Preventing Complications & Comfort Measures Flashcards
What should the nurse do to reduce fall risk in postpartum pts who had an epidural? (5)
- Assess muscle/motor strength and sensory function of legs before allowing a patient to get out of bed
- Ensure they are safe to ambulate before assisting them.
- Always assist with ambulation the first time post-epidural.
- Monitor for dizziness and provide support when necessary.
- Stay nearby when toileting pt
Even when the epidural wears off the patient is still at fall risk!!
Why are postpartum mothers at risk for syncopal episodes?
hemodynamic changes after delivery, especially post-epidural
What are the interventions for preventing syncopal episodes? (3)
- “Dangle” at the bedside before standing
- Keep a wheelchair nearby in case of fainting.
- Make sure vitals and bleeding are stable before ambulating
What might be used if a pt does experience a syncope episode?
ammonia inhalant
What are the methods for DVT prevention in post c-section pts? (3)
- Administer lovenox/heparin
- Use sequential compression device (SCDs)
- Encourage ambulation ASAP
What are the methods for preventing respiratory complications in post c-section pts? (3)
- Use incentive spirometry → improves lung function & encourages movement
- Encourage deep breathing & coughing exercises → prevents pooling of respiratory secretions in lungs
- Ambulation ASAP
What are the methods for preventing wound infections in post c-section pts? (4)
- Hand hygiene before touching incision
- Daily shower; use clean towels
- Teach pt proper wound care
- Teach pt to inspect daily for signs of infection (redness, edema, ecchymosis, drainage, approximation)
What methods are used to promote normal bowel function? (7)
- offer colace (docusate sodium)
- dulcolax
- milk of magnesia
- ambulation
- fluids
- fiber
- bring it up before they ask → embarrassment + fear factor = needless suffering
What are some non-pharmacological pain relief methods following vaginal delivery? (4)
First 24-48 hours:
- Ice packs in underwear for 24-48 hrs
After 24-48 hrs use warmth:
- sitz baths
- peri-bottle
- warm compress or heating pad to abdomen for cramping to relax muscles
What pharmacological pain relief is used for post-vaginal delivery pts? (2 & key points)
Ibuprofen/Acetaminophen for cramping
- Try to keep up with ibuprofen as much as we can as long as it is not contraindicated (ex: bleeding disorders)
- Teach to take it with food or milk to prevent stomach upset
- We can supplement Ibuprofen with Tylenol (Acetaminophen)
What pharmacological pain relief is avoided in post-vaginal delivery pts? What are the exceptions?
Avoid opioids unless necessary due to their side effects (sedation, constipation, nausea).
Can use if they have 4th degree laceration or medial-lateral episiotomy
What pharmacological pain relief methods are used for pts with perineal/sore nipple discomfort? (3)
Dermoplast numbing spray
Pads with witch hazel
Ointments for hemorrhoids
What pharmacological pain relief would be given to a woman post c-section under general anesthesia?
narcotic analgesia → probably morphine or dilaudid through PCA pump
What pharmacological pain relief would be given to a woman post c-section who had a spinal with duramorph?
she might not get extra narcotics for 24 hours but after that 24hr mark when the duramorph wears off she is gonna get some percocet or oxycodone with or without tylenol
What med is a really important adjunct tx for pain relief for pts post c-section? how can it be given and why is it useful?
Ketorolac → in the first 24hrs when mom is not eating a lot and had a empty stomach or if she was kept NPO or on clear liquids through labor we usually give ketorolac
can be given through IV and works really well in conjunction with the spinal or even with the PCA
After the first 24 hours after c-section when mom is eating, what med can we give for pain relief? how is it typically dosed?
Ibuprofen, given in larger doses usually about 800 mg
what other pain med can be given to post c-section women that is a very good adjunct to the narcotics & NSAIDs? How is it given and dosed?
Acetaminophen → you can get a synergistic effect from using all 3 of these in combination
given IV or PO
650-1000 mg will usually work and make sure you are under the max dose of 4000 mg
what med can be given for gas pain & discomfort caused by intestinal bloating after c-section?
Simethicone (Gas-X)
what pharmacological pain relief med is used for uterine involution or “afterpains”? How/when is it given and what dosage?
Ibuprofen 600 mg PO every 6 hours
what pharmacological pain relief meds are NOT used for uterine involution or “afterpains” ? (3)
opioids like oxycodone
tylenol
docusate sodium
List non-pharmacological pain relief methods for women post c-section (3)
- Splinting of incision when moving or coughing → helps reduce strain & pain on abdominal muscles
- Ambulation
- Buddy pillow or abdominal binders
What are the benefits of ambulation post c-section? (5) When is it usually encouraged?
- promotes interstitial motility
- prevents gas
- reduces risk of paralytic ileus
- reduces risk of DVT
- reduces risk of venous stasis
usually encouraged 8 hours post surgery
what is the most important factor in preventing pain during breastfeeding?
proper positioning & latch
list non-pharmacological pain relief methods for breastfeeding mothers with sore or cracked nipples (3)
- proper positioning & latch
- topical lanolin
- gel discs
does topical lanolin need to be washed off before breastfeeding?
No
What are the benefits of gel discs for nipple pain?
- they promote moist wound healing
- keeping them in fridge adds extra comfort
list non-pharmacological pain relief methods for non-breastfeeding mothers with engorgement (3)
- supportive bra
- ice packs
- cabbage leaves in the bra
Why should a woman experiencing engorgement wear a supportive bra?
bra should gently compress the breasts which can help reduce the heaviness and discomfort; loose fitting bras allow too much movement which can be uncomfortable and exacerbate swelling
what should women experiencing engorgement NOT do?
- do not try to express milk!
- do not put any warmth on them (they should put their back to warm water in shower)
How can cabbage leaves in the bra help with engorgement pain? when should they be removed?
shown to have anti-inflammatory properties that may help reduce swelling & discomfort
remove after 20 mins to avoid any skin irritation
when should the postpartum mother call doctor or 911? (5)
Teach mothers to be aware of signs that require immediate medical attention, such as
- Severe headaches
- Pain in the legs (DVT)
- Excessive bleeding
- Trouble breathing.
- Instruct mother to call if soaking a pad in less than an hour or passing a clot bigger than an egg
