Term
| a woman can have any medical problem after a birth, but most complications r/t to childbirth fall into one fo six categories |
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Definition
shock
hemorrhage
thromboembolic disorders
puerperal infections
subinvolution of the uterus
mood disorders |
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Term
| defined as a condition in which the cardiovascular system fails ot provide essential oxygen and nutrients to the cels |
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Definition
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Term
| postpartum shock r/t childbearing includes |
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Definition
| cardiogenic, hypovolemic, anaphylactic, and septic shock |
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Term
| cardiogenic shock is caused by |
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Definition
| pulmonary embolism, anemia, htn, or cardiac diorders |
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Term
| hypovolemic shock is caused by |
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Definition
| postpartum hemorrhage or blood clotting disorders |
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Term
| anaphylactic shock is caused by |
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Definition
| allergic responses to drugs administered |
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Term
| septic shock is caused by |
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Definition
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Term
| the inherent danger of _ shock is that the body compensation can mask the signs until the condition becomes _ |
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Definition
| obstetric, life threatening |
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Term
| postpartum hemorrhage is traditionally defined as blood loss greater than _ after vaginal birht or _ after cesarean birht resulting in s&s of hypovolemia |
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Definition
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Term
| early postpartum hemorrhag occurs within _ of birth |
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Definition
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Term
| late pospartum hemorrhage occurs after _ and within _ after birth |
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Definition
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Term
| the major risk of hemorrhage is _ which interrupts blood flow to body cells |
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Definition
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Term
| the leading cause of postpartum death around the world |
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Definition
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Term
| occurs when the volume of blood is depleted and cannot fill the circulatory system |
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Definition
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Term
| the body initially responds to a reduction in blood volume with increased |
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Definition
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Term
| is usually the first signe of inadequate blood volume |
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Definition
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Term
| the first blood pressure change r/t hypovolemia is a decreased |
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Definition
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Term
| with hypovolemia the woman's skin and mucous membranes may become |
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Definition
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Term
| as blood loss continues, flow ot the brain decreases resulting in mental changes such as |
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Definition
| anxiety, confusion, reslessness and lethargy |
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Term
| medical management of hypovolemic shock resulting from hemorrhage may influde: |
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Definition
- stopping the blood loss
- giving IV fluids to maintain circulating volume/replace fluids
- giving blood transfusions
- giving oxygent to increase the saturation of remaining blood cells
- placing an indwelling catheter to assess urine output
- uterine massage and administration of drugs to contract the uterus
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Term
| routine postpartum care involves assessing vital signs every _ until stable to that the signs of postpartum hemorrhage are identified _ |
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Definition
| 15 min, as early as possible |
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Term
| the woman should be observed closely for early signs of shock such as |
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Definition
tachycardia, pallor, cold and clammy hands amd decreased urine output
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Term
| may be a late sign of hypovolemic shock |
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Definition
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Term
| when the amount and character of the lochia are normal and the uterus is firm but signs of hypovolemia are still evident the cause may be a large: |
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Definition
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Term
| the occurence of _ may indicate a blood clotting problem |
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Definition
petechia, bleeding from venipuncture sites or oliguria
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Term
| early postpartum hemorrhage results from one of three cause |
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Definition
uterine atony, lacerations of the reproductice tract, hematomas of the reproductive tract
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Term
| most common cause of postpartum hemorrhage |
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Definition
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Term
| describes a lack of normal muslce tone |
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Definition
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Term
| a large hollow organ with tree layers of muscle |
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Definition
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Term
| allows the blood vessels at eht palcenta site to bleed freelyand ususally massively |
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Definition
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Term
| ny of these may cause atony |
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Definition
uterine overdistention, reained placental fragments, prologned labor, use of drugs during labor that relax the uterus
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Term
| after a full term birth the uterus should easily be felt through the abdominal wall as a firm mass about the size of a |
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Definition
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Term
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Definition
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Term
| the amount of lochia during the first few hours should be no more than _ saturated perineal pad per hour |
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Definition
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Term
| if the bladder is ful the uterus is _ and _ rather than located in the middle of the abdomen |
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Definition
| higher, and pushed to one side |
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Term
| when the uterus is boggy it should be |
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Definition
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Term
| pressing toward the vagina should expel any clots or blood pooled in the vagina after the uterus is |
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Definition
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Term
| first the uterus is _ and then the bladder is _ to keep the uterus firm |
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Definition
| massaged to firmness, emptied |
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Term
| the ost common drug ordered to control uterine atony |
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Definition
| a dilute oxytocin IV infustio |
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Term
