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POSTPARTUM COMPLICATIONS

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MAJOR CAUSES: uterine atony, laceration of vagina, cervix, perineum, and ... EARLY PP HEMORRHAGE-1ST 24 HR CAUSED BY UTERINE ATONY & LACERATION ... – PowerPoint PPT presentation

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Title: POSTPARTUM COMPLICATIONS


1
POSTPARTUM COMPLICATIONS
  • CHAPTER 18

2
FIVE CATEGORIES OF COMPLICATIONS
  • Hemorrhage
  • Thromboembolic disorders
  • Subinvolution of the uterus
  • Infections
  • Depression

3
POSTPARTUM HEMORRHAGE
  • MOST COMMON CAUSE OF EXCESSIVE BLEEDING DURING
    CHILDBEARING CYCLE
  • DEFINED AS LOSS OF MORE THAN 500 ML OF BLOOD
    FOLLOWING UNCOMPLICATED VAGINAL BIRTH OR 1000ML
    OF BLOOD AFTER C-S
  • FIRST 24 HOURS IS MOST CRITICAL TIME
  • BOX 18-1 RISK FACTORS

4
PP HEMORRHAGE
  • NOTORIOUSLY INACCURATE-WHY?
  • DUE TO INCREASE IN BLOOD VOLUME DURING PREGNANCY
    THE WOMAN CAN TOLERATE MOST BLOOD LOSS IF NOT
    EXCESSIVE
  • HH WILL DECREASE SLIGHTLY WITH 450-500ML OF
    BLOOD LOSS
  • MAJOR CAUSES uterine atony, laceration of
    vagina, cervix, perineum, and retained placental
    fragments

5
STAGES OF PP HEMORRHAGE
  • EARLY PP HEMORRHAGE-1ST 24 HR CAUSED BY UTERINE
    ATONY LACERATION
  • LATER PP HEMORRHAGE- FROM 24 HOURS TO 6 WEEKS PP
    CAUSED BY RETAINED PLACENTAL FRAGMENTS
    SUBINVOLUTION OF THE UTERUS

6
UTERINE ATONY (hypotonic uterus)
  • The inability of the uterine muscle to contract
    stay contracted around the open blood vessels
  • 1 CAUSE OF EARLY PP HEMMORHAGE
  • Placental fragments, clots, extreme uterine
    distention, precipitate births, forceps, lactic
    acid build-up r/t exhaustion, hypocalcemia, drugs
    like Magnesium Sulfate to prevent seizures

7
LACERATIONS TRAUMA
  • Lacerations- tears in the vagina, cervix, or
    perineum. May occur with difficult or
    precipitate deliveries, large newborn, use of
    forceps or vacuum extractors
  • S/S - excessive bleeding with a firm fundus
    blood is usually bright red continuous
    trickling of blood out of the vagina

8
RETAINED PLACENTA HEMATOMA
  • Retained Placenta
  • may result in early or late bleeding
  • examine the placenta
  • oxytocin given after delivery of placenta to
    help them be expelled completely
  • may require DC
  • placenta accreta placenta adheres to uterine
    wall must be surgically removed
  • Hematomas
  • perineal pain with firm uterus
  • bulging, bluish mass in perineal area

9
Coagulation Pathology
  • DIC
  • Clotting anticoagulation occur at the same time
  • treat the cause which may be abruptio
    placentae, gestational HTN, missed AB, fetal
    death in utero
  • Von Willebrands Disease
  • an inherited disorder with defect in platelet
    function
  • treated with administration of clotting factor
  • Amniotic Fluid Embolism
  • when the amniotic fluid enters the mothers
    blood circulation causes an anaphylactic
    reaction. Can result in death

10
Prevention of Hemorrhage
  • Use of Pitocin after delivery of placenta
  • Massage of the uterine fundus
  • Assessment of fundus bleeding with prompt
    intervention

11
Signs and Symptoms of PP Hemorrhage
  • Boggy uterus (not firm about the size of a
    grapefruit)
  • Uterus above level of umbilicus
  • Excessive lochia

12
Assessment Management of PP Hemorrhage box
18-2, nursing care plan 18-1
  • ID the cause of the hemorrhage
  • Stop the blood loss
  • Start or maintain IV fluids
  • Monitor V/S
  • Provide 02
  • Insert f/c to measure accurate IO to assess
    kidney function
  • Accurate assessment of blood loss by weighing
    pads underpads 1G1ML/CC

13
WHAT CAN YOU AS THE NURSE DO?
  • ADMINISTER IV OXYTOCIN AS PRESCRIBED TO CAUSE THE
    UTERUS TO CONTRACT
  • MASSAGE THE UTERUS IN A CIRCULAR MOTION AND
    EXPRESS CLOTS
  • MONITOR LOCHIA CAREFULLY!
  • NEVER push on an uncontracted uterus- can cause
    inversion and hemorrhage!!
  • Fig 18-1

