Postpartum Woman at Risk

1
Chapter 22

• Postpartum Woman at Risk

2
Postpartum Hemorrhage

• Early- r/t trauma, retained placental fragments
• Assess- blood loss, V/S, pallor, labs, TS
• Late- subinvolution
• Assess- lochia remains rubra, uterus boggy
• Change in vital signs late indication of blood
  loss

3
4 Ts

• Tone- Was uterus over distended?
• Tissue- Did placenta deliver intact?
• Trauma-Was the delivery difficult?
• Thrombis-Does clotting seem normal?

4
Problems with coagulation

• ITP-platelet destruction, autoimmune
• Assess- gums, epitaxis, menorrhagia, hematoma
• Von Willdebrand-Depletion of factor
• Assess- bleeding, oozing, bruising
• DIC-Depletion of certain clotting factors
• Medical emergency

5
Nursing Management

• Most likely to bleed PP
• Assess- amount, firmness, slow steady stream,
  review labs
  
• Interventions-massage, IV, V/S, bladder, teach to
  massage own uterus

6
Thromboembolic conditions

• Thrombophlebitis- most common, eval for
  varicosities
  
• Tenderness, temp, redness
• Heat analgesics, support hose

7
Deep Vein Thrombosis

• DVT- can lead to embolism
• Prevention avoid stasis, mobility, avoid trauma,
  stockings, deep breathing, hydration
  
• At risk- bed rest, obese, diabetics, C/S, AMA,
  smoking, oral contraceptives.
  
• S/S- calf edema, Homans, erythema, tenderness

8
Pulmonary Embolism

• Medical emergency
• Mortality is high
• S/S- sudden onset, resp. distress, chest pain,
  tachy, apprehension, sweaty, change in mental
  status
  
• O2, IV. CPR, cardiovascular support

9
PP Infections

• Above 38 degrees 24 after delivery
• Assess risk factors
• Most common metritis
• UTI- Why at risk?
• Perineal wound- Teach care
• Peri bottle-wiping-discharge

10
Mastitis

• Causes- cracked nipples, over distension,
  manipulation, stasis
  
• S/S- fever, chills, poor feeding technique,
  evaluate positioning, supportive bra.
  
• Interventions- pump, continue breastfeeding,
  compress

11
PP Emotional Disorders

• Baby blues- self limiting-does not effect ability
  to function
  
• PP Depression-last beyond 6 weeks
• Usually have history- assess during pregnancy
• PP