Presentation on theme: "Nancy Pares, RN, MSN Metro Community College"— Presentation transcript:
1 Nancy Pares, RN, MSN Metro Community College NURS Unit 3Nancy Pares, RN, MSNMetro Community College
2 Assessment of Postpartum Hemorrhage Fundal height and toneVaginal bleedingSigns of hypovolemic shockDevelopment of coagulation problemsSigns of anemia
3 Risk Factors for Postpartum Hemorrhage Cesarean deliveryUnusually large episiotomyOperative deliveryPrecipitous laborAtypically attached placentaFetal demisePrevious uterine surgery
4 Causes of Postpartum Hemorrhage Uterine atonyLacerations of the genital tractEpisiotomyRetained placental fragmentsVulvar, vaginal, or subperitoneal hematomas
5 Causes of Postpartum Hemorrhage (continued) Uterine inversionUterine ruptureProblems of placental implantationCoagulation disorders
6 Nursing Interventions Uterine massage if a soft, boggy uterus is detectedEncourage frequent voiding or catheterize the womanVascular accessAssess abnormalities in hematocrit levelsAssess urinary outputEncourage rest and take safety precautions
7 Nursing Diagnoses: Postpartum Hemorrhage Health-seeking Behaviors related to lack of information about signs of delayed postpartal hemorrhageFluid Volume Deficit related to blood loss secondary to uterine atony, lacerations, hematomas, coagulation disorders, or retained placental fragments
8 Prevention of Postpartum Hemorrhage Adequate prenatal careGood nutritionAvoidance of traumatic proceduresRisk assessmentEarly recognition and management of complications
9 Postpartal Hemorrhage Table 38–2 Signs of postpartal hemorrhage.
10 Self-Care Measures: Postpartum Hemorrhage Fundal massage, assessment of fundal height and consistencyInspection of the episiotomy and lacerations if presentReport:Excessive or bright red bleeding, abnormal clotsBoggy fundus that does not respond to massageLeukorrhea, high temperature, or any unusual pelvic or rectal discomfort or backache
11 Community Based Care: Postpartum Hemorrhage Clear explanations about condition and the woman’s need for recoveryRise slowly to minimize orthostatic hypotensionWoman should be seated while holding the newbornEncourage to eat foods high in ironContinue to observe for signs of hemorrhage or infection
12 Uterine Atony Risk factors Assessment findings Overdistension of the uterusUterine anomalyPoor uterine toneAssessment findingsExcessive bleeding, boggy fundus
13 Uterine Atony (continued) ManagementFundal massageBlood products if loss is excessiveMedicationsOxytocin, methergine, carboprost tromethamine (Hemabate)
14 Uterine AtonyTable 38–1 Uterine stimulants used to prevent and manage uterine atony.
15 Uterine AtonyTable 38–1 (continued) Uterine stimulants used to prevent and manage uterine atony.
16 Retained Placental Fragments Risk factorsMismanagement of third stagePlacental malformationsAbnormal placental implantationAssessment findingsExcessive bleeding, boggy fundus
17 Retained Placental Fragments (continued) ManagementManual exploration of the uterusD&CBlood products if loss is excessive
19 Assessment of Infection (continued) FeverMalaiseAbdominal painFoul-smelling lochiaLarger than expected uterusTachycardia
20 Lacerations Risk factors Assessment findings Operative delivery Precipitous deliveryExtension of the episiotomyVaricesAssessment findingsExcessive bleeding with a firm uterus
21 Lacerations (continued) ManagementSuture the lacerationBlood products if loss is excessive
22 Endometritis Infection of the uterine lining Risk factors Cesarean sectionAssessment findingsFever, chillsAbdominal tendernessFoul-smelling lochiaManagementAntibiotics
23 MetritisTable 38–3 Common causative organisms in metritis.
24 MastitisTable 38–4 Factors associated with development of mastitis.
25 Assessment of Mastitis Breast consistencySkin colorSurface temperatureNipple conditionPresence of pain
26 Mastitis Infection of the breast Risk factors Assessment findings Damaged nipplesFailure to empty breasts adequatelyAssessment findingsFever, chillsBreast pain, swelling, warmth, rednessManagementAntibioticsComplete breast emptying
27 Figure 38–2 Mastitis. Erythema and swelling are present in the upper outer quadrant of the breast. Axillary lymph nodes are often enlarged and tender. The segmental anatomy of the breast accounts for the demarcated, often V-shaped wedge of inflammation.
