Nebraska Methodist College NRS400 Final Exam Flashcards and
Study Guide 2026/2027
PPH volumes for C-section and vaginal - Correct answer✅✅ >500mL vaginal
>1000mL c-section
early/acute PPH timeline is: - Correct answer✅✅ within 24 hours
late/secondary PPH timeline is: - Correct answer✅✅ 24hrs-6wks
PPH Cause: Uterine Atony
what is it?
causes? - Correct answer✅✅ leading cause of PPH
the uterus is not clamping down
casued by: lots of babies, lots of births, lot of fluid lost, big babies
Why are obese women more likely to get uterine atony (2 reasons) - Correct answer✅✅ - it's harder
to feel the uterus under more fat
- pitocin diffuses into fat so it's not as effective
PPH Cause: Retained Placenta
what is nonadherent retained placenta
what is adherent retained placenta - Correct answer✅✅ - nonadherent is when the placenta
membrane is stuck in the uterus
- adherent is when the placenta is still attached to the uterine wall
PPH Cause: Laceration of the genital tract
difference between venous/arterial laceration?
,mgmt? - Correct answer✅✅ venous: dark red blood, superficial, from birth canal)
arterial: bright red, deep, from cervix
mgmt: suture, pericare, pain mgmt, stool softeners, ambulation
PPH cause: Hematoma
what is it?
what increases risk for it?
s/s:
risk for:
mgmt: - Correct answer✅✅ - a blood clot or collection of blood that forms in the pelvic area
- long 2nd stage of labor and use of forceps increases it's risk
- s/s include pain and pressure
- risk for going into shock
mgmt: evacuate the hematoma, ice, pericare, pain mgmt, stool softener, ambulation
PPH Cause: Inversion of uterus
MEDICAL EMERGENCY!!
what is it:
casues:
mgmt:
at risk for: - Correct answer✅✅ - a prolapsed uterus
- caused by: excessive traction on the cord and excessive pressure on relaxed uterus (this is why you
support uterus from below)
- mgmt: give nitro IV/subq to relax uterus and push back in, give anesthesia/pain meds
- pt at risk for bleeding out very quickly
PPH cause: Subinvolution of the uterus
what is it:
s/s:
,casues:
mgmt: - Correct answer✅✅ - the uterus stays large when it should be shrinking 1cm/day
- s/s: rubra bleeding for days, foul smelling lochia,
casues: infection
mgmt: methergine for 48hours, then a DNC if stuff still up there
PPH Cause: Placenta Acreta
what is it:
different types:
why do ultrasound?
what to do if we know before birth: - Correct answer✅✅ - when the placenta grows into the uterine
wall
- 3 types
Acreta: just on wall, can scrape off
increta: in myometrium, need hysterectomy
Procreta: grown through uterus into other organs, hysterectomy and possibly other organs too
- ultrasound to see where it has grown onto
- if we know before birth, we will do a c-section
PPH mgmt: why do we want to watch the women closely? - Correct answer✅✅ early recognition,
intervene early and fast
PPH mgmt: why is the firm fundus massage the initial intervention?
- what to do if still boggy? - Correct answer✅✅ - stimulate uterine contractions, prevent postpartum
hemorrhage, and expel any blood clots causing excessive bleeding
- call out for help if still boggy
never leave the woman!
PPH mgmt: elimination of bladder distention
how do we know if bladder is distended?
, what should we do and what do we weigh? - Correct answer✅✅ - bladder is distended if uterus is one
one side or another
- put catheter in and do not get her up, measure both urine and blood, weight pads,
1cc=1g!!
PPH mgmt: IV infusion of oxytocin and fluid
- how much of each?
- what are some additional meds and what are the contraindications of them?
- what to do if bleeding still has not stopped? - Correct answer✅✅ - 10-40 units of oxytocin + 100mL
of fluid
- can also give methergine unless they have HTN or cardiac problems
- can also give hemabate unless they have asthma -> can cause bronchoconstriction)
- DNC if bleeding still has not stopped
how much blood volume lost is considered hemorrhagic (hypovolemic) shock? - Correct answer✅✅
30-40% blood lost
PPH medical mgmt of hemorrhagic shock? - Correct answer✅✅ - find where blood is coming from
- give RBC
- draw labs bc they can go into DIC very quickly
PPH hypovolemic shock nursing Mgmt
what to monitor?
