chapter 13: postpartum complications Flashcards
care of the woman w/ postpartum hemorrhage
- leading cause of maternal mortality
- amount varies between vaginal delivery and cesarean
- primary v secondary hemorrhage
risk factors for subinvolution postpartum hemorrhage
- retained placenta
- failure to progress during second stage of labor
- placenta accreta
- lacerations
- LGA newborn
- instrumental delivery
- hypertension
- induced labor
- augmentation with oxytocin
- overdistention of the uterus
- bmi over 40
- mnemonic 4 t’s: tone, tissue, trauma, thrombosis
signs and symptoms of postpartum hemorrhage
- heavy vaginal bleeding
- constant trickling or oozing
- uterine atony
- passing of blood clots larger than a quarter
- return of lochia rubra
- cool, clammy, pale skin
- tachycardia and decreased bp
nursing care with postpartum hemorrhage
- collaborative process of the healthcare team
- identify excessive bleeding
- notify rapid response
management of postpartum hemorrhage
- fundal massage
- support lower segment support, measure vitals, assess level of consciousness and amount of vaginal bleeding
- notify physician or midwife
- weigh peripads and linens to obtain accurate measurement
- assess bladder
- IV fluids
- monitor oxygen
- elevate legs
- psychosocial support to pt and family
- oxytocic drugs if ordered
- bimanual massage
- operating room
hematoma
collection of blood outside the blood vessel
common locations of hematoma in delivery
vaginal wall
vulvar area
risk factors of hematoma in delivery
- episiotomy
- lacerations to genital tract
- instrumental delivery
- nulliparity
- difficult or prolonged second stage of labor
signs and symptoms of a hematoma during delivery
- constant pain and pressure
- discoloration and bulging of the tissue
- tenderness of the tissue
- a feeling of needing to defecate
- inability to urinate
- signs of shock depending on size
medical management of hematoma during delivery
- observe perineal area for swelling and discoloration
- report abnormal findings
- apply ice for 20 mins for hematoma less than 3-5cm
- observe perineal area for swelling and discoloration
- report abnormal findings
- size 3-5cm: apply ice for 20 min every 2 hours, warm sitz baths, pain medication
- greater than 5cm: drained in OR
- significant blood loss managed as postpartum hemorrhage
- monitor vital signs
- explain treatments and rational
endometritis risk factors
- prolonged labor or prolonged rupture of membranes
- internal monitoring
- cesarean delivery
- frequent vaginal infections
organisms that cause uterine infections
- e.coli
- group b streptococcus
signs and symptoms of uterine infection
- temperature at or above 100.4F for 2 or more days
- foul smelling lochia
- lower abdominal tenderness
medical management of uterine infection
- pelvic exam
- cbc
- blood cultures
- pelvic ultrasound
- administer IV fluids and antibiotics
nursing care of the woman with a uterine infection
- administer IV fluids
- administer pain medication and antipyretics
- encourage fluid intake and foods
explain treatment and rationale - support with bonding and breastfeeding
wound infection can occur in…
episiotomy incisions
perineal lacerations
cesarean incision
signs and symptoms of wound infection
- redness
- warmth
- poor wound approximation
- tenderness
- pain
- fever and malaise
medical management of wound infection
lab
antibiotics
nursing care of the woman with a wound infection
- obtaining wound culture
- administration of antibiotics
- encourage adequate fluid intake andprotein intake
- assess pain
- teach patient proper hand washing
UTIs are common due to ______ of childbirth
trauma
other risk factors in UTI during delivery
foley catheter
prolonged labor
organisms that cause UTIs
e.coli and klebsiella, proteus and enterobacter
signs and symptoms of UTI
- urgency
- dysuria
- increased frequency
- urination of small amounts
- fever
- flank pain
- hematuria
medical management of UTI
- largely based on symptoms
- urine specimen
- oral antibiotics
nursing care of UTI
- administer antibiotics
- encourage fluid intake
- teach pt to clean the perineum and use peri-bottle
mastitis
infection of the breast tissue, blocked mi lk ducts
organisms that cause mastitis
staphylococcus aureus
mastitis transmitted from
infant’s mouth or woman’s hands through cracked nipples
signs and symptoms of mastitis
- sudden onset
- red swollen area or mass on breast
- fever 100.4F or higher
- pain or burning sensation
- malaise
medical management
breast examination, rule out breast abscess, antibiotics, and pain relievers
nursing care of mastitis
- teaching mother to wash hands before feeding
- observing latch-on and teach correct method
- lactation specialist
- encourage regular feedings
- administer antibiotics
- assess pain and administer medication
- reassurance
- apply warmth to breast
- teaching signs of mastitis
thromboembolism
blood vessel becomes inflamed and thrombus develops
- pregnancy increases the risk 4-6 times
- highest risk in first 12 weeks
major causes of postpartum thromboembolic disease
- venous stasis
- hypercoagulable blood
- injury to endothelial surface of blood vessel
- 1 in 1,000 pregnancies and deliveries have complications like DVT or PE
risk factors of postpartum thromboembolic disease
- obesity
- prolonged bed rest
- advanced maternal age
- still birth
- premature birth
- gestational diabetes
- cesarean delivery
- multiparity
- varicose veins
- smoking
prevention of postpartum thromboembolic disease
- encourage postpartum pts to ambulate frequently
- carefully assess legs
- identify women at high risk
signs and symptoms of postpartum thromboembolic disease
- swelling
- pain or tenderness
- erythema
- pain on ambulation
- stiffness of the leg
- large, hard, cordlike vein
diagnosis of postpartum thromboembolic disease
- doppler ultrasound
- MRI
medical management of postpartum thromboembolic disease
- IV heparin therapy
- low molecular weight heparin
- compression stockings
- bed rest
- analgesics
- moist heat
nursing care of postpartum thromboembolic disease
- administer heparin
- monitor INR and PT
- apply compression stockings correctly
- maintain bed rest
- measure calf
- administer analgesics
- apply moist heat
- monitor for complications such as pulmonary emboli
postpartum depression
- more serious and incapacitating than postpartum blues
- interfere w/ self care and care of newborn
- usually develops during first 4 months
- high risk: personal history of depression, lack of social support, stressful events, unintended pregnancy, financial factors
signs and symptoms of postpartum depression
- intense sadness with crying, feeling overwhelmed
- feeling moody and irritable
- anxiety or worrying
- feelings of guild or inadequacy
- ambivalence
- lack of motivation for self care or infant care
- anhedonia
- appetite disturbances
- insomnia
- fatigue
- thoughts of hurting baby
- suicidal thoughts
medical management of postpartum depression
- counseling
- antidepressant medications
nursing care of postpartum depression
- monitor for signs of suicidal thoughts or thoughts of harming baby
- encourage compliance w/ antidepressants
- encourage follow up appts
- encourage pt to seek counseling
- encourage rest and naps when baby sleeps
- seek out community groups
- encourage partner to locate help and support
- encourage verbalization of feelings
postpartum psychosis
most severe form of postpartum psychiatric illness
high risk for postpartum psychosis
those with history of bipolar or previous postpartum psychosis episode
- occurs within 48-72 hours
signs and symptoms of postpartum psychosis
- incoherent
- rapidly shifting mood from depression to elation
- delusional beliefs
- hallucinations
- medical emergency requiring hospitalization
nursing care of postpartum psychosis
- immediate reporting
- reorienting pt with surroundings
- provide safety
- arrange for admission to psychiatric facility
- provide emotional support