| other drugs to increase uterine tone include |
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Definition
| methylergonovine (methergine) and prostoglandis (hemabate or cytotec) |
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Term
| _ increase blood pressure and should not be given to a woman with hypotension |
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Definition
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Term
| excessive bleeding may also be managed by providing |
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Definition
| a uterine tamponade, using an intrauterine balloon, sleective arterial embolization or surgical ligation of the artery |
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Term
| IV _ may be used to counteract a tocolytic drug tha tmay have been administered to relax the uterus during labor |
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Definition
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Term
| IV _ may be used to counteract a tocolytic drug tha tmay have been administered to relax the uterus during labor |
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Definition
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Term
| the woman should be _ status until bleeding is controlled |
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Definition
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Term
| lacerations fo the _ can cause postpartum bleeding |
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Definition
| perineum, vagina, cervix or are around the urethra |
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Term
| blood lost in lacerations is usually a _ than lochia and flows in a _ |
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Definition
| brighter red, continuouis trickle |
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Term
| with lacerations the uterus is typically |
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Definition
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Term
| genital trauma can cause long term effects such as |
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Definition
| cystocele, a prolapsed uterus or urinary incontinence |
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Term
| a collection of blood within the tissues |
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Definition
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Term
| hematomas resulting from birht trauma are usually on the |
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Definition
| vulva or inside the vagina |
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Term
| hematomas may be easily seen as a |
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Definition
| bulging bluish or purplish mass |
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Term
| the woman with a hematoma usually has severe unrelenting pain that: |
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Definition
| analgesics do not relieve |
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Term
| depending on the amount of blood in the tissues due to hematoma, the woman may also describe pressure in the |
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Definition
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Term
| the woman may be unable to _ because of the pressure caused by hematoma |
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Definition
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Term
| the woman may develop signs of _ if the hematoma is lare |
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Definition
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Term
| small hematomas usually resolve without |
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Definition
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Term
| with larger hematomas the bleeding vessel is _ or the area packed with a _ to stop the bleeding |
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Definition
| ligated, hemostatic material |
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Term
| an _ to the perineum is sufficient for fsmall perineal hematomas and requires no prescription |
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Definition
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Term
| signs of concealed blood loss accompanied by maternal complaints of _ should be reported |
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Definition
| severe pain, perineal or vaginal pressure, or inability to void |
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Term
| the medication _ can be used to inhibit the breakup of clots that form which supports the devloping blood clot that is necessary to control hemmorhage |
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Definition
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Term
| tranexamic acid must be administered within _ of delivery |
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Definition
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Term
| late postpartum hemorrhage usually results from |
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Definition
| retention of placentla fragments, subinvolution of the uterus |
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Term
| retentio of placental fragments is more likely to occur if the placenta is |
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Definition
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Term
| placental fragments are also more likely to exist if the placenta grows _ into the uterine muscle that is normal |
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Definition
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Term
| treatment of late postpartum hemorrage consists of administartion fo drugs such as |
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Definition
| oxytocin, methylergonovine or prostoglandins |
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Term
| if bleeding continues _ is performed |
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Definition
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Term
| scraping or vacumming of the inner surface of the uterus |
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Definition
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Term
| curettage is also known as |
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Definition
| dilation and curretage (d&c) or dilation and evacuation (d&e) |
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Term
| the woman should be instructed tor report the following signs of late post partum hemorrhage to her health care provider |
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Definition
persistent bright red bleeding
return of red bleeding after it has changed to pinkish or white |
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Term
| the return of the uterus to is nonpregnant condition after birth |
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Definition
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Term
| normally the utuerus descends at the rat of _ per day and and is no longer detectable by _ post partum |
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Definition
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Term
| the ;acental site heals by |
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Definition
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Term
| a slower than expected return of the uterus to its nonpregnnat conditon |
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Definition
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Term
| most common cuases of subinvolution |
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Definition
| infection and retained fragments |
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Term
| typical signs of subinvolution |
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Definition
| fundal height greater than expected for the amount of time since birth, persistence of lcohia rubra or a slowed progression, pelvic paine, heavinessm fatigue |
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Term
| medical treatment for subinvolution may include |
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Definition
| methylergonovine, antibiotics, dialion and curettage |
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Term
| a blood clot within a vein |
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Definition
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Term
| the size of the clot can increase as circulating blood passes over it and deposits more |
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Definition
| platelets, fibrin and cells |
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Term
