postpartum complications
Call Kai
Learn
Practice Test
Spaced Repetition
Match
Flashcards
Knowt Play1/132
Earn XP
Description and Tags
NRS 400
133 Terms
What are the main learning objectives of the postpartum complications lecture?
Identify causes, signs and symptoms, and medical/nursing management of postpartum hemorrhage; describe hemorrhagic shock and treatment hazards; differentiate postpartum infection causes and care; and describe thromboembolic disorders, including incidence, etiology, signs/symptoms, and management.
How is postpartum hemorrhage (PPH) traditionally defined after vaginal birth in this lecture?
Blood loss of 500 mL.
How is postpartum hemorrhage traditionally defined after cesarean birth in this lecture?
Blood loss of 1000 mL.
What hematocrit change is listed as a traditional definition of postpartum hemorrhage?
A 10% change in hematocrit between labor and postpartum.
What is the significance of postpartum hemorrhage in maternal health?
It is a leading cause of maternal morbidity and mortality and a leading reason for obstetric intensive care unit admissions.
Why can postpartum hemorrhage be dangerous before it is recognized?
It may go unrecognized until the mother has profound symptoms.
What is early, acute, or primary postpartum hemorrhage?
PPH that occurs within 24 hours of birth.
What is late or secondary postpartum hemorrhage?
PPH that occurs more than 24 hours but less than 6 weeks after birth.
What is uterine atony?
Marked hypotonia, or poor tone, of the uterus.
What is the leading cause of postpartum hemorrhage?
Uterine atony.
What risk factors for uterine atony are listed in the lecture?
High parity, hydramnios, a macrosomic fetus, and multifetal gestation.
What does high parity mean as a PPH risk factor?
Having had multiple births; it is listed as associated with uterine atony.
What is hydramnios, as used in the PPH risk-factor list?
A condition listed by the lecture as associated with uterine atony.
How can retained placenta contribute to postpartum hemorrhage?
Placental tissue remains retained after birth.
What two types of retained placenta are listed as causes of PPH?
Nonadherent retained placenta and adherent retained placenta.
What other trauma-related causes of PPH are listed?
Lacerations of the genital tract and hematomas.
Why is uterine inversion a serious postpartum complication?
It is potentially life-threatening.
How often does uterine inversion occur according to the lecture?
Approximately 1 in 2,500 births.
What is uterine subinvolution associated with in the lecture?
Late postpartum bleeding.
What does the PPH management flowchart on page 4 visually emphasize?
A decision pathway for recognizing postpartum hemorrhage and selecting interventions according to the suspected cause and response.
What is the first intervention listed for postpartum hemorrhage?
Firm massage of the uterine fundus.
Why is early recognition and treatment of PPH critical?
PPH can cause severe maternal compromise and is a major cause of maternal morbidity and mortality.
What should the nurse do about clots in the uterus during PPH management according to the lecture?
Express any clots in the uterus.
What should the nurse address if bladder distention is present during PPH?
Eliminate bladder distention.
What oxytocin infusion is listed for PPH management?
A continuous IV infusion of 10–40 units of oxytocin added to 1,000 mL of IV fluid.
What additional medication category may be used for PPH?
Additional uterotonic medications.
A postpartum patient has a boggy uterus and heavy bleeding. What initial intervention from the lecture should the nurse perform?
Firmly massage the uterine fundus.
A postpartum patient has PPH and a distended bladder. What contributing issue should the nurse address?
Bladder distention.
What is the overall priority in postpartum hemorrhage management?
Recognize and treat the hemorrhage early, intervene to improve uterine tone and address contributing causes, and support circulation.
What causes hemorrhagic (hypovolemic) shock in the postpartum context?
Hemorrhage.
What is hemorrhagic or hypovolemic shock?
An emergency in which perfusion of body organs may become severely compromised and death may occur.
What is the medical-management goal for hemorrhagic shock?
Restore circulating blood volume.
What vital signs should the nurse monitor with hemorrhagic shock?
Pulse and blood pressure.
What replacement therapies are listed for hemorrhagic shock?
Fluid or blood replacement therapy.
Why is hemorrhagic shock a life-threatening emergency?
Organ perfusion can become severely compromised, and death can occur.
What is idiopathic thrombocytopenic purpura (ITP) according to the lecture?
An autoimmune disorder in which antiplatelet antibodies decrease the life span of platelets.
How does ITP affect platelets?
Antiplatelet antibodies decrease the life span of platelets.
What is von Willebrand disease (vWD) described as in the lecture?
A type of hemophilia involving a deficiency or defect in a blood-clotting protein.
Why are coagulopathies important in obstetric complications?
Clotting disorders are associated with many obstetric complications, and treatment side effects may further compromise a patient with a hemorrhagic disorder.
What is venous thromboembolism (VTE)?
