UNIT 4 POSTPARTUM COMPLICATIONS CHAPTER 20 & CHAPTER 21

Question 1

What is EARLY Hemorrhage?

Answer 1

bleeding caused by UTERINE ATONY within 24 HRS of delivery

Question 2

What is LATE Hemorrhage?

Answer 2

bleeding caused by PLACENTAL RETAINMENT after 24HRS delivery

Question 3

Cause of Post Partum hemorrhage

Answer 3

• Uterine atony
• Overdistended uterus
• Large fetus
• Multiple fetuses
• Hydramnios
• Distention with clots
• General or halogenated anesthesia
• Previous history of uterine atony
• High parity
• Prolonged labor, oxytocin-induced labor
• Chorioamnionitis
• Retained placental fragments
• Trauma during labor and birth
• Forceps-assisted birth
• Vacuum-assisted birth
• Cesarean birth
• Unrepaired lacerations of the birth canal
• Ruptured uterus
• Inversion of the uterus
• Placenta accreta syndrome/morbidly adherent placenta (placenta accreta,
  increta, or percreta)
• Coagulation disorders
• Placental abruption
• Placenta previa
• Manual removal of a retained placenta
  *Magnesium sulfate administration during labor or the postpartum period
• Uterine subinvolution
• Hypertensive disorders
• Intrauterine fetal demise
• Failure to progress during the second stage of labor

Question 4

What are the risk factors Early Hemorrhage

Answer 4

Within first 24 hours
Most common cause is uterine atony resulting from the following:
Risk factors
-macrosomia
-multiple gestation
-polyhydramnios
-chorioamnionitis
-prolonged labor
-use of Magnesium Sulfate
-use of oxytocin (Pitocin)

Question 5

What is an Intervention for Post Partum Hemorrhage

Answer 5

Fundal Massage- creates uterine contractions to decrease blood.

Vital Signs
-tachycardia
-hypotension
-decreased level of consciousness

Medications
-Methergine
-Cervidil

Possible Surgical
Interventions
Fluid Replacement

Question 6

Are Hematomas painful

-Yes
-No

Answer 6

-Yes

Signs and Symptoms
 Discoloration of
Perineum
 Perineal Pain
 Edema
 Rectal Pressure
 Bleeding

Question 7

Late Post partum Hemmorhage

Answer 7

More than 24 hours but less
than 6 weeks after birth

Common cause- retained
placenta

• After the first postpartum day the
  most common
• cause of uterine atony is retained
  placental
• fragments. The nurse must check
  for the
• presence of fragments in lochial
  tissue

Question 8

What is Thrombosis

Answer 8

a blood clot

Signs and Symptoms of DVT or thrombosis
-Calf tenderness
-Leg pain
-Swelling
-Redness
-Heat
-Unilateral swelling
-Homan sign: CALF PAIN AT DORSIFLEXION OF THE FOOT

MAJOR COMPLICATIONS OF THROMBOSIS
-PULMONARY EMBOLISM

Question 9

What is the best way to confirm a DVT?

Answer 9

by ultrasound

Question 10

Thrombophlebitis

Answer 10

Description

A clot forms in a vessel wall as a result of inam-
mation of the vessel wall.
2. A partial obstruction of the vessel can occur.
3. It most commonly occurs in the legs and can be
supercial or deep; pulmonary embolism is a
concern.
4. Increased blood-clotting factors in the postpar-
tum period place the client at risk.

Question 11

Thrombophlebitis and Thrombosis Intervention

Answer 11

early ambulation in the postoperative period after cesarean section is a preventive measure.

Rest
Elevation
Compression Stockings
Increased Fluids
Moist, Warm Packs

Question 12

What is Endometritis

Answer 12

Def- a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant.

S/S: Temp > 100.4,
*Pelvic Pain,
*Uterine Tenderness,
*Heavy and Foul Smelling Lochia
*Chills,
*Increased WBC

Question 13

Signs and Symptoms of Wound Infections

Answer 13

S/S:
*Pain,
*Foul Smelling Drainage,
*Low Grade Fever/High Fever,
*Chills,
*Abdominal Tenderness,
*Edema,
*Erythema,
*Warmth at the Incision

Question 14

Signs and Symptoms of Urinary Tract Infection UTI

Answer 14

S/S:
*Asymptomatic,
*Dysuria,
*Frequency,
*Flank pain,
*Hematuria
(cath sample),
* Fever

Question 15

What is Mastitis
Signs and Symptoms

Answer 15

Mastitis is inflammation of the breast/chest as a
result of a blocked duct and infection.

S/S:
*Fever,
*Warm,
*Tender,
*Hard Breast (Usually Only One
Breast),
*Enlarged Axillary Lymph Nodes,
*Chills,
*Generalized Aching,
*Headache,
*Malaise

Mastitis Signs- AND sYMPTOMS
1. Localized heat and swelling
2. Pain; tender axillary lymph nodes
3. Elevated temperature
4. Complaints of flulike symptoms

Question 16

Interventions for Mastitis

Answer 16

Management of Postpartum Infections
Antibiotics
Rest
Increased Fluids
Comfort Measures

Question 17

POSTPARTUM
PSYCHOLOGIC
COMPLICATIONS

Answer 17

Mood disorders of Pregnancy
70% of women experience a mild depression or
“baby blues”
Some women have more serious depression
Can eventually incapacitate them to point of
being unable to care for themselves and their
babies

Question 18

Postpartum Blues Signs and symptoms

Answer 18

The “pink” period surrounding the first day or two after birth, character- ized by heightened joy and feelings of well-being, is often followed by a “blue” period. Many women of all ethnic and racial groups experience the postpartum blues or “baby blues.” During the blues, women are emotionally labile and often cry easily for no apparent reason.

