GRCC High Risk postpartum care
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| What are the primary physiological disorders postpartum? | Hemorrhage, coagulation disorders and infection.
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| What are the primary psychological disorders? | Postpartum depression and postpartum psychosis.
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| What is a major complication of postpartum hemorrhage? | Hemorrhagic shock related to hypovolemia.
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| What is early postpartum hemorrhage (PPH)? | Defined as blood loss of greater than 500 mL within the first 24 hours.
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| What are causes of early PPH? | Uterine atony, lacerations and hematomas.
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| What are causes of late PPH? | hematomas, subinvolution and retained placental tissue.
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| subinvolution | Failure of the uterus to return to its normal size following childbirth.
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| Risk factors of PPH | Neonatal macrosomia; polyhydraminos; operative vag delivery; induced labor;ineffective uterine contractions;precipitous labor;general anesthesia.
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| Polyhydrminos | presence of excessive amniotic fluidamniotic fluid surrounding the unborn infant.
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| Signs and symptoms of early PPH | 10% increase in hct post birth; saturation of peripad within 15 minutes;fundus that remains boggy after massage;tachycardia; decrease in blood pressure.
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| Thrombosis | A blood clot within the vascular system. women are at risk for forming blood clots during pregnancy through the first 6 weeks of pg
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| Risk factors for thrombosis | Normal physiological changes in coagulation related to pregnancy; c-section (5x greater than vag birth); endometrititis; decreased mobility; obesity; increased parity
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| Signs and symptoms of thrombosis | Positive homans sign, tenderness and heat over the affected area, leg pain with walking, swelling in the affected leg.
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| Medical mgmt of thrombosis | Doppler ultrasonagraphy;compression stockings; coagulation therapy; antibiotic and bed rest.
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| What is the major cause of death for mama's? | Genital tract infection.
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| What is the major cause for endometritis? | Streptococci...it is a local infection of the endometrium- who lining of the uterus can get infected.
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| Signs and symptoms of endometritis | Increased temp, increased pulse, chills and malaise. Decreased appetite, back ache and sever after birth pain. Also, foul smelling lochia..unless streptococcus is present, then lochia is scant and odorless.
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| Risk factors for endometritis | Prolonged rupture of membranes; prolonged labor; c-section;internal fetal and uterine monitoring; anemia;malnutrition; PPH; diabetes
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| Medical mgmt of endometriosis | Antibiotic;UA, CBC, Blood culture; endometrial culture; have mama sit in fowler position
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| Salpingitis | Infection of fallopian tubes transmitted from uterus to venous how tubes infected
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| Signs and symptoms of salpingitis | Increase temp, increase pulse, rigidity ab.
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| Med mgmt of salpingitis | antibiotics and analgesics.
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| Complications of salpingitis | Infertility, usually just one side
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| Nursing actions for endometris | Min fluid intake of 3000 ml/day, change peripads each time they void, proper hand washing techniques, high diet in protein and vitamin C,.
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| Cystitis is an infection of the bladder | This is a common occurence in the postpartum period. If left untreated, could lead to pyelonephritis.
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| Signs and symptoms of cystitis | Low grade fever (<38.5c/101F), burning urination, supapubic pain, urgency to void, small frequent voids (less than 150 ml/voiding)
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| Med mgmt of cystitis | Encourage to void, if not more than 200 ml/void, then you'll have to cath the mom. Give antibiotics and get labs (UA, CBC, urine culture)
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| How many times/day should a woman void if she has cystitis? | Every three to four hours
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| What foods would you recommend for someone with cystitis | cranberry juice, apricots and plums.
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| Thrombolitis | Blood clots in legs due to extra blood; puts pressure on femoral arteries; use support stockings.
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| Treating thrombolitis | Encourage early ambulation to avoid blood pooling.
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| Thromobolitis manifestations | warmth, swelling reddish
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| Med mgmt of thrombolitis | Give heparin
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| Complications of thrombolitis | Pulmonary emboli, filling of lungs, pneumonia.
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| Mastitis | Inflammation/infection of the breast- usually unilaterally w/in first 2 postpartum weeks after milk flow
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| When does infection resolve if mama has mastitis? | Usually within 24 to 48 hours of antibiotic therapy.
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| Risk factors for mastitis | History of it, cracked and or sore nipples, use of antifungal nipple cream (usually applied when NB has thrush)
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| If abscess occurs in breast | encourage mama to continue expressing milk to promote flow and prevent it from plugging up.
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| Treating mastitis | Broad spectrum antibiotics, apply heat and/or cold, breastfeed every 2 to 3 hours
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| Post partum depression | Requires psychiatrtic interventions, occurs within 6 months post partum, unable to safely care for baby or self
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| Post partum blues | Symptoms disappear without medical intervention, occurs within 2 weeks postpartum, able to safely care for baby and self.
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| Post partum psychosis | varian bi-polar disorder; delusional, mood swings, agitation;confused thinking;strange beliefs.
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