what are the 4 main reasons for PPH?
Tone: ( uterine atony)
Tissue: retained placental fragments
Trauma: Lacerations, hematoma’s, uterine inversion
thrombin: development of disseminated intravascular coagulation
PPH can be be early or late
less than 24 hrs or greater than 24hrs to 6 weeks
what is uterine atony? and it is the most frequent cause of what
uterine atony is relaxation of the uterus
and it is the most frequent cause of PPH
what conditions put at greater risk for PPH?
- conditions that distend the uterus beyond capacity (multiple gestation-more than one baby, hydraminos-excessive amount of amniotic fluid, macrosomia-large baby)
- conditions that could have caused cervical or uterine lacerations (an operative birth, a rapid birth)
- conditions with varied placental site or attachment (placenta previa, placenta acceuta, premature seperation of the placenta, retained placental fragments)
- conditions that leave uterus unable to contract readily: (deep anesthesia or analgesia, labor initiated or assisted by oxytocin agent, high parity or maternal age over 35 yrs, previous uterine atoney surgery, endometriosis, prior hx of PPH, prolonged use of mg sulfate or other toxyoltic agent
- condition that lead to inadequate blood coagulation: fetal death, DIC
what are the interventions if your patient is having a PPH?
- stay with pt, 02
- Fundal massage, support & express clots
- Call for help, alert physician
- VS
- lower HOB
- IV normal saline or ringers lactate as orderd
- administer medications (oxytocin, misoprostil, ergometrine, carboprost)
- catheter
- put another IV in (large gauge)
what are some risk factors for post-partum infection?
- retained products of conception
- PPH
- pre-existing anemia
- prolonged labour
- use of instruments
- internal fetal monitoring
- repeated vaginal exams
- ++ manual exploration of uterus after delivery
- unsterilized equipment & gloves
- improper or no peri-care after delivery
- poor handwashign
- shared supplies between patients
- cleaning between patients limited or poorly done
- bedding soiled (think PV losses, moisture, feet in bed & guests in bed)
what might you find on assessment if your patient has a postpartum infection?
-uterine pain, malaise, foul smelling lochia, fever, icnreased PV losses, discoloured lochia, WBC count won’t be helpful because usually elevated after delivery
what is the focus of nursing care for a newborn infant (high risk & non high risk)
- respiration & extrauterine circulation
- temperature
- fluids & electrolytes
- nutrition & waste
- preventing infection
- bonding & attachment
what are the NORM VS FOR a newborn?
respiration: 30-60
temp: 36.5-37.2 axilla
Pulse: 110-160
sugars: 3.2-6
(we do not want to see see-saw respirations, intercostal indrawing, xiphoid retractions, flared or nasal grunting)
Gestational age
- recoil of extremities
- extremities
- sole (plantar) creases
- breast tissue
- genitalia
ABC problems always take priority for neonates, _______ & _______ influence ABC status
-thermoregulation & blood sugars
what is the relation of macrosomia & respiratory distress?
- the workload of supplying a large body mass with oxygenated blood is can prove too much for baby’s lungs and heart
- additionally a newborn may not feed well in the first hours of life, worsening the risk for low sugars. Low BS contribute to acidosis & impede respiratory function
- macrosomic babies are supported with frequent BS monitoring, supplemental feeds, possible IV & Oxygen
what are some S&S of neonatal abstinence syndrome?
- irritability
- disturbed sleep pattern
- constant movement, tremors
- frequent sneezing
- shrill, high-pitched crying
- possible hyperreflexia & clonus
- convulsions
- tachypnea
- vomiting & diarrhea
what factors predispose women to DVT’s?
- woman’s fibrinogen level is elevated from pregnancy leading to increased blood clotting
- dilation of lower extremity veins is still present as a result of pressure of the fetal head during pregnancy & birth so blood circulation is sluggish
if pt has DVT why is it dangerous to massage skin over clotted area?
-because you can loosen clot which will than cause a PE or cerebral embloism
what is early preterm & what is late preterm? and what kinds of problems do they usually have?
-early preterm 24-34 weeks
-late preterm 34-37 weeks
preterm infants usually have problems with resp function, anemia, jaundice, persistent patent ductus arteriosus & intracranial hemorrhage
what is respiratory distress syndrome? and what infants are most at risk for it?
-commonly occurs in preterm infants from lack of surfacant, without surfacant alveoli collapse on respiration & require extreme force for eh-inflation
when does surfacant usually form
the 34th week of gestation
what is transient tachypnea of the newborn & what causes it?
-at birth a newborn may have a rapid rate of respiration’s up to 80 breaths/ minute when crying caused by retained lung fluid
what is meconium aspiration syndrome?
-meconium aspiration syndrome occurs when infant aspirates meconium stained amniotic fluid before or during birth
why is meconium aspiration syndrome dangerous?
- mecinoum is irritating to the airway leading to airway spasm & pneumonia
- meconium can cause severe respiratory distress in 3 ways; causes
why is meconium aspiration syndrome dangerous?
- mecinoum is irritating to the airway leading to airway spasm & pneumonia
- meconium can cause severe respiratory distress in 3 ways; causes inflammation of the bronchioles because it is a foreign substance, it can block small bronchioles by mechanical plugging & it can cause a decrease in surfacant production through the lung
- can lead to hypoxemia, carbon dioxide retention, & intrapulmonary & extrapulmonary shunting can occur
