Nursing Care During the Postpartum Period

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Questions and Answers

What is defined as blood loss greater than 500 mL after vaginal birth?

Postpartum hemorrhage (correct)

Anaphylactic shock

Shock

Hypovolemic shock

Which type of shock is caused by postpartum hemorrhage or blood clotting disorders?

Septic shock

Anaphylactic shock

Cardiogenic shock

Hypovolemic shock (correct)

Which of the following complications occurs within 24 hours of birth?

Cardiogenic shock

Subinvolution of the uterus

Primary postpartum hemorrhage (correct)

Late postpartum hemorrhage

What does the condition of shock generally result from?

Failure of the cardiovascular system Signup and view all the answers

Which of the following is NOT a category of complications related to childbirth?

Respiratory distress Signup and view all the answers

What is the initial cardiovascular response of the body to hypovolemia?

Increased heart rate and respiratory rate Signup and view all the answers

What change in blood pressure is typically observed first in hypovolemia?

Narrow pulse pressure with falling systolic and rising diastolic pressure Signup and view all the answers

Which nursing care action is essential for monitoring early signs of postpartum hemorrhage?

Weighing perineal pads to assess blood loss Signup and view all the answers

Which characteristic is associated with uterine atony during early postpartum hemorrhage?

Soft, high uterine fundus that is difficult to feel Signup and view all the answers

What is a common sign indicating a decrease in kidney function due to hypovolemic shock?

Decreased urine output Signup and view all the answers

What factor is NOT associated with the risk of uterine atony?

High maternal age 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?

Puerperal fever Signup and view all the answers

Which of the following is NOT a risk factor for puerperal sepsis?

Intake of high protein foods 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?

Check for localized signs of infection Signup and view all the answers

What is the primary goal of medical treatment for puerperal sepsis?

To eliminate the infection Signup and view all the answers

Which is an appropriate nursing instruction to prevent urinary tract infections (UTIs) postpartum?

Encourage the intake of cranberry juice Signup and view all the answers

What is the expected size and feel of the uterus immediately after a full-term birth?

Firm and the size of a grapefruit Signup and view all the answers

What indicates the presence of uterine atony after childbirth?

Lochia contains large clots Signup and view all the answers

What is the primary action to take when the uterus is found to be boggy?

Massage the uterus until it firms up Signup and view all the answers

What characteristic of lochia is considered normal in the first few hours postpartum?

Dark red and not exceeding one saturated pad per hour Signup and view all the answers

What can occur if a woman has a full bladder after childbirth?

Elevation and lateral displacement of the uterus Signup and view all the answers

What type of laceration typically presents with continuous bleeding while the uterus remains contracted?

Vaginal laceration Signup and view all the answers

Which medication is commonly administered to help control uterine atony?

Oxytocin (Pitocin) Signup and view all the answers

What symptom is often associated with a hematoma after childbirth?

Severe and unrelenting pain Signup and view all the answers

Which medication can inhibit the breakup of clots to help control postpartum hemorrhage?

Tranexamic acid Signup and view all the answers

What is a common cause of late postpartum hemorrhage?

Retention of placental fragments Signup and view all the answers

What nursing action is essential if a woman reports severe pain and inability to void post-delivery?

Report to the healthcare provider Signup and view all the answers

What sign indicates that subinvolution of the uterus may be occurring?

Fundal height greater than expected Signup and view all the answers

What is the proper response if a postpartum woman experiences persistent bright red bleeding after discharge?

Contact healthcare provider immediately Signup and view all the answers

What should a nurse teach a postpartum woman to monitor concerning lochia?

Persistent red bleeding should be reported Signup and view all the answers

Which of the following interventions is appropriate for managing retained placental fragments?

Dilation and curettage (D&C) Signup and view all the answers

What is TRUE regarding the administration of methylergonovine?

It helps maintain firm uterine contractions. Signup and view all the answers

How long post-delivery is a woman expected to remain NPO prior to examination by a healthcare provider?

Until the healthcare provider prescribes treatment Signup and view all the answers

Which sign is NOT a typical symptom of subinvolution of the uterus?

Firm uterus palpated at delivery Signup and view all the answers

What is the primary cause of venous thrombosis in pregnant women?

Venous stasis from compression Signup and view all the answers

Which signs should be monitored to confirm the diagnosis of deep venous thrombosis (DVT)?

Leg edema and color changes Signup and view all the answers

What is a key preventive measure for thrombus formation during postpartum care?

Early ambulation and leg movement Signup and view all the answers

What common treatment is used for superficial venous thrombosis?

Analgesics and leg elevation Signup and view all the answers

Which factor may contribute to a state of hypercoagulability in pregnant women?

Increased fibrinogen and clotting factors Signup and view all the answers

What should a nurse teach a postpartum woman using antiembolic stockings?

The proper technique to put them on Signup and view all the answers

What condition may arise from a pulmonary embolism?

Decreased level of consciousness Signup and view all the answers

Which anticoagulant is commonly used post-surgery to prevent DVT?

Heparin Signup and view all the answers

What is a potential sign of a pulmonary embolism?

Shortness of breath Signup and view all the answers

Which action should be avoided to promote venous blood flow in pregnant women?

Crossing the legs 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

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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.