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NURS 315: Postpartum Hemorrhage – Qs And As (100%)
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NURS 315: Postpartum Hemorrhage – Qs And As (100%)
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NURS 315: Postpartum Hemorrhage – Qs And As(100%)
Definition of a hemorrhage with a vaginal delivery Right Ans - blood loss
greater than 500cc from vaginal delivery
Definition of a hemorrhage with a c-section Right Ans - blood loss greater
than 1,000cc from c/s delivery
EBL Right Ans - estimated blood loss
QBL Right Ans - quantified blood loss
S/S of hemorrhage Right Ans - • Lightheadedness
• Tachycardia
• Syncope
• Fatigue
• Oliguria
• Soaked Peri-Pad
• Shortness of breath
Risk factors for PPH Right Ans - • Multiple Gestation
• Large baby (LGA, macrosomia)
• Polyhydramnios (too much amniotic fluid)
• Multipartity (particularly grand multiparity, more than 5-term pregnancies)
-> the uterus is getting tired
• Prolonged labor (uterine inertia)
• Labor augmented with Pitocin (relaxes the uterine muscle)
• General Anesthesia
• Placenta Previa
• Abruptio Placentae
• Magnesium Sulfate infusion
Why do you give magnesium sulfate in L&D? Right Ans - - pre-eclampsia
- neuro protection (give 12 hrs before pre-term baby is born)
What are the 4 causes of PPH? Right Ans - Tone
Trauma
, Tissue
Thrombin
Tone Right Ans - lack of uterine tone (uterine atony)
- the uterus is soft and boggy + steady blood loss
Treatment to fix tone Right Ans - - fundal massage
- urination (uterus will be displaced to the right side if the bladder is full)
- medications
Trauma Right Ans - damage to genital structures (uterus, cervix, vagina,
and perineum)
- AN EMERGENCY!
Tissue Right Ans - Placental fragments retained in the uterine cavity
Prevention of tissue Right Ans - Make sure the placenta comes out INTACT!
or remove any pieces that don't
Thrombin Right Ans - blood clotting
- could be genetic
Prevention of PPH Right Ans - #1: breastfeeding immediately after delivery
- massage the uterus to express clots
- empty bladder
- repair lacerations
- IV Pitocin
Management of PPH ... #1 Right Ans - • First assess uterine position &
Lochia, L.O.C.
• First action: massage uterus
• First action: Call for help! At least one nurse to help and one to record. Get
hemorrhage kit/cart.
• Obtain vital signs (decreased BP and O2, increased HR)
• Delegate to other staff
• Call MD
• Hang IV- wait for order to start - run bolus
Management of PPH... #2 Right Ans - • Get order for Pitocin/Oxytocin
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