Term
| what is Early Postpartum Hemorrhage? |
|
Definition
| Hemorrhage occurring within the first 24 hours after delivery |
|
|
Term
| what is delayed Postpartum Hemorrhage? |
|
Definition
| Hemorrhage occurring after the first 24 hours postpartum and 6-12 weeks postpartum |
|
|
Term
| what are some of the causes of PPH? |
|
Definition
Often unknown etiology
Subinvolution of placental site: +/- 80% of cases
Infection
Delayed involution of uterus
Uterine atony - with or without infection
Cesarean scar dehiscence
Coagulopathies
von Willebrand Disease: +/- 50% present with delayed PPH and frequently require a blood transfusion |
|
|
Term
| what are differentials to PPH? |
|
Definition
Uterine atony
Genital tract lacerations
Hematoma
Infection due to endometritis
Retained products of conception |
|
|
Term
| review management and care for PPH |
|
Definition
Most delayed PPH will settle on their own without any interventions
The etiology - if known - will direct management
Treatment based on the pathological process
Sonography to assess if uterus is empty or contains retained products of conception
Repair of any previously unidentified lacerations
If client stable: start with administration of oxytocin, ergonovine, methylergonovine, or a prostaglandin analog to control hemorrhaging - when would we NOT follow this course?
Antimicrobials are started with suspected uterine infection
D & C for retained fragments or if large clots are present - not routinely performed
D & C when medication management fails
Hysterectomy as last resort |
|
|
Term
| what is uterine subinvolution? |
|
Definition
| uterus fails to return to it’s pre-pregnant state within the time frame of the postpartum period |
|
|
Term
| when uterine subinvolution likely to be dx? |
|
Definition
| Often diagnosed at routine 2-week postpartum visit |
|
|
Term
| what is the most common cause of secondary PPH? |
|
Definition
|
|
Term
| what is the most common cause of uterine subinvolution? |
|
Definition
|
|
Term
| what are risk factors for retained placental parts? |
|
Definition
Prolonged second or third stage
Augmented labor
Nulliparity
Preterm Birth |
|
|
Term
| placental site subinvolution is an under-recognized condition is related to |
|
Definition
Uteroplacental arteries fail to close
Fill with thrombi
Inadequate sloughing
Endothelial lining not regenerated |
|
|
Term
| most likely to see PPH in 2nd due to |
|
Definition
| placental site subinvolution |
|
|
Term
| who is at highest risk of endometritis? |
|
Definition
| those who have cesarean births |
|
|
Term
| what are additional risk factors for endometritis? |
|
Definition
Prolonged ROM or labor
Increased number of vaginal exams
Undiagnosed/untreated infection prior to labor
Internal monitoring
Low socioeconomic status
Retained placental fragments
Uterine manipulation or exploration |
|
|
Term
| excessive maternal activity can also lead to |
|
Definition
|
|
Term
| list s/s of uterine infection |
|
Definition
Malodorous lochia
Adnexal pain or tenderness with movement of uterus
Cervical motion tenderness with vaginal examination |
|
|
Term
| why is US inconclusive when assessing for retained placental fragments? |
|
Definition
| Differentiation between blood clots and placental fragments may be difficult |
|
|
Term
| review tx options for subinvolution |
|
Definition
Antibiotics
Indicated if positive lochial culture
Broad spectrum
Hospital admission may be required
IV Clindamycin and Gentamicin
IV Clindamycin and Unasyn
IV Ampicillin and Gentamicin
Methergine (methylergonovine)
0.2mg PO Q4 hours for 24 to 48 hours |
|
|
Term
| in regards to subinvolution, when should the pt be referred or at a minimal, a consultation occur? |
|
Definition
Infection
Retained placental fragments
Minimal or no improvement
Worsening condition |
|
|
Term
| what is PP thrombophlebitis? |
|
Definition
| Inflammation of a vein with the formation of a thrombosis or blood clot. Thrombosis can occur in superficial or deep veins. |
|
|
Term
|
Definition
Stasis
Vascular trauma
Hypercoagulability |
