• natural redheads (tend to experience heavier bleeding after delivery)
• uterine atony (relaxation of uterus): this is a mechansim for hemostasis after birth of placenta
• 75% of all PPH is due to uterine atony

• increased vaginal bleeding
• uterine atony
• clots larger than a quarter
• perineal pad saturation in 15 min or less
• return of lochia rubra on it has progressed to serosa or alba
• constant oozing, trickling, or frank flow of bright red blood from the vagina
• tachycardia and hypotension
• pale, cool, clammy skin with poor turgor and pale mucus mambranes, oliguria
• lab data: hgb/hct decreased, type and cross

• uterine atony
• lacerations
• hematoma
• retained placental fragments
• DIC
• redheads
• med use: general anesthesia, mag sulfate, pitocin
• low platelet count sceondary to PIH

• monitor VS
• assess fundus for height, firmness and position
• perform fundal massage if indicated
• assess maternal hemodynamic staus even with firm uterus
• assess lochia for color, quantity and clots
• assess for signs of bleeding from lacerations/episiotomy/hematomas
• assess bladder for distention
• maintain or initiate IV fluids to replace fluid volume loss with IV isotonic solutions (LR or NS, albumin or blood products)
• provide O2 @ 2-3L nasal canula
• elevate clients legs to 20-30 degree angle to increase venous return
• meds to use: methergine, cytotec, hemabate

• assess breast consistency
• niplle condition (warm/reddened)
• painful/swollen axillary lymph nodes
• generalized fever
• flulike sx's

• breastfeed
• antibiotic
• supportive bra
• VS with temp
• educate on proper hygeine
• teach breast care
• increase fluids

• flu like sx's
• anorexia and nausea
• pelvic pain
• chills
• fatigue & malaise
• abnormal lab values (sed rate/wbc's elevated)
• loss of appetite
• abnormal lochia
• tachycardia delayed involution
• pain/tenderness of perineum
• backache

• redness
• edema
• ecchymosis/skin discoloration
• approximation of edges
• fever warmth and tenderness

• urgency
• frequency
• dysuria
• urnary retention
• hematuria
• pyuria
• elevated temp
• chills
• suprapubic pain
• malaise
• malodorous cloudy urine

• decreased BP
• increased pulse
• increased respiratory rate
• weak/thready pulse
• oliguria
• rapid shallow breathing
• pallor
• cold extremities

• I & O
• VS
• IV fluids s/a LR
• O2 as necessary
• type and cross
• Pad count
• ABG's
• elevate legs to increase venous return
• central venous pressure or pulmonary artery cath

• a "cut" in the uterus/cervix/vagina after birth
• uterus is firm and contracted
• bright red blood ora steady trickle of blood
• may account for up to 20% of early PPH

• accumulation fo blood in ine area
• often vulvar/vaginal
• occurs d/t injury to a blood vessel during delivery
• bleeding, extension of episiotomy, firm/contracted uterus, pain and difficulty voiding are symptoms

• increased risk of infection
• increased risk for seperation of sutures

• inspect cervix/vagina/perineum/rectum
• assess episiotomy for extension to 3rd/4th degree laceration
• evaluate lochia
• assess VS and hemodynamic status
• attmept to Id source of bleeding
• assist PCP with repair procedures
• ice packs to treat small hematomas
• larger hematoma >5cm evacuate hematoma
• ligate bleeding vessel if needed
• urinary catheter to prevent straining
• antibiotics/pain meds
  
• sitz bath after 24hr & peri care post void/defecation
  

• edematous lower extremities
• low to high grade temp
• pain in lower leg
• positive homans sign
• abd pain
• decreased peripheral pulses
• possible pulomnary embolism may result (dyspnea, chest pain, may need blood gases/xray/vq scan)
• increased risk for stroke

• support hose
• early ambulation
• encourage leg exercises
• with previous DVT monitor for signs of PE
• increase fluid intake
• warm moist compress (no ice)
• measure extremities daily
• monitor for signs of bleeding
• keep vit k (coumadin) and protamine (heparin) available
• monitor pt/ptt

• obesity
• >maternal age
• anesthesia or surgery resulting in venous stasis
• prolonged bedrest
• c-section
• hx dvt
• cigarette smoking
• maternal anemia or diabetes

