Postpartal Family at Risk

1. Postpartal Family at Risk Chapter 32

2. Early Postpartal Hemorrhage • Occurs within first 24 hrs • Uterine atony • Lacerations • Retained placental fragments- inspect • Hematomas- trauma, excise over 5 cm • Report feeling pressure

3. Late Postpartal Hemorrhage • 1-2 weeks after childbirth • Increase fundal height- lochia remains rubra • Leukorrhea, backache, foul smelling lochia • Methergine and ABX as indicated • Take all c/o pain seriously • Assess v/s,fundus, bleeding

4. Reproductive Tract Infections • Puerperal infection-up to 6 wks. PP • Endometritis most common, 38C. or above after 24 hrs • Often at site of placenta- medium for growth • Saw tooth temp, chills, foul smelling lochia • Pelvic cellulitis- ascending infection, lymph • Peritonitis-pelvis abcess • High temp, acutely ill, tachy, sever pain

5. Wound Infection • Episiotomy infection R/S/T, discharge, wound gaping • Tx ABX, heal by secondary closure • Cesarean wound infection- warm, drainage, edema, tenderness, fever, pain

6. Treatment of Wound Infection • Cultures, r/o UTI • Tx with ABX, sitz bath, analgesics • May need to remove sutures and pack • Endometritis- ABX • Peritonitis-ABX may require incision and drainage • REEDA- redness, edema, ecchymosis, discharge, approximation

7. Health Promotion • Teach self care • Good hygiene • Change peripads • Diet • Fluid intake • No tampons or douching

8. Urinary Tract Infection • At risk due to diuresis, bladder capacity, distention, trauma • Need to void frequently • Warm water over perineum • If need catheterization be gentle • Use aseptic technique

9. Cystitis • Will ascend from bladder - kidney - renal pelvis • Get midstream sample • Give ABX • S/S dysuria, urgency, frequency, nocturia • Pylonephritis- chills, fever, flank pain • Prevention- voiding after intercourse, good hygiene, drink fluids, cotton underwear • Drink acidic fruit juice

10. Mastitis • Infection in connective tissue 2-4 wks pp • Fatigue, trauma, milk stasis, organisms in babies mouth and nose • Shooting pain, pink, flaking, prutitic • C&S breast milk • Rest, supportive bra, ABX, NSAIDS, pumping, aspiration

11. Prevention of Mastitis • Wear supportive bra, prevent stasis, express milk, massage breast, pump • Empty effected side completely, point baby chin towards effected side • Teach breast care, positioning, latch on • Develops after discharge • Flu like symptoms consider mastitis

12. Thromboembolitic Disease • Clot formation- danger if breaks off • Inflammatory response = thrombophlebitis • Non inflammatory thrombis at risk for embolism • Contributing factors increase coags, obesity ,immobility, varicosities

13. Types of Thrombis • Superficial- common pp, saphenous vein. • S/S heat, tenderness, temp • Tx- heat, rest, analgesics, stockings • DVT- hx of thrombosis • S/S ankle-leg edema, low to high temp, chills, pain, Homan’s + or- , pale, cool limb • Septic pelvic thrombophlebitis- C/S with reproductive tract infection • S/S guarding, ab., flank pain, fever chills • Tx- ABX and anticoagulants

14. Treatment of Thromboembolic Disease • Difficult to diagnose • Bed rest, elevate leg, anticoagulant, analgesic, walk with stockings • Prevention- fluid, stirrups, ambulate, exercise • After dx- watch for emboli, avoid sitting, standing • Tx with Warfarin- s/s of bleeding, no BF

15. Postpartum Depression • Baby Blues- mild depression, self limiting • More often with primiparas • Hormonal • Acknowledge as real and normal • PP psychosis- first three months • Tx- may need hospitalization and meds • PP depression- 4th week, return of menses, weaning

16. Depression Assessment • PP depression can be progressive • Assess for stressors • Observe for excessive fatigue, anxiety, crying • Assess for strange behavior • Refer to social worker • Father may be overwhelmed by assumption of responsibilities