Term
|
Definition
fetal tachycardia
maternal tachycardia, hypotension, weak peripheral pulses,
increased RR and low o2 sats
cool pale skin and MM
cyanosis
decreased UO
restlessness agitation, difficulty concentrating |
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|
Term
| What is often the first sign of maternal or fetal hypovolemia? |
|
Definition
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|
Term
| THe patient has a urine output of 27ml/hr what is this indicitive of? |
|
Definition
|
|
Term
| What is postpartum hemorrage? |
|
Definition
| blood loss of more than 500cc after vaginal birth or 1000 after cesarean |
|
|
Term
| The patient has saturated a peripad within one hour, what should the nurse do? |
|
Definition
| massage the fundus to expel clots and promote decreased hemorrhage |
|
|
Term
| what types of postpartum hemorrhage are there? |
|
Definition
early postpartum hemmorhage (1st hour)
late postpartum hemmorhage (24 hrs or 6-12 weeks) |
|
|
Term
| s/sx of postpartum hemorrhage |
|
Definition
fundus is difficult to locate
soft of boggy feel to uterus
uterus if firm when massaged but loses tone when it has stopped
excessive lochia or clots are expelled
fundus is higher than expected level |
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|
Term
| Why would the fundus be higher than the expected level? |
|
Definition
| build up of blood in the uterus |
|
|
Term
| Predisposing factors for postpartum hemmorhage |
|
Definition
overdistention of the uterus
multiparity (5+)
fast labor or delivery
prolonged labor
use of forceps or vaccum extractor
fibroids
tocolytic drugs
c-section or previous surgery
previous pp hemmorhage
manual removal of placenta (D&C scraping)
chorioamniontis
clotting disorders |
|
|
Term
| What can cause overdistention of the uterus |
|
Definition
| multiple gestation, large infant, hydramnios |
|
|
Term
| Why does the use of tocolytic drugs increase the risk for postpartum hemorrhage |
|
Definition
|
|
Term
| Management of PP hemorrhage |
|
Definition
fundal massage: can be done by bedside
methylergonovine (methergine)
Carboprost Tromethamine (hemabate, Prostin) |
|
|
Term
| What should the uterus feel like for the first 24 hours postpartum |
|
Definition
| like a firmly contracted ball roughly the size of a large grapefruit, located at the level of the umbilicus |
|
|
Term
|
Definition
| dark red and moderate in amount |
|
|
Term
| the patients uterus is soft and boggy, there is a steady trickle of blood from the vagina, and she has saturated one peripad in 15 minutes, what is this considered and what can the nurse do by the bedside? |
|
Definition
hemmorrhage
fundal massage to contract uterus |
|
|
Term
|
Definition
| stimulates uterine contractions |
|
|
Term
| What nursing considerations are associated with methergine? |
|
Definition
Given IM in conjunction with Pitocin
monitor for increase in blood pressure |
|
|
Term
| The patient has severe unrelieved perineal and rectal pain, she also has tachycardia, and an uncontracted uterus. She has been diagnosed with HTN in the past and has methergine prescribed to her. Should the nurse question this order? |
|
Definition
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|
Term
| Carboprost Tromethamine (Hemabate, Prostin) is ordered for PP hemorrhage, what should the nurse consider? |
|
Definition
Treats hemorrhage caused by uterine atony that is not controlled by other methods
give IM and aspirate
store in the refigerator |
|
|
Term
| Nursing Assessment for Uterine Atony |
|
Definition
fundus, bladder, lochia, vital signs, skin temperature and color.
consistency and location of fundus
watch for full bladder
weigh peripads, linen, and linen savers
ask the woman to turn to side
vs q15min |
|
|
Term
| the fundus is above the level of the umbilicus and displaces, what should the nurse consider is the cause? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| The nurse notices small oozing of blood from the vagina, what should she remember? |
|
Definition
| that although it is not profuse, it can still cause postpartum hemorrhage if not controlled |
|
|
Term
| Nursing assessment for trauma |
|
Definition
if the fundus if firm but bleeding is excessive this may be the problem
inspect for lacerations
examination of vaginal walls and cervix by hcp
comfort level deep severe pelvic/rectal pain cause may be concealed bleeding and formation of hematoma. |
|
|
Term
| Interventions for preventin hemorrhage |
|
Definition
|
|
Term
| How often to assess for hemorrhage? |
|
Definition
q15min for first hour
q30 min for 2 hours
q1hr for 4 hours |
|
|
Term
| Collaborative care with the HCP |
|
Definition
begin massage if fundus is soft
weight blood soaked pads and linen
bedrest
modified trendelenburg (legs 20-30 degrees, trunk horizontal, and head slightly elevated)
meds and fluids as ordered
bp for methergine
breath sounds for pulmonary edema if oxytocin is given |
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|
Term
| What is Disseminated Intravascular Coagulation? |
|
Definition
| inappropriate coagulation that causes uncontrolled bleeding. |
|
|
Term
| Major effects on the body |
|
Definition
increased uncontrolled bleeding
anemia
organ tissue damage
tissue hypoxia -> necrosis |
|
|
Term
| What causes organ damage in DIC? |
|
Definition
|
|
Term
|
Definition
intrauterine death with retained fetus
abruptio placentae
severe preeclampsia
retained placenta
hemmorhagic shock |
|
|
Term
|
Definition
sudden excessive bruising and petechiae
oozing from puncture sites (IV)
Mild GI bleeding
hemoptysis
hypoxemia
oliguria -> renal failure
progressive organ failure
ICP |
|
|
Term
|
Definition
Decreased RBC, platelet, PT, PTT, fibriogen level
Damaged abnormal RBC fragements
Elevated D-Dimer |
|
|
Term
|
Definition
Identify and treat underlying cause
Replace fibrinogen and other coagulation factors
blood transfusion
vitamin k
heparin (controversial) |
|
|
Term
| The patient has had a missed abortion and has developed DIC, what should be done? |
|
Definition
delivery of the fetus and placenta which are fueling the process
blood replacement products like whole blood, PRBC and cryoprecipitate are administered |
|
|
Term
| Nursing Considerations for Hemorrhagic complications |
|
Definition
monitor bp and pulse
observe for shock
count pads
save tissue and clost
geatation 12+ weeks assess FHR with doppler
prepare for ultrasound or pelvic
assess patient and family response to situations |
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