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

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Hemorrhage Definition Accurately estimating blood loss Early vs. late LARRY 4 “T’s”

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Hemorrhage Uterine atony Hallmark—soft uterus filled with clots and blood Genital tract trauma Uterus firm Tissue Thrombin

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Hemorrhage Late postpartum hemorrhage Retained placental fragments Ergonovine medication, antibiotics, and possible D&C Hypovolemic shock

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley 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

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hematoma Definition Signs and symptoms Unremitting pain and pressure Collaborative management Careful assessment Implement pain relief measures

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Puerperal Infections Definition Types of puerperal infections Endometritis Mastitis Operative wound Urinary tract Careful assessment

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Collaborative Management Antibiotics Encourage rest, increased fluids, proper nutrition Comfort measures NSAIDs Educate patient and family

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Thrombophlebitis and Thrombosis Definition Pathophysiology—hypercoagulable state, venous stasis and vein injury Signs/symptoms—pain, tenderness; may be asymptomatic Diagnostic tests

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Collaborative Management Analgesics; elevate extremity; TED hose; increase fluids; apply moist, warm packs Complete bedrest with bathroom privileges Anticoagulation therapy Measure leg circumference

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Complication: Pulmonary Embolism Abrupt onset: chest pain, dyspnea, diaphoresis, syncope, anxiety ABC response Limit visitors Educate woman and family regarding prevention of thrombus reoccurrence

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Psychosocial Complications Postpartum blues Self-limiting Postpartum depression One of two symptoms exist most/all day Identify risk factors Screen at postpartum visits

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley 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

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Psychosocial Postpartal Nursing Care Teach to seek help if feeling overwhelmed Encourage rest Support bonding Perform holistic assessment Advocate for home follow-up

Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Nursing for Vulnerable Populations Victims of abuse Undocumented immigrants Limited Access to care/homelessness