1. POSTPARTUM COMPLICATIONS Mrs. G.SAVITHA M.Sc (N) Assistant Professor, OBG Department Annammal College of Nursing

2. CYSTITIS An infection of the bladder ASSESSMENT Burning & pain on urination Lower abdominal pain Increased frequency of urination Costovertebral angle tenderness Fever Proteinuria, hematuria, bacteriuria, WBC in the urine.

3. IMPLEMENTATION Palpate bladder for distension Palpate fundus Obtain urine specimen for culture & sensitivity if prescribed Institute measures to assist the client to void Encourage frequent & complete emptying of the bladder Force fluids to 3000ml per day Administer antibiotics as prescribed after the urine culture is obtained Instruct the client in the methods of prevention & treatment of cystitis

4. HEMATOMA Localized collection of blood into the tissues of the reproductive sac after the delivery Predisposing conditions include operative delivery with forceps & injury to a blood vessel Can be life- threatening condition

5. Assessment Abnormal severe pain Pressure in the perineal area Sensitive, bulging mass in the perineal area with discolored skin Inability to void Decreased hemoglobin & hematocrit levels Signs of shock, such as pallor, tachycardia, & hypotenion, if significant blood loss has occurred

6. IMPLEMENTATION Monitor vital signs Monitor client for abnormal pain, especially when forceps delivery has occurred Place ice at the hematoma site Administer analgesics as prescribed Monitor I/O Encourage fluids & voiding Prepare for urinary catheterization if the client is unable to void Administer blood products as prescribed Monitor for signs, such of infection, such as increased temperature, pulse rate, & WBC count Administer antibiotics as prescribed, as infection is common following hematoma formation Prepare for incision & evacuation of hematoma if necessary

7. HEMORRHAGE Bleeding of 500ml or more following delivery ASSESSMENT EARLY Hemorrhage occurs during the first 24 hrs after delivery Caused by uterine atony, lacerations, or inversion of the uterus LATE Hemorrhage occurs after thr first 24 hrs following delivery Caused by retained placental fragments

8. IMPLEMENTATION Massage fundus, with care not to overmassage Notify physician if hemorrhage occurs Monitor vital signs & fundus every 5 to 15 minutes Remain with the client Assess & estimate blood loss by pad count Assess level of consciousness Administer fluids & monitor I & O Maintain asepsis, since hemorrhage predisposes to infection Prepare for the administration of Oxytocin if prescribed Prepare for blood transfusion if prescribed

9. INFECTION Any infection of the reproductive organs that occurs within 28 days of delivery or abortion ASSESSMENT Fever Chills Anorexia Pelvic discomfort or pain Vaginal discharge Elevated WBC count

10. IMPLEMENTATION Monitor vital signs(temperature) Make her comfortable;position for comfort & to promote drainage Keep the mother warmed if chilled Isolate the baby from the mother only if the mother can infect the baby Provide nutritious, high calorie, protein diet Force fluids to 3000 to 4000 ml per day, if not contraindicated Encourage frequent voiding & monitor I &O Monitor culture results Administer antibiotics according to organism, as prescribed

11. MASTITIS Inflammation of the breast as a result of infection Primarily seen in breastfeeding mothers 2 to 3 weeks after delivery but may occur at any time during lactation ASSESSMENT Localized heat & swelling Pain Elevated temperature complaints of flu like symptoms

12. IMPLEMENTATION Instruct the mother in good hand washing & breast hygiene techniques Promote comfort Apply heat or cold to site as prescribed Maintain lactation in breastfeeding mothers Encourage manual expression of breast milk or use of breast pump every 4 hrs Encourage mother to support breasts by wearing supportive bra Administer analgesics & antibiotics as prescribed

13. PULMONARY EMBOLISM The passage of thrombus, often originating in one of the uterine or other pelvic veins, into the lungs, where it disrupts the circulation of the blood ASSESSMENT Dyspnea, tachypnea, & tachcardia Cough & rales Hemoptysis Pleuritic chest pain Feeling of impending doom

14. IMPLEMENTATION Administer oxygen as prescribed Position client with the head of the bed elevated to promote comfort Monitor vital signs frequently Frequently assess respiratory rate & breadth sounds Monitor for signs of respiratory distress & for signs of increasing hypoxemia Administer IV fluids as prescribed Administer anticoagulants as prescribed Prepare to assist physician to administer streptokinase to dissolve the clot if prescribed

15. SUBINVOLUTION Incomplete involution or failure of the uterus to its normal size & condition ASSESSMENT Uterine pain on palpation Uterus is larger than expected Greater than normal vaginal bleeding

16. IMPLEMENTATION Assess vital signs Assess uterus & fundus Monitor for vaginal bleeding Elevate the legs to promote venous return Encourage frequent voiding Monitor Hb & hematocrit Prepare to administer Methergine as prescribed

17. THROMBOPHLEBITIS A condition in which a clot forms in a vessel wall as a result of the inflammation of the vessel wall A partial obstruction of the vessel can occur Increased blood clotting factors in the postpartum period place the client at risk TYPES Superficial thrombophlebitis Femoral thrombophlebitis Pelvic thrombophlebitis

18. Assessment of the type of Thrombophlebitis SuperficialFemoralPelvic Tenderness & pain in affected lower extremity Chills, fever,malaise, positive Homan’s sign Severe chills Warm & pinkish red color over thrombus area Pain, stiffness & swelling of the affected leg Body temperature changes Palpable thrombus that feels bumpy & hard Shiny, white skin over the affected area, diminished peripheral pulses Occurrence of pulmonary embolism may be first sign

19. IMPLEMENTATION Assess lower extremities for edema, tenderness, varices & increased skin temperature Evaluate the legs for Homan’s sign by extending the legs with the knees slightly flexed & dorsiflexing the foot Maintain bed rest Elevate the affected leg Apply bed cradle & keep bedclothes off affected leg Never massage the leg Monitor for manifestations of pulmonary embolism

20. Superficial thrombophlebitis Provide bed rest Apply hot packs to the affected site as prescribed Apply elastic stockings Administer analgesics as prescribed Femoral Thrombophlebitis Provide bed rest Elevate affected leg Apply moist heat continuously to affected area to alleviate discomfort Administer analgesics & antibiotics as prescribed Prepare to administer IV heparin sodium to prevent further thrombus formation

21. Pelvic Thrombophlebitis Provide bed rest Administer analgesic & antibiotic as prescribed Prepare to administer IV heparin sodium

22. Client Education Avoid pressure behind the knees Avoid prolonged sitting Avoid constrictive clothing Avoid crossing the legs Never massage the legs Understand the importance of anticoagulant therapy as prescribed Understand the importance of follow-up with the health care provider