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NURS 2410 Unit 3

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NURS 2410 Unit 3 Nancy Pares, RN, MSN Metro Community College * Table 38 10 (continued) Postpartum depression predictors inventory (PDPI) revised and guide ... – PowerPoint PPT presentation

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Title: NURS 2410 Unit 3


1
NURS 2410 Unit 3
  • Nancy Pares, RN, MSN
  • Metro Community College

2
Assessment of Postpartum Hemorrhage
  • Fundal height and tone
  • Vaginal bleeding
  • Signs of hypovolemic shock
  • Development of coagulation problems
  • Signs of anemia

3
Risk Factors for Postpartum Hemorrhage
  • Cesarean delivery
  • Unusually large episiotomy
  • Operative delivery
  • Precipitous labor
  • Atypically attached placenta
  • Fetal demise
  • Previous uterine surgery

4
Causes of Postpartum Hemorrhage
  • Uterine atony
  • Lacerations of the genital tract
  • Episiotomy
  • Retained placental fragments
  • Vulvar, vaginal, or subperitoneal hematomas

5
Causes of Postpartum Hemorrhage (continued)
  • Uterine inversion
  • Uterine rupture
  • Problems of placental implantation
  • Coagulation disorders

6
Nursing Interventions
  • 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

7
Nursing Diagnoses Postpartum Hemorrhage
  • 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

8
Prevention of Postpartum Hemorrhage
  • Adequate prenatal care
  • Good nutrition
  • Avoidance of traumatic procedures
  • Risk assessment
  • Early recognition and management of complications

9
Postpartal Hemorrhage
10
Self-Care Measures Postpartum Hemorrhage
  • 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

11
Community Based Care Postpartum
Hemorrhage
  • Clear explanations about condition and the
    womans 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

12
Uterine Atony
  • Risk factors
  • Overdistension of the uterus
  • Uterine anomaly
  • Poor uterine tone
  • Assessment findings
  • Excessive bleeding, boggy fundus

13
Uterine Atony (continued)
  • Management
  • Fundal massage
  • Blood products if loss is excessive
  • Medications
  • Oxytocin, methergine, carboprost tromethamine
    (Hemabate)

14
Uterine Atony
15
Uterine Atony
16
Retained Placental Fragments
  • Risk factors
  • Mismanagement of third stage
  • Placental malformations
  • Abnormal placental implantation
  • Assessment findings
  • Excessive bleeding, boggy fundus

17
Retained Placental Fragments (continued)
  • Management
  • Manual exploration of the uterus
  • DC
  • Blood products if loss is excessive

18
Assessment of Infection REEDA Scale
  • R redness
  • E edema
  • E ecchymosis
  • D discharge
  • A approximation

19
Assessment of Infection (continued)
  • Fever
  • Malaise
  • Abdominal pain
  • Foul-smelling lochia
  • Larger than expected uterus
  • Tachycardia

20
Lacerations
  • Risk factors
  • Operative delivery
  • Precipitous delivery
  • Extension of the episiotomy
  • Varices
  • Assessment findings
  • Excessive bleeding with a firm uterus

21
Lacerations (continued)
  • Management
  • Suture the laceration
  • Blood products if loss is excessive

22
Endometritis
  • Infection of the uterine lining
  • Risk factors
  • Cesarean section
  • Assessment findings
  • Fever, chills
  • Abdominal tenderness
  • Foul-smelling lochia
  • Management
  • Antibiotics

23
Metritis
24
Mastitis
25
Assessment of Mastitis
  • Breast consistency
  • Skin color
  • Surface temperature
  • Nipple condition
  • Presence of pain

26
Mastitis
  • Infection of the breast
  • Risk factors
  • Damaged nipples
  • Failure to empty breasts adequately
  • Assessment findings
  • Fever, chills
  • Breast pain, swelling, warmth, redness
  • Management
  • Antibiotics
  • Complete breast emptying