|
|
Term
| During pregnancy/ postpartum women have a 5-7% increased risk for |
|
Definition
|
|
Term
| when do most women develop thromboses? |
|
Definition
| PP period; half of all cases |
|
|
Term
| what is the greatest risk of thrombosis? |
|
Definition
| PE; not common with superficial thrombosis |
|
|
Term
| what are risk factors for thrombosis? |
|
Definition
Obesity
Smoking
Advanced maternal age
Hx of thrombosis
Genetic thrombophilias
Antiphospholipid antibody syndrome
Sickle cell disease
Heart disease
Diabetes
Multiple pregnancy
Preeclampsia
Operative vaginal delivery
Cesarean section
Infection
Vascular trauma
Immobilization
Postpartum hemorrhage |
|
|
Term
| what are the Signs and Symptoms of thrombosis? |
|
Definition
Leg pain
Localized heat
Tenderness
Palpation of a knot or cord
Inflammation at the sight |
|
|
Term
| ______________ is the gold standard for diagnosis and differentiation between deep and superficial thrombosis |
|
Definition
| Compression venous ultrasound |
|
|
Term
| what are other test you should consider for dx of thrombosis? |
|
Definition
Homan’s sign- no longer recommended
Serial calf measurements
D-Dimer- nonspecific in pregnancy
Testing for bleeding or clotting disorders, coagulation factors: PT, PTT |
|
|
Term
| what is the tx for thrombosis? |
|
Definition
Leg rest
Elevation of affected extremity
Supportive stockings
Analgesics as needed
Avoid- constrictive clothing, long periods of sitting/ standing, crossing legs, leg massage |
|
|
Term
| When dealing with thrombophlebitis, when is it appropriate for the CNM to refere, consult, or collaborate? |
|
Definition
*Consultation
Occurs with early superficial thrombophlebitis
*Collaboration
Occurs when pt develops warning signs
Suspected deep-venous system involvement
Anticoagulation therapy needed
*Referral
Clinical presentation worsens
Pulmonary Embolism suspected
1/7000 pregnancies
10% maternal death |
|
|
Term
| what are common causes of hematoma's of the genital tract? |
|
Definition
| instrumental birth or episiotomy/laceration |
|
|
Term
| what are risks factors for hematoma? |
|
Definition
Primiparity
Multiple gestation
Preeclampsia
Coagulopathies
Vulvovaginal varicocities
Prolonged second stage |
|
|
Term
| what are s/s of genital tract hematomas? |
|
Definition
*Anemia
Tired or exhausted
*Perineal swelling
Urinary retention
*Pain
Sitting/walking; may need support/help |
|
|
Term
| what is the management of genital tract hematomas? |
|
Definition
According to size, onset, and expansion
Expectant = small or slower onset
2-3 cm
Frequent observation, spontaneously absorbed
Surgical = severe pain or enlarging
≥ 5 cm |
|
|
Term
| reveiw s/s of vaginal hematoma |
|
Definition
Severe pain
Perineal, vaginal, urethral, bladder or rectal pressure
Discoloration of tissue
Swelling – firm & rounded |
|
|
Term
| review s/s of Retroperitoneal hematoma |
|
Definition
Rarely occurs with vaginal birth
Uterine pain – extends to flank
Painful swelling noted on rectal examination
Ridge of tissue above pelvic rim
Abdominal distention
Assess for signs of hypovolemic shock |
|
|
Term
| what are risk factors for PP infection? |
|
Definition
Preexisting medical conditions: DM, immune disorders, HTN
Obesity or excessive gestational weight gain
Advanced maternal age
Low socioeconomic status
Insufficient PNC or lack of access to care
Smoking
Poor hygiene
Undiagnosed or re-infection of STI (chlamydia and gonorrhea) |
|
|
Term
| what are intrapartum risk factors for postpartum infection? |
|
Definition
Cesarean Section
Operative / Instrumental vaginal birth
Prolonged ROM
Prolonged labor
Frequent vaginal examinations
IUPC and FSC fetal monitoring
Chorioamnionitis |
|
|
Term
| what are PP risk factors for pp infection? |
|
Definition
Vaginal laceration / episiotomy
Retained placenta
Manual exploration / manipulation of the uterus
PP hemorrhage
Hematoma formation
Poor sterile technique
Poor provider technique |
|
|
Term
| what are s/s of PP infection? |
|
Definition
Fever >100.4 °F
Malaise
Chills
Tachycardia
