Nursing care for the post-partum patient

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  1. Common complications?
    • Hemorrhage
    • preeclampsia
    • infection
    • thrombophlebitis
    • postpartum depression
  2. postpartum hemorrhage
    • 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
  3. Treatment for postpartum hemorrhage
    • monitor for bleeding
    • assist uterus to contract (massage)¬†
    • maintain fluid balance
    • Vitals
    • O2
    • US for placental fragments
    • Surgical interventions may be necessary
  4. PP: hemorrhage-laceration
    • Tears in genital tract=result of trauma
    • firm uterus with continued bleeding
    • monitor for lochia-vaginal discharge-blood, mucous, uterine tissue
  5. PP: hemorrhage-hematoma
    • Sudden onset of perineal-rectal pain
    • firm uterus
    • bulging area underskin?
    • difficulty voiding?
    • assess for visible hematoma
    • may need to be excised and drained
  6. PP: hemorrhage-placental fragments
    • Most late PP-hemorrhage-caused by retained fragments.
    • placenta does not appear intact
    • ultrasound findings
    • D&C may be needed
    • prevention of hypovolemic shock.
  7. PP: hemorrhage-Uterine inversion
    • 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
  8. PP: hemorrhage: DIC
    • Disseminated intravascular clotting¬†
    • disturbance in normal clotting
    • multiple blood clots throughout the body.
  9. Control of coagulation
    • Fibrinolytic system
    • Antithrombin III
    • Protein C
    • Rapid blood flow
    • Removal of activated clotting factor by the reticuloendothelial system
  10. Normal coagulation
    • Trauma occurs
    • Platelets respond
    • Coagulation cascade begins
    • Thrombin is generated
    • Thrombin reacts with fibrinogen to form a stable clot
  11. Coagulation in pregnancy
    • 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
  12. DIC: intervention
    • 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
  13. DIC is increased with...
    • preeclampsia
    • placental abruption
    • amniotic fluid embolism
  14. Lab values for DIC
    • Platelet count-decreased
    • fibrinogen-decreased
    • PT: prolonged
    • PTT: prolonged
    • Antithrombin III: decreased activity
    • FSP/FDP: greater than 40
    • SFMC: Increased
    • D-dimer: increased
  15. Preeclampsia
    • Chronic hypertension
    • vascular damage and spasms
    • renal and hepatic impairment
    • cerebral edema
    • decreased osmotic pressure leading to pulmonary edema
    • uteroplacental insufficiency
  16. PP: infection
    • S&S of infection
    • UTI-dysuria
    • Mastitis-breast infection-redness-tenderness
    • Wound infection
    • Endometritis- boggy uterus-foul smelling lochia, increased bleeding.
  17. PP: mood disorders
    • Blues
    • depression
    • psychosis
  18. PP: Blues
    • occurs in 50-80%
    • mild depression interspersed with happier feelings
    • short lived begin within days of birth and resolved by 10 days
  19. PP: depression
    • major mood disorder
    • usually begins 4 weeks after birth
    • occurs in 4-28% of new moms
  20. PP: psychosis
    • Occurs 1-3 months after birth
    • agitation
    • hyperactivity
    • insomnia
    • Irrationality
    • Hallucinations/delusions related to infants
  21. HELLP?
    Hemolysis, elevated liver enzyme, low platelets
  22. Postpartum adaptations
    • atony-lack of usual muscle tone
    • attachment-infant
    • bonding
    • catabolism-involved in involution(normal changes) of the uterus after child birth
  23. decidua
    endometrium during pregnancy-all but the deepest layer is shed.
  24. Involution
    retrogressive changes that return the reproductive organs particularly the uterus to their non pregnant size and condition
  25. Puerperium
    period from the end of childbirth until involution of the reproductive organss-approx. 6 weeks.
  26. REEDA
    • Redness
    • Ecchymosis
    • Edema
    • Discharge
    • Approximation
    • useful for assessing wound and healing
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318410
Card Set
Nursing care for the post-partum patient
Description
Complications of post birth
Updated
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