what they should have (lines/tubes)
other mgmt: - Correct answer✅✅ - monitor HR and BP
- 2 large bore IVs for NS and blood
- foley catheter to assess kidney function (should have 30mL/hr)
- put on 10l O2 non-rebreather
- fluid/blood replacement therapy
Study Guide 2026/2027
PPH volumes for C-section and vaginal - Correct answer✅✅ >500mL vaginal
>1000mL c-section
early/acute PPH timeline is: - Correct answer✅✅ within 24 hours
late/secondary PPH timeline is: - Correct answer✅✅ 24hrs-6wks
PPH Cause: Uterine Atony
what is it?
causes? - Correct answer✅✅ leading cause of PPH
the uterus is not clamping down
casued by: lots of babies, lots of births, lot of fluid lost, big babies
Why are obese women more likely to get uterine atony (2 reasons) - Correct answer✅✅ - it's harder
to feel the uterus under more fat
- pitocin diffuses into fat so it's not as effective
PPH Cause: Retained Placenta
what is nonadherent retained placenta
what is adherent retained placenta - Correct answer✅✅ - nonadherent is when the placenta
membrane is stuck in the uterus
- adherent is when the placenta is still attached to the uterine wall
PPH Cause: Laceration of the genital tract
difference between venous/arterial laceration?
,mgmt? - Correct answer✅✅ venous: dark red blood, superficial, from birth canal)
arterial: bright red, deep, from cervix
mgmt: suture, pericare, pain mgmt, stool softeners, ambulation
PPH cause: Hematoma
what is it?
what increases risk for it?
s/s:
risk for:
mgmt: - Correct answer✅✅ - a blood clot or collection of blood that forms in the pelvic area
- long 2nd stage of labor and use of forceps increases it's risk
- s/s include pain and pressure
- risk for going into shock
mgmt: evacuate the hematoma, ice, pericare, pain mgmt, stool softener, ambulation
PPH Cause: Inversion of uterus
MEDICAL EMERGENCY!!
what is it:
casues:
mgmt:
at risk for: - Correct answer✅✅ - a prolapsed uterus
- caused by: excessive traction on the cord and excessive pressure on relaxed uterus (this is why you
support uterus from below)
- mgmt: give nitro IV/subq to relax uterus and push back in, give anesthesia/pain meds
- pt at risk for bleeding out very quickly
PPH cause: Subinvolution of the uterus
what is it:
s/s:
,casues:
mgmt: - Correct answer✅✅ - the uterus stays large when it should be shrinking 1cm/day
- s/s: rubra bleeding for days, foul smelling lochia,
casues: infection
mgmt: methergine for 48hours, then a DNC if stuff still up there
PPH Cause: Placenta Acreta
what is it:
different types:
why do ultrasound?
what to do if we know before birth: - Correct answer✅✅ - when the placenta grows into the uterine
wall
- 3 types
Acreta: just on wall, can scrape off
increta: in myometrium, need hysterectomy
Procreta: grown through uterus into other organs, hysterectomy and possibly other organs too
- ultrasound to see where it has grown onto
- if we know before birth, we will do a c-section
PPH mgmt: why do we want to watch the women closely? - Correct answer✅✅ early recognition,
intervene early and fast
PPH mgmt: why is the firm fundus massage the initial intervention?
- what to do if still boggy? - Correct answer✅✅ - stimulate uterine contractions, prevent postpartum
hemorrhage, and expel any blood clots causing excessive bleeding
- call out for help if still boggy
never leave the woman!
PPH mgmt: elimination of bladder distention
how do we know if bladder is distended?
, what should we do and what do we weigh? - Correct answer✅✅ - bladder is distended if uterus is one
one side or another
- put catheter in and do not get her up, measure both urine and blood, weight pads,
1cc=1g!!
PPH mgmt: IV infusion of oxytocin and fluid
- how much of each?
- what are some additional meds and what are the contraindications of them?
- what to do if bleeding still has not stopped? - Correct answer✅✅ - 10-40 units of oxytocin + 100mL
of fluid
- can also give methergine unless they have HTN or cardiac problems
- can also give hemabate unless they have asthma -> can cause bronchoconstriction)
- DNC if bleeding still has not stopped
how much blood volume lost is considered hemorrhagic (hypovolemic) shock? - Correct answer✅✅
30-40% blood lost
PPH medical mgmt of hemorrhagic shock? - Correct answer✅✅ - find where blood is coming from
- give RBC
- draw labs bc they can go into DIC very quickly
PPH hypovolemic shock nursing Mgmt
what to monitor?
what they should have (lines/tubes)
other mgmt: - Correct answer✅✅ - monitor HR and BP
- 2 large bore IVs for NS and blood
- foley catheter to assess kidney function (should have 30mL/hr)
- put on 10l O2 non-rebreather
- fluid/blood replacement therapy
