Download NURS 2410 Unit 3

Nancy Pares, RN, MSN
Metro Community College
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Relate specific pathophysiology and nursing
process specific to postpartum.
Idenitify specific post partum complications
and nursing management
◦ Placental issues, uterine issues, vaginal issues
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Fundal height and tone
Vaginal bleeding
Signs of hypovolemic shock
Development of coagulation problems
Signs of anemia
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Cesarean delivery
Unusually large episiotomy
Operative delivery
Precipitous labor
Atypically attached placenta
Fetal demise
Previous uterine surgery
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Uterine atony
Lacerations of the genital tract
Episiotomy
Retained placental fragments
Vulvar, vaginal, or subperitoneal hematomas
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Uterine inversion
Uterine rupture
Problems of placental implantation
Coagulation disorders
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Uterine massage if a soft, boggy uterus is
detected
Encourage frequent voiding or catheterize the
woman
Vascular access
Assess abnormalities in hematocrit levels
Assess urinary output
Encourage rest and take safety precautions
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Health-seeking Behaviors related to lack of
information about signs of delayed postpartal
hemorrhage
Fluid Volume Deficit related to blood loss
secondary to uterine atony, lacerations,
hematomas, coagulation disorders, or
retained placental fragments
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Adequate prenatal care
Good nutrition
Avoidance of traumatic procedures
Risk assessment
Early recognition and management of
complications
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Fundal massage, assessment of fundal
height and consistency
Inspection of the episiotomy and lacerations
if present
Report:
◦ Excessive or bright red bleeding, abnormal clots
◦ Boggy fundus that does not respond to massage
◦ Leukorrhea, high temperature, or any unusual
pelvic or rectal discomfort or backache
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Clear explanations about condition and the
woman’s need for recovery
Rise slowly to minimize orthostatic
hypotension
Woman should be seated while holding the
newborn
Encourage to eat foods high in iron
Continue to observe for signs of hemorrhage
or infection
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Risk factors
◦ Overdistension of the uterus
◦ Uterine anomaly
◦ Poor uterine tone
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Assessment findings
◦ Excessive bleeding, boggy
fundus
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Management
◦ Fundal massage
◦ Blood products if loss is excessive
◦ Medications
 Oxytocin, methergine, carboprost tromethamine
(Hemabate)
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Risk factors
◦ Mismanagement of third stage
◦ Placental malformations
◦ Abnormal placental implantation
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Assessment findings
◦ Excessive bleeding, boggy fundus
Accreta
villi attach to the outer layer myometrium
Increta
villi attach within the muscle layer of the
myometrium
Percreta
villi attach deep within the myometrium
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Management
◦ Manual exploration of the uterus
◦ D&C
◦ Blood products if loss is excessive
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Risk factors
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Operative delivery
Precipitous delivery
Extension of the episiotomy
Varices
Assessment findings
◦ Excessive bleeding with a firm uterus
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Management
◦ Suture if needed
◦ Blood products if loss is excessive
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Identify nursing process for post partum
psycho social disorders
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Depression scales
Anxiety and irritability
Poor concentration and forgetfulness
Sleeping difficulties
Appetite change
Fatigue and tearfulness
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Occurs within 3 to 10 days of delivery
Generally transient
Usually resolves without treatment
Assessment findings
◦ Tearful, fatigue, anxious, poor appetite
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Etiology
◦ Hormonal changes and adjustment to motherhood
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Longer than two weeks in duration requires
medical evaluation
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Onset slow, usually around the fourth week
after delivery
Assessment findings
◦ Depressed mood, fatigue, impaired concentration,
thoughts of death or suicide
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Risk factors
◦ History of depression, abuse, low self-esteem
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Management
◦ Psychotherapy, medications, hospitalization
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Generally after the second PP week
Assessment findings
◦ Sleep disturbance, agitation, delusions
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Risk factors
◦ Personal or family history of major psychiatric
illness
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Management
◦ May lead to suicide or infanticide
◦ Hospitalization, medications, psychotherapy
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Help parents understand the lifestyle changes
and role demands
Provide realistic information
Anticipatory guidance
Dispel myths about the perfect mother or the
perfect newborn
Educate about the possibility of postpartum
blues
Educate about the symptoms of postpartum
depression
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Signs and symptoms of postpartum
depression
Contact information for any questions or
concerns
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Foster positive adjustments in the new family
Assessment of maternal depression
Teach families symptoms of depression
Give contact information for community
resources
Make referrals as needed
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Ineffective Individual Coping related to
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Risk for Altered Parenting related to
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postpartum depression
postpartal mental illness
Risk for Violence against self (suicide),
newborn, and other children related to
depression
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Components of grief work
◦ Accepting the painful emotions involved
◦ Reviewing the experiences and events
◦ Testing new patterns of interaction and role
relationships
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Four stages of grief
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Shock and numbness
Searching and yearning
Disorientation
Reorganization
Symptoms of normal grief
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Inability to conceive
Spontaneous abortion
Preterm delivery
Congenital anomalies
Fetal demise
Neonatal death
Relinquishment
SIDS
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Review nursing interventions associated with
◦ DVT, Hematoma, hemorrhoids, endometritis,
wound infections, urinary infections and STD
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R: redness
E: edema
E: ecchymosis
D: discharge
A: approximation
