OB 409 Maternity Study Guide for Exam 2 Complete

Maternity Study Guide (Exam 2) 1. How do we know if a patient is experiencing postpartum hemorrhage? (pg 506) • Postpartum Hemorrhage [PPH] (Leading Cause of Morbidity/Mortality Worldwide) ▪ Blood Loss of 500 ml (Vaginal) or Loss of 1000 mL (C- Section) ▪ 10% Change in Hematocrit (From Admission (Labor) to Postpartum) ▪ Life-Threatening Event that Occurs with Little Warning ▪ Uterine Atony (Leading Cause of Early PPH) ▪ Hematomas/Unrepaired Lacerations (Second Leading Cause of PPH) o Hematoma (Blood Collecting Under Tissue; Bruising/Swelling) Vulvar (Most Common Site); Pain (Most Common Symptom) 2. Appropriate interventions for hemorrhaging. • Hemorrhaging Interventions ▪ GOAL: Maintain Vital Signs and O2 Saturation ▪ Massage Fundus (Firms the Fundus - Alleviating Atony) ▪ Eliminate Bladder Distension ▪ Intravenous Fluids ▪ Uterotonic Medications (Produces Contractions) o Oxytocin o Hemabate (IM) CONTRAINDICATION: Asthma o Methergine (IM) CONTRAINDICATION: Hypertension 3. If a patient is experiencing hypovolemia related to hemorrhaging, what interventions can we expect to perform, and how can we effectively monitor the patient? (Pg 513 – 514) • Hypovolemia Related to Hemorrhaging (Interventions) ▪ GOAL: Restore Oxygen Delivery to Tissues and Maintain Cardiac Output ▪ Establish/Maintain Venous Access (18g or Larger) ▪ Ensure Patent Airway; Administer Oxygen (10 – 12 L; Nonrebreather Mask) ▪ Fluid Resuscitation (Monitor for Fluid Overload) 4. What different problems can we see on the perineum following a vaginal delivery, and what signs/symptoms will accompany those problems? (pg 462) • Perineum Issues (After Vaginal Delivery) ▪ Hemorrhoids (Anal Varicosities) o Itching, Discomfort, Bright Red Bleeding ▪ Edema ▪ Lacerations or Episiotomy ▪ Hematoma 5. What is an appropriate intervention with a pregnant person who is choking? • Choking Interventions (Chest Thrusts) ▪ Similar to Heimlich Maneuver BUT Position Hands Higher at the Base of the Breastbone (Just Above the Joining of the Lowest Ribs) 6. In consideration of a major repair to the perineum, following delivery, what contraindications would we want to be aware of with treatments? • Contraindications with Treatments ▪ Hemabate (IM) o Contraindication: Asthma ▪ Methergine (IM) o Contraindication: Hypertension 7. When teaching about breastfeeding to a new mom, what teaching and interventions would be most appropriate? • Breastfeeding ▪ Ideal Time to Initiate: First 1 – 2hrs After Birth ▪ Teaching Infant how to Latch ▪ Reveal Pain/Reduce Swelling (Ice Pack, Cabbage Leaves, Ibuprofen) ▪ DO NOT Stimulate Breast IF Not Breastfeeding 8. What is the difference between postpartum blues, postpartum depression and postpartum psychosis? • Postpartum Blues [“Baby Blues”] ▪ Peaks around the 5th day (Subsides by 10th Day) ▪ Emotionally Labile ▪ Cries Easily, Sadness ▪ Anxiety, Insomnia, Fatigue • Postpartum Depression [PPD] ▪ Lasts More than 2 Weeks (Rarely Disappears without Help) ▪ Intense/Pervasive Sadness ▪ Difficulty Sleeping, Loss of Appetite ▪ Thoughts of Self-Harm • Postpartum Psychosis ▪ PPD with Psychotic Features ▪ Rapid Onset ▪ Bizarre Behavior, Hallucinations, Paranoid Delusions ▪ Impulsivity with Risk of Suicide or Infanticide 9. How can a nurse teach about bonding with a new baby, especially if depression is being experienced by the new mother? • Mother-Infant Bonding ▪ Process: Love and Acceptance Between Mother and Infant ▪ Facilitates vs Inhibits Behaviors Affecting Parental Attachment (Table 20.1; 20.2 pg 488) o Eye Contact o Touching/Holding o Talking o Participating in Care ▪ Skin-to-Skin Contact Immediately After Birth ▪ Extended Contact Valuable for Parents with High Risk for Parenting Inadequacies 10. How can it be determined if a person is controlling their blood glucose, when they are diabetic? • Controlled Diet • Oral Medications • Insulin (Ex. Humulin) 11. What treatment/interventions should we put in place when a patient has preeclampsia? • Preeclampsia Treatments/Interventions ▪ Delivery of Fetus Close to Term as Possible o Either Inducing Labor or (If Possible) Prolonging Pregnancy Until Term 12. How can we determine if a patient actually has preeclampsia? • Preeclampsia Diagnosis Criteria ▪ Hypertension ( ≥ 140/90 mm Hg) AND One Other Symptom (Below) ▪ Proteinuria (≥ 300 mg in 24hrs; Protein/Creatinine Ration: 0.3) ▪ Thrombocytopenia (Platelet Count: Less than 100,000) ▪ Impaired Liver Function (Elevated LFTs, RUQ Pain) ▪ Renal Insufficiency (Protein/Creatinine Ratio of Greater than 0.3) ▪ SEVERE: Pulmonary Edema (Present) ▪ Cerebral/Visual Disturbances (Headache, “Floaters”, Blurry Vision) • Risk Factors Associated with Preeclampsia ▪ Obesity, Gestational Diabetes, Chronic Hypertension 13. Being diabetic and having a baby has several risks. What are they? • Fetal/Neonate Risk Factors with Diabetes ▪ Increased Infant Morbidity/Mortality (Depends on Glucose Control) ▪ Stillbirth (Intrauterine Fetal Demise) ▪ Extreme Prematurity ▪ Birth Defects/Congenital Anomalies (If Poor Glucose Control in First Trimester) ▪ Neonate Hyperglycemia ▪ Birth Injuries Due to Macrosomia (Big Baby – Greater than 4000 – 4500 grams) 14. What is ketoacidosis and why is it a problem? • Ketoacidosis (MEDICAL EMERGENCY) ▪ Accumulation of Ketones o Resulting from Hyperglycemia to Metabolic Acidosis ▪ Occurs During the 2nd to 3rd Trimester (Where Diabetogenic Effects are Greatest) ▪ Can Lead to Intrauterine Fetal Death 15. Why is controlling diabetes so important with respect to pregnancy? • Importance of Controlling Diabetes when Pregnant ▪ Reduces Risks for… o Tube Defects (Ex. Spina Bifida, Anencephaly, Microcephaly) o Macrosomia (Large Baby) Extra Weight Leads to Respiratory Issues 16. What are the differences between gestational hypertension, preeclampsia, eclampsia, and H.E.L.L.P. Syndrome? • Gestational Hypertension ▪ Onset of Hypertension without Proteinuria or Other Systemic Findings Related for Preeclampsia After 20 Weeks of Pregnancy • Preeclampsia ▪ Progressive Disorder Originating from the Placenta o Generalized Vasospasm o Poor Tissue Perfusion o Increased Peripheral Vascular Resistance o Increased BP • Eclampsia ▪ Seizure/Coma in Preeclampsia Woman (NOT Associated with Another Condition) • H.E.L.L.P. Syndrome ▪ Hemolysis ▪ Elevated Liver Enzymes ▪ Low Platelets 17. If we suspect that a patient has placenta previa, what signs have we seen with the patient, and what interventions would we perform? • Placenta Previa (Placenta Implants in Lower Uterus Close to/Over Cervical OS ▪ Signs/Symptoms o Painless, Bright Red Bleeding ▪ Interventions o Ultrasound to Diagnose o Deliver by Cesarean 18. What symptoms would be associated with preeclampsia? • Preeclampsia (Symptoms) ▪ Generalized Vasospasm ▪ Poor Tissue Perfusion ▪ Increased Peripheral Vascular Resistance ▪ Increased BP 19. How do we help a person who is having a seizure? (pg 1386) • Clear and Maintain an Open Airway (Very Important) • Shout for Help (NEVER Leave the Patient) • Raise Siderails and Pad Hard Objects • Administer Magnesium Sulfate 20. Magnesium sulfate is used for what, during pregnancy? How do we know if a patient has too much built up in their system? • Magnesium Sulfate ▪ Used to Prevent/Treat Seizure Activity ▪ Neuroprotection of Baby ▪ Decreases Edema and Increases Diuresis as Preeclampsia Resolves ▪ Relaxes the Uterus • Toxicity S/S of Magnesium Sulfate ▪ Absent Deep Tendon Reflexes ▪ Heart Block ▪ Respiratory Depression/Paralysis ▪ Blurred Vision; Slurred Speech ▪ Severe Muscle Weakness ▪ Cardiac Arrest • ANTIDOTE: Calcium Gluconate IV 21. How do we know if a patient is okay on the level of Magnesium Sulfate they are receiving? • Deep Tendon Reflexes Present (Using Percussion Hammer) • Level within Therapeutic Range (4 – 7 mEq/L) • Therapeutic Effects Occur (Seizure Subsides, Uterus Relaxes, Etc.) • Monitor Maternal VS Every 15 – 30 mins (Continuous Monitoring of Fetal VS) 22. Why is too little amniotic fluid (oligohydramnios) a bad thing? • Oligohydramnios (Too Little Amniotic Fluid) ▪ Can Lead to Cord Compression and Hypoxemia 23. What signs do we watch for, to assure us that the patient with preeclampsia is recovering from this condition? (pg 292) • Signs of Patient Recovering from Preeclampsia (Usually After 48 Hours) ▪ Blood Pressure Stabilizes ▪ Increased Urinary Output ▪ Reduced/No Protein in Urine ▪ Vision Clears ▪ Reduced to No Headache 24. If a patient is having a difficult time keeping any food down, and has terrible nausea, what can the nurse teach her to hopefully improve her ability to not vomit. • Patient Teachings (Vomiting)