maternal infant final

what are common sources of infection postpartum?

endometritis, mastitis, urinary tract infection, wound infection

what is the definition of endometritis?

inflammation of the endometrial lining, usually due to infection

what are signs and symptoms of endometritis?

lower abdominal pain, uterine tenderness, foul smelling lochia, temp >100.4, tachycardia, chills, aching

what are risk factors for endometritis?

PROM, multiple vaginal exams in labor, instrumental deliveries, c section

how is endometritis treated?

culture/sensitivity, cephalosporins/penicillins unless allergic, IV antibiotics until afebrile X 24 hours, and broad spectrum antibiotics for aggressive infections

what are risk factors for urinary tract infections?

urinary stasis, urinary catheterization, trauma in delivery to bladder/urethra

what are signs and symptoms of urinary tract infections?

burning, urinary urgency/frequency, nocturia, fevers, chills, flank pain, nausea, vomiting, CVA tenderness

if left untreated, urinary tract infections can progress into what?

pyelonephritis

what medications are used to treat urinary tract infections?

bactrim, septra, nitrofurantoin, augmentin

what medications are used to treat pyelonephritis?

IV antipyretics/analgesics like acetaminophen and ibuprofen, with pyridium as an antispasmodic as needed

what are possible locations for postpartum wound infections?

episiotomy, laceration, c-section

what are risk factors for postpartum wound infections?

presence of staples, compromised health status (diabetes), obesity, poor hygiene

what is the REEDA assessment used for and what does it stand for?

assessing wounds for infection

Redness

Edema

Ecchymosis

Discharge

Approximation

what is the most likely culprit of postpartum wound infection?

MRSA

how are postpartum wound infections treated?

culture/sensitivity, antibiotics, pain relief, may require opening and packing, wound vac may be necessary

what is the definition of mastitis?

inflammation of the breast

what are risk factors for mastitis?

inconsistent nursing/pumping, cracked nipples, compromised health status, antibiotic therapy

what are signs and symptoms of mastitis?

red superficial lump in the breast, mild fever, chills, pain, yeast (ground glass in nipples), abscess, feeling “unwell”

what are nursing interventions for mastitis?

don’t stop nursing, pump if nursing is too painful, use heat and massage to encourage milk expression

what is treatment for mastitis?

antibiotics (usually cephalosporins), diflucan for yeast, incision and drainage for abscess

what are risk factors for postpartum deep vein thrombosis?

obesity, sedentary habits after delivery, past medical/family history, cesarean birth, positioning in stirrups for prolonged periods

what are signs and symptoms of deep vein thrombosis?

unilateral redness, swelling, heat, pain, low grade fever

how is deep vein thrombosis diagnosed?

doppler and elevated D dimer

what is contraindicated in patients with deep vein thrombosis?

massaging the calves

what medications are indicated in deep vein thrombosis?

heparin drip, eventually converted to warfarin

what is the antidote for heparin?

protamine sulfate

what is the antidote for warfarin?

vitamin k

how long do the baby blues last?

2 weeks

postpartum depression affects what percent of patients postpartum?

10-20%

at what point postpartum does a patient have postpartum depression?

6 weeks after birth up to a year

what are risk factors for postpartum depression?

history of mood disorder, stressful life events, unplanned pregnancy, lack of social support, complications during pregnancy/delivery, body image issues

what are signs and symptoms of postpartum depression?

persistent sadness/lack of joy, disturbances in eating or sleeping, feelings of worthlessness, thoughts of hurting self, may have OCD component, may have significant anxiety

what type of therapy is recommended for postpartum depression?

cognitive behavioral therapy and support groups

what medications are commonly used to treat postpartum depression?

SSRIs because most are compatible with breastfeeding

how common is postpartum psychosis?

1 in 1000 patients

what demographic is at the highest risk of developing postpartum psychosis?

patients with bipolar

what are signs and symptoms of postpartum psychosis?

delusions, hallucinations, depersonalization, bizarre and disorganized behavior, neglect of self/infant

how is postpartum psychosis managed?

safety of patient and infant are most important! hospitalization, stabilization on antipsychotics, support group

what does the acronym POST-BIRTH mean and what does it stand for?

postpartum complication warning signs

Pain in chest

Obstructed breathing

Seizures

Thoughts of hurting self/others

Bleeding

Incision not healing

Red or swollen leg

Temp of 100.4 or higher

Headache that doesn’t get better even after medicine

what volume of blood loss within 24 hours of delivery is considered postpartum hemorrhage?

1,000 mL

blood flow from the uterine artery supplies what percent of a pregnant person’s cardiac output?

15%

past history of postpartum hemorrhage increases a patient’s risk for another postpartum hemorrhage by how much?

double

what are risk factors for postpartum hemorrhage?

overdistention of uterus, prolonged/dysfunctional labor, high parity, preeclampsia, obesity, placenta previa/abruption, uterine rupture, medications that relax smooth muscle like mag sulfate

what would make postpartum hemorrhage especially dangerous?

if the patient has anemia or low platelets

how can we prevent complications from postpartum hemorrhage?

identify patients at risk, notify blood bank, frequent assessment of postpartum patient, avoidance of invasive procedures, oxytocin after delivery, early intervention when bleeding is heavy

what is the number one cause of postpartum hemorrhage?

uterine atony

what are the 4 T’s in relation to causes of postpartum hemorrhage?

