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Davis Advantage for Maternal-Child Nursing Care, Third Edition.

Chapter 12

Caring for the Woman Experiencing Complications During the Postpartal Period

Postpartum Hemorrhage

Quantify blood loss immediately after birth

Remain alert to indicators of ongoing obstetric hemorrhage

Increased heart rate

Decreased blood pressure

Decreased oxygen saturation

Evaluating blood loss

Recognizing Additional Indicators of Hemorrhage

Early vs. late postpartum hemorrhage

Uterine atony

Trauma

Tissue

Thrombin

Collaborative management of PPH

Characteristics of Postpartal Bleeding

Color of blood

Character of blood

Consistency of blood

Dark red with clots: uterine atony

Bright red without clots: lacerations from the perineum, cervix, or vagina

Blood Loss and Vital Signs

Signs of shock may not be present

Restlessness

Anxiety

Pallor

Cool, clammy skin

Increased pulse

Tachypnea

Shaking

Decreased blood pressure

Hematomas

Localized collection of blood under the skin

Incidence

Risk factors include genital tract lacerations, episiotomies, operative vaginal deliveries, difficult or prolonged second stage of labor, and nulliparity

Signs and symptoms

Collaborative management

Thrombophlebitis and Thrombosis

Describe an inflammation of the venous circulation and blood clot formation

Typically occur in the lower extremities

Superficial venous thrombosis

Deep venous thrombosis

Pulmonary embolism

Increased risk during the postpartum period

Recognizing Signs and Symptoms of DVT

Unilateral leg pain

Calf tenderness

Swelling

May be asymptomatic

Symptoms depend on the size, location, degree of vessel occlusion, and development of collateral circulation

Positive Homans’ sign

Venous Thrombosis

Lab test for venous thrombosis

D-dimer

Basic chemistry test

PT and aPTT

Collaborative management

Avoiding extremity massage when DVT is suspected

Patient education

Puerperal Infections

Bacterial infection that occurs within 28 hours after miscarriage, induced abortion, or childbirth

Most commonly involve

Endometrium

Operative wound

Urinary tract

Breasts

Risk Factors for Puerperal Infections

Poor hygiene

Low socioeconomic status

Smoking

Malnutrition

Obesity

Comorbidities

Infections in pregnancy

Prevention of Infection

Hand washing

Squeeze bottle of water to cleanse perinium

Change peripad at least every 3 to 4 hours

Drink extra fluids to increase urine production

Wash incisions with soap and water

Maintain glycemic control

Lifestyle changes

Essential Information

Notify your health-care provider if you develop pain, redness, or swelling at the site of any incision.

Notify your health-care provider if you develop a fever of 100.4°F (38°C). (If you are breastfeeding, a temperature elevation to 100.4°F [38°C] may occur when your milk production begins).

Mitigating Risk for Infection

Education client and family that might be at risk for infection

Postpartum and newborn visit by a registered nurse

Notify lactation consultant or breastfeeding support group, newborn’s physician, or public health nurse of events during labor

Follow up

Postpartum Psychosocial Complications

Emotional, spiritual, relational, and socioeconomic concerns

May not recognize need for help

May be reluctant to ask for help

Nurse can be a lifeline for the woman experiencing postpartum psychosocial complications

Postpartum Blues

Common emotional response of periods of happiness followed by periods of tearfulness

Self-limiting and resolve by 10 days postpartum

Signs and symptoms: tearfulness, mood swings, anxiety, fatigue, sadness, insomnia, forgetfulness, and confusion

Alleviating factors

Postpartum Depression (PPD)

Occurs within 6 months postpartum

Significant health effect on the woman, infant, and other family members

Those with a history of PPD are more likely to experience mental health disorders

Signs and symptoms

Assessment

Collaborative management

Postpartum Psychosis

Rare but severe form of mental illness

Affects not only the new mother, but also the entire family

Greatest risk in those with pre-existing psychosis

Behavioral cues that signal postpartum psychosis

Collaborative management

Childbirth-Induced Post-traumatic Stress Disorder

Reaction occurring after experiencing a highly stressful event

Characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of the event

Nursing !!!Power point expert only 10 slices. TTP

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