Postpartum Complications

Question 1

Cystitis

Answer 1

• an infection of the bladder.

- encourage adequate fluid intake and voiding frequently to avoid bladder distension.

Question 2

Hematoma

Answer 2

• localized collection of blood in the tissues and can occur internally, involving the vaginal sulcus or other organs; vulvar hematomas are the most common. Can result in shock.
• assessment: abnormal pain, pressure in the perineal area, may have a sensitive, bulging mass with discolored skin. Inability to void, decrease in Hb and Ht levels. Restlessness and changes in VS.
• Monitor client’s VS and signs of shock.
• Place ice on the hematoma site.
• Adm analgesics, ATB, and blood products as prescribed.
• Prepare for catheterization if unable to void.
• Prepare for incision and evacuation of hematoma if necessary.

Question 3

Uterine Atony

Answer 3

• a poorly contracted uterus that does not adequately compress large open vessels at the placental site; this can result in hemorrhage.
• a softy (boggy) uterus noted on palpation of the fundus.
• massage the uterus until firm.
• empty the bladder if that is contributing to the uterine atony.
• notify OB if interventions do not resolve.

Question 4

Hemorrhage and Shock

Answer 4

• bleeding greater than 1000ml after delivery or a 10% drop in Hb and Ht from admission with signs and symptoms.
• can occur early during the first 24h or later after 24h following delivery.
• early: within 4h (greatest risk).
• late: beyond 4h.
• assessment: persistent bleeding (perineal pad soaked within 15 min). Signs of shock, cool and clammy skin or grayish color.
• causes: uterine atony, laceration of the cervix or vagina, hemotoma development (in the cervix, perineum, or labia), retained placental fragments.
• predisposing factors: previous history of postpartum hemorrhage, placenta previa, abruptio placentae, overdistention, infection, multiparity, dystocia or labor that is prolonged, cesarean or forceps delivery.

Question 5

Hemorrhage and Shock: Priority Nursing Actions

Answer 5

• notify OB by asking someone else and stay with the client.
• if uterus is atonic, massage firmly.
• elevate her legs to at least 30 degree angle.
• adm oxygen by face mask at 8-10L/min.
• monitor VS and empty bladder by catheterization if prescribed.
• adm uterotonic meds (oxytocin, prostaglandins) as prescribed to increase uterine tone.
• provide additional or maintain existing IV infusion (woman should have 2 patent IV lines; insert the second one using a 16 to 18 gauge IV catheter).
• adm blood products as prescribed.
• insert an indwelling urinary catheter to monitor perfusion of kidneys.
• adm emergency meds as prescribed.
• prepare for possible surgery or procedure.
• record event, interventions and response.

Question 6

Infection

Answer 6

• any infection of the reproductive organs that occurs within 28 days of delivery or abortion.
• endometritis is inflammation/infection of the inner lining of the uterus.
• assessment: fever, chills, anorexia, pelvic discomfort or pain, vaginal discharge that is malodorous, elevated WBC count.
• monitor VS every 2-4h.
• position client to promote vaginal drainage.
• isolate the newborn if necessary (airborne illness)
• provide a nutritious, high-calorie, high-protein diet.
• encourage fluids to 3-4L/day (if not contraind.)
• encourage frequent voiding and monitor intake and output.
• monitor culture results and adm ATB as prescribed.

Question 7

Mastitis

Answer 7

• is inflammation of the breast as a result of a blocked duct and infection.
• mastitis occur primarily in breast-feeding mothers 2-3 weeks after delivery but may occur at any time during lactation.
• assessment: localized heat and swelling, pain, tender axillary lymph nodes, elevated temperature, complaints of flu-like symptoms.
• instruct good hand-washing and breast hygiene.
• promote comfort and apply heat to the site as prescribed.
• maintain lactation in breast-feeding mothers.
• encourage manual expression of breast milk or use of breast pump every 3 to 4h.
• encourage to support breast by wearing bra and avoiding underwire.
• adm analgesics and ATB as prescribed.

Question 8

Pulmonary Embolism

Answer 8

• passage of thrombus, often originating in a uterine or other pelvic vein, into the lungs, where it disrupts the circulation of the blood.
• assessment: sudden dyspnea and chest pain, tachypnea and tachycardia, cough and lung crakles, hemoptysis, feeling of impending doom.
• adm oxygen, position client with head of the bed elevated, monitor VS and breath sounds, signs of respiratory distress. Adm IV fluids and anticoagulants as prescribed.

Question 9

Subinvolution

Answer 9

• incomplete involution or failure of the uterus to return to its normal size and condition.
• assessment: uterine pain on palpation, uterus larger than expected, more than normal vaginal bleeding.
• assess VS, uterus and fundus.
• monitor uterine pain and vaginal bleeding.
• elevate legs to promote venous return.
• encourage frequent voiding.
• monitor Hb and Ht.
• prepare to adm methylergonovine maleate, which provides sustained contraction of the uterus, as prescribed.

Question 10

Thrombophlebitis

Answer 10

• a clot forms in a vessel wall as a result of inflammation of the vessel wall.
• a partial obstruction of the vessel can occur.
• increased blood-clotting factors in the postpartum period place the client at risk.
• early ambulation in the post-op period after cesarean section is a preventive measure.
• types: superficial, femoral, pelvic.
• specific therapies may depend on the location.
• maintain bed rest, elevate effected leg and never massage the leg.
• apply a bed cradle and keep bed clothes off the affected leg.
• monitor for manifestations of pulmonary embolism.
• apply hot packs or moist heat to the affected site as prescribed to alleviate discomfort.
• apply elastic stockings if prescribed.
• adm analgesics, ATB and heparin sodium as prescribed.

Question 11

Perinatal Loss

Answer 11

• is associated with miscarriage, neonatal death, stillbirth, and therapeutic abortion.
• loss and grief also may occur with the birth of a preterm baby, a newborn with complications of birth, or with congenital anomalies. It also may occur in a client who is giving up a child for adoption.
• communicate therapeutically and actively listen, providing parents time to grieve.