Uterine tenderness
Pain that increases in severity over time
Malodorous lochia |
|
|
Term
| where does endometritis most often occur? |
|
Definition
|
|
Term
| women who are _________ are more likely to develop endometritis? |
|
Definition
|
|
Term
| what is the tx for endometritis? |
|
Definition
Moderate to severe cases, or those following a cesarean = refer to a physician for hospitalization and IV antibiotics
IV gentamicin and clindamycin are the gold standard for these cases
Improvement usually seen within 48-72 hours after initiation of treatment |
|
|
Term
| what is the cause of PP sepsis? |
|
Definition
|
|
Term
| what is the etiology of mastitis? |
|
Definition
Benign
Self-limiting
Unilateral (typically)
Staphylococcus Aureus (40% MRSA)
Streptococcus (rare, subclinical)
Infants nose/throat > cracks/fissures
Physical Exam and Milk Culture |
|
|
Term
| what are the risk factors for mastitis? |
|
Definition
stress/fatigue
cracked/fissured nipples
plugged/blocked ducts
ample milk supply or decreased feedings
engorgement/stasis
poor feeding
outside employment or pump usage |
|
|
Term
| what are the s/s of mastitis? |
|
Definition
'Flu' like symptoms
Fever
Chills/rigors
Fatigue (lingers)
Headache
Muscle ache
Tenderness/Pain
Reddened, hot breast
Engorgement
Inflammation |
|
|
Term
| what is the tx of mastitis? |
|
Definition
CONTINUE BREASTFEEDING!
Moist Heat
Increase Fluid Intake
Bed Rest and TLC
Pain Medication
Antibiotics?!?
current experience in area, Dicloxacillin
Erythromycin for penicillin sensitive |
|
|
Term
| what is the cause of nipple candida? |
|
Definition
Candida albicans (typically)
From Baby
Antibiotic Usage
Nipple Trauma
Vaginal Candida
Physical Exam |
|
|
Term
| review management of nipple candida |
|
Definition
Recommendations vary, but most recommend topical treatment initially if only nipple involvement
Nystatin on nipples first line, before and after each feeding
Or can use other azole creams- clotrimazole, oxiconazole
3 prong treatment- a topical azole cream to the nipples; topical antibiotic cream such as bactroban; & a cortisone cream. Also, recommend nystatin for infant concurrently.
Nystatin for baby if involved if first time treatment
Diflucan for persistent cases (may be for mom & baby)
Diluted vinegar soak (1 part vinegar, 4 parts water), air dry after
Gentian violet- Old fungal medication. Used 2nd line. Painted on baby’s mouth & mom’s nipple. Stains everything purple. May irritate mucous membranes especially when alcohol based. Some pharmacies can prepare aqueous based!!
Newman’s all purpose nipple ointment-mixed by pharmacist (mupirocin 2% ointment, nystatin 100,000unit/ml, clotrimazole 10% cream, betamethasone 0.1% ointment)
Probiotic supplement daily taken until at least 2 weeks after symptoms resolve
Non-evidence based: apple cider vinegar by mouth, oregano oil topically or PO, coconut oil internally and topically |
|
|
Term
| what is Postpartum Preeclampsia? |
|
Definition
| Development of preeclampsia within the first 24 to 48 hours postpartum |
|
|
Term
| what is Late Preeclampsia/Eclampsia? |
|
Definition
| Development of preeclampsia/eclampsia between 48 hours and 6 weeks, after delivery (one source reports prior to 4 weeks postpartum) |
|
|
Term
| reveiw definiton of Severe Preeclampsia |
|
Definition
BP ≥ 160 systolic or ≥ 110 diastolic on two occasions at least 6 hours apart
pulmonary edema
epigastric pain
neurologic changes
proteinuria (≥ 3+ on two random urine dips at least 4 hours apart, or ≥ 5 grams in 24 hours
oliguria (< 500cc in 24 hours)
impaired LFT
thrombocytopenia |
|
|
Term
| PP pre-e can lead to _____ and _____. |
|
Definition
| pulmonary edema and renal failure |
|
|
Term
| renal damage increases the risk of |
|
Definition
|
|
Term
| If the pt presents with elevated BPs and no other symptoms, then you should |
|
Definition
| control the blood pressure |
|
|
Term
| when are antihtn medications recommended? |
|
Definition
| if systolic BP remains persistently > 150 mm Hg, or diastolic BP persists > 100 mmHg. |
|
|
Term
