question

thrombophlebitis

answer

thrombus that is associated with inflammation

question

the postpartum client is at greatest risk for what? leading to what?

answer

DVT leading to pulmonary embolism

question

s/s DVT

answer

-leg pain and tenderness -unilateral area of swelling, warmth, and redness -calf tenderness

question

prevention of thrombophlebitis

answer

-education -antiembolism stockings -no prolonged bed rest -early and frequent ambulation -avoid prolonged periods of sitting or standing -elevate legs when sitting -avoid crossing legs -maintain adequate fluid intake -stop smoking (risk factor) -measure lower extremities for fitted elastic hose

question

management of thrombophlebitis

answer

-encourage rest -bed rest and elevation of extremities -warm moist compresses intermittently -measure leg circumferences -do NOT massage affected limb (dislodgment may occur) -thigh-high antiembolism stockings -analgesics -anticoagulants for DVT (heparin and warfarin)

question

pulmonary embolus

answer

-fragments or entire clot dislodges and moves into circulation

question

s/s PE

answer

-apprehension -pleuritic chest pain -dyspnea, tachypnea, hemoptysis, heart murmurs, peripheral edema, distended neck veins, elevated temp, hypotension, hypoxia

question

nursing care for PE

answer

-semi-fowlers -oxygen by face mask -thrombolytic therapy -heparin, warfarin as well

question

Idiopathic thrombocytopenic purpura

answer

-coagulaopathy that is an autoimmune disorder in which the life span of platelets is decreased by antiplatelet antibodies -can result in severe hemorrhage after c-section or lacerations

question

disseminated intravascular coagulation

answer

-coagulopathy in which clotting and anticlotting mechanisms occur at the same time

question

suspect coagulaopathies when?

answer

when the usual measures to stimulate uterine contractions fail to stop vaginal bleeding

question

s/s of coagulopathies

answer

=unusual spontaneous bleeding from client's gums and nose -oozing, trickling, or flow of blood from incision, lacerations or episiotomy -petechiae and eccyhymoses -excessive bleeding from venipuncture, injection sites, or slight trauma

question

nursing care

answer

-assess injection sites, lacerations, etc for bleeding -VS and hemodynamic status -UO -transfuse platelets -maybe splenectomy for ITP -DIC- fluids, antibiotics, etc

question

postpartum hemorrhage

answer

-considered to occur if the client loses more than 500 mL of blood after a vaginal birth or more than 1,000 mL of blood after a c-section -complications can include hypovolemic shock and anemia

question

s/s of postpartum hemorrhage

answer

-increase or change in lochial pattern (large clots) -uterine atony -blood clots larger than a quarter -perineal pad saturated in 15 minutes or less -constant oozing, trickling, or frank flow of bright red blood from the vagina -tachycardia and hypotension -skin pale, cool, and clammy with loss of turgor and pale mucous membranes -oliguria

question

nursing care for postpartum hemorrhage

answer

-VS -source of bleeding- fundus, lochia, lacerations, episiotomy -bladder for distention -IV fluids (LR or 0.9%) -oxygen 2-3L/minute NC -elevate legs to 20 or 30 degrees to increase venous return

question

meds for postpartum hemorrhage

answer

-oxytocin- uterine stimulant (water intoxication, lightheadedness, NV, HA, malaise) -methylergonovine (adverse- hypertension, N/V, HA) -misoprostol -carboprost tromethamine (chills, HA, fever, N/V)

question

uterine atony

answer

results from the inability of the uterine muscle to contract adequately after birth can lead to postpartum hemorrhage

question

s/s uterine atony

answer

-increased vaginal bleeding -uterus that is larger than normal and boggy, possible lateral displacement -prolonged lochial discharge -irregular or excessive bleeding -tachycardia, hypotension -skin is pale, cool, and clammy, loss of turgor and pale mucous membranes

question

nursing care for uterine atony

answer

-ensure bladder is empty -monitor fundus, lochia, fundal massage if needed -hysterectomy if it persists -VS, IV fluids, oxygen -meds the same as postpartum hemorrhage -limit physical activity and eat lots of iron and protein for RBCs

question

subinvolution of the uterus

answer

when the uterus remains enlarged with continued lochial discharge and may result in postpartum hemorrhage

question

s/s subinvolution of the uterus

answer

-increased vaginal bleeding -uterus is enlarged and boggy -prolonged lochia discharge

question

nursing care for subinvolution

answer

-monitor fundal position and consistency -lochia -VS -encourage breastfeeding, ambulation and frequent voiding to stimulate the uterus -oxytocin -may need antibiotic therapy to prevent and treat infection

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inversion of the uterus

answer

-turning inside out of the uterus and may be partial or complete -emergency situation that can result in postpartum hemorrhage and requires immediate intervention

question

s/s inversion of the uterus

answer

-pain in lower abdomen -vaginal bleeding -dizziness - low BP -pallor

question

nursing care for inversion of the uterus

answer

-assess inverted uterus by visualizing the introitus, pelvic exam, IV fluids, give oxygen -stop oxytocin -avoid excessive traction on umbilical cord -meds: turbutaline- tocolytic= relaxes uterus

question

retained placenta

answer

-placenta or fragments of the placenta remain in the uterus and prevents the uterus from contracting, which can lead to uterine atony or subinvolution

question

meds for retained placenta

answer

oxytocin and terbutaline

question

lacerations/hematomas

answer

tearing of soft tissues clotted blood oozing blood, excessive rubra red for laceration difficulty urination, pain, pressure for hematoma

question

A nurse is caring for a postpartum client. The nurse should understand that which of the following findings are the earliest indication of hypovolemia caused by hemorrhage? a. increasing pulse and decreasing BP b. dizziness and increasing resp rate c. cool, clammy skin, and pale mucous membranes d. altered mental status and LOC

answer

a. increasing pulse and decreasing BP

question

A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following should be included in the discussion? (multiple select) a. precipitous delivery b. lacerations c. inversion of the uterus d. oligohydramnios e. retained placental fragments

answer

a. precipitous delivery b. lacerations c. inversion of the uterus e. retained placental fragments

question

A nurse on the postpartum unit is performing a physical assessment of a client who is being admitted with a suspected DVT. Which of the following clinical findings should the nurse anticipate the client will exhibit? (multiple select) a. calf tenderness on palpation b. swelling of the extremity c. elevated temp d. area of warmth e. report of nausea

answer

a. calf tenderness on palpation b. swelling of the extremity c. elevated temp d. area of warmth

question

A nurse on the postpartum unit is planning care for a client who has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care? a. apply cold compresses to the affected extremity b. massage the affected extremity c. allow the client to ambulate d. measure leg circumferences

answer

d. measure leg circumferences

question

A nurse is caring for a client who has DIC. Which of the following antepartum complications should the nurse understand is a risk factor for this clinet? a. preeclampsia b. thrombophlebitis c. placenta previa d. hyperemeiss gravidarum

answer

d. hyperemeiss gravidarum

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