27
Figure 382 Mastitis. Erythema and swelling are
present in the upper outer quadrant of the
breast. Axillary lymph nodes are often enlarged
and tender. The segmental anatomy of the breast
accounts for the demarcated, often V-shaped wedge
of inflammation.
28
Prevention of Mastitis
  • Proper feeding techniques
  • Supportive bra worn at all times to avoid milk
    stasis
  • Good handwashing
  • Prompt attention to blocked milk ducts

29
Self-Care Measures Mastitis
  • 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

30
Breast Problems
31
Nursing Diagnoses Mastitis
  • Health-seeking Behaviors related to lack of
    information about appropriate breastfeeding
    practices
  • Ineffective Breastfeeding related to pain
    secondary to development of mastitis

32
Community Based Care Mastitis
  • 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

33
Assessment of Thrombophlebitis
  • Homans sign
  • Pain in the leg, inguinal area, or lower abdomen
  • Edema
  • Temperature change
  • Pain with palpation

34
Figure 383 Homans sign. With the clients
knee flexed to decrease the risk of embolization,
the nurse dorsiflexes the clients foot. Pain in
the foot or leg is a positive Homans sign.
SOURCE Photographer, Elena Dorfman
35
Thrombophlebitis
  • Inflammation of the lining of the blood vessel
    due to clot formation
  • Can occur in the legs (DVT) or pelvis (SPT)
  • Risk factors
  • Cesarean section
  • Prolonged bed rest
  • Infection

36
Thrombophlebitis (continued)
  • Assessment findings
  • Pain, fever, redness, warmth, tender abdomen/calf
  • Management
  • Anticoagulants
  • Antibiotics for septic pelvic thrombophlebitis

37
Thromboembolic Factors
38
Decreasing Thromboembolic Risk
39
Prevention of Thrombophlebitis
  • Avoid prolonged standing or sitting
  • Avoid crossing her legs
  • Take frequent breaks while taking car trips

40
Self-Care Thromboembolic Disease
  • Condition and treatment
  • Importance of compliance and safety factors
  • Ways of avoiding circulatory stasis
  • Precautions while taking anticoagulants

41
Nursing Diagnoses Thromboembolic Disease
  • 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

42
Vitamin K Foods
43
Assessment of Postpartum Psychiatric
Disorders
  • Depression scales
  • Anxiety and irritability
  • Poor concentration and forgetfulness
  • Sleeping difficulties
  • Appetite change
  • Fatigue and tearfulness

44
Postpartum Blues
  • Occurs within 3 to 10 days of delivery
  • Generally transient
  • Usually resolves without treatment
  • Assessment findings
  • Tearful, fatigue, anxious, poor appetite

45
Postpartum Blues (continued)
  • Etiology
  • Hormonal changes and adjustment to motherhood
  • Longer than two weeks in duration requires
    medical evaluation

46
Postpartum Mood Disorder Depression
  • Onset slow, usually around the fourth week after
    delivery
  • Assessment findings
  • Depressed mood, fatigue, impaired concentration,
    thoughts of death or suicide
  • Risk factors
  • History of depression, abuse, low self-esteem
  • Management
  • Psychotherapy, medications, hospitalization

47
Postpartum Psychosis
  • Generally after the second PP week
  • Assessment findings
  • Sleep disturbance, agitation, delusions
  • Risk factors
  • Personal or family history of major psychiatric
    illness
  • Management
  • May lead to suicide or infanticide
  • Hospitalization, medications, psychotherapy

48
Postnatal Depression
49
Postnatal Depression
50
Postnatal Depression
51
Postnatal Depression
52
Postnatal Depression
53
Prevention of Depression
54
Prevention of Postpartum Psychiatric
Disorders
  • 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

55
Self-Care Postpartum Psychiatric
Disorders
  • Signs and symptoms of postpartum depression
  • Contact information for any questions or concerns

56
Nursing Diagnoses Postpartum Psychiatric
Disorder
  • Ineffective Individual Coping related to
    postpartum depression
  • Risk for Altered Parenting related to postpartal
    mental illness
  • Risk for Violence against self (suicide),
    newborn, and other children related to depression