| ________ and )__________are used initially if there is persistent elevations in BP to levels > 160 mm Hg systolic, and >110 mm Hg diastolic. |
|
Definition
| Bolus IV injections of either labetalol or hydralazine |
|
|
Term
| *Oral nifedipine is associated with improved ________, which results in diuresis |
|
Definition
|
|
Term
| Women with persistent hypertension despite the use of maximum doses of antihypertensives require evaluation for the presence of either: |
|
Definition
Renal artery stenosis
Primary hyperaldosteronism |
|
|
Term
| What is Postpartum Thyroiditis? |
|
Definition
| Inflammation of thyroid gland with phases of both hyperthyroid and hypothyroid states. |
|
|
Term
| Who is at risk for PP thyroiditis? |
|
Definition
Type I diabetes
Autoimmune disorders
Thyroid dysfunction /disorder prior to pregnancy
Family history of thyroid disorder |
|
|
Term
| PP thyroiditis occurs in 25% of all women with |
|
Definition
|
|
Term
| PP thyroiditis occurs in 5-10% of all |
|
Definition
|
|
Term
| When does PP thyroiditis occur? |
|
Definition
Hyperthyroid phase:
Onset 1-4 months postpartum
Duration: 1-3 months
Hypothyroid phase:
Onset 4-8 months postpartum
Duration: 9-12 months
Patients may experience only one phase or both phases. |
|
|
Term
| review the s/s of hypothroiditis |
|
Definition
Decreased concentration
Depression
Fatigue
Weight gain
Constipation
Dry skin
Goiter |
|
|
Term
| review the s/s of hyperthyroiditis |
|
Definition
Palpitations
Anxiety
Irritability / restlessness
Weight loss
Insomnia
Fatigue
Goiter |
|
|
Term
| how is hyperthyriodism dx? |
|
Definition
Decreased serum levels of thyroid stimulating hormone
Thyroid peroxidase antibodies present
Lack of TSH receptor antibodies |
|
|
Term
| how is hypothyroidism dx? |
|
Definition
Increased TSH levels
Positive anti-thyroid pyroxidase antibodies |
|
|
Term
| what is the tx for hyperthyroidism? |
|
Definition
| Beta blockers to control symptoms of palpitations, tremors, and restlessness |
|
|
Term
| what is the tx for hypothyroidism? |
|
Definition
| Levothyroxine continue 6-12 months postpartum |
|
|
Term
| why shoudl beta blockers be tapered off when treating a pt for hyperthyroidism? |
|
Definition
| because this is a transient condition |
|
|
Term
| what is the rationale for tapering a pt off of levothyroxine during treatment of hypothyroidism? |
|
Definition
| to assess whether permanment replacement is needed |
|
|
Term
| what is the recovery time for PP thyroiditis? |
|
Definition
| approx 1 yr with a recurrence rate of 50-70% with subsequent pregnancies |
|
|
Term
| what is the likelihood of developing permanent hypothyroidism? |
|
Definition
| 50% of affected women will develop it in 5-10yrs |
|
|
Term
|
Definition
Abrupt onset of a hypermetabolic state
and is life-threatening |
|
|
Term
| when is a thyroid storm most likely to occur? |
|
Definition
| within the first month PP |
|
|
Term
| what are s/s of thyroid storm? |
|
Definition
| S/Sx include N/V, diarrhea, fever, tachycardia, hypertension, and tremors |
|
|
Term
| if left untx, thyroid storm can cause |
|
Definition
| seizures, coma, heart failure, and death. |
|
|
Term
| this condition is often mistaken for |
|
Definition
| postpartum pre-eclampsia or eclampsia |
|
|
Term
| when are baby blues most likely to occur? |
|
Definition
| 7-10 days after birth but last less than 2wks |
|
|
Term
| what is the onset of PP depression |
|
Definition
| 2 months to 1 year after birth but more than two weeks |
|
|
Term
| what is the onset of PP psychosis? |
|
Definition
| Anytime in the first 2 to 4 weeks with an average duration of 40days |
|
|
Term
| Acute onset of psychosis and delusional thoughts |
|
Definition
|
|
Term
| Anhedonia, sleep disturbance, guilt, feeling of isolation and loneliness |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the first line tx for PP depression? |
|
Definition
| SSRIs are usually first line pharmacologic treatment |
|
|
Term
| review risk factors for PP pychosis |
|
Definition
Primiparous women
Age <25 y.o. or >35 y.o.