| levels of fibrinogen and other clotting factors normally _ during pregnancy, whereas levels of clot dissolving factors are normally _ |
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Definition
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Term
| preventative measures for trhomboembolic disorders |
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Definition
| use of pneumatic compresion devices on the lower extrimtes, prophylactic heparin for women undergoing c-section or are on prolonged bed rest |
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Term
| three types of throboembolic disorders |
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Definition
| superficial and deep venous thrombosis, and pulmonary embolism |
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Term
| involves the saphenous vein of the lower leg |
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Definition
| superficial venous thrombosis |
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Term
| superficial venous thormbosis is characterized by |
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Definition
| painful, hard, reddened, warm vein that is easily seen |
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Term
| can involve veins from the feet to the femoral are |
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Definition
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Term
| deep venous thrombosis is characterized by |
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Definition
| pain, calf tendernes,s leg edema, color changes, pain when walking, and sometims positive homans' sign |
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Term
| an increase inleg circumference greater than _ accompannied by _ should be promptly reported |
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Definition
2cm
redness, tenderness, and edema |
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Term
| occurs when the pulmonary artery is obstructed by a blood clot that breaks of and lodges in the lungs |
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Definition
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Term
| s&s of pulmonary embolism |
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Definition
| sudden chest pain, cough, dyspnea, decreased LOC and signs of heart failus |
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Term
| a small pulonary embolism may have nonspecific signs and symptoms such as |
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Definition
| shortness of breath, palpitations, hemptysis, faintness and a low grade fever |
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Term
| super venous thrombosis is treade iwht |
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Definition
| administration of analgesics, local application of eat and elevatio of the legs to rpormote venous drainage |
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Term
| deep venous thrombosis is treated similaryl to superficial venous thrombosis with the addition of |
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Definition
| IV anticoagulation drugs such as heparin |
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Term
| low molecular weight heparin such as _ may be used to treat deep venous thrombosis because it is _ and requires _ doses and lab testing |
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Definition
| lovenox, long acting, less frequent |
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Term
| LMWH anticoagulants are contraindicated with |
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Definition
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Term
| _ suggest PE and must be reported immediately |
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Definition
| dyspnea, coughing and chest pain |
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Term
| provention of _ is most important |
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Definition
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Term
| when the legs are elevated there should not be _ at the groin or _ in the popliteal space behind the knee which would restrict _ |
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Definition
| sharp flexion, pressure, venous flow |
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Term
| early _ are valuable aids to preventing thrombus formation in the postpartum woman |
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Definition
| ambulation or ROM exercises |
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Term
| If stirrups are used during birth they should be _ to preven pressure at the popliteal angle |
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Definition
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Term
| signs of excess antiocoagulation |
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Definition
| prolonged bleeding from minor injuries, bleeding cums, nosebleeds, unexplained bruising |
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Term
| the woman undergoing anticoagulat therapy at hom should be taught: |
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Definition
| how to self administer, use of a soft toothbrush, avoid minor trauma that may cause bleeding or large hematoma |
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Term
| an infection or speticemia after child birth |
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Definition
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Term
| risk factors for puerperal sepsis |
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Definition
| tissue trauma during labor, open wound of the pleacental insertion site, surgical incisisons, cracks in the nipples, increased pH of the vagina after birht |
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Term
| fever r/t infection is most often caused by |
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Definition
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Term
| an inflammation of the inner lining of the uterus |
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Definition
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Term
| Increases susceptibility to infection |
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Definition
| blockage of the lochial flow because of retained placenta ro clots |
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Term
| the danger of postpartum infectio is that ta localized infection of the _ can ascend the reporductive tract and spread to the _ causing peritonitis which is a life threatening condition |
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Definition
perineum, vagina or cervix
uterus, fallopian tubes, peritoneum |
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Term
| puerperal fever is defined as a temp of _ or highre after the first 24 hrs for at least _ during the first _ after birth |
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Definition
| 38C(100.4), 2 days, 10 days |
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Term
| slight temperature elevation with no other signs of infection often occur during the first 24 hours because of |
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Definition
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Term
| a puls rate that is higher than expected and an elevated tep often occur when the woman has an |
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Definition
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Term
| the assessment of any c-cesion wound or episiotomy using the _ criteria or reveals _ of the operative area, shourld be promptly reported and documented |
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Definition
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Term
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Definition
| redness, edema, ecchymosis, discharge, approximation |
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Term
| white blood cells are normally elevated during the early postpartum period to about |
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Definition
| 20,000 to 30,000 cell/mm3 |
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Term
| the goals of medicalt treatment for puerperal sepsis are to limit _ |
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Definition
| spread of infection, and to eliminate it completely |
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Term
| To achieve the goal of preventing infection and facilitating treatment the nurse should |
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Definition
- use and teach hygienic measures to reduce the nuber of organisms that can cause infection
- promote adequete rest and nutritin for healing
- observe for signs of infection
