Therapeutic Management: High - Risk Postpartum Conditions Flashcards
Uterine Atony: Nursing Management
a. Assess symptoms for shock and blood loss (vital signs)
b. Make a rough estimate of the patient’s blood loss.
c. Palpate fundus at frequent intervals
○ Contracted uterus- FIRM and easily recognizable
○ Fundal Massage
- Stimulates uterine contraction, promote uterine tone, and consistency and minimize the risk of hemorrhage. Supine position with knees flexed
Uterine Atony: Therapeutic
a. I.V. administration of oxytocin
○ Make sure not to administer oxytocin on IV PUSH
○ 10-40u is added to an existing intravenous line (LRs)
b. I.M. administration of methergine or prostaglandins
○ Always remember to obtain first the woman’s baseline BLOOD PRESSURE prior to administering methergine (DO NOT give if BP is 140/90 mmHg or greater)
c. Blood transfusion
○ Replace blood loss with postpartum hemorrhage
○ Proper blood typing and cross- matching
d. Suturing/ Balloon Compression
○ Last resort
○ Effective management to halt bleeding
○ Embolization of pelvic and uterine vessels by angiographic technique
Cervical Laceration: Therapeutic
a. Give regional anesthetic
○ to relax the uterine muscle and to prevent pain
b. Try to maintain an air of calm and reassure the mother about the baby’s condition
Vaginal Laceration
a. Suturing of the lacerations must be done to avoid excessive bleeding
b. Vaginal packing may be done to maintain pressure on the suture line
○ It will be removed 24-48 hours after
○ Packing that is left in place too long leads to stasis and infection similar to toxic shock syndrome
c. Insert an indwelling urinary catheter
○ Packing causes pressure on the urethra and can interfere with voiding
Perineal Laceration: Therapeutic
a. Distinguish and Document saturated laceration and episiotomy
b. Increase fluid intake
○ if not contraindicated to prevent constipation and maintain adequate hydration
c. Prescribe a high fiber diet and stool softeners
○ Prescribe for the first week to prevent constipation and hard stools which could break the sutures
d. Note the degree of the perineal laceration
Perineal Hematomas: Nursing Management
a. Small hematomas (<3 cm) are left to resolve on their own, ice pack may be applied
b. Large hematomas (>3cm) requires evacuation of the blood and ligation of the bleeding vessels
c. Mild analgesics may be given to relieve pain
d. Broad- spectrum antibiotics may be given due to increased chance of infection
e. Prescribe food high in Iron
f. Instruct the use of sitz bath to provide perineal comfort after the first 24 hours and at home
g. Monitor VS to evaluate for signs of shock
h. Help relieve voiding problems by:
○ If ambulating : assisting the client to void
○ If unable to ambulate : offer bed pad
○ Run water while the woman is attempting to void
Retained Placental Fragments: Nursing Management
a. Dilatation and curettage (D&C)
○ To remove the placental fragment
b. Methotrexate
○ To destroy the retained placental issue
c. Every placenta should be inspected carefully after birth to see if it is complete
Subinvolution: Nursing Management
a. Methergine, PO 0.2mg qid
○ Improves uterine tone & complete involution
b. Oral antibiotics
○ For endometritis
c. Oxytocin
○ Improve uterine contractions
d. Teach client to recognize usual bleeding patterns
○ Normal: 300-500mL
Endometritis: Nursing Management
a. Antibiotic therapy: Clindamycin
○ Depending on the result of the culture from the vagina
b. Administration of methergine
○ To encourage uterine contraction
c. Encourage client to increase oral fluid intake to combat fever
d. Sitting in Fowler’s position or walking
○ Encourages lochia discharge drainage by gravity & help prevent pooling of infected secretions
Infection of the Perineum: Nursing Management
a. Remove perineal sutures
○ To open the area & allow for drainage
b. Packing (iodoform gauze) may be placed in the open lesion
○ To keep it open & allow drainage.
c. Administration of systemic or topical antibiotic (Wet areas- cream; Dry areas- ointment)
d. Administer analgesics
○ To alleviate discomfort.
e. Sitz baths or warm compress
○ To hasten drainage & cleanse the area.
f. Encourage to ambulate
Urinary Tract Infection: Nursing Management
a. Administer antibiotics as ordered. (7 days)
b. Administered analgesics
○ To relieve pain.
c. Catheterize client if ordered, using sterile technique
d. Force fluids: may need minimum of 3 liters/day
○ To help flush out infection.
e. Check bladder status frequently
Mastitis: Nursing Intervention
a. Administer antibiotics as ordered.
b. Application of ice or heat to relieve pain.
○ cold decreases tissue metabolism & milk production.
○ hot/ warm → may cause increased milk production (worsen symptoms)
c. Have client wear well-fitting bra for support
d. Help client with milk expression or regular basis
Homan’s Sign: Nursing Management
a. Maintain bed rest with leg elevated on pillow. Never raise knee gatch on bed
b. Apply moist heat as ordered
c. Administer analgesics
d. Administer anticoagulant therapy (heparin) as ordered.
○ Observe signs of bleeding
e. Teach the client NOT to massage legs
f. Allow client to express fear and reactions to condition
g. Apply elastic support hose if ordered
○ Daily inspections of legs with hose removed
h. Observe client for signs of Pulmonary Embolism
Postpartum Blues: Nursing Management
a. No specific treatment is required
b. Talk to the mother and ask how they feel
c. Instruct client for bed rest
d. Encourage mother for social interactions
e. Suggest diversional activities
f. Suggest mother’s group for the mother to be able to share her feelings with women of the same experiences
Postpartum Depression: Nursing Management
a. Counselling
b. It may help to talk the concerns with a psychiatrist, psychologist, or other mental health professionals
c. Through counseling, we can find better ways to cope with the feelings, solve problems, and set realistic goals
d. Sometimes, family or marital therapy is also helpful
Postpartum Depression: Administration of Antidepressants
a. Most commonly used for postpartum depression come from a group of drugs called selective serotonin reuptake inhibitors (SSRIs): sertraline, paroxetine, fluoxetine
b. Health teaching about the side effects of antidepressants: weight gain and loss of libido]
Postpartum Depression: Administration of Hormone Therapy
Estrogen replacement may help counteract the rapid drop in estrogen that accompanies childbirth, which may ease the s/sx of PPD in some women.
Postpartum Depression: Tell the mother to be careful not to blame the baby
Older children may become angry with the baby for “making mommy feel bad” and harbor negative feelings for the baby
Postpartum Depression: Measures
a. Plan a balanced program of nutrition, exercise, and sleep. Plan meals that are easy to prepare; sleep whenever the baby sleeps; begin a program of walking daily with the baby b. Encourage expressing feelings with a support person.
c. Take some time every day to do something for yourself (work on a scrapbook, go shopping) and have a break from baby care.
d. Do not try to be perfect. Analyze what are the important things to do and get done. Let unimportant things go for another day.
e. Do not let herself be isolated by baby care. Use the Internet or telephone to keep in contact with your friends to avoid loneliness.
Postpartum Psychosis: Measures
a. Call the doctor or advise to go to the nearest hospital emergency room.
b. Family support, and educating the family regarding what has occurred is also extremely important.
c. It is important that the affected individual not be labeled a bad mother.
Postpartum Psychosis: Administration of Antipsychotics
a. Two commonly used choices are Risperidone and Olanzapine.
b. It is important that treatment is started at the earliest opportunity.
c. In much the same way as diabetes and high blood pressure cause less complications if caught early, the longer a woman is left untreated the less effective medication may be.