Autoimmune Thyroid Disease
Single mother or partner absent from birth and postpartum period
Sleep loss
Poor socioeconomic status and/or environment
Birth by cesarean or complications during birth
Having a female infant
Preterm birth, low birthweight, neonatal complications and/or perinatal death
Family history of PP, depression and/or bipolar
25-50% of women who are bipolar will experience PP
57% of women with history of PP will have repeat episodes in a subsequent pregnancy |
|
|
Term
| review s/s of pp psychosis |
|
Definition
Often sudden and unexpected
Usually occurs 48 hours-4 weeks after birth
Peak occurrence is at 2 weeks, but may occur anytime during first year
after birth.
Duration: Mean is 40 days but may take 12 months or longer to feel fully recovered
Recent research suggests that half of women present in first 3 days postpartum with mild hypomanic symptoms.
Rapid progression from onset to full psychosis
Clinical presentation varies widely among women |
|
|
Term
| women with PP psychosis will typically have dellusions that revolve around |
|
Definition
|
|
Term
| PP psychosis pt may what type of hallucitionations? |
|
Definition
| Auditory, visual and olfactory hallucinations are common |
|
|
Term
| review the effects of mental health disorders on the family unit |
|
Definition
| Those families affected often have increased marital stress and separation or divorce, lack mother-baby attachment, have decreased breastfeeding rates, and often infants have delayed development, behavioral problems, temperament difficulties, and impaired emotional, cognitive and attention functioning. |
|
|
Term
| women with PP psychosis will likely |
|
Definition
| commit suicide or infanticide (4-5%) |
|
|
Term
| Women are frequently diagnosed with Bipolar Disorder after their ______ episode. |
|
Definition
|
|
Term
| 62% of women will experience_____ with subsequent presgnancies. |
|
Definition
|
|
Term
| what is Obsessive Compulsive Disorder? |
|
Definition
Persistent recurrence of thoughts and
behaviors |
|
|
Term
| in OCD, intrusive thoughts are referred to as |
|
Definition
|
|
Term
| in OCd, ritualized behavior is referred to as the |
|
Definition
|
|
Term
|
Definition
Repeated thoughts or images
Routine rituals
Uncontrollable thought and behaviors
Displeasing
Quality of life issues |
|
|
Term
| review risk for development of OCD |
|
Definition
Affects men and women equally
Higher incidence in Caucasian and African American women
Familial
Usually appear
Childhood
Adolescence
Early adulthoo |
|
|
Term
| when is the onset of OCD likely to occur? |
|
Definition
Symptoms usually begin childhood with mean onset 19 years of age
Prevalence is equal among men and women
Women have a later onset
Symptoms may come and go and be better or worse at various times |
|
|
Term
|
Definition
Psychotherapy
- Cognitive behavior therapy
a. Exposure and response prevention
b. Psychoeducation
c. Cognitive restructuring
Psychopharmacological treatment
- Anti-anxiety
- Antidepressants
Prozac (fluoxetine)
Paxil (paroxetine)
Zoloft (sertraline |
|
|
Term
| relapse is high in what condition when medications are disconditued? |
|
Definition
|
|
Term
| Re-experiencing the event with nightmares, flashbacks, or intrusive thoughts |
|
Definition
|
|
Term
| Long term pain from birth itself. Lack of vaginal sensation , extreme exhaustion and lack of energy |
|
Definition
| physical symptoms of PTSD |
|
|
Term
| extreme depression, suicidal intentions anger, and positive self image to feelings of no worth |
|
Definition
| psychological symptoms of PTSD |
|
|
Term
| women with PP PTSD often fear |
|
Definition
|
|
Term
| review the risk factors for development of PP ptsd |
|
Definition
Women who have experienced childhood trauma, sexual abuse, depression, or prior PTSD are at an increased risk postpartum
Depression , Anxiety or fear of childbirth during pregnancy
Emergency cesarean and instrumental deliveries |
|
|
Term
|
Definition
| SSRIs like zoloft and paxil. Zoloft seems to be more effective |
|
|
Term
| reveiw the Impact of PPD on Family Members |
|
Definition
Postpartum depression affects the whole family
Interventions must address the needs of the whole family
Fathers
directly experience PPD themselves or indirectly in supporting partner
depressed fathers more likely to engage in physical aggression
PPD puts strain on intimate relationships=increased divorce
Mothers less affectionate, more anxious
PPD limits ability to use appropriate discipline
lead to excess criticism, hostility, rejection of children
Long term impact on health, cognitive, and social-emotional development
Children affected by hostility between parents |
|
|
Term
| review long term conseqences of PPD in children |
|
Definition
Delayed cognitive development and emotional problems in child
Increased risk of depression by age 16
Lower IQ scores, behavior and attention problems, difficulty in math