Formation of a blood clot or clots inside a blood vessel, associated with inflammation or partial vessel obstruction.
What is superficial venous thrombosis?
Thrombosis involving the superficial saphenous venous system.
What is deep vein thrombosis (DVT)?
A thrombus in a deep vein, most often in the lower extremities; it may extend from the foot to the iliofemoral region.
What is a pulmonary embolism (PE)?
A complication of DVT in which part of a blood clot dislodges, travels to the pulmonary artery, occludes the vessel, and obstructs blood flow to the lungs.
What incidence of venous thromboembolic disorders in pregnancy is listed in the lecture?
1 per 1,000 pregnancies.
What are the major causes of VTE listed in the lecture?
Venous stasis and hypercoagulation.
What is the most common form of venous thromboembolic disorder listed?
Superficial venous thrombosis.
What are the clinical manifestations of superficial venous thrombosis listed in the lecture?
Pain and tenderness in the lower extremity.
What anatomical area is shown in the venous thrombosis illustration on page 13?
The lower extremities, illustrating the leg location of venous thromboembolic disorders.
Which VTE categories are described in the lecture?
Superficial venous thrombosis, deep venous thrombosis (DVT), and pulmonary embolism (PE).
A postpartum patient reports pain and tenderness in a lower extremity. Which venous disorder matches the lecture's description of the most common form?
Superficial venous thrombosis.
How does a pulmonary embolism affect pulmonary circulation according to the lecture?
The clot obstructs a pulmonary artery and blocks blood flow to the lungs.
What is another name for postpartum infection in the lecture?
Puerperal infection.
How does the lecture define postpartum infection by timing and location?
A clinical infection of the genital tract occurring within 28 days after miscarriage, induced abortion, or birth.
What fever pattern defines postpartum infection in the lecture?
A temperature of 38°C (100.4°F) or higher on 2 successive days during the first 10 postpartum days, excluding the first 24 hours after birth.
What is endometritis?
An infection of the lining of the uterus.
What is the most common postpartum infection according to the lecture?
Endometritis.
When do postpartum wound infections often develop?
Often after the mother has been discharged home.
Which sites are typical for postpartum wound infection?
Cesarean incision, repaired laceration, or episiotomy site.
What wound-assessment mnemonic is listed on the postpartum infection slide?
REEDA.
What other type of postpartum infection is listed besides endometritis and wound infections?
Urinary tract infection (UTI).
Why are postpartum UTIs common according to the lecture?
Because of trauma experienced during labor.
What is the most effective and least expensive treatment for postpartum infection according to the lecture's key points?
Prevention.
What is the overall importance of postpartum infection in maternal health?
It is a major cause of maternal morbidity and mortality worldwide.
Before administering methylergonovine (Methergine) 0.2 mg IM postpartum, what should the nurse assess first according to the lecture question?
Obtain the client's blood pressure.
Why does the lecture's Methergine question prioritize blood pressure assessment?
The keyed intervention on page 20 is to obtain the client's blood pressure before administration.
A postpartum patient has excessive vaginal bleeding, weakness, cool clammy skin, a rapid pulse, and decreased blood pressure. Which complication pattern on page 8 does this resemble?
Postpartum hemorrhage with possible circulatory compromise.
A postpartum patient has a pulse above 100, progressive generalized edema, crackles, dyspnea, orthopnea, tachypnea, cough, and cyanosis. Which complication pattern does this resemble?
Cardiac decompensation, as contrasted with postpartum hemorrhage on the previous pregnancy-disorders lecture.
A postpartum patient has a fever of 38.2°C on two successive days beginning after the first 24 hours postpartum. Does this meet the lecture's fever criterion for postpartum infection?
Yes, if it occurs on two successive days within the first 10 postpartum days, excluding the first 24 hours after birth.
A postpartum patient develops infection at a cesarean incision after discharge. Which postpartum infection category is described?
Wound infection.
A postpartum patient develops fever and uterine infection. Which is the most common postpartum infection listed?
Endometritis.
A postpartum patient has sudden respiratory compromise after a leg clot dislodges and reaches the pulmonary artery. What complication is described?
Pulmonary embolism.
A postpartum patient has bleeding and signs of shock. What are the key management priorities listed in the lecture?
Restore circulating blood volume, monitor pulse and blood pressure, and provide fluid or blood replacement therapy.
A postpartum patient has a suspected uterine atony-related hemorrhage. What are the initial management actions listed in the lecture?
Firm fundal massage, expression of clots, elimination of bladder distention, IV oxytocin, and additional uterotonic medications as indicated.
What are the four broad topics emphasized in the lecture's learning objectives?
Postpartum hemorrhage, hemorrhagic shock, postpartum infection, and thromboembolic disorders.
What should the nurse recognize about therapeutic interventions in a patient with a hemorrhagic disorder?
Potential side effects of therapy can further compromise the patient.