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Chapter 16

Chapter 16. Caring for the Woman Experiencing Complications During the Postpartal Period. Postpartum Hemorrhage. Definition Accurately estimating blood loss Early vs. late LARRY 4 “T’s”. Postpartum Hemorrhage. Uterine atony Hallmark — soft uterus filled with clots and blood

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Chapter 16

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  1. Chapter 16 Caring for the Woman Experiencing Complications During the Postpartal Period

  2. Postpartum Hemorrhage • Definition • Accurately estimating blood loss • Early vs. late • LARRY • 4 “T’s”

  3. Postpartum Hemorrhage • Uterine atony • Hallmark—soft uterus filled with clots and blood • Genital tract trauma • Uterus firm • Tissue • Thrombin

  4. Postpartum Hemorrhage • Late postpartum hemorrhage • Retained placental fragments • Ergonovine medication, antibiotics, and possible D&C • Hypovolemic shock

  5. Collaborative Management • Frequent vital signs and fundal massage • Note patient’s behavior • Medical management depends on cause • Administer oxygen • Obtain laboratory tests • Accurate I/O

  6. Hematoma • Definition • Signs and symptoms • Unremitting pain and pressure • Collaborative management • Careful assessment • Implement pain relief measures

  7. Puerperal Infections • Definition • Types of puerperal infections • Endometritis • Mastitis • Operative wound • Urinary tract • Careful assessment

  8. Collaborative Management • Antibiotics • Encourage rest, increased fluids, proper nutrition • Comfort measures • NSAIDs • Educate patient and family

  9. Thrombophlebitis and Thrombosis • Definition • Pathophysiology—hypercoagulable state, venous stasis and vein injury • Signs/symptoms—pain, tenderness; may be asymptomatic • Diagnostic tests

  10. Collaborative Management • Analgesics; elevate extremity; TED hose; increase fluids; apply moist, warm packs • Complete bedrest with bathroom privileges • Anticoagulation therapy • Measure leg circumference

  11. Complication: Pulmonary Embolism • Abrupt onset: chest pain, dyspnea, diaphoresis, syncope, anxiety • ABC response • Limit visitors • Educate woman and family regarding prevention of thrombus reoccurrence

  12. Postpartum Psychosocial Complications • Postpartum blues • Self-limiting • Postpartum depression • One of two symptoms exist most/all day • Identify risk factors • Screen at postpartum visits

  13. Postpartum Psychosis • Onset within first 8 weeks after childbirth • Distinguishing signs: hallucinations, agitation, confusion, suicidal/homicidal thoughts, delusions, sleep disturbances, loss of touch with reality • Requires hospitalization

  14. Psychosocial Postpartal Nursing Care • Teach to seek help if feeling overwhelmed • Encourage rest • Support bonding • Perform holistic assessment • Advocate for home follow-up

  15. Postpartum Nursing forVulnerable Populations • Victims of abuse • Undocumented immigrants • Limited Access to care/homelessness

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