Nursing Management of Postpartum Woman at Risk PDF

Chapter 22 Nursing Management of the Postpartum Woman at Risk Objectives Examine the major conditions that put a postpartum woman at risk. Analyze the risk factors, assessment, preventative measures, and nursing management of common postpartum complications. Differentiate the causes of pos...

Chapter 22 Nursing Management of the Postpartum Woman at Risk Objectives Examine the major conditions that put a postpartum woman at risk. Analyze the risk factors, assessment, preventative measures, and nursing management of common postpartum complications. Differentiate the causes of postpartum hemorrhage based on underlying pathophysiologic measures. Describe the S&S and management of PPH. Outline the nurses role in assessing and managing the care of a woman with a thromboembolic condition. Characterize the nursing management of a woman who develops a postpartum infection. Compare and contrast postpartum depression and psychosis, describing specific therapeutic management of each. Copyright © 2017 Wolters Kluwer · All Rights Reserved Common Postpartum Disorders Postpartum Hemorrhage Infection Thromboembolic disease Postpartum Psychiatric disorders Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Hemorrhage (PPH) Postpartum hemorrhage is a potentially life-threatening complication of both vaginal and cesarean births It is the leading cause of maternal mortality in the United States Blood loss – >500 mL following a vaginal birth – >1,000 mL following a cesarean birth Any amount of bleeding that places the mother in hemodynamic jeopardy (10% drop in hematocrit, shock) Copyright © 2017 Wolters Kluwer · All Rights Reserved Causes of Postpartum Hemorrhage: “Five Ts” Tone: uterine atony*, distended bladder Tissue: retained placenta and clots Trauma: vaginal, cervical, or uterine injury Thrombin: coagulopathy (pre-existing or acquired) Traction: causing uterine inversion *most common cause Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Hemorrhage: Risk Factors Multiparity Multiple Gestation Polyhydramnios Macrosomic Newborn Chronic Coagulation Disorders Prolonged Labor Induction of Labor General Anesthesia Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Hemorrhage: Therapeutic Management Focus on underlying cause Uterine massage Removal of retained placental fragments Antibiotics for infection Repair of lacerations Copyright © 2017 Wolters Kluwer · All Rights Reserved Question Is the following statement True or False? Postpartum hemorrhage is most commonly due to uterine atony. a. True b. False Copyright © 2017 Wolters Kluwer · All Rights Reserved Answer a. True Uterine atony is the most common cause of postpartum hemorrhage. Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Hemorrhage: Assessment and Nursing Management Nursing Assessment – Risk factors – Uterine tone; vaginal bleeding Nursing management – Fundal massage; pad count – Administration of uterotonics Pitocin (oxytocin) Cytotec (misoprostol) Hemabate (carboprost) Methergine (methylergonovine) – Fluid administration – Monitoring for signs and symptoms of shock Copyright © 2017 Wolters Kluwer · All Rights Reserved Perineal Hematoma Collection of blood underneath the skin Localized, bluish bulging area in perineum – May report severe perineal pain and difficulty voiding – May exhibit hypotension, tachycardia, and anemia Requires surgical management – Hematoma evacuated with incision – Pressure bandage applied to prevent reformation Copyright © 2017 Wolters Kluwer · All Rights Reserved Thromboembolic Conditions Inflammation of blood vessel lining Three most common types – Superficial thrombosis Usually confined to the saphenous vein in lower leg – Deep vein thrombosis May cause pulmonary embolism – Pulmonary embolism Most serious complication Copyright © 2017 Wolters Kluwer · All Rights Reserved Thromboembolic Conditions Pathophysiology – Venous stasis – Injury to innermost layer of blood vessel – Hypercoagulation (Increased clotting factors in pregnancy) Copyright © 2017 Wolters Kluwer · All Rights Reserved Thromboembolic Conditions (cont.) Nursing assessment – Risk factors – Signs and symptoms Nursing management – Prevention – Adequate circulation: NSAIDs, bed rest, antiembolism stockings, anticoagulant therapy (heparin); emergency measures for pulmonary embolism – Education Copyright © 2017 Wolters Kluwer · All Rights Reserved Question Which drug would the nurse expect to administer to a postpartum woman with deep vein thrombosis? a. Ibuprofen b. Amoxicillin c. Heparin d. Acetaminophen Copyright © 2017 Wolters Kluwer · All Rights Reserved Answer c. Heparin For the postpartum woman with deep vein thrombosis, heparin would be given to reduce the risk of further clot formation. Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Infections Fever >38°C or 100.4°F after first 24 hours Organisms usually those of normal vaginal flora (aerobic and anaerobic) Metritis: infection of endometrium, decidua, and adjacent myometrium Wound infections Urinary tract infections Mastitis: infection of the breast Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Infections (cont.) Therapeutic management – Broad-spectrum antibiotics for metritis – Wound care for wound infections – Fluids and antibiotics for UTIs – Breast emptying and antibiotics for mastitis Nursing assessment – Risk factors – Signs and symptoms REEDA Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Infections: Nursing Management Infection prevention – Aseptic technique; handwashing; perineal hygiene – Screening of visitors Administration of antibiotics; wound care Client teaching Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Affective Disorders Baby Blues Postpartum Depression Postpartum Psychosis Copyright © 2017 Wolters Kluwer · All Rights Reserved Signs of Postpartum or Baby Blues Emotional lability Irritability Insomnia Typically resolves within 2 weeks (by postpartum day 10) Usually self-limiting Copyright © 2017 Wolters Kluwer · All Rights Reserved Signs of Postpartum Depression Major depressive episode associated with childbirth Symptoms lasting beyond 2-6 weeks and worsening Symptoms Include (box 22.2): – Hopelessness – Worthlessness – Guilt – Anhedonia – Loss of Libido – Feeling sad Copyright © 2017 Wolters Kluwer · All Rights Reserved Signs of Postpartum Psychosis Surfaces within 3 weeks of giving birth Increased risk with history of mental illness Symptoms: – Sleep disturbances – Fatigue – Depression – Hypomania – Hallucinations – Delusions Copyright © 2017 Wolters Kluwer · All Rights Reserved Question Is the following statement True or False? Postpartum psychosis is the most severe form of postpartum affective disorder. a. True b. False Copyright © 2017 Wolters Kluwer · All Rights Reserved Answer a. True At the severe end of the continuum of postpartum affective disorders is postpartum psychosis. Copyright © 2017 Wolters Kluwer · All Rights Reserved Postpartum Affective Disorders: Management Baby Blues – Recommend social support; reassure that baby blues are normal Postpartum Depression – Lifestyle Changes – Medication – Cognitive Behavioral Therapy Postpartum Psychosis – Do not leave infant alone with mother – Hospitalization – Psychotropic drug treatment – Individual and group therapy Copyright © 2017 Wolters Kluwer · All Rights Reserved