hemorrhage?
Signup and view all the answers
What is a common cause of late postpartum hemorrhage?
Signup and view all the answers
What nursing action is essential if a woman reports severe pain and inability to void post-delivery?
Signup and view all the answers
What sign indicates that subinvolution of the uterus may be occurring?
Signup and view all the answers
What is the proper response if a postpartum woman experiences persistent bright red bleeding after discharge?
Signup and view all the answers
What should a nurse teach a postpartum woman to monitor concerning lochia?
Signup and view all the answers
Which of the following interventions is appropriate for managing retained placental fragments?
Signup and view all the answers
What is TRUE regarding the administration of methylergonovine?
Signup and view all the answers
How long post-delivery is a woman expected to remain NPO prior to examination by a healthcare provider?
Signup and view all the answers
Which sign is NOT a typical symptom of subinvolution of the uterus?
Signup and view all the answers
What is the primary cause of venous thrombosis in pregnant women?
Signup and view all the answers
Which signs should be monitored to confirm the diagnosis of deep venous thrombosis (DVT)?
Signup and view all the answers
What is a key preventive measure for thrombus formation during postpartum care?
Signup and view all the answers
What common treatment is used for superficial venous thrombosis?
Signup and view all the answers
Which factor may contribute to a state of hypercoagulability in pregnant women?
Signup and view all the answers
What should a nurse teach a postpartum woman using antiembolic stockings?
Signup and view all the answers
What condition may arise from a pulmonary embolism?
Signup and view all the answers
Which anticoagulant is commonly used post-surgery to prevent DVT?
Signup and view all the answers
What is a potential sign of a pulmonary embolism?
Signup and view all the answers
Which action should be avoided to promote venous blood flow in pregnant women?
Signup and view all the answers
Study Notes
Thromboembolic Disorders
- Venous thrombosis is a blood clot in a vein, occurring in 1 in 1500 pregnancies.
- Blood clots can increase in size due to accumulating platelets, fibrin, and cells.
- Pregnant women have an increased risk of venous thrombosis due to venous stasis caused by uterine compression or pressure behind the knees.
- Blood vessel injury during cesarean section can also contribute to clot formation.
- Pregnant women have higher fibrinogen and clotting factor levels, and lower clot-dissolving factor levels, making them more susceptible to blood clots.
- Varicose veins and prolonged bed rest increase the risk of thrombosis.
- Preventive measures include pneumatic compression devices and prophylactic heparin for women undergoing cesarean sections or prolonged bed rest.
- Three types of thromboembolic disorders:
- Superficial venous thrombosis (SVT) involves the saphenous vein, characterized by a painful, reddened, and warm vein.
- Deep venous thrombosis (DVT) affects veins from the feet to the femoral area, causing pain, calf tenderness, leg edema, color changes, and pain when walking.
- Pulmonary embolism (PE) occurs when a blood clot travels to the lungs, causing sudden chest pain, cough, dyspnea, decreased consciousness, and signs of heart failure.
- Treatment for superficial venous thrombosis includes analgesics, heat application, and leg elevation.
- Deep venous thrombosis treatment includes analgesics, heat application, leg elevation, and anticoagulants.
- Low-molecular-weight heparin (LMWH) is a long-acting anticoagulant requiring less frequent doses and lab testing.
- LMWH is contraindicated with regional anesthesia.
Nursing Care for Thromboembolic Disorders
- Observe women for signs of venous thrombosis before and after birth.
- Dyspnea, coughing, and chest pain suggest pulmonary embolism and should be reported immediately.
- Prevent thrombi by encouraging women not to cross their legs, avoiding sharp flexion at the groin or pressure in the popliteal space, and promoting venous flow during and after birth.
- Early ambulation and range of motion exercises aid in preventing thrombus formation.
- Antiembolic stockings are helpful if varicose veins are present.
- Pad stirrups used during birth or episiotomy repair to avoid pressure at the popliteal angle.
- Teach women undergoing anticoagulant therapy at home about administration methods, signs of excess anticoagulation, and self-care adjustments to avoid excessive bleeding.
Puerperal Sepsis
- Puerperal sepsis is a postpartum infection or septicemia, the fourth leading cause of maternal mortality in the US.
- Risk factors include tissue trauma during labor, placental insertion site, surgical incisions, nipple cracks, and increased vaginal pH after birth.
- Endometritis, an inflammation of the uterine lining, frequently causes fever.
- Blocked lochial flow due to retained placenta or clots increases infection susceptibility.
Manifestations of Puerperal Sepsis
- Puerperal fever is defined as a temperature of 38° C (100.4° F) or higher after the first 24 hours and for at least 2 days during the first 10 days after birth.
- Dehydration can cause slight temperature elevations, but other infection signs should be monitored.
- Elevated pulse rate along with fever often indicates infection.
- Signs and symptoms can be localized or systemic.
- Assess C-section wounds or episiotomy wounds using REEDA criteria (redness, edema, ecchymosis, discharge, approximation).
- Report and document any fever, pain, foul odor, or abnormal findings from routine postpartum assessments.
- White blood cell (leukocyte) counts may be elevated during the early postpartum period, but their diagnostic value for infection is limited.
Treatment of Puerperal Sepsis
- Limit the spread of infection, prevent it from reaching the blood, and eliminate infection.
