Nursing care for the post-partum patient

• Hemorrhage
• preeclampsia
• infection
• thrombophlebitis
• postpartum depression

• blood loss greater than 500cc in first 24 hours
• Late postpartum hemorrhage 7-14 days (lacerations, hematoma, uterine atony-boggy uterus-retained placental fragments, inversion of the uterus, disseminated intravascular clotting

• monitor for bleeding
• assist uterus to contract (massage) 
• maintain fluid balance
• Vitals
• O2
• US for placental fragments
• Surgical interventions may be necessary

• Tears in genital tract=result of trauma
• firm uterus with continued bleeding
• monitor for lochia-vaginal discharge-blood, mucous, uterine tissue

• Sudden onset of perineal-rectal pain
• firm uterus
• bulging area underskin?
• difficulty voiding?
• assess for visible hematoma
• may need to be excised and drained

• Most late PP-hemorrhage-caused by retained fragments.
• placenta does not appear intact
• ultrasound findings
• D&C may be needed
• prevention of hypovolemic shock.

• Emergency when uterus turns inside out and delivers after the baby or placenta
• sudden severe bleeding
• unusual crater like fundal exam
• uterus must be replaced quickly- OB and anesthesia-start 2nd IV line
• prepare for surgery

• Disseminated intravascular clotting 
• disturbance in normal clotting
• multiple blood clots throughout the body.

• Fibrinolytic system
• Antithrombin III
• Protein C
• Rapid blood flow
• Removal of activated clotting factor by the reticuloendothelial system

• Trauma occurs
• Platelets respond
• Coagulation cascade begins
• Thrombin is generated
• Thrombin reacts with fibrinogen to form a stable clot

• There are higher levels of all the clotting factors except VIII and I
• There is less fibrinolytic activity
• There is less Protein C effect
• Protein S which activates Protein C is also decreased

• early recognition-signs of thrombosis occur first
• assessment is critical-hemorrhage follows-can be obvious bleeding or oozing-lochia
• eliminate the underlying condition
• monitor lab values
• manage systemic manifestation-hypotension-other signs of shock

• preeclampsia
• placental abruption
• amniotic fluid embolism

• Platelet count-decreased
• fibrinogen-decreased
• PT: prolonged
• PTT: prolonged
• Antithrombin III: decreased activity
• FSP/FDP: greater than 40
• SFMC: Increased
• D-dimer: increased

• Chronic hypertension
• vascular damage and spasms
• renal and hepatic impairment
• cerebral edema
• decreased osmotic pressure leading to pulmonary edema
• uteroplacental insufficiency

• S&S of infection
• UTI-dysuria
• Mastitis-breast infection-redness-tenderness
• Wound infection
• Endometritis- boggy uterus-foul smelling lochia, increased bleeding.

• Blues
• depression
• psychosis

• occurs in 50-80%
• mild depression interspersed with happier feelings
• short lived begin within days of birth and resolved by 10 days

• major mood disorder
• usually begins 4 weeks after birth
• occurs in 4-28% of new moms

• Occurs 1-3 months after birth
• agitation
• hyperactivity
• insomnia
• Irrationality
• Hallucinations/delusions related to infants

Hemolysis, elevated liver enzyme, low platelets

• atony-lack of usual muscle tone
• attachment-infant
• bonding
• catabolism-involved in involution(normal changes) of the uterus after child birth

endometrium during pregnancy-all but the deepest layer is shed.

retrogressive changes that return the reproductive organs particularly the uterus to their non pregnant size and condition

period from the end of childbirth until involution of the reproductive organss-approx. 6 weeks.

• Redness
• Ecchymosis
• Edema
• Discharge
• Approximation
• useful for assessing wound and healing