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HIGH RISK POSTPARTUM NURSING CARE
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HIGH RISK POSTPARTUM NURSING CARE
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HIGH RISK POSTPARTUM NURSING CAREThe nurse works in a labor and delivery facility with new protocols for estimating
postpartum blood loss. Which method for estimating blood loss is implemented in the
delivery room?
1. Ask the patient how many peripads she considered to be "soaked."
2. Collect blood in calibrated, under-buttocks drapes for vaginal birth.
3. Place a basin at the foot of the delivery table to catch any blood.
4. Rely on the primary health care provider's estimate of blood loss - answer- ANS 2
Collecting blood in calibrated, under-buttocks drapes for vaginal birth and then weighing
the drapes is the easiest way to estimate blood loss in the delivery room.
What is a postpartum hemorrhage? - answer- defined as a loss of >500mL of blood for
vaginal delivery OR >1000 mL for C-section occurring before, during, or after delivery of
the placenta
How much mL is considered a postpartum hemorrhage after vaginal delivery? - answer-
500 ml
How much ml is considered a postpartum hemorrhage after a C-section? - answer-
1000 ml
What kind of assessment is important when it comes to a postpartum hemorrhage? -
answer- Lochia assessment - want to know mom's baseline!
How many hours should a pad hold for? - answer- 3 hours
When a mom is walking and all of a sudden feels dizzy what should the nurse do? -
answer- Have her sit and MASSAGE THE FUNDUS, look for that blood clot
Causes of a postpartum hemorrhage - answer- uterine atony, lacerations, retained
placental fragments, DIC
What is the number one cause of postpartum hemorrhage?! - answer- Uterine atony =
uterus is calm & relaxed
What kind of patients are more at risk for uterine atony? - answer- HYPTONIA patients,
patients who had an infection
Retained placental fragments - answer- Placental fragments occasionally adhere to the
uterine wall and prevent the uterus from contracting fully
CLEAN OUT THE UTERUS - make sure there is no retained placental fragments
Symptoms of postpartum hemorrhage - answer- -Decreased blood pressure
-Increased shallow respirations
,-Pale clammy skin
-Increasing anxiety
-Uterus is boggy/doughy
True or false: Postpartum hemorrhage is a medical emergency - answer- True!
Medical management for a postpartum hemorrhage - answer- Pitocin
Bimanual compression
Methergine/Hemabate
Blood replacement - vessel might need to be ligated
Hysterectomy
MASSAGE THE FUNDUS (15 second every minute)
Bimanual compression - answer- Insert the fist in the vaginal canal, pressing the
knuckles on the uterus and the other hand abdomen. Pushing to make sure the uterus
realizes that it needs to contract then release
True or false: If mom is hypertensive would you give methergine - answer- FALSE - do
not give it, GET blood pressure before giving this medication. If they are hypotensive
give this medication
Nursing interventions for a postpartum hemorrhage - answer- Fundal massage
Measure fundal height
Assess Lochia
Offer a bedpan - empty the bladder, might need to straight-cath
V/S
Oxygen by face mask
Subinvolution - answer- Delayed return of the uterus to its nonpregnant size and
consistency.
Involution - answer- Shrinking of the uterus (womb) to its normal size after childbirth.
Symptoms of involution - answer- Late postpartum hemorrhage (1-2 weeks -> childbirth)
excessive blood loss
Lochia fails to progress from Rubra-Serosa-Alba
Lochia Rubra persists after 2 weeks
Methergine - answer- Improves muscle tone, shocks the uterus to make it involute
What vital sign is important to take before giving Methergine? - answer- blood pressure
Teaching points when giving Methergine? - answer- importance of why she needs to
void, can't have a full bladder, best thing to do to enhance involution is breast feeding -
released natural Pitocin (oxytocin) make the uterine contract
, Deep vein thrombosis - answer- blood clot forms in a large vein (thrombus forms)
usually in a lower limb
Femoral deep vein thrombosis signs - answer- decreased pedal pulses
pain
stiffness
swelling in the affected leg
Pelvic deep vein thrombosis signs - answer- high temperature (101/102)
chills/shivering
Three types of deep vein thrombosis - answer- Superficial thrombophlebitis
Femoral
Pelvic
Symptoms of deep vein thrombosis - answer- Edema of ankle and leg
Low grade fever followed by chills and high fever
Pain
Peripheral pulses decreased
Dyspnea and chest pain
Chain in LOC
Hypotension
Nursing interventions for DVT - answer- IV heparin using infusion pump - to prevent
clotting, doesn't cure --> progress to warfarin
Assess the pain
Call and get a doppler for her*
strict bedrest until symptoms subside, elevation of leg
monitor signs of early PE
prevent with early ambulation, regular leg exercises
also provide support stockings
Initial treatment for a DVT - answer- Drink lots of fluids!
Early ambulation
Continuous IV Heparin (3-5 days)
NSAID
Bedrest with affected leg elevated
What is the most common cause of postpartum infection? - answer- Endometritis
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