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5 main causes of postpartal hemorrhage
- uterine atony
- lacerations
- retained placental fragments
- uterine inversion
- disseminated intravascular coagulation
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Uterine atony
- relaxation of the uterus
- most frequent cause of postpartal hemorrhage
- use uterine massage to help uterus contract
- Pitocin or prostaglandins promote contractions
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Retained placental fragments
- the retained portion keeps the uterus from fully contracting
- detected by placental inspecion, ultrasound, or hCG in blood
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Subinvolution
- incomplete return of the uterus to its prepregnant size and shape
- uterus still enlarged and soft at postpartal visit (4-6 weeks)
- lochial discharge is usually still present
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Methylergonovine
- an ocytocic agent -> improves uterine tone
- indications: uterine atony, subinvolution
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Puerperal infection
- infection of the reproductive tract
- treat with antibiotics after c&s testing
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Endometritis
- infection of the endometrium
- 100.4F (38C) for 48 consecutive hours days, occuring 3-4 days after birth
- dark brown, foul odor lochia
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Peritonitis
- infection of the peritoneal cavity (an grave extension of endometritis)
- rigid abdomen, abdominal pain, high fever, rapid pulse, vomiting
- paralytic ileus -> NG tube/TPN
- lots of antibiotics
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Thrombophlebitis
- inflammation of the lining of a blood vessel and formation of blood clots (aka. DVT)
- fever, pain & redness in affected leg, 10-16 days after birth
- treat w/ bed rest, anticoagulants, moist heat
- do not massage!
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Mastitis
- infection of the breast occurs through cracked/fissured nipples
- pain, swelling, redness
- treat w/ antibiotics
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Eight priority needs in the first few days of life
- respirations
- circulation
- body temperature
- nourishment
- waste elimination
- infection prevention
- infant-parent relationship
- developmental care
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Kernicterus
- destruction of brain cells by invasion of indirect bilirubin (d/t breakdown of RBCs)
- common condition of preterm immaturity
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Respiratory Distress Syndrome of the newborn
- deficient surfactant -> alveoli collapse -> poorly perfused lungs and poor gas exchange
- grunting, central cyanosis, tachypnea, nasal flaring, retractions, shock
- surfactant replacement, O2 administration, ventilation
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tocolytic vs. ocytocic
- tocolytic: halts labor progression
- ocytocic: quickens labor progression
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Meconium Aspiration Syndrome
hypoxia -> vagal reflex -> meconium released & aspirated
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Hemorrhagic disease of the newborn
- vitamin K deficiency
- petechiae, other hemorrhages, hematemesis or melena
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Patent urachus
fistula between the bladder and umbilicus
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Exstrophy of the bladder
- infant's bladder is exposed in the abdomen
- corrected surgically
- skin around the bladder becomes excoriated because of constant exposure to acid urine
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Hypospadias
- urethral opening is on the ventral (lower) aspect of the penis
- (epispadias - opening on the dorsal [upper] aspect)
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Vesicoureteral reflux
- retrograde flow of urine from the bladder into the ureters
- valve is defective
- surgically corrected
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Hydronephrosis
enlargement of the pelvis of the kidney with urine d/t back-pressure in the ureter
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Glomerulonephritis
- maybe have had recent upper resp infection
- coke-colored urine, lowered blood protein level, increased BUN
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Nephrosis (nephrotic syndrome)
- proteinuria, edema, hypoalbuminemia, hyperlipidemia
- treated w/ corticosteroids
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Renal failure
- acute - oliguria, azotemia, uremia, BUN increase, hyperkalemia
- chronic - polyuria, enuresis, hypocalcemia, hyperphosphatemia, anemia
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Anasarca
- overall, systemic edema
- indicates severe cardiovascular disease
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Patent ductus arteriosus
- hole between the left and right ventricles
- acyanotic defect
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Glactosemia
don't feed the baby milk!
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Hydrocephalus
- head significantly larger than the chest
- enlarged/bulging fontanel
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Polyhydraminos can lead to...
- digestive blockage
- i.e. esophageal atresia, tracheoesophageal fistula
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