28 Prevention of Mastitis Proper feeding techniquesSupportive bra worn at all times to avoid milk stasisGood handwashingPrompt attention to blocked milk ducts
29 Self-Care Measures: Mastitis Importance of regular, complete emptying of the breastsGood infant positioning and latch-onPrinciples of supply and demandImportance of taking a full course of antibioticsReport flu-like symptoms
30 Breast ProblemsTable 38–5 Comparison of findings of engorgement, plugged duct, and mastitis.
31 Nursing Diagnoses: Mastitis Health-seeking Behaviors related to lack of information about appropriate breastfeeding practicesIneffective Breastfeeding related to pain secondary to development of mastitis
32 Community Based Care: Mastitis Home care nurse may be the first to suspect mastitisObtain a sample of milk for culture and sensitivity analysisTeach mother how to pump if necessaryAssist with feelings about being unable to breastfeedReferral to lactation consultant or La Leche League
33 Assessment of Thrombophlebitis Homan’s signPain in the leg, inguinal area, or lower abdomenEdemaTemperature changePain with palpation
34 Figure 38–3 Homans’ sign. With the client’s knee flexed to decrease the risk of embolization, the nurse dorsiflexes the client’s foot. Pain in the foot or leg is a positive Homans’ sign. SOURCE: Photographer, Elena Dorfman
35 ThrombophlebitisInflammation of the lining of the blood vessel due to clot formationCan occur in the legs (DVT) or pelvis (SPT)Risk factorsCesarean sectionProlonged bed restInfection
37 Thromboembolic Factors Table 38–6 Factors associated with increased risk of thromboembolic disease.
38 Decreasing Thromboembolic Risk Table 38–7 Measures to decrease risk of thromboembolic disease in childbearing women.
39 Prevention of Thrombophlebitis Avoid prolonged standing or sittingAvoid crossing her legsTake frequent breaks while taking car trips
40 Self-Care: Thromboembolic Disease Condition and treatmentImportance of compliance and safety factorsWays of avoiding circulatory stasisPrecautions while taking anticoagulants
41 Nursing Diagnoses: Thromboembolic Disease Pain related to tissue hypoxia and edema secondary to vascular obstructionRisk for Altered Parenting related to decreased maternal-infant interaction secondary to bed rest and intravenous linesAltered Family Processes related to illness of family memberDeficient Knowledge related to self-care after discharge on anticoagulant therapy
42 Vitamin K FoodsTable 38–8 Foods high in vitamin K.
43 Assessment of Postpartum Psychiatric Disorders Depression scalesAnxiety and irritabilityPoor concentration and forgetfulnessSleeping difficultiesAppetite changeFatigue and tearfulness
44 Postpartum Blues Occurs within 3 to 10 days of delivery Generally transientUsually resolves without treatmentAssessment findingsTearful, fatigue, anxious, poor appetite
45 Postpartum Blues (continued) EtiologyHormonal changes and adjustment to motherhoodLonger than two weeks in duration requires medical evaluation
46 Postpartum Mood Disorder: Depression Onset slow, usually around the fourth week after deliveryAssessment findingsDepressed mood, fatigue, impaired concentration, thoughts of death or suicideRisk factorsHistory of depression, abuse, low self-esteemManagementPsychotherapy, medications, hospitalization
47 Postpartum Psychosis Generally after the second PP week Assessment findingsSleep disturbance, agitation, delusionsRisk factorsPersonal or family history of major psychiatric illnessManagementMay lead to suicide or infanticideHospitalization, medications, psychotherapy
50 Postnatal DepressionTable 38–10 Postpartum depression predictors inventory (PDPI)—revised and guide questions for its use.
51 Postnatal DepressionTable 38–10 (continued) Postpartum depression predictors inventory (PDPI)—revised and guide questions for its use.
52 Postnatal DepressionTable 38–10 (continued) Postpartum depression predictors inventory (PDPI)—revised and guide questions for its use.