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Fever
Malaise
Abdominal pain
Foul-smelling lochia
Larger than expected uterus
Tachycardia
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Risk for Injury related to the spread of
infection
Pain related to the presence of infection
Deficient Knowledge related to lack of
information about condition and its treatment
Risk for Altered Parenting related to delayed
parent-infant attachment secondary to
woman’s pain and other symptoms of
infection
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Infection of the
uterine lining
Risk factors
◦ Cesarean section
Assessment
findings
◦ Fever, chills
◦ Abdominal
tenderness
◦ Foul-smelling lochia
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Management
◦ Antibiotics
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Breast consistency
Skin color
Surface temperature
Nipple condition
Presence of pain
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Infection of the breast
Risk factors
◦ Damaged nipples
◦ Failure to empty breasts
adequately
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Assessment findings
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Management
◦ Fever, chills
◦ Breast pain, swelling,
warmth, redness
◦ Antibiotics
◦ Complete breast emptying
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Proper feeding techniques
Supportive bra worn at all times to avoid milk
stasis
Good handwashing
Prompt attention to blocked milk ducts
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Importance of regular, complete emptying of
the breasts
Good infant positioning and latch-on
Principles of supply and demand
Importance of taking a full course of
antibiotics
Report flu-like symptoms
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Health-seeking Behaviors related to lack of
information about appropriate breastfeeding
practices
Ineffective Breastfeeding related to pain
secondary to development of mastitis
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Home care nurse may be the first to suspect
mastitis
Obtain a sample of milk for culture and
sensitivity analysis
Teach mother how to pump if necessary
Assist with feelings about being unable to
breastfeed
Referral to lactation consultant or La Leche
League
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Homan’s sign
Pain in the leg, inguinal area, or lower
abdomen
Edema
Temperature change
Pain with palpation
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Inflammation of the lining of the blood vessel
due to clot formation
◦ Can occur in the legs (DVT) or pelvis (SPT)
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Risk factors
◦ Cesarean section
◦ Prolonged bed rest
◦ Infection
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Assessment findings
◦ Pain, fever, redness, warmth, tender abdomen/calf
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Management
◦ Anticoagulants
◦ Antibiotics for septic pelvic thrombophlebitis
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Avoid prolonged standing or sitting
Avoid crossing her legs
Take frequent breaks while taking car trips
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Condition and treatment
Importance of compliance and safety factors
Ways of avoiding circulatory stasis
Precautions while taking anticoagulants
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Pain related to tissue hypoxia and edema
secondary to vascular obstruction
Risk for Altered Parenting related to
decreased maternal-infant interaction
secondary to bed rest and intravenous lines
Altered Family Processes related to illness of
family member
Deficient Knowledge related to self-care after
discharge on anticoagulant therapy
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Large mass in abdomen
Increased vaginal bleeding
Boggy fundus
Cramping
Backache
Restlessness
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Frequency and urgency
Dysuria
Nocturia
Hematuria
Suprapubic pain
Slightly elevated temperature
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Risk factors
◦ Urinary catheterization
◦ Long labor, operative delivery
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Assessment findings
◦ Dysuria, frequency, urgency
◦ Fever
◦ Suprapubic pain
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Management
◦ Antibiotics
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Good perineal care
Hygiene practices to prevent contamination
of the perineum
Thorough handwashing
Sitz baths
Adequate fluid intake
Diet high in protein and vitamin C
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Good perineal hygiene
Good fluid intake
Frequent emptying of the bladder
Void before and after intercourse
Cotton underwear
Increase acidity of the urine
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Frequent monitoring of the bladder
Encourage spontaneously voiding
Assist the woman to a normal voiding
position
Provide medication for pain
Perineal ice packs
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Risk for Infection related to urinary stasis
secondary to overdistention
Urinary Retention related to decreased
bladder sensitivity and normal postpartal
diuresis
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Pain with voiding related to dysuria secondary
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Health-seeking Behaviors related to need for
to infection
information about self-care measures to
prevent UTI
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Activity and rest
Medications
Diet
Signs and symptoms of complications
Importance of completion of antibiotic
therapy
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May need assistance when discharged from
the hospital
May need a referral for home care services
Instruct family on care of the newborn
Instruct mother about breast pumping to
maintain lactation if she is unable to
breastfeed
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Instruct family members on care of mother
and newborn
Referral for home care if necessary
Provide resources for follow-up or questions
Teach all families to observe for signs and
symptoms
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Assessment findings
◦ Severe perineal pain
◦ Ecchymosis
◦ Visible outline of the
hematoma
◦ Blood loss may not be visible
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Treatment
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Surgical drainage
Antibiotics
Analgesics
Blood products if loss is excessive
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Hypotension
Tachycardia, weak,
thready pulse
Decreased pulse
pressure
Cool, pale, clammy
skin
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Cyanosis
Oliguria, anuria
Thirst
Hypothermia
Behavioral changes
(lethargy,
confusion, anxiety)
Pg 664- table
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Monitor vital signs frequently
Large-bore IV for fluids, blood products
Administer oxygen, assess oxygen saturation
Assess hourly urine output
Assess level of consciousness
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Administer and monitor fluids, blood
products
Draw/monitor laboratory results
Assess quantity and quality of bleeding
Provide emotional support to patient/family
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Fever > 100.5
Severe pain, redness,swelling at incision site
Passing of large clots
Increased bleeding
Burning on urination
Insomnia
Impaired concentration
Feeling inadequate