14
THROMBOPHLEBITIS THROMBOEMBOLISM
  • Vein Inflammation
  • Box 18-3-Risks
  • May affect superficial or deep veins
  • measures to prevent thrombophlebitis- Fast
    Focus 18-1
  • rest, TED hose analgesics
  • Deep Vein Thrombosis pain and edema in the calf
    Homans sign
  • more common w/ C-sections
  • IV Heparin is started
  • PTTS are done
  • Protamine Sulfate is on hand Heparin antidote

15
PULMONARY EMBOLISM
  • ONE OF THREE LEADING CAUSES OF MATERNAL DEATH
  • OCCURS WHEN FRAGMENTS OF A BLOOD CLOT DISLODGE
    AND ARE CARRIED TO THE PULMONARY ARTERY WHERE
    THEY CAN OCCLUDE THE VESSEL
  • IF CIRCULATION IS COMPROMISED, DEATH MAY OCCUR IN
    MINUTES!!

16
THE DIAGNOSIS
  • VENTILATION/PERFUSION SCAN
  • BLOOD GASES
  • X-RAYS
  • PULMONARY ANGIOGRAM
  • REQUIRES ICU CARE
  • CRISIS INTERVENTION WITH EMERGENCY TEAM

17
SIGNS AND SYMPTOMS
  • CHILLS
  • HYPOTENSION
  • DYSPNEA
  • CHEST PAIN
  • ABDOMINAL PAIN
  • TACHYPNEA AND APPREHENSION

18
IMMEDIATE NURSING ACTION
  • ELEVATE HOB
  • O2 BY MASK
  • IV FLUIDS
  • PULSE OX
  • FREQUENT V/S
  • HEPARIN

19
POSTPARTUM INFECTIONS
  • First category
  • REPRODUCTIVE SYS. INFECTIONS, PUERPERAL INFECTION
    AND FEVER
  • BACTERIAL INFECTIONS OF GENITAL TRACT
  • Second category
  • SITES OTHER THAN GENITAL TRACT Include
    MASTITIS, UTIS, AND ARE R/T PREGNANCY, LABOR,
    BIRTH, AND LACTATION

20
INFECTIONS--SEE FAST FOCUS 18-2 BOX 18-4
  • Uterus vagina open after vaginal delivery
    provide easy access to microorganisms
  • Most effective method of prevention is scrupulous
    aseptic technique during labor, delivery post
    partum
  • Each vaginal exam increases the risk of pathogens
    entering the vagina
  • Increased risk of infection with c-sections due
    to altered skin integrity

21
ENDOMETRITIS
  • Most common puerperal infection
  • If not treated can spread to peritoneum become
    peritonitis
  • S/S onset within 24 hrs of delivery, uterine
    tenderness enlargement, foul odor to lochia,
    malaise, fatigue, tachycardia, elevated
    temperature
  • Nursing care blood cultures, supportive care to
    include administration of antibiotics lochia,
    pain relief

22
WOUND INFECTION
  • Most common site is the perineum c-s surgical
    incision
  • Use REEDA for assessment of perineum
  • S/S fever, increased drainage, redness, warmth
    of site
  • Stress importance of frequent perineal hygiene
    peri pad changes

23
URINARY TRACT INFECTION Box 18-4
  • May occur after birth due to hypotonia of
    bladder, urinary stasis, birth trauma, catheter
    insertion, frequent vag exams, or epidural
    anesthesia
  • S/S dysuria, frequency, urgency, low-grade
    fever
  • Pylonephritis may develop with CVA tenderness,
    chills, fever, hematuria
  • Cystitis usually treated on outpatient basis with
    antibiotics
  • Nursing stress proper perineal hygiene, wiping
    the perineum from front to back

24
MASTITIS
  • Infection of the breasts may occur as early as
    the 7th postpartum day or 2-3 weeks later
  • Risks milk stasis, nipple trauma, poor
    breastfeeding technique, improper handwashing
  • S/S painful, tender localized hard mass
    reddened area to usually one breast, fever,
    chills, malaise
  • Treatment antibiotics, complete emptying of
    both breasts with feeding, wear a supportive bra
  • Fast focus 18-3

25
POSTPARTUM BLUES DEPRESSION
  • 1. POSTPARTUM BLUES
  • 2. POSTPARTUM DEPRESSION
  • 3. POSTPARTUM PSYCHOSIS

26
THE BLUES
  • TRANSIENT WEEPINESS
  • MOOD CHANGES
  • ANXIETY
  • IRRITABILITY
  • FEW DAYS PP TO 10-14 DAYS
  • CAUSE- HORMONES?

27
DEPRESSION
  • S/S wt loss, sleeplessness, ambivalence towards
    the newborn family
  • If S/S present refer for MD follow up sooner than
    the traditional 6 weeks
  • Risks
  • hx of previous depressive episodes
  • hx of limited support system
  • low self-esteem
  • dissatisfaction with education, economics, or
    partner choice

28
PSYCHOSIS
  • S/S signs of depression, suicidal thoughts,
    delusions
  • Mother child are at risk
  • Should be referred for psychiatric treatment
  • Nursing provide support, encourage expression
    of feelings, validate feelings, support groups,
    marital counseling as needed
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