53 Prevention of Depression Table 38–11 Primary prevention strategies for postpartum depression.
54 Prevention of Postpartum Psychiatric Disorders Help parents understand the lifestyle changes and role demandsProvide realistic informationAnticipatory guidanceDispel myths about the perfect mother or the perfect newbornEducate about the possibility of postpartum bluesEducate about the symptoms of postpartum depression
55 Self-Care: Postpartum Psychiatric Disorders Signs and symptoms of postpartum depressionContact information for any questions or concerns
56 Nursing Diagnoses: Postpartum Psychiatric Disorder Ineffective Individual Coping related to postpartum depressionRisk for Altered Parenting related to postpartal mental illnessRisk for Violence against self (suicide), newborn, and other children related to depression
57 Assessment of Overdistention of the Bladder Large mass in abdomenIncreased vaginal bleedingBoggy fundusCrampingBackacheRestlessness
58 Assessment of Cystitis Frequency and urgencyDysuriaNocturiaHematuriaSuprapubic painSlightly elevated temperature
59 Prevention of Infection Good perineal careHygiene practices to prevent contamination of the perineumThorough handwashingSitz bathsAdequate fluid intakeDiet high in protein and vitamin C
60 Prevention of Bladder Overdistension Frequent monitoring of the bladderEncourage spontaneously voidingAssist the woman to a normal voiding positionProvide medication for painPerineal ice packs
61 Prevention of a UTI Good perineal hygiene Good fluid intake Frequent emptying of the bladderVoid before and after intercourseCotton underwearIncrease acidity of the urine
62 Self-Care Measures: UTI Good perineal hygieneMaintain adequate fluid intakeEmpty bladder when she feels the urge to void or at least every 2-4 hours while awake
63 Nursing Diagnoses: Bladder Distention Risk for Infection related to urinary stasis secondary to overdistentionUrinary Retention related to decreased bladder sensitivity and normal postpartal diuresis
64 Nursing Diagnoses: UTI Pain with voiding related to dysuria secondary to infectionHealth-seeking Behaviors related to need for information about self-care measures to prevent UTI
65 Self-Care Measures: Puerperal Infection Activity and restMedicationsDietSigns and symptoms of complicationsImportance of completion of antibiotic therapy
66 Community Based Care: Puerperal Infection May need assistance when discharged from the hospitalMay need a referral for home care servicesInstruct family on care of the newbornInstruct mother about breast pumping to maintain lactation if she is unable to breastfeed
67 Community Based Care: Thromboembolic Disease Instruct family members on care of mother and newbornReferral for home care if necessaryProvide resources for follow-up or questionsTeach all families to observe for signs and symptoms
68 Community Based Care: Postpartum Psychiatric Disorders Foster positive adjustments in the new familyAssessment of maternal depressionTeach families symptoms of depressionGive contact information for community resourcesMake referrals as needed
69 Pelvic Hematoma Assessment findings Severe perineal pain Ecchymosis Visible outline of the hematomaBlood loss may not be visible
70 Pelvic Hematoma (continued) TreatmentSurgical drainageAntibioticsAnalgesicsBlood products if loss is excessive
72 Nursing Implications: Shock Monitor vital signs frequentlyLarge-bore IV for fluids, blood productsAdminister oxygen, assess oxygen saturationAssess hourly urine outputAssess level of consciousness
73 Nursing Implications: Shock (continued) Administer and monitor fluids, blood productsDraw/monitor laboratory resultsAssess quantity and quality of bleedingProvide emotional support to patient/family
75 Nursing Diagnoses: Puerperal Infection Risk for Injury related to the spread of infectionPain related to the presence of infectionDeficient Knowledge related to lack of information about condition and its treatmentRisk for Altered Parenting related to delayed parent-infant attachment secondary to woman’s pain and other symptoms of infection
76 Reproductive Loss Components of grief work Accepting the painful emotions involvedReviewing the experiences and eventsTesting new patterns of interaction and role relationships
77 Reproductive Loss (continued) Four stages of griefShock and numbnessSearching and yearningDisorientationReorganizationSymptoms of normal grief
78 Examples of Reproductive Loss Inability to conceiveSpontaneous abortionPreterm deliveryCongenital anomaliesFetal demiseNeonatal deathRelinquishmentSIDS
79 Warning signs of illness PP Fever > 100.5Severe pain, redness,swelling at incision sitePassing of large clotsIncreased bleedingBurning on urinationInsomniaImpaired concentrationFeeling inadequate