1. Chapter 16
Caring for the Woman Experiencing Complications During the Postpartal Period

2. Postpartum Hemorrhage
Definition
Accurately estimating blood loss
Early vs. late
LARRY
4 “T’s”

3. Postpartum Hemorrhage
Uterine atony
Hallmark—soft uterus filled with clots and blood
Genital tract trauma
Uterus firm
Tissue
Thrombin
Refer to Box 16-1 for risk factors for uterine atony
Refer to Box 16-2 for genital tract lacerations

4. Postpartum Hemorrhage
Late postpartum hemorrhage
Retained placental fragments
Ergonovine medication, antibiotics, and possible D&C
Hypovolemic shock

5. Collaborative Management
Frequent vital signs and fundal massage
Note patient’s behavior
Medical management depends on cause
Administer oxygen
Obtain laboratory tests
Accurate I/O
Refer to Box 16-3 for nursing diagnoses related to PPH
Refer to Box 16-4 for goals for PPH

6. Hematoma Definition Signs and symptoms Collaborative management
Unremitting pain and pressure
Collaborative management
Careful assessment
Implement pain relief measures
Refer to Figures 16-2 & 16-3 for hematomas
Refer to Box 16-5 for possible nursing diagnoses & goals

7. Puerperal Infections Definition Types of puerperal infections
Endometritis
Mastitis
Operative wound
Urinary tract
Careful assessment
Refer to Tables 16-2 through 16-6 for other infections

8. Collaborative Management
Antibiotics
Encourage rest, increased fluids, proper nutrition
Comfort measures
NSAIDs
Educate patient and family

9. Thrombophlebitis and Thrombosis
Definition
Pathophysiology—hypercoagulable state, venous stasis and vein injury
Signs/symptoms—pain, tenderness; may be asymptomatic
Diagnostic tests
Refer to Figure 16-6 for Homan’s sign

10. Collaborative Management
Analgesics; elevate extremity; TED hose; increase fluids; apply moist, warm packs
Complete bedrest with bathroom privileges
Anticoagulation therapy
Measure leg circumference
Refer to Box 16-6 for nursing diagnoses & goals

11. Complication: Pulmonary Embolism
Abrupt onset: chest pain, dyspnea, diaphoresis, syncope, anxiety
ABC response
Limit visitors
Educate woman and family regarding prevention of thrombus reoccurrence

12. Postpartum Psychosocial Complications
Postpartum blues
Self-limiting
Postpartum depression
One of two symptoms exist most/all day
Identify risk factors
Screen at postpartum visits
Refer to Box 16-7 for signs/symptoms of postpartum depression
Refer to Box 16-8 for nursing diagnoses related to postpartum depression

13. Postpartum Psychosis Onset within first 8 weeks after childbirth
Distinguishing signs: hallucinations, agitation, confusion, suicidal/homicidal thoughts, delusions, sleep disturbances, loss of touch with reality
Requires hospitalization

14. Psychosocial Postpartal Nursing Care
Teach to seek help if feeling overwhelmed
Encourage rest
Support bonding
Perform holistic assessment
Advocate for home follow-up

15. Postpartum Nursing for Vulnerable Populations
Victims of abuse
Undocumented immigrants
Limited Access to care/homelessness
Refer to Tables 16-7 & 16-8 for Risk factors for intimate partner abuse