NURS 247 - CH 22 - Nursing Management of the Postpartum Woman at Risk Questions and Answers
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NUR 247
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NUR 247
What is the leading cause of maternal death in both developed and developing countries., accounting for about 25% of all maternal deaths worldwide? Postpartum Hemorrhage
PPH is defined as: Cumulative blood loss greater than 1,000 mL with signs and symptoms of hypovolemia within 24 hours of the bir...
NURS 247 - CH 22 - Nursing Management of the Postpartum Woman at Risk Questions and Answers What is the leading cause of maternal death in both developed and developing countries., accounting for about 25% of all maternal deaths worldwide? ✅Postpartum Hemorrhage PPH is defined as: ✅Cumulative blood loss greater than 1,000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process. Morbidity from PPH can be severe when paired with: ✅-Organ Failure -Shock -Edema -Thrombosis -Acute respiratory distress -Sepsis -Anemia -Intensive care admissions -Prolonged Hospitalization. What is the most common reason postpartum women are admitted to intensive care units? ✅Hemorrhage Define Primary Postpartum Hemorrhage: ✅-Immediate or Early -Blood loss that occurs within 24 hours of birth Define Delayed Postpartum Hemorrhage: ✅-Late -Blood loss that occurs 24 hours to 12 weeks. The most common cause of PPH is: ✅Uterine Atony Define Uterine Atony: ✅Failure of the uterus to contract and retract after birth. What is responsible for the majority of primary PPH? ✅Uterine Atony What is responsible for the majority of delayed PPH? ✅-Obstetric Lacerations -Uterine Inversion -Subinvolution -Rupture Can a full bladder that displaces the uterus cause bleeding? ✅Yes. any factor that causes the uterus to relax after birth will cause bleeding. What medication (not specific) promote uterine contraction to prevent atony and speed delivery of the placenta? ✅Uterotonic Medications Clinical Manifestation of Shock due to blood loss: ✅Mild: 20%. Diaphoresis, increased cap refill, cool extremities, maternal anxiety Moderate: 20 -40%. Tachycardia, postural hypotension, oliguria Severe: >40%. Hypotension, agitation/confusion, hemodynamic instability When do the typical signs of hemorrhage appear? ✅Typical signs don't appear until as much as 1,800 - 2,100 mL of blood has been lost. Less common causes of PPH include: ✅-Lacerations of the geintal tract -Episiotomy -Retained placental fragments -Uterine Inversion -Coagulation disorders -Large -for-gestational age newborn -Failure to progress during the second stage of labor -Placenta accreta -Induction or augmentation of labor with oxytocin -Surgical Birth -Hematomas of the vulva, vagina or subperitoneal areas A helpful way to remember the cause of PPH is by using the five T's: ✅1) Tone: Uterine atony, distended bleadder 2) Tissue: Retained placenta and clots; uterine subinvolution 3) Trauma: Lacerations, hematoma, inversion, rupture 4) Thrombin: Coagulopathy (preexisting or acquired) 5) Traction: Too much pulling on umbilical cord The causes of PPH - Tone: ✅-Refers to Uterine Atony -Uterus with sufficient tone clamps to constrict blood vessels -Altered uterine muscle tone most commonly results from overdistention of the uterus. Why is overdistention important to know with PPH? ✅-Its the main reason for Uterine Atony -Caused by: Multiple gestation, fetal macrosomia, hydramnios, fetal abnormality, placenta previa, precipitous birth, or retained placental fragments. -Other causes might include: prolonged or rapid, forceful labor, bacterial toxins, use of anesthesia, halothane, and magnesium sulfate for preeclampsia. -Can cause displacement of the uterus from midline to either side, which impedes its ability to contract to reduce bleeding. The causes of PPH - Tissue: ✅-Refers to placental fragments, membranes, or clots left inside the uterus. -Uterine contracts and retracts lead to detachment and expulsion of the placenta after birth -S/S: small gush of blood with lengthening of the umbilical cord & slight rise of the uterus. -Failure of complete separation and expulsion lead to retained fragments, preventing full clamping. Subinvolution refers to: ✅Incomplete involution of the uterus or failure to return to its normal size and condition after birth. Typically, Subinvolution occurs when: ✅The myometrial fibers of the uterus do not contract effectively causing relaxation. Complications of subinvolution include: ✅-Hemorrhage -Pelvic Peritonitis -Salpingitis -Abscess formation Causes of Subinvolution include: ✅-Retained Placental Fragments -Distended Bladder -Excessive maternal activity prohibiting proper recovery -Uterine Myoma -Infection What is the clinical picture of subinvolution: ✅-Fundal heigh highter than expected with boggy uterus -Lochia fails to change color from red to serosa to alba within a few weeks The causes of PPH - Trauma: ✅-Damage to the genital tract -Lacerations -Hematomas -Uterine Inversion -Uterine Rupture: cause damage to the genital tract Treatment for Uterine Inversion includes: ✅-Giving Uterine Relaxants -Immediate Manual Replacement by the health care provider. Define Uterine Rupture & how to handle it: ✅-Causes damage to the genital tract -Most common in women with previous c/s -S/S: combine pain, FHR abnormalities, and vaginal bleeding
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