Postpartum Surgical Care Flashcards
Know your patient history
Risk Factors?
- Bleeding disorders
- Diabetes
- Heart disease
- UTI
- Liver disease
- Fever
- COPD
- Immunological disorders
- Street drug abuse
- Chronic pain
Other questions to ask
- How much blood did she lose in the OR?
- Incision type
- Dressing condition
- Uterus firm in PACU?
- How much Pit did she receive?
- How is pain managed/is it effective?
What is the key to treating hemorrhage?
Early recognition and quick/effective action
Hemorrhage 4 Ts?
- Tone: uterine atony (most common)
- Tissue: retained placenta
- Trauma: lacerations, uterine rupture
- cloTTing: coagulopathy
Definition of Hemorrhage
- 500 mL + loss after vag delivery
- 1000 mL + loss after cesarean
- blood loss significant enough to cause hemodynamic instability
Primary PPH
first 24 h of delivery
Secondary PPH
24 h - 12 weeks after delivery
Interventions for uterine atony
- Assess for bleeding
- Assess fundal height
- Encourage voiding
- Pit
- Fundal massage
- Contact physician
- Methergine
- IV fluid/blood transfusion
- Bimanual compression of uterus
- Ligation of uterine vessels or hysterectomy
Puerperal (Postpartum) Infections
- Infections of the reproductive tract associated with childbirth
Three types of puerperal infections
- Metritis
- Perineal
- Cesarean wound
Causes of metritis
- Cesarean
- PROM
- FSC
- OB trauma
- Manual removal of placenta
- Preexisting infection
- Compromised health status
- Prolonged labor
- Multiple vag exams
- IUPC
- Instrument assisted birth
Metritis Assessment
- Significant abdominal/uterine pain
- Foul smelling vag discharge
- Fever 101-104 deg F
- Chills
- Malaise
- 30% increase in WBC
Metritis Intervention
- CBC
- Cultures
- Hygiene
- Drain abscess
- IV antibiotics
- Antipyretics
- ICU hospitalization
Cesarean Wound Infection S/S
- Pain
- Redness
- Odor
- Temp above 101.5 deg F
- Drainage
Cesarean Wound Dehiscence
- Wound has reopened
- Can be many degrees of this (should measure opening)
Thrombophlebitis
Blood clot formed from impeded blood flow
Causes of thrombophlebitis
- Hypercoagulability of blood
- Venous stasis
- Injury to epithelium of vessels
Prevention of thrombophlebitis
- Avoid dehydration
- Early PP ambulation
- Leg exercises to support venous return
- No smoking
- Antiembolism stockings
Assessment of Superficial Thrombophlebitis
- Tenderness
- Swelling
- Low fever
- Localized heat
- Redness
Intervention for Superficial Thrombophlebitis
- Elevate leg
- Local moist heat
- Support hose
- Bed rest
- Analgesia
Superficial Thrombophlebitis
- Usually 3-4 day after delivery
- Superficial vein, can be seen on surface (inflammation)
- Little risk of pulmonary embolism
Deep Vein Thrombosis
- 10-20 days after delivery
- Deep vein
- Clot can travel to lungs and cause pulmonary embolism
Deep Vein Thrombosis Assessment
- Swelling
- Pain
- Erythema
- Heat
- Pedal edema
- Low to high fever
- Sometimes decreased perfusion
- Chills
Deep Vein Thrombosis Intervention
- Bed rest
- Analgesia
- Elevate leg
- Antibiotics
- Anticoagulant therapy: IV heparin, Coumadin for 2-6 months
- Monitor for pulmonary embolism
Deep Vein Thrombosis Prevention
- Promote ambulation
- TED hose
- SCDs
Pulmonary Embolism
- Clot moves to pulmonary artery
Pulmonary Embolism Assessment
- Dyspnea
- Cough
- Cyanosis
- Tachypnea
- Chest pain
- Hemoptysis
- Hypotension
- Tachycardia
Pulmonary Embolism Treatment
- Alert physician
- O2
- Anticoagulation with heparin
- Elevate head of bed
- Narcotics
Paralytic Ileus
Slowed movement through gut
Causes of paralytic ileus
- Post-op complication
- Abdominal surgery
- Use of narcotic drugs
- NPO before/after surgery
Assessment of paralytic ileus
- Abdominal pain/distention
- Absent bowel sounds
- N/V
- Always assess bowel sounds post-op before feeding (and do ab assess)
- Ask about passing gas
Intervention for paralytic ileus
- Assess
- Document
- Notify MD of findings
- May do X-ray and CT scan to confirm diagnosis
- May have to insert NG tube
Cause of UTIs
- Retention of urine
- Bacteria from catheterization (most commonly E. Coli)
Cystitis Assessment
- Bladder infection
- Increased urinary frequency
- Urgency
- Dysuria
- Pain above pubic region
- WBCs and bacteria in urine
- More common in women
Cystitis Intervention
- Increase fluids
- Empty bladder
- Void frequently
- Urine culture
- Antibiotics
Cystitis Prevention
- Hygiene
- Void Q2-4 h
- Increase acidity of urine
Pyelonephritis Assessment
- Kidney infection
- UTI signs
- Chills
- N/V
- High fever
- Flank pain
- Acutely ill
Pyelonephritis Intervention
- IV antibiotics
- Antipyretics
- Increase fluids
- Analgesic
- Follow-up culture in 2 weeks
