Postpartum Hemorrhage
When is mom at the biggest risk for postpartum hemorrhage?
Within one hour of birth
During hemorrhagic/hypovolemic shock, where is most of the blood diverted?
The heart and brain
What are three risk factors for postpartum depression?
Anxiety, depression, young age, unintended pregnancy, unmarried status, marital troubles, lack of social support, socioeconomic deprivation, lower education, substance abuse, low self-esteem, and stressful life events, and intimate partner violence. Having a preterm baby, ill baby, and low birth weight are also factors.
What is an infection of the lining of the uterus, and what are the signs/symptoms?
Endometritis
Fever, increased pulse, chills, anorexia, nausea, fatigue, lethargy, pelvic pain, and foul-smelling profuse lochia
Thrombocytopenia, capillary fragility and increased bleeding time are diagnostic findings of what?
Idiopathic Thrombocytopenic Purpura (ITP)
Name 3 causes of postpartum hemorrhage.
Uterine atony, retained placenta, lacerations, hematomas, inversion of the uterus.
What percentage of blood volume will be lost before a postpartum mom shows signs of shock?
30-40%
Shock index is the ratio of heart rate to systolic blood pressure (513)
What are some symptoms of postpartum depression?
Postpartum blues that last past 2 weeks. Guilt, inadequacy, anxiety, feelings of worthlessness, intense fear, anxiety, and sadness with labile mood swings.
What are three antepartal factors that increase the risk for postpartum infection?
Diabetes, alcoholism, drug abuse, immunocompression, anemia, malnutrition, obesity, preeclampsia, hx of previous venous thrombosis, utis, mastitis, and pneumonia
Which is the most common congenital bleeding disorder and a type of hemophilia?
Von Willebrand Disease
What are the top three nursing interventions if a mom is bleeding heavily?
Massage the fundus, have mom urinate, and continue IV fluids with oxytocin.
What does fluid resuscitation include?
Two large bore IVs and giving LR, NS, albumin, blood, and blood products
What are the methods of medical management for PPD?
Psychotherapy, antidepressants, and other nonpharmacological treatments (520)
What are three signs of wound infections?
Fever, erythema, edema, warmth, tenderness, pain, drainage, foul smelling discharge, and wound separation
What are the clinical manifestations and treatments of choice for a DVT?
More common in pregnancy than postpartum characterized by unilateral leg pain, calf tenderness, and swelling, redness, warmth, and a positive homan's sign. Some may have a rather large clot with no symptoms.
TX: Anticoagulants, bedrest, pain meds, elevate extremity
Name three risk factors for postpartum hemorrhage.
Large fetus, multiple fetuses, hydramnios, general anesthesia, obesity, high parity, trauma during birth, coagulation disorders, placenta previa (See box 21.2 on 507)
Management of hypovolemic shock includes which two things?
Restoring circulating blood volume, and eliminating the cause of the hemorrhage.
What percentage of moms with postpartum psychosis will experience it more than once?
50%
What are three risk factors for UTIs?
Catheterization, frequent pelvic exams, regional anesthesia, genital tract injury, history of utis, and c-section birth
Why do you never want to rub a person's leg who has a DVT?
Risk of pulmonary embolism
Name three medications that are used during postpartum hemorrhages.
Oxytocin, Cytotec, and Methergine
What type of assessment findings would you expect for a patient in shock?
Rapid and shallow respirations, rapid, weak and irregular pulse, decreasing b/p, cool, pale, clammy skin, decreasing urinary output, lethargy, anxiety, and decreased central venous pressure
What are the characteristics of postpartum psychosis?
Rapid onset of bizarre behavior, auditory or visual hallucinations, paranoid or grandiose delusions, elements of delirium or disorientation, and extreme deficits in judgment accompanied by high levels of impulsivity that can contribute to increased for suicide or infanticide.
Name 4 important things moms with UTIs need to be taught.
How to properly wipe, urinating after intercourse, how to monitor temperature, bladder function, and urine appearance, perineal and hand hygiene, increasing fluids, and the importance of taking all of their antibiotics.
What are the risk factors for DVT?
C-section birth doubles the risk, obesity, immobility, malignancy, and other chronic health problems.