Chapter 20 - Key Complications PDF

**Key Complications** Complication Description ---------------------------- ---------------------------------------------------------------------------------------------------- Deep-Vein Thrombosis (DVT) Thrombus formation in deep veins, especially in the legs, leading to po...

**Key Complications** Complication Description ---------------------------- ---------------------------------------------------------------------------------------------------- Deep-Vein Thrombosis (DVT) Thrombus formation in deep veins, especially in the legs, leading to potential pulmonary embolism. Pulmonary Embolus Occurs when a clot from DVT travels to the lungs, causing obstruction and respiratory distress. Coagulopathies Disorders like ITP and DIC that lead to abnormal bleeding and clotting issues. Postpartum Hemorrhage Significant blood loss post-delivery, requiring immediate assessment and intervention. Uterine Atony Failure of the uterus to contract effectively, leading to increased risk of hemorrhage. **Key Assessment Techniques** - **Physical Assessment**: Monitor for signs of DVT (leg pain, swelling, warmth) and postpartum hemorrhage (uterine tone, lochia). - **Diagnostic Procedures**: Use Doppler ultrasound for DVT, and CBC for coagulopathy assessment. - **Vital Signs Monitoring**: Regularly check for tachycardia and hypotension as indicators of hemorrhage or shock. **Key Risk Factors** Condition Risk Factors ---------------------------- -------------------------------------------------------------------------------------------------- Deep-Vein Thrombosis (DVT) Pregnancy, cesarean birth, immobility, obesity, smoking, age \> 35, history of thromboembolism. Postpartum Hemorrhage Uterine atony, overdistended uterus, prolonged labor, high parity, retained placental fragments. Coagulopathies Genetic factors (ITP), abruptio placentae, severe preeclampsia, infection, and hemorrhage. **Facts to Memorize** - Postpartum hemorrhage is defined as losing more than 500 mL of blood after a vaginal birth or more than 1,000 mL after a cesarean birth. - Heparin antidote: Protamine sulfate. - Warfarin antidote: Phytonadione. - Normal aPTT range: 30 to 40 seconds (therapeutic range for DVT: 1.5 to 2.5 times the control level). - Normal PT range: 11 to 13.5 seconds (therapeutic range for warfarin: INR 2.0 to 3.0). **Reference Information** - Risk factors for DVT include pregnancy, cesarean birth, immobility, obesity, smoking, and age over 35. - Common medications for postpartum hemorrhage include Oxytocin, Methylergonovine, Misoprostol, and Carboprost tromethamine. **Concept Comparisons** Concept Description ---------------------------- ------------------------------------------------------------------------------------------------------------ Deep Vein Thrombosis (DVT) A thrombus associated with inflammation, primarily in deep veins, leading to potential pulmonary embolism. Pulmonary Embolism (PE) Occurs when a dislodged thrombus travels to the pulmonary artery, obstructing blood flow to the lungs. Coagulopathies Disorders affecting blood clotting, such as ITP and DIC, leading to increased risk of bleeding. Postpartum Hemorrhage Excessive bleeding following childbirth, often due to uterine atony or retained placental fragments. **Cause and Effect** Cause Effect ------------------------------ ------------------------------------------------------------------------------------ Uterine atony Leads to postpartum hemorrhage due to inadequate uterine contractions. Retained placental fragments Can cause subinvolution of the uterus and prolonged bleeding. Coagulopathies (e.g., DIC) Results in simultaneous clotting and bleeding, increasing risk of hemorrhage. Deep vein thrombosis (DVT) Can lead to pulmonary embolism if the thrombus dislodges and travels to the lungs. **Key Terms/Concepts** - **Postpartum Disorders**: Unexpected events or occurrences during the postpartum period that require nursing intervention. - **Deep-Vein Thrombosis (DVT)**: A thrombus associated with inflammation, primarily occurring in the lower extremities. - **Pulmonary Embolus**: A complication of DVT where a clot dislodges and obstructs blood flow to the lungs. - **Coagulopathies**: Disorders affecting blood coagulation, including Idiopathic Thrombocytopenic Purpura (ITP) and Disseminated Intravascular Coagulation (DIC). - **Postpartum Hemorrhage**: Excessive bleeding following childbirth, defined as more than 500 mL after vaginal birth or more than 1,000 mL after cesarean birth.