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Postpartal Family at Risk. Chapter 32. Early Postpartal Hemorrhage. Occurs within first 24 hrs Uterine atony Lacerations Retained placental fragments- inspect Hematomas- trauma, excise over 5 cm Report feeling pressure. Late Postpartal Hemorrhage. 1-2 weeks after childbirth

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early postpartal hemorrhage
Early Postpartal Hemorrhage
  • Occurs within first 24 hrs
  • Uterine atony
  • Lacerations
  • Retained placental fragments- inspect
  • Hematomas- trauma, excise over 5 cm
  • Report feeling pressure
late postpartal hemorrhage
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
reproductive tract infections
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
wound infection
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
treatment of wound infection
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
health promotion
Health Promotion
  • Teach self care
  • Good hygiene
  • Change peripads
  • Diet
  • Fluid intake
  • No tampons or douching
urinary tract infection
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
cystitis
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
mastitis
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
prevention of mastitis
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
thromboembolitic disease
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
types of thrombis
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
treatment of thromboembolic disease
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
postpartum depression
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
depression assessment
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
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