Behavioral and developmental problems in adolescence
More violent behavior especially in boys in adolescence
Social problems with peers, less ego-resilient, low school adjustment |
|
|
Term
| Breastfeeding can positively affect PP adjustment by increasing positive mood through a natural anxiolytic called |
|
Definition
|
|
Term
| mothers with low vit D and lower levels of Omega 3s are at higher risk of |
|
Definition
|
|
Term
| more long term consquences of PPD on children |
|
Definition
Delayed cognitive development and emotional problems in child
Increased risk of depression by age 16
Lower IQ scores, behavior and attention problems, difficulty in math
Behavioral and developmental problems in adolescence
More violent behavior especially in boys in adolescence
Social problems with peers, less ego-resilient, low school adjustment |
|
|
Term
|
Definition
| The cultural or public display of grief through behavior |
|
|
Term
|
Definition
| The entire process precipitated by the loss of a loved one through death |
|
|
Term
| what are the two categories of loss? |
|
Definition
|
|
Term
|
Definition
| : loss of something intangible, ie: a relationship, retirement, freedom |
|
|
Term
|
Definition
| loss of something tangible recognizable by others, ie: death of a person |
|
|
Term
| Five Characteristics of Grief are |
|
Definition
Somatic distress
Preoccupation with the image of the deceased
Guilt
Hostile reactions
Loss of patterns of conduct |
|
|
Term
| review Worton’s Four Tasks of Mourning |
|
Definition
To accept the reality of the loss
To work through the pain of grief
To adjust to a world without the deceased: Internal, external and spiritual
Find an enduring connection with the deceased while embarking on a new life |
|
|
Term
| What are the five stages of grief? |
|
Definition
Denial
Anger
Bargaining
Depression
Acceptance |
|
|
Term
| conscious/unconscious refusal to accept a situation/reality |
|
Definition
|
|
Term
| Person realizes that denial can’t continue and may ask, "why me?" |
|
Definition
|
|
Term
Hope that death can be delayed/postponed
Usually made with God in exchange for lifestyle change in grieving person |
|
Definition
|
|
Term
Certainty of death understood
Behaviors: silence, refusal of visitors, crying, grieving
Disconnection from love and affection |
|
Definition
|
|
Term
| A “coming into terms” with their mortality or that of their loved one |
|
Definition
|
|
Term
description of grief:
Be in a state of tension: tightened facial musculature
Be unable to relax for fear they might break down
Require persuasion to yield to the grief process
Be less willing to accept the discomfort of bereavement |
|
Definition
|
|
Term
description of grief:
~ Blame themselves
~ Feel intense guilt
~ Los of self, unable to move emotionally or physically
~ Be outwardly emotional |
|
Definition
|
|
Term
| 50% of women with ____ will have a PP hemorrhage |
|
Definition
|
|
Term
| when are the majority of von willebrand's dieased women dx? |
|
Definition
|
|
Term
| women with von willebrand's disease can experience PPH up to ____ postpartum |
|
Definition
|
|
Term
| If a woman experiences PP hemmorhage on days 2-5 PP, what condition should be suspected? |
|
Definition
|
|
Term
| when delayed PPH occurs and placental fragments and infection have been ruled out, the tx of choice is |
|
Definition
|
|
Term
| what is the risk of a D and C when there is delayed PPH? Why? |
|
Definition
| uterine perforation due to soft uterus |
|
|
Term
| most women respond to tx for ______ within 24-48hrs and do not require further tx |
|
Definition
|
|
Term
| the increasing number of pt's recieving antibiotics for GBS prophylaxis is related to the increase in |
|
Definition
|
|
Term
| can occur where niple candida proliferates and infiltratres the milk ducts causing severe bilaterla pbeast pain in addition to nipple pain, itching, burning, and sometimes shooting pain thru the nipple during let-down |
|
Definition
|
|
Term
| to decrease the risk of endometritis, ACOG recommends that _____ be given one hour prior to cesarean section. |
|
Definition
|
|
Term
| what is the most common cause of PP fever? |
|
Definition
|
|
Term
| 3% of women with mastitis will develop a |
|
Definition
|
|
Term
| what is the cause of a breast abcess? |
|
Definition
|
|
Term
| abrupt onset; severe leg pain esp with standing or motion |
|
Definition
|
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Term
| generalized leg pain with calf pressure |
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Definition
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Term
| generalized edema of the leg, ankle, and thigh |
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Definition
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Term
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Definition
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Term
| leg tenderness, but not severe |
