PPH OB Clinical Quiz

scant is considered how much

less than 1 inch, less than 10 mL

small (pad assessment) is considered how much

less than 4 in, 10-25 mL

moderate pad assessment is how much

less than 6 inches, 25-50 mL

heavy assessment of pad is

fully saturated in one hour

order of degrees of shock

compensated or pre shock

mild shock or early decompensated

moderate or late decompensated

severe/irreversible

compensated or pre shock amount of blood loss

500-1000 mL

compensated or preshock s/s

normal/slightly elevated BP, tachycardia, restlessness, dizzyness

mild shock/early decompensated amount of BL

1,000 to 1,500 BL

mild shock/early decompensated s/s

small fall in BP, weak, diaphoretic, tachycardia

moderate/late decompensated amount of BL

1,500 to 2,000 BL

moderate/late decompensated shock s/s

moderate drop in BP, pale, oliguria, restless

severe/irreversible shock amount of blood loss

2,000 to 3,000 BL

severe/irreversible shock s/s

marked drop in BP, collapse, air hunger, anuria

what type of shock is from PPH

hypovolemic shock

4 T’s and O of PPH

tone, trauma, thrombin, tissue, other

tone of PPH causes

atonic uterus, massage fundus, empty bladder

tissue of PPH causes

retained placenta, physically remove, D+C

trauma of PPH causes

lacerations, hematoma, repair, slow dribble of blood

thrombin of PPH causes

coagulopathy

purpose of intrauterine tamponade balloons

stops bleeding cessation for placental site bleeding and uterine atony

top nursing action for PPH

massage fundus

order of nursing actions

massage fundus, empty bladder, position legs, oxygen, IV and fluid resuscitation, uterotonics, labs

what is the number cause of uterine atony

bladder distention

do not mix oxytocin with what

dextrose solutions

main ADEs of oxytocin (3)

hypotension, MI, water intoxication

what is the first line of uterotonic drugs

oxytocin (pitocin)

oxytocin should be run

continuously

methylergonovine contraindicated in those with (4)

HTN, heart disease, pre e, macrolide antibiotics

carboprost (hemabate) contraindicated in those with (5)

asthma, HTN, PID, renal impairment, cardiovascular disease

carboprost can do what with other drugs

augment activity of other oxytocic agents

dinoprostone is inserted how

vaginally, rectally

dinoprostone use

PPH from uterine atony

how is misoprostol (cytotec) given

rectally

misoprostol should be avoided in patients with

allergies to prostaglandins

what is PPH defined as for drop of H&H

10% drop

most common etiology of PPH

uterine atony

what are the uterotonic medications mentioned

oxytocin, methergine, carboprost, dinoprostone, misoprostol (cytotec)