- teach signs of infection that the woman should report after dicharge
- teach womant to tak al of the antibiotics prescribed rather than stopping them after her symptoms are eliminated
- teach the woman how to apply perineal pads
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Term
| The nurse and sometimes dietition should teach the woman about foods that are high in _ because these foods are especially improtant for healing |
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Definition
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Term
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Definition
| meats, cheese, milk, legumes |
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Term
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Definition
| citrus fruits and jiuces, strawberries, cantaloup |
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Term
| foods high in irion to correct anemia include |
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Definition
| meats, enriched cereals, breas and dark grean leafty veggies |
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Term
| is an infection of the breast |
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Definition
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Term
| mastitis usually occurs about _ after giving birht |
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Definition
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Term
| occurs when organisms fromt he skin or the infant's mouth enter small cracks in the nipples or areolae |
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Definition
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Term
| _ are associated with mastitis |
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Definition
| breast engorgement and inadequate emptying of milk |
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Term
| s&s of mastitis include the following |
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Definition
| redness and heat in the breast, tendernes, edema and a heaviness in the breast, purulent drainage(may or may not be present) |
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Term
| if mastitis is not treated the infected area becomes encapuslated and an _ forms |
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Definition
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Term
| mastitis infection is usually outside the ducts of the breast meaning the milk is not |
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Definition
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Term
| primary treatments for mastitis |
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Definition
| antibiotics and continued remvoal of milk from the breast |
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Term
| if the woman should stop nursing for any reason r/t mastitis she should continue to |
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Definition
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Term
| the woman with mastitis should not wean her infant when she has mastitis because weaning leads to _ which worsens the mastitis |
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Definition
| engorgemnet and stasis of milk |
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Term
| nursing care for mastitis centers on |
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Definition
| relieving pain and maintaing lactation |
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Term
| _ promotes blood flow to the area, comfort and complete emtpying of the breast |
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Definition
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Term
| both breasts sould be emptied regulary to reduce _ which increases the risk for _ formation |
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Definition
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Term
| The mother with mastitis can _ the area of inflammation to improve milk flow and rduce stasis |
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Definition
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Term
| _ on the unaffected side starts the milk flow in both breasts and can improve emptying with less pain when dealing with mastitis |
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Definition
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Term
| _ on the unaffected side starts the milk flow in both breasts and can improve emptying with less pain when dealing with mastitis |
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Definition
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Term
| other nursing measures for mastitis include |
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Definition
- encouraging fluid intake
- advising the woman to wear a good support bra to support breast and limit movement
- supporting the woman emotionally and reassuring her that she can continue to breastfeed
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Term
| a pervasive and sustained emotion that can color one's view of live |
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Definition
|
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Term
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Definition
| postpartum blues or baby blues |
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Term
| involves serious impairment of one's perception of reality |
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Definition
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Term
| disorders that are more serious than postpartum blues |
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Definition
| postpartum depression and postpartum psychosis |
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Term
| after childbirt _ levels decrease rapidly which leads to increased brain levels of _ which is r/t to theonset of postpartum depression |
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Definition
| estrogen and progesterone levels, monoamineoxidase A(MOA-A) |
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Term
| research has shown that a nutritional supplement of _ counters the effects of increased MAO-A levels and mya prevent the delopment of pospartum depression |
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Definition
| trypotophan, tyrosin and blueberry juice |
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Term
| three types of postpartum depression |
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Definition
adjustment disorder (baby blues)
postpartum mood disorder
postpartum depression |
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Term
| postpartum depression is a depressive illness that is usually manifested within _ after delivery |
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Definition
|
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Term
| risk factors for postpartum depression |
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Definition
| inadequate social support, poor relatioship with the parter, life and childcare stress, low self esteem and an uplanned pregnancy |
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Term
| s&s of depression may include |
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Definition
- lack of enjoyment in life
- disinterest in others, loss ofnormal give and take in relatioships
- intense feeling of inadequacy, uworthiness, guilt inability to cope
- loss of mental concentration, inability to make decisions
- disturbed sleep or appetite
- constant fatigue and feelings of ill health
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Term
| complementary and alternative treatment strategies that may help in the managment of postpartum depression |
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Definition
light therapy and exercise
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Term
| women experiencing a postpartum psychocis have an impaired sense of |
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Definition
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Term
| two most often encountered psychiatric disorder |
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Definition
| bipolar disorder, major depression |
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Term
| a disorder characterized by episodes of mania and depression |
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Definition
|
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Term
| major depression is a disorder characterized by |
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Definition
| deep feelings of worthlessness and guilt, serious sleep and appetite disturbances and sometimes delusions about the infant being dead |
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