57
Assessment of Overdistention of the Bladder
  • Large mass in abdomen
  • Increased vaginal bleeding
  • Boggy fundus
  • Cramping
  • Backache
  • Restlessness

58
Assessment of Cystitis
  • Frequency and urgency
  • Dysuria
  • Nocturia
  • Hematuria
  • Suprapubic pain
  • Slightly elevated temperature

59
Prevention of Infection
  • 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

60
Prevention of Bladder Overdistension
  • Frequent monitoring of the bladder
  • Encourage spontaneously voiding
  • Assist the woman to a normal voiding position
  • Provide medication for pain
  • Perineal ice packs

61
Prevention of a UTI
  • Good perineal hygiene
  • Good fluid intake
  • Frequent emptying of the bladder
  • Void before and after intercourse
  • Cotton underwear
  • Increase acidity of the urine

62
Self-Care Measures UTI
  • Good perineal hygiene
  • Maintain adequate fluid intake
  • Empty bladder when she feels the urge to void or
    at least every 2-4 hours while awake

63
Nursing Diagnoses Bladder Distention
  • Risk for Infection related to urinary stasis
    secondary to overdistention
  • Urinary Retention related to decreased bladder
    sensitivity and normal postpartal diuresis

64
Nursing Diagnoses UTI
  • Pain with voiding related to dysuria secondary to
    infection
  • Health-seeking Behaviors related to need for
    information about self-care measures to prevent
    UTI

65
Self-Care Measures Puerperal Infection
  • Activity and rest
  • Medications
  • Diet
  • Signs and symptoms of complications
  • Importance of completion of antibiotic therapy

66
Community Based Care Puerperal Infection
  • 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

67
Community Based Care Thromboembolic
Disease
  • 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

68
Community Based Care Postpartum
Psychiatric Disorders
  • 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

69
Pelvic Hematoma
  • Assessment findings
  • Severe perineal pain
  • Ecchymosis
  • Visible outline of the hematoma
  • Blood loss may not be visible

70
Pelvic Hematoma (continued)
  • Treatment
  • Surgical drainage
  • Antibiotics
  • Analgesics
  • Blood products if loss is excessive

71
Signs and Symptoms of Shock
  • Hypotension
  • Tachycardia, weak, thready pulse
  • Decreased pulse pressure
  • Cool, pale, clammy skin
  • Cyanosis
  • Oliguria, anuria
  • Thirst
  • Hypothermia
  • Behavioral changes (lethargy, confusion, anxiety)
  • Pg 664- table

72
Nursing Implications Shock
  • Monitor vital signs frequently
  • Large-bore IV for fluids, blood products
  • Administer oxygen, assess oxygen saturation
  • Assess hourly urine output
  • Assess level of consciousness

73
Nursing Implications Shock (continued)
  • Administer and monitor fluids, blood products
  • Draw/monitor laboratory results
  • Assess quantity and quality of bleeding
  • Provide emotional support to patient/family

74
Urinary Tract Infection
  • Risk factors
  • Urinary catheterization
  • Long labor, operative delivery
  • Assessment findings
  • Dysuria, frequency, urgency
  • Fever
  • Suprapubic pain
  • Management
  • Antibiotics

75
Nursing Diagnoses Puerperal Infection
  • 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 womans
    pain and other symptoms of infection

76
Reproductive Loss
  • Components of grief work
  • Accepting the painful emotions involved
  • Reviewing the experiences and events
  • Testing new patterns of interaction and role
    relationships

77
Reproductive Loss (continued)
  • Four stages of grief
  • Shock and numbness
  • Searching and yearning
  • Disorientation
  • Reorganization
  • Symptoms of normal grief

78
Examples of Reproductive Loss
  • Inability to conceive
  • Spontaneous abortion
  • Preterm delivery
  • Congenital anomalies
  • Fetal demise
  • Neonatal death
  • Relinquishment
  • SIDS

79
Warning signs of illness PP
  • Fever gt 100.5
  • Severe pain, redness,swelling at incision site
  • Passing of large clots
  • Increased bleeding
  • Burning on urination
  • Insomnia
  • Impaired concentration
  • Feeling inadequate
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