Chapter 16 Caring for the Woman Experiencing Complications During the Postpartal Period

Postpartum Hemorrhage Definition Accurately estimating blood loss Early vs. late LARRY 4 “T’s”

Postpartum Hemorrhage Uterine atony Hallmark—soft uterus filled with clots and blood Genital tract trauma Uterus firm Tissue Thrombin Refer to Box 16-1 for risk factors for uterine atony Refer to Box 16-2 for genital tract lacerations

Postpartum Hemorrhage Late postpartum hemorrhage Retained placental fragments Ergonovine medication, antibiotics, and possible D&C Hypovolemic shock

Collaborative Management Frequent vital signs and fundal massage Note patient’s behavior Medical management depends on cause Administer oxygen Obtain laboratory tests Accurate I/O Refer to Box 16-3 for nursing diagnoses related to PPH Refer to Box 16-4 for goals for PPH

Hematoma Definition Signs and symptoms Collaborative management Unremitting pain and pressure Collaborative management Careful assessment Implement pain relief measures Refer to Figures 16-2 & 16-3 for hematomas Refer to Box 16-5 for possible nursing diagnoses & goals

Puerperal Infections Definition Types of puerperal infections Endometritis Mastitis Operative wound Urinary tract Careful assessment Refer to Tables 16-2 through 16-6 for other infections

Collaborative Management Antibiotics Encourage rest, increased fluids, proper nutrition Comfort measures NSAIDs Educate patient and family

Thrombophlebitis and Thrombosis Definition Pathophysiology—hypercoagulable state, venous stasis and vein injury Signs/symptoms—pain, tenderness; may be asymptomatic Diagnostic tests Refer to Figure 16-6 for Homan’s sign

Collaborative Management Analgesics; elevate extremity; TED hose; increase fluids; apply moist, warm packs Complete bedrest with bathroom privileges Anticoagulation therapy Measure leg circumference Refer to Box 16-6 for nursing diagnoses & goals

Complication: Pulmonary Embolism Abrupt onset: chest pain, dyspnea, diaphoresis, syncope, anxiety ABC response Limit visitors Educate woman and family regarding prevention of thrombus reoccurrence

Postpartum Psychosocial Complications Postpartum blues Self-limiting Postpartum depression One of two symptoms exist most/all day Identify risk factors Screen at postpartum visits Refer to Box 16-7 for signs/symptoms of postpartum depression Refer to Box 16-8 for nursing diagnoses related to postpartum depression

Postpartum Psychosis Onset within first 8 weeks after childbirth Distinguishing signs: hallucinations, agitation, confusion, suicidal/homicidal thoughts, delusions, sleep disturbances, loss of touch with reality Requires hospitalization

Psychosocial Postpartal Nursing Care Teach to seek help if feeling overwhelmed Encourage rest Support bonding Perform holistic assessment Advocate for home follow-up

Postpartum Nursing for Vulnerable Populations Victims of abuse Undocumented immigrants Limited Access to care/homelessness Refer to Tables 16-7 & 16-8 for Risk factors for intimate partner abuse