- Culture and sensitivity tests identify effective antibiotic treatment.
- IV antibiotics and bed rest may be prescribed.
Nursing Care for Puerperal Sepsis
- Prevent infection and facilitate medical treatment.
- Teach and utilize hygienic measures to reduce infection risk (e.g., hand hygiene, perineal care).
- Promote adequate rest and nutrition for healing.
- Observe for signs of infection.
- Teach women to report infection signs after discharge.
- Educate women on completing prescribed antibiotic regimens.
- Teach women proper perineal pad application (front to back).
- Encourage hand hygiene before and after self-care involving contact with secretions.
- Help women obtain sufficient rest.
- Encourage high-protein and vitamin C-rich foods for healing.
- Recommend iron-rich foods to address anemia.
Mastitis
- Mastitis is a breast infection typically occurring 2-3 weeks after birth.
- Causes include organisms from the skin or infant's mouth entering cracks in the nipples or areolae.
- Breast engorgement and inadequate milk emptying contribute to mastitis.
Manifestations of Mastitis
- Redness and heat in the breast.
- Tenderness.
- Edema and heaviness in the breast.
- Purulent drainage (may or may not be present).
- Fever, chills, and systemic symptoms.
Treatment for Mastitis
- Antibiotics and continued milk removal are primary treatments.
- Mild analgesics provide comfort.
- An abscess may require incision and drainage, and IV antibiotics.
- Mothers can typically continue breastfeeding.
- If breastfeeding is interrupted, mothers should pump their breasts to prevent engorgement and worsening mastitis.
Nursing Care for Mastitis
- Teach proper breastfeeding techniques to reduce mastitis risk.
- Relieve pain and maintain lactation.
- Apply heat to promote blood flow, comfort, and breast emptying.
- Regular emptying of both breasts reduces milk stasis and abscess risk.
- If breastfeeding is painful, use a breast pump to empty the breast.
- Massage the inflamed area to enhance milk flow.
- Nurse first on the unaffected side to initiate milk flow in both breasts.
- Encourage adequate fluid intake.
- Advise women to wear supportive bras.
- Provide emotional support and reassurance about continued breastfeeding.
Mood Disorders
- Mood is a sustained emotion influencing one's view of life.
- Postpartum blues are common after birth, characterized by feelings of let-down, but overall joy in life and motherhood.
- Postpartum blues are typically self-limiting as women adapt to life changes.
- Psychosis involves impaired perception of reality.
- Postpartum depression and postpartum psychosis are more serious than postpartum blues.
Postpartum Blues (Adjustment Reaction)
- Occur in about 75% of women, appearing on day 5 and disappearing by day 10.
- Rapid estrogen and progesterone decline after childbirth leads to increased brain levels of monoamine oxidase-A (MAO-A).
- Tryptophan, tyrosine, and blueberry juice supplementation might counter the effects of increased MAO-A and potentially prevent postpartum depression.
Postpartum Depression
- A depressive illness typically manifesting within 2-4 weeks after delivery.
- Can interfere with responding to infant cues and maternal-infant bonding.
- Formal postpartum depression screening is not standard practice in the US, emphasizing the nurse's role in detecting and referring problems.
- Risk factors include inadequate social support, poor partner relationships, childcare stress, low self-esteem, and unplanned pregnancy.
Manifestations of Postpartum Depression
- Lack of enjoyment in life.
- Disinterest in others; loss of normal interaction in relationships.
- Intense feelings of inadequacy, unworthiness, guilt, inability to cope.
- Loss of concentration; inability to make decisions.
- Disturbed sleep or appetite.
- Constant fatigue and feeling unwell.
Treatment of Postpartum Depression
- Often involves psychotherapy and antidepressants, either outpatient or inpatient.
- Screening tools are available.
- Nurses provide support and behavioral observation, being alert to self-harm risks.
- Light therapy and exercise are complementary and alternative treatment strategies that may help.
- Refer women to community mental health services for ongoing care and support.
- Involve partners and families in counseling.
Postpartum Psychosis
- Involves impaired sense of reality, less common than postpartum depression.
Mood Disorders in the Postpartum Period
- Two most common psychiatric disorders in postpartum women are bipolar disorder and major depression.
- Bipolar disorder is characterized by alternating episodes of mania and depression.
- Major depression involves feelings of worthlessness, guilt, sleep and appetite disturbances, and sometimes delusions about the infant.
- Postpartum psychosis can be potentially fatal for both the mother and infant.
- During manic episodes, mothers may endanger themselves and their infants due to poor judgment and a feeling of invulnerability.
- Suicide and infanticide are possible, particularly during depressive episodes.
- Treatment options include community counseling or inpatient psychiatric care.
- Three types of postpartum mood disorders include adjustment disorder ("baby blues"), postpartum mood disorders, and postpartum depression.
- Major depression in postpartum women can lead to an increased risk of suicide and infanticide for both the mother and infant.
Review of Main Points
- Hemorrhagic complications
- Thromboembolic disorders
- Puerperal sepsis
- Mood disorders
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers thromboembolic disorders, particularly focusing on venous thrombosis during pregnancy. It addresses risk factors, types, and preventive measures critical for pregnant women. Understanding these conditions is essential for the safety and health of expectant mothers.
