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julianne.elizabeth
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What constitutes Post Partum hemorrhage?
- Early is within the first 24 hrs
- Estimated blood loss for Vaginal Del: 500ml +
- Estimated blood loss for C-birth: 1000ml +
- Can be caused by uterine atony, lacerations, retained placental pieces, and hematomas
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What are the symptoms of uterine atony?
- Boggy uterus
- Heavy lochia, often with clots
- Bladder distention
- Possible signs of hypovolemic shock
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What factors contribute to uterine atony?
- Birth weight >4000g
- Polyhydramnios
- Abnormal or prolonged labor
- Over-distended uterus (multiples or grandparity)
- Use of oxytocin during labor
- Tocolytic use
- Anesthesia
- Prolonged third stage of labor
- Preeclampsia
- Cesarean Birth, forceps, or vacuum assisted
- Retained placental fragments
- Bladder distension
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What is the treatment for uterine atony?
- Bimanual compression of uterus
- Medications: oxytocin, methergonovine (methergine),Carboprost (hemabate), or rectal Misoprostal (Cytotec)
- IV Therapy for risk of hypovolemia
- Platelet Transfusion
- Uterin packing
- Uterine tamponade- foley with 30ml balloon inserted into uterus and over inflated to 60-80ml of saline to put pressure on vessels at placental site
- Hysterectomy
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What can cause early post partum hemorrhage other than uterine atony?
- Lacerations in the perineal, vagina, or cervix
- S/S of a laceration include bright red bleeding with a firm fundus at mid-line
- Hematomas in the vulva, vagina,or pelvis may be bleeding into an enclosed space
- Small (<3cm) hematomas may resolve without treatment
- Larger (>3cm) hematomas may require and incision and drainage if she is symptomatic
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What is Late Postpartum hemorrhage and what can cause it? What is the treatment?
- occurs after the first 24 hrs within 6 weeks postpartum
- Can be caused by hemotomas
- Subinvolusion is when the uterus does not descend back into the pelvis and can be r/t fibroids, retained placental pieces, or metritis
- In subinvolusion, the lochia will return to rubra with back pain
- Retained placental pieces can also cause late postpartum hemorrhage
- Treatment: D & C to removed retained placental pieces, methylergonovine (methergine) to shrink fibroids, or antibiotic therapy for metritis
- * if hypovolemic shock occurs, this is called a code crimson
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What are the three common types of Postpartal Thromboembolitic Diease?
- Superficial Vein Thrombosis
- Deep Vein Thrombosis
- Pulmonary Embolism
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What are the risk factors, treatment, and nursing care for Postpartal Thromboembolitic Disease?
- Risk Factors: pregnancy, c-birth, metritis, decreased mobility, obesity
- Medical Treatment: coagulation therapy (heparin & Warfarin ok to BF), antibiotics, bed rest with leg elevated, compression stockings)
- Nursing Care: decrease the risk of formation of thrombosis by maintaining pressure stockings and early ambulation, administer meds as ordered
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What is a Puerperal Infection and where is it most common?
- Infection of the reproductive tract up to 6 weeks postpartum
- Common sites:
- -Uterus (metritis)
- -Bladder (cystitis)
- -Breast (mastitis)
- -Incision (wound)
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What is Metritis and what nursing care is involved?
- The most common postpartum infection
- Infection of the endometrium, myometrium, and or parametrium
- Nursing care includes reducing the risk by using proper ascetic technique, teaching the woman about proper personal hygiene, administer antibiotics, pain relief, and discharge teaching
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What can cause postpartal cystitis and what nursing care is involved?
- urinary retention
- catheters
- trauma to the bladder
- Nursing care: reduce risk for infection, monitor s/s, admin antibiotics as ordered
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What is mastitis and how is it treated?
- Unilateral infection of the breast connective tissue
- Prevent is the best treatment: decrease nipple irritation and prevent cracked nipples, proper hand hygiene for both staff and mom
- If an infant has oral thrush, treat mom as well as it can spread to her nipple
- Other treatment includes antibiotics, analgesics, warm compresses, continue to breastfeed, pump and dump only for abscess
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What are common sites for postpartal wound infections and what nursing care is involved?
- Perineal Wound
- Cesarean Wound
- Nursing care: assess wound, proper hand hygiene for mother & hospital personnel, antibiotics, pain management
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What are the post partum blues?
- Also called Adjustment Reaction with Depressed mood
- 50-75% of new mothers
- Mild Depression
- Self Limiting
- Relation to changes in estrogen, progesterone, and prolactin
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What are the contributing factors to post partum blues and how is it treated?
- Contributing factors include emotional letdown, pain, fatigue, anxiety, and ears about physical changes
- Treatment:
- -provide reassurance that this is normal
- -promote rest and comfort
- -allow mom to talk about experience and feelings
- -encourage family to watch for s/s of deepening depression
- -symptoms disappear without medical intervention
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What is post partum depression and what are the risk factors?
- Post partum mood disorder affects 14-15% of women
- May occur up to a year after birth
- Risk factors:
- -history of depression before pregnancy
- -depression or anxiety during pregnancy
- -inadequate social support
- -poor quality relationship with partner
- -life and child stresses
- -complications of pregnancy and/or childbirth
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What are the symptoms of post partum depression?
- Significant weight loss
- Insomnia
- Changes in psychomotor activity; agitation or retardation
- Decreased Energy
- Feelings of Worthlessness
- Inability to care for self or infant
- Decreased ability to concentrate
- Recurrent thoughts of death
- Suicide Attempts
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What is the treatment for post partum depression?
- Mild: Psychotherapy
- Moderate: psychotherapy & antidepressant
- Severe: Intense psychiatric care, crisis intervention, psychotherapy, antidepressants, electroconvulsive therapy
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What is post partum PTSD and what are the s/s?
- Woman's labor and birth did not occur in the manner she had envisioned
- Her perceptions of events are different from reality
- S/S: feeling numb, seemingly dazed, unaware of environment, intrusive thoughts, flashbacks to traumatic events, tachycardia, hyperventilation, nausea (s/s may develop after discharge)
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What is post partum psychosis and what are the s/s?
- rare and only occurs 1-2/ 1000 patients
- Variant of Bipolar Disorder
- Develops 1-2 weeks PP
- Media attention when accompanied by infanticide
- S/S:
- -paranoia, grandious or bizarre delusions associated with baby
- -mood swings
- -extreme agitation
- -depressed or elated moods
- -distraught feelings about ability to enjoy infant
- -confused thinking
- -strange beliefs that she or the infant must die
- -disorganized behavior
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What is the treatment for post partum psychosis?
- Hospitalization
- Anti-psychotic medications (cannot breastfeed)
- Sedatives
- Removal of infant (may be temporary or permanent)
- Social Support
- Psychotherapy
- Electroconvulsive therapy
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Define perinatal loss, Intrauterine fetal demise (IUFD), and Spontaneous abortion (miscarriage)
- Perinatal loss: death of the fetus occurring from conception to 28 days after birth
- IUFD: death occurring after 20 wks and before birth
- Spontaneous Abortion (miscarriage): death occurring before 20 wks gestation
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What factors affect bereavement and grief of the family after fetal loss?
- age of the parents
- family dynamics
- gender
- infertility
- early or late in the pregnancy
- multifetal pregnancy
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What nursing care can be done when there is fetal loss?
- Avoid Cliche's
- Facilitate family mourning
- Postmorten Care
- Memory box of infant
- Discharge care
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