Postpartum complications assessment and nursing care

PP Psychosis onset

2-3 weeks NEEDS IMMEDIATE DIAGNOSIS AND TREATMENT

Hemorrhage definition

Blood loss of >500mL after vaginal birth >1000mL after Cesarean

Endometritis risk factors

C-section Prolonged ROM Vaginal exams Internal fetal monitoring Poor nutrition

Infection Uterine: Endometritis

Infection and inflammation of the endometrium (the lining of the uterus) Most common PP infection

Infection types

Local process Uterine Mastitis UTI

Endometritis meds

Methergine IV Antibiotics Iron

Infection organism

Most common organism: staphylococcus aureus

Uterine atony associated with Hemorrhage

Over distended uterus, grand multiparty, anesthesia, rapid labor, long labor, pitocin use in labor, MgSO4 use in labor, ruptured uterus

Mastitis Nursing Intervention

PREVENTION rest, encourage fluids, supportive bra, frequent nursing*, local heat/cold, analgesics, antibiotics (dicloxacillin)

Positive Homan's sign response

Pain in the calf with this maneuver may be consistent with the diagnosis of DVT

Laceration/episiotomy comfort strategies

Pain medication, ice on sore stitches, sitting or lying positions that are most comfortable, initially place ice every 12-24 hours, instruct to wash and wipe front to back and pat dry, squeeze bottle after each void and stool, after 24 hours may offer sitz bath, anesthetic spray, medication, sitting on firm surface pulls less on perineum, consider offering stool softener

Hypovolemic Shock

Persistent significant bleeding -Soaking prepaid within 15 minutes -watch for signs of hematoma Body compensation for large blood loss -Arteriole and venous constriction (Skin, lungs, GI tract, and kidneys) -Blood diverted to brain and heart

PP Depression

Pervasive sadness beyond 2 weeks PP; rumination of guilt and inadequacy; anger; thoughts of harming self or baby; increased risk with hx of depression; need to make a careful assessment (Edinburgh Postnatal Scale); teach family to watch for signs of depression

PP Depression Tx

Professional counseling and talk therapy Evaluation for medication Group or family/community support

Infection factors

Prolonged ROM, vaginal flora altered, stasis, underlying disease such as diabetes, multiple vaginal exams, traumatic birth

PP Psychosis

Rare; usually begins with severe depression, delusions (auditory hallucinations)

Mastitis symptoms (usually 2 weeks PP)

Reddened, warm, swollen & painful area Unilateral flu-like symptoms chills fever > 101 headache

Endometritis nursing interventions

Rest, nutrition/hydration, meds, pain management, and pre/post care for curettage

Hemorrhage nursing interventions

Restoring blood volume and treating cause of hemorrhage Rapid IV infusion Blood transfusion Plasma transfusion may also be needed (Clotting factors and platelets low) Continuous monitoring (VS, skin, respirations, breaths)

Mastitis common organisms

Staphylococcus Aureus E. Coli Yeast

Factors associated with hemorrhage

Uterine atony, lacerations, retained placental fragments, birth trauma, clotting problems

Postive Homan's sign elicitation

With the knee in the flexed position, forcible dorsiflex the ankle

Dead fetus syndrome

Woman had stillbirth inside, depending on how long she had the baby inside, can cause infection and may develop DIC

DIC Tx

correct underlying cause, anticoagulants, replace blood components, O2, and fluids

DIC causes

hemorrhage, sepsis, severe preeclampsia, abruption, dead fetus syndrome, amniotic fluid embolism

PP Psychosis behaviors

incoherence/irrational statements suspiciousness agitation confusion

Mastitis occurence

Approximately 1-10% of women Any time during lactation

Disseminated intravascular coagulation (DIC) definition

Cascade of clotting uses up factors (consumption of large amounts of clotting factors including platelets, fibrinogen, prothrombin, & factor V & VII)

Hypovolemic Shock S/S

Complaints of weakness, light headedness or nausea Anxiety Air hunger (rapid and shallow respirations) Skin turns grayish Skin is cool and clammy Decreased urine output Pulse increases BP decreases

Mastitis contributors

Cracked/infected nipples Fatigue Stress Milk stasis Poor drainage (blocked duct)

Priorities in care of women with complications

Hemorrhage Infection Embolic phenomena Mental health

Hemorrhage categories

Early/Acute/Primary: First 24 hours Late: 2nd day - 6-12 weeks PP

Baby blues

Experienced by 50-80% of women after birth in the first few days; cries easily without apparent cause; fatigued, disrupted sleep; doesn't affect care of self or baby; resolves without tx

Endometritis S/S

Foul smelling lochia Tender, boggy uterus (will have increased bleeding) Fever (chills) Increased pulse

Hemorrhage facts

Generally women have good fluid reserve Fluid overload state in pregnancy is somewhat protective Allows the body to compensate for a while PPH may happen rapidly with little warning (Becomes life threatening)