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Nur 343 Exam 3 Summarized Notes

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Course
NUR 343 Maternity

Institution
University Of Rhode Island

This is a comprehensive, detailed and Summarized Exam 3 Notes for Nur 343. *For effective exam prep!! *Essential Study Material!! *For you, at a price that's fair enough!!

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Uploaded on September 19, 2024
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nur 343
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fall
autumn
spring
maternity
island
rhode
kingston
reproductive health
nursing in childbearing
childbearing
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exam 3
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MATERNITY EXAM 3: PP Woman at Risk 1
PP Conditions that put Women at Risk:
● Postpartum hemorrhage
● Thromboembolic conditions
● Postpartum infections

Postpartum Hemorrhage
● Potentially life threatening complication
● Leading cause of  worldwide
● Defined as blood loss of:
○ > 500 ml (vaginal birth) 10%
○ > 1000 ml (C section) 25%
●
Causes→ 4 T’s
●
○ Uterine atony: failure of the uterus to contract after birth (most common cause of pp hemorrhage)
■ CAUSES
●

● Overdistention of uterus caused by: multifetal gestation, macrosomia, placental
fragments
● Prolonged or rapid labor
● Uterine infections
● Anesthesia, MgSO4, Pitocin given before delivery of placenta
○ Magnesium: dangerous drug, high dose can stop heart (only give to severely
hypotensive pts)
●
○ Retained placenta
○ complete detachment & expulsion permits continued contraction & optimal occlusion of blood vessels
○ Thorough inspection of placenta necessary
●
○ Damage to genital tract: ○ Hematomas: (damage to larger blood
■ Cervical and vaginal wall vessel→ blood seeps outside into tissue)
lacerations ■
■ “Trickling” of  ■
■ Spontaneous or via manipulation ■
● :
○ Hypercoagulation: normal* and protective; YOU WANT BLOOD TO BE CLOTTING
○ Coagulopathies:
■ bleeding disorders characterized by prolonged excessive bleeding
■ suspected if postpartum bleeding persists  
■ Often masked by routine use of  
■ Assess lab values for: ↓ platelets & fibrinogen, ↑ prothrombin time, and prolonged bleeding
time
○ Examples:
■ Idiopathic thrombocytopenic purpura (ITP): disorder of increased platelet destruction r/t
autoantibodies, will see bleeding from IV sites, bruising
■ von Willebrand disease (vWD): congenital disorder of bleeding time, doesn’t show up until
significant bleeding event, treated with  (desmopressin) give IV if dx is 100%
● von Willebrand factor (WWF) is an essential clotting protein
● Missing or lacking WWF in vWD

, MATERNITY EXAM 3: PP Woman at Risk 2
■ Disseminated intravascular coagulation (DIC): clotting system abnormally activated causing
widespread clots throughout the body, increased systemic clotting depletes factors needed to
stop excessive bleeding; caused by severe injury or infection

Nursing Assessment for Bleeding:
● Assess amount of bleeding:
○ Heavy and slow, steady loss
○ Weigh peri pads to measure blood loss (ml = g)
■ 1,000 mL of blood weighs 1,000g
● Assess tone and location of fundus q 15 min for 1-2 hrs then q 1 hr for 4 hours
● Assess VS especially BP and pulse, UO, LOC
○ UO helps assess kidney function
○ < 30mL in 1 hr → kidneys starting to shut down r/t lack of perfusion
○ Foley catheter with urine meter for exact measurement in mL
● Look for hematoma
Risk Factors for PP Hemorrhage:
● Prolonged labor ● Preeclampsia ● Grand multiparity
● Precipitous birth ● Maternal hypotension ● Hydramnios (too much
● History of PP hemorrhage ● Lacerations amniotic fluid)
● Multiple gestations ● Operative birth ● Coagulation abnormalities
● Uterine infection ● Augmented labor
● Manual extraction of (stimulation of uterus to
placenta promote cxs)

During Hemorrhage:
● Monitor VS q 5 min until stable
○ Note trend in VS (pulse and RR increases, BP decreases, temp shouldn’t change)
● Administer oxygen at  L via mask
● Palpate fundus and massage prn
● Insert foley catheter
● Initiate pad count**
● Assess emotional and mental status
● Administer uterotonic drugs: 

Parameters Class I Hemorrhage Class II Hemorrhage Class III Hemorrhage Class IV Hemorrhage

Estimated 15% 15-30% 30-40% > 40%
Blood Loss

Pulse < 100 > 100 > 120 > 140

BP Normal or increased Decreased Decreased Decreased

RR Normal 20-30 30-40 > 40

Urine output > 30 ml/hr 20-30 ml/hr 5-15 ml/hr Negligible

Thromboembolic Conditions: Thromboembolism
● Obstruction of a blood vessel by a blood clot
● Superficial or deep (both can cause pulmonary embolism)
● Leading cause of  in the US
Nursing Management:

, MATERNITY EXAM 3: PP Woman at Risk 3
● Identify those at increased risk (smoking, history of birth control pills, varicosities)
● Prevent venous pooling
○ Elevate legs with pillows
○ Stirrups maximizes leg drainage (legs above heart level)
○ Avoid crossing legs
● Prevent  : encourage ambulation, TEDs, compression devices (especially after C section)
● Meds to decrease hypercoagulability (if pt really at risk): 
● Coagulation studies & elevation
Postpartum Infection
● Affects  of all births
● Defined as fever > 100.4 after 24 hrs postpartum occurring for at least 2 of the first 10 days after birth
● Normal physiologic changes of childbirth increase risk of infection (amniotic fluid, blood, lochia all  )
Common PP Infections:
● Teach mom to report any temp >  
● Metritis
○ Inflammation of uterus
○ Caused by bacterial infection of uterine wall
● Wound infection: cesarean incisions, perineal lacerations/incisions
● UTIs
● Mastitis: milk stasis & (can be caused by improper latch)

Postpartum Period
Postpartum Period:
● Begins after the delivery of the placenta and lasts 6 weeks
● Marked by physiologic and psychological changes
○ Attempt to return to pre-pregnant state
○ Adjustment within family, change in family structure and roles

Uterine Involution: Pregnant→ Non-Pregnant State

*Remember to support uterus at the bottom, place head of bed
flat, and check for increased bleeding as you massage



Factors
Factors that facilitate Uterine Involution:
that inhibit Uterine Involution:

Complete expulsion of placenta Incomplete expulsion of placenta
Complication free labor and birth process Uterine atony
Breastfeeding Prolonged labor and difficult birth
Early ambulation Uterine infection
Full bladder or overdistention of uterine muscles
Anesthesia
Close birth spacing

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Nur 343 Exam 3 Summarized Notes

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