Tone: uterine atony

Tissue: retained placental fragments

Trauma: unrepaired lacerations or hematoma

Thrombins: thrombocytopenia or coagulopathy

what are the goals in managing postpartum hemorrhage?

stop the bleeding at its root cause, replace fluid volume, support hemodynamic stability

how would we know if the patient’s postpartum hemorrhage was caused by tone?

uterus will be boggy and high, typically above the uterus

how would we know if the patient’s postpartum hemorrhage was caused by tissue?

may have trailing membranes

how would we know if the patient’s postpartum hemorrhage was caused by trauma?

continuous trickle with firm fundus at umbilicus OR symptoms of a perineal hematoma

how would we know if the patient’s postpartum hemorrhage was caused by thrombins?

abnormal lab values

how do we replace fluid volume and support hemodynamic stability in patients with postpartum hemorrhage?

get a second IV site (preferably 18 gauge), LR or NS, frequent monitoring of vital signs for signs of hypovolemic shock, elevate legs 30 degrees to perfuse vital organs, foley catheter, transfusion if indicated

what is the first intervention for postpartum hemorrhage caused by atony?

fundal massage

what medication is used for postpartum hemorrhage caused by atony?

oxytocin is first line agent, methergine (check BP for HTN first), misoprostol, tranexamic acid (TXA), carboprost (avoid in patients with asthma)

if postpartum hemorrhage is not manageable with just medications, what are other possible treatments?

bimanual exam, placement of balloon for uterine tamponade, B-lynch suture, ligation of uterine arteries, hysterectomy, exploration of uterus for retained placenta

how would postpartum hemorrhage from perineal hematoma present and be treated?

sudden excruciating pain, swelling at the site with discoloration and a mass that can fill with up to 500 mL of blood; treat small ones with ice and pressure and large ones with incision and drainage followed by packing

how would postpartum hemorrhage from trauma be treated?

provider must repair laceration

how would postpartum hemorrhage from retained placental fragments be treated?

manual removal at bedside or dilation and curettage in OR

how would postpartum hemorrhage from thrombins be treated?

replace clotting factors with FFP and platelets, administer tranexamic acid (TXA), avoid using any NSAIDs, minimize invasive procedures

what are the two main priorities for the newborn’s transition from intrauterine to extrauterine?

respiratory and thermal regulation

why is the respiratory system especially important in newborns?

in order to transition from intrauterine to extrauterine successfully, the newborn needs to be stimulated to take the first breath

what is the definition of surfactant and what is its purpose?

a substance that coats the alveoli, preventing collapse and reducing surface tension

how might a premature newborn’s respiratory system differ from a term newborn’s respiratory system?

not enough surfactant

why do newborns have difficulty regulating temperature?

they have a higher ratio of body surface to body mass and they do not shiver/sweat

what adaptations are helpful with thermal regulation in newborns?

flexed position (decreases surface area), frequent movements, brown fat reserves (low glucose)

what is evaporation in relation to thermal regulation?

liquid evaporating from the body, lowering body temp

what is conduction in relation to thermal regulation?

direct contact with a cooler surface, lowering body temp

what is convection in relation to thermal regulation?

transfer of heat to surrounding air, lowering body temp

what is radiation in relation to thermal regulation?

transfer of heat to nearby surfaces, lowering body temp

what materials should we have prepared for the arrival of a newborn?

warmer, baby blankets, suction, oxygen, resuscitator

how long of a wait is considered delayed cord clamping?

at least 30 seconds

what are the benefits of delayed cord clamping?

increased blood volume up to 30%, increased iron stores for up to 6 months, increased oxygenation of vital organs

when is delayed cord clamping contraindicated?

immediate neonatal resuscitation

when is the APGAR score measured?

1 minute and 5 minutes after death

what does APGAR stand for?

Appearance

Pulse

Grimace

Activity
Respirations

what APGAR score indicates the need for intervention?

less than 7

what are the scores for appearance in regard to APGAR?

0: cyanotic trunk and limbs

1: pink trunk and cyanotic limbs

2: pink trunk and limbs

what are the scores for pulse in regard to APGAR?

0: no pulse

1: <100 bpm

2: >100 bpm

how is grimace tested in regards to APGAR?

stimulation, ex. suctioning of the nares

what are the scores for grimace in regard to APGAR?

0: no response, floppy

1: some extremity flexion or cry

2: pulls away, sneezes, or coughs

what are the scores for activity in regard to APGAR?

0: absent

1: flexion of arms and legs

2: active movement

what are the scores for respirations in regard to APGAR?

0: absent

1: weak, slow

2: strong cry

what are abnormal respiratory assessments of a newborn?

cyanosis, apnea greater than 20 seconds, nasal flaring, intercostal/substernal retractions, seesaw breathing, grunting, stridor

what are interventions for a newborn’s respiratory system?

tactile stimulation, suctioning of airways, supplemental oxygen

what is a nursing intervention for thermal regulation in relation to evaporation?

dry the baby

what is a nursing intervention for thermal regulation in relation to conduction?

encourage skin to skin and use warm blankets

what is a nursing intervention for thermal regulation in relation to convection?

keep away from windows and drafts

what is a nursing intervention for thermal regulation in relation to radiation?

cover with a hat and swaddle, using a warmer as a last resort

what are interventions for newborn/infant safety in the hospital?

hugs tag, safe sleep precautions, matching ID bands with baby and birthing parent

what is the normal respiration range in newborns?

30-60 breaths per minute

what is the normal heart rate range in newborns?

120-160 beats per minute

what is the normal temperature range in newborns in celcius?

36.5-37.2

what is the normal temperature range in newborns in farenheit?

97.7-98.96

what positioning is normal in newborns?

flexed

what is acrocyanosis?

cyanosis in the hands or feet, which is a normal adaptation postpartum

what is abnormal positioning for a newborn?

hypotonia, floppy and limp

what is caput succedaneum?

edema between the scalp and skull

what is cephalohematoma?

blood between the scalp and skull

what are abnormal variations in a newborn’s head?

bulging or sunken fontanelles