The initial management of excessive postpartum bleeding is a firm massage of the uterine fundus. Although establishing venous access may be a necessary intervention, fundal massage is the initial intervention. The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention is to assess the uterus.
Full Answer
What is the treatment of choice for von Willebrand disease (vWD)?
Desmopressin is the primary treatment of choice for vWD and can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer.
What is the pathophysiology of late PPH?
b. Defective vascularity of the decidua. d. Coagulation disorders. ANS: A Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments. Late PPH is not typically a result of defective vascularity of the decidua, cervical lacerations, or coagulation disorders. 20
Which medications are used in the treatment of varicose vein disease (vWD)?
Desmopressin is the primary treatment of choice for vWD and can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage.
What is the pathophysiology of pelvic inflammatory disease (PPH)?
Recognized causes of subinvolution include retained placental fragments and pelvic infection. Although defective vascularity, cervical lacerations, and coagulation disorders of the decidua may also cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.
Which medications are used to manage PPH?
The medications most commonly used in PPH management are uterotonic agents. These medications include oxytocin (Pitocin®), misoprostol (Cytotec®), methylergonovine maleate (Methergine®,), carboprost tromethamine (Hemabate®), and dinoprostone (Prostin E2®). All of these medications are available in the United States.
How do you treat PPH?
Oxytocin is the most effective treatment for postpartum hemorrhage, even if already used for labor induction or augmentation or as part of AMTSL. The choice of a second-line uterotonic should be based on patient-specific factors such as hypertension, asthma, or use of protease inhibitors.
What are priority nursing interventions for postpartum hemorrhage?
Nursing Interventions Save all perineal pads used during bleeding and weigh them to determine the amount of blood loss. Place the woman in a side lying position to make sure that no blood is pooling underneath her. Assess lochia frequently to determine if the amount discharged is still within the normal limits.
Which procedure will help in the management of atonic PPH?
Safety pin uterine compression suture is a simple, safe, highly effective, and life-saving conservative procedure to control atonic postpartum hemorrhage with the advantage of preserving future fertility.
What is the first-line management of postpartum hemorrhage?
Oxytocin is an effective first-line treatment for postpartum hemorrhage31; 10 international units (IU) should be injected intramuscularly, or 20 IU in 1 L of saline may be infused at a rate of 250 mL per hour. As much as 500 mL can be infused over 10 minutes without complications.
How do you manage primary PPH?
Treatment for primary PPH requires a multidisciplinary approach. Any measures and/or drug therapy taken as part of the initial treatment is considered first‐line therapy. In most cases, this includes resuscitation measures, exclusion of genital tract laceration, checking of the placenta and the use of uterotonics.
What is PPH nursing management?
Postpartum hemorrhage (PPH) is defined as a cumulative blood loss greater than or equal to 1,000 mL of blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, regardless of route of delivery.
Which of the following management should be performed in the setting of postpartum hemorrhage following a vaginal delivery?
Oxytocin is an effective first-line treatment for postpartum hemorrhage31; 10 international units (IU) should be injected intramuscularly, or 20 IU in 1 L of saline may be infused at a rate of 250 mL per hour. As much as 500 mL can be infused over 10 minutes without complications.
What medications are used for prevention and treatment of postpartum hemorrhage?
Uterotonic agents include oxytocin, ergot alkaloids, and prostaglandins. Oxytocin is the most effective treatment for postpartum hemorrhage, even if already used for labor induction or augmentation or as part of AMTSL.
What medications are used for prevention and treatment of postpartum hemorrhage?
Oxytocin (Pitocin) is the first choice for prevention of postpartum hemorrhage because it is as effective or more effective than ergot alkaloids or prostaglandins and has fewer side effects.
What are the 4 causes of PPH?
As a way of remembering the causes of PPH, several sources have suggested using the “4 T' s” as a mnemonic: tone, tissue, trauma, and thrombosis.
Why is TXA given slowly?
TXA should be administered slowly as an IV injection over 10 min because bolus injection carries a potential risk of transient lowering of blood pressure.
1. A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the client is experiencing profuse bleeding. What is the most likely cause for this bleeding? a. Uterine atony b. Uterine inversion c. Vaginal hematoma d. Vaginal laceration
ANS: A Uterine atony is significant hypotonia of the uterus and is the leading cause of postpartum hemorrhage. Uterine inversion may lead to hemorr...
2. What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony? a. Establishing venous access b. Performing fundal massage c. Preparing the woman for surgical intervention d. Catheterizing the bladder
ANS: B The initial management of excessive postpartum bleeding is a firm massage of the uterine fundus. Although establishing venous access may be...
3. What is the most common reason for late postpartum hemorrhage (PPH)? a. Subinvolution of the uterus b. Defective vascularity of the decidua c. Cervical lacerations d. Coagulation disorders
ANS: A Late PPH may be the result of subinvolution of the uterus. Recognized causes of subinvolution include retained placental fragments and pelvi...
4. Which client is at greatest risk for early PPH? a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress b. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. Primigravida in spontaneous labor with preterm twins
ANS: B Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uter...
5. The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis? a. Absence of cyanosis in the buccal mucosa b. Cool, dry skin c. Calm mental status d. Urinary output of at least 30 ml/hr
ANS: D Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation during which the perfusion of body organs may become severely co...
6. The most effective and least expensive treatment of puerperal infection is prevention. What is the most important strategy for the nurse to adopt? a. Large doses of vitamin C during pregnancy b. Prophylactic antibiotics c. Strict aseptic technique, including hand washing, by all health care personnel d. Limited protein and fat intake
ANS: C Strict adherence by all health care personnel to aseptic techniques during childbirth and the postpartum period is extremely important and t...
7. What is one of the initial signs and symptoms of puerperal infection in the postpartum client? a. Fatigue continuing for longer than 1 week b. Pain with voiding c. Profuse vaginal lochia with ambulation d. Temperature of 38° C (100.4° F) or higher on 2 successive days
ANS: D Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abort...
8. Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate? a. PPH is easy to recognize early; after all, the woman is bleeding. b. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH. c. If anything, nurses and physicians tend to overestimate the amount of blood loss. d. Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.
ANS: D Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH. Unfortunately, PPH can occur with little warning and...
9. A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed? a. Disseminated intravascular coagulation (DIC); asking for laboratory tests b. von Willebrand disease (vWD); noting whether bleeding times have been extended c. Thrombophlebitis; using real-time and color Doppler ultrasound d. Idiopathic or immune thrombocytopenic purpura (ITP); drawing blood for laboratory analysis
ANS: C Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound examinati...
What is the treatment for von Willebrand disease?
Desmopressin. This medication is available as an injection (DDAV P) or nasal spray (Minirin) It's a synthetic hormone that controls bleeding by stimulating your body to release more of the von Willebrand factor stored in the lining of your blood vessels. Many doctors consider DDAVP the first treatment for managing von Willebrand disease.
Why do von Willebrand tests fluctuate?
The results of these tests can fluctuate in the same person over time due to factors such as stress, exercise, infection, pregnancy and medications. So you might need to repeat some tests. If you have von Willebrand disease, your doctor might suggest ...
What is the Von Willebrand factor?
Von Willebrand factor antigen. This determines the level of von Willebrand factor in your blood by measuring a particular protein. Von Willebrand factor activity. There are a variety of tests to measure how well the von Willebrand factor works in your clotting process. Factor VIII clotting activity.
What is the FDA approved replacement therapy for adults 18 and older?
Another replacement therapy approved by the FDA for treating adults 18 and older is a genetically engineered (recombinant) von Willebrand factor product. Because recombinant factor is made without plasma, it can reduce the risk of a viral infection or allergic reaction. Oral contraceptives.
Does von Willebrand disease stop bleeding?
Even though von Willebrand disease has no cure, treatment can help prevent or stop bleed ing episodes. Your treatment depends on: Your doctor might suggest one or more of the following treatments to increase your von Willebrand factor, strengthen blood clots or, in women, control heavy menstrual bleeding: Desmopressin.
Can von Willebrand disease be diagnosed?
Diagnosis. Mild forms of von Willebrand disease can be difficult to diagnose because bleeding is common, and, for most people, doesn't indicate a disease. However, if your doctor suspects you have a bleeding disorder, he or she might refer you to a blood disorders specialist (hematologist). To evaluate you for von Willebrand disease, your doctor ...
