Transcript
Postpartum Maternal Complications
Copyright © 2019 by Elsevier, Inc. All rights reserved.
Postpartum Hemorrhage
Early postpartum hemorrhage
Uterine atony
Predisposing factors
Clinical manifestations
Therapeutic management
Trauma
Predisposing factors
Lacerations
Hematomas
Therapeutic management
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Postpartum Hemorrhage (Cont.)
Late postpartum hemorrhage
Subinvolution
Retained placental fragments and infection
Clinical manifestations
Predisposing factors
Therapeutic management
Nursing considerations
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Hypovolemic Shock
Pathophysiology
Clinical manifestation
Therapeutic management
Nursing considerations
Immediate care
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Application of the Nursing Process: Woman with Excessive Bleeding
Assessment
Uterine atony or trauma
Identification of patient problems
Planning
Interventions
Preventing hemorrhage
Collaborating with health care provider
Providing support for the family
Posthemorrhage care and home care
Evaluation
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Case Study
You are the mother–baby nurse assigned to Ms. Avery. She is a gravida 6 para 5015 who gave birth to a 9-lb baby boy this morning. Ms. Avery had an uncomplicated and precipitous vaginal birth. Perineum is intact. She is breastfeeding. All labs are normal. She is now 5 hours postpartum. A family member calls out from the patient room for assistance. When you walk into the room, Ms. Avery is standing up on her way to the bathroom with a large pool of blood on the floor. She states, “I don’t know what happened; it all just came when I stood up. I am so dizzy and light-headed."
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Case Study (Cont.)
What should the nurse do?
What are Ms. Avery’s risk factors for postpartum hemorrhage (PPH)?
What should the medical management include?
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Thromboembolic Disorders
Definitions
Thrombus
Thrombophlebitis
Embolus
Pulmonary embolus
Incidence and etiology
Venous stasis
Hypercoagulation
Blood vessel injury
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Superficial Venous Thrombosis
Clinical manifestations
Therapeutic management
Analgesics
Rest
Elastic support
Elevation of lower extremities
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Deep Venous Thrombosis (DVT)
Signs and symptoms
Absent in most women affected
Diagnosis
Doppler
Magnetic resonance imaging (MRI)
Therapeutic management
Preventing thrombus formation
Initial treatment
Subsequent treatment
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Application of the Nursing Process: Deep Venous Thrombosis
Assessment
Identification of patient problems
Planning
Interventions
Monitoring for signs of bleeding
Explaining continued therapy
Helping family adapt to home care
Evaluation
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Pulmonary Embolism
Pathophysiology
Clinical manifestations
Dyspnea, chest pain, tachycardia, and tachypnea
Hemoptysis (expectoration of blood or bloody sputum)
Pulmonary rales, cough
Abdominal pain
Low-grade fever
Therapeutic management
Nursing considerations
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Puerperal Infection
Definition
Bacterial infection after childbirth
Temperature of 38°C (100.4°F) or higher after the first 24 hours and occurring on at least 2 of the first 10 days following childbirth
Effect of normal anatomy and physiology on infection
Other risk factors
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Endometritis
Incidence and etiology
Clinical manifestations
Therapeutic management
Complications
Nursing considerations
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Wound Infection
Clinical manifestations
Therapeutic management
Nursing considerations
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Urinary Tract Infections
Etiology
Clinical manifestations
Therapeutic management
Nursing considerations
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Mastitis
Incidence and etiology
Clinical manifestations
Therapeutic management
Nursing considerations
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Septic Pelvic Thrombophlebitis
Incidence and etiology
Clinical manifestations
Therapeutic management
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Application of the Nursing Process: Infection
Assessment
Identification of patient problems
Planning
Interventions
Promoting hygiene
Preventing urinary stasis
Teaching breastfeeding techniques
Evaluation
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Question
Fran delivered a 9 lb, 10 oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch diameter puddle of blood. What is your first action?
Call for help
Assess the fundus for firmness
Take her blood pressure
Check the perineum for lacerations
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