Although the postpartum blues are usually mild and short-lived,

SYMPTOMS OF POST PARTUM BLUES

*a let-down feeling,
*rest-lessness,
* fatigue,
*insomnia,
*headache,
*anxiety,
*sadness,
*and anger.

• Sad,
  anxious,or over whelmed feelings
• Crying spells
• Difficulty sleeping

Question 19

Which one is more severe Postpartum depression or Postpartum Blues?

A.PPB-Postpartum Blues
B. PPD -Postpartum depression

Answer 19

approximately 8% to 20% of women experience a more severe disor- der termed postpartum depression (PPD)

Question 20

Does Post Partum depression often go unnoticed?

A. Yes
B. No

Answer 20

A. Yes

It is likely, how- ever, that the actual occurrence of PPD is greater than the reported numbers because it is often unrecognized and undiagnosed .

Question 21

Can only the mother experience post partum depression?

Answer 21

No , Mom and Dad can experience it

Question 22

Signs and feeling mom may experience with Post Partum Depression

Answer 22

A woman with PPD may have obsessive thoughts about harming the infant, and these thoughts can be very frightening to her. However, she does not act on those thoughts and is vigilant about preventing any action that would bring harm to her infant. In contrast, women experiencing postpartum psychosis are likely to act on their thoughts

-anxiety

Feelings of detachment toward the newborn or not feeling love for the newborn are common symptoms of PPD. Women feel guilt and shame for having these feelings and are not likely to verbalize or dis- cuss them with anyone. Many women feel especially guilty about feel- ing depressed at a time when they believe they should be happy.\

Samesignsasbabyblues,buttheylastlongerandaremoresevere * Thoughtsofharmingyourselforyourbaby
* Nothavinganyinterestinthebaby

Question 23

Post Partum Pychosis. signs and symptoms

Answer 23

Signs of postpartum psychosis:
* Seeing or hearing things that are not there
* Feelings of confusion
* Rapid mood swings
* Trying to hurt yourself or your baby

Postpartum psychosis, or postpartum depression with psychotic features, occurs in 1 to 2 per 1000 births (VanderKruik, Barreix, Chou, et al., 2017). It is more common among primiparous women.

Question 24

Is Postpartum Psychosis Acute or abrupt or a disorder that progresses slowly?

A. Acute
B. Processes slowly

Answer 24

A. Acute

In general, postpartum psychosis is characterized by acute onset of bizarre behavior, auditory or visual hallucinations, paranoid or gran- diose delusions, elements of delirium or disorientation, and extreme deficits in judgment accompanied by high levels of impulsivity that can contribute to increased risk for suicide or infanticide.

Question 25

Nursing Interventions for PostPartum emotional disorders

Answer 25

Postpartum nurses carefully observe all new mothers for signs of psy- chiatric disorders such as depression or anxiety disorders and conduct further assessments as necessary.

As part of routine postpartum care, prior to discharge from the birth facility, nurses educate the woman and her partner/family about signs of postpartum blues, PPD, and postpartum psychosis, as well as when and where to seek help (see the Patient Teaching box: Signs of Postpartum Blues, Depression, and Psychosis).

Question 26

Are there ways to prevent Post Partum Depression

Answer 26

• Share knowledge about postpartum emotional problems with close family and friends.
• At least once each day or every other day, purposely relax for 15 min by deep breathing, meditating, or taking a hot bath.
• Take care of yourself: eat balanced diet.
• Exercise on a regularbasis, atleast 30min a day.
  *Sleep as much as possible;make a promise to yourself to try to sleep when
  the baby sleeps.
• Get out of the house: try to leave home for 30 min a day; take a walk
  outdoors.
• Share your feelings with someone close to you.
• Don’t overcommit yourself or feel like you need to be a superwoman. Ask
  for help from family and friends.
  *Don’tplaceunrealisticexpectationsonyourself;nomotherisperfect!
• Be flexible with your daily activities.
  *Find a support group: participate in a new mothers’ support group in personor online.

Question 27

Your postpartum patient has expressed to you that she is having thoughts on harming her baby. Would this warrant immediate attention and evaluation?

A. Yes
B. No

Answer 27

A. Yes

Suicidal or homicidal ideations and/or attempt to cause harm to self or others (including the infant) are among the most serious symptoms of postpartum psychiatric disorders. This is considered a psychiatric emergency and warrants immediate assessment, evaluation, and intervention by a mental health care professional.

Question 28

Safety Concerns - Postpartum Psych disorders

Answer 28

When a woman is suffering from postpartum psychiatric disorders, there can be safety concerns related to the risk for self-harm or harm to the infant. It is important to ask if she has had thoughts of harming herself or her infant. If she responds affirmatively, further assessment is needed. Using a standardized risk assessment tool or through direct questioning, she is asked to describe the specific thoughts, how often they occur, any plans to act on those thoughts (e.g., method, availabil- ity, specificity, lethality), whether anyone close to her is aware she is having thoughts of harming herself or her infant, etc.