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Definition
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Term
| inflammation is localized at site of thrombosis |
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Definition
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Term
| what are the risk of performing the Homan's sign? |
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Definition
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Term
| what two conditions require anticoagulant treatment? |
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Definition
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Term
| what is the medication tx for DVT? |
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Definition
| warfarin for at least 6months. May resume amb when symptoms subside |
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Term
| warfarin is safe during _____ and should be discontinued during _____. |
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Definition
| breastfeeding and pregnancy |
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Term
| MgSO4 should continue for 24hrs after the _____. |
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Definition
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Term
| women who suffer PP depression will have infants who show less _____faces and more ____faces |
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Definition
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Term
| infants of mothers with PP depression will continue an attempt to _______ |
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Definition
| gain their mother's attention, though attempts will decrease over time. |
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Term
| for dx of PP depression, two or more of the following symptoms must be present for at least 2wks: |
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Definition
| insomnia or hypersomnia, agitation or retardation, fatigue, changes in appetitie, feelsing of worhlessness or guile, decreased concentration, and suicidal thoughts along with depressed mood or loss of interest/pleasure |
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Term
| this is the most studied and validated depression scale used |
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Definition
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Term
| What are the characteristics that the Edinburgh scale assess? |
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Definition
| emotional and cognitive symptoms of PPD like the ability to laugh, anxiety, fear, and crying |
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Term
| what is are the maximum amount of points you can obtain on the Edinburgh scale? |
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Definition
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Term
| with the edinburgh scale, the higher the points, the_____ |
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Definition
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Term
| One of the benefits of the Edinburgh scale is that it is |
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Definition
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Term
| The PPD screening scale has 35 items which are ____points each. |
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Definition
| 5; much longer than the Edinburgh scale |
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Term
| Review the items reviewed on the PPD scale |
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Definition
| sleep, appetite, anxiety, mood lability, cognition, loss of self, shame, comptemplating harm to self or baby |
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Term
| Autoimmune thyroid disease may contribute to |
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Definition
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Term
| woman may be out of touch with reality and unable to sleep at all |
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Definition
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Term
| why is accurate dx important when preparing to tx PP depression versus bipolar disorder? |
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Definition
| tx of bipolar with antidepressants can cause a psychotic break or mania |
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Term
| generalized anxiety is dx after symptoms have been present for more than |
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Definition
|
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Term
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Definition
| SSRIs......zoloft or paxil. |
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Term
| maternal activity is the biggest cause of |
|
Definition
| subinvolution; which leads to PP hemorrhage |
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