• crying
• fatigue
• inability to concentrate
• obsessive about not being a good mother
• thoughts of harming baby
• anorexia
• flat effect with baby
• sleep disorders

• uterine stimulant
• controls PPH
• assess uterine tone and vaginal bleeding
• do not administer to hypertensive patients, sepsis, toxemia or renal disease
• monitor client for adverse reactons including htn, nausea, vomiting, and headache

• uterine stimulant
• controls PPH
• assess uterine tone and vaginal bleeding
• not for use in breastfeeding

• uterine stimulant
• controls PPH
• assess uterine tone and vaginal bleeding
• monitor for advers reactions: fever, chills, nausea, vomiting and diarrhea
• contraindicated in: PID, cardiac, renal, hepatic asthma, htn, previous uterine surgery

• uterine stimulant
• promotes uterine contractions
• assess uterine tone and vaginal bleeding
• monitor for adverse reactions: water intoxication s/a lightheadedness, nausea, vomiting, headache, malaise (these reactions can lead to cerebral edema with seizures, coma and death)

• higher chance of aspirating meconium
• dry peelling skin
• overgrown nails
• abundant amounts of hair
• visible creases on palm of hands/bottoms of feet
• sometimes brown/yellow/green stained skin d/t meconium
• might be large and need assistance from forceps/vacuum
• hypoglycemia

• ok in breastfeeding
• antidote is protamine
• given IV or subq
• avoid sitting/crossing legs for long periods of time
• avoid alcohol use
• brush teeth gently
• watch for bleeding gums/nose/easy bruising
• avoid massaging legs

• oral dosing
• vit k is antidote
• no breastfeeding
• monitor for signs of bleeding
• brush teeth gently
• avoid alcohol
• monitor PT

The only real intervention is to educate mom on the importance to avoid any and all alcohol use while pregnant.  Ensure that mom quits drinking ASAP.  Get  mom into an alcohol treatment program early on in her pregnancy.

• phototherapy starts if serum bilirubin is >15mg/dL prior to 48hr of age, >18mg/dL prior to 72hr of age and if it increases >20mg/dL at anytime
• reposition q 2hr to expose all of body
• check lamp energy with a photometer per unit protocol
• observve for complications of phototherapy: bronze discoloration, maculopapular skin rash, pressure areas, dehydration, elevated temperature

• benign
• results from normal newbor physiology of increased bilirubin production d/t breakdown of fetal RBC's and liver immaturity
• signs appear after 24hr of age

• result of an underlying disease
• usually caused by a blood group incompatibility or an infection
• may be result of RBC disorders
• appears before 24hr of age or is persistant after day 7

• weight in 90th percentile or higher
• infant may not be able to descend into pelvic rim properly
• c-section may be necessary
• vaginal birth may dispose infant to bruising or injury s/a broken clavicle, paralysis from trauma to cervical nerves
• infant may score low on gestational age exams with immature reflexes

• facial anomolies, small lowset eyes, thin upper lip, palpebral fissure, small upper jaw, short uptorned nose, smooth philthrum, prominent epicanthal folds
• growth deficiency, cns problems, sga, microcephaly
• cognitive challenges
• behavior problems
• learning difficulties
• in infancy poor sucking reflex, sleep disturbances, seizures and tremulousness
• babies are very irritable and very inconsolable
• may have heart murmur and skeletal abnormalities

• when a fetus is deprived of oxygen they initially experience tachypnea
• with continued asphyxia respiratory movements cease and the heart rate falls
• in most cases exposure to oxygen and stimulation will induce respirations
• always treat as though it is secondary apnea

• with continued asphyxia the infant develops deep gasping respirations, heart and BP continue to decrease
• respiratons become weaker until they cease
• infant is unresponsive to stimulation
• artificial ventilation with oxygen must be initiated
• infant may have passed into secondary while in utero

• hypoglycemia (irritability, tremors, high pitched cry)
• gestational age
• birth trauma from cephalopelvic disproportion
• congenital anomolies
• hyperbilirubinemia
• meconium aspiration
• electrolyte imbalance
• birth weight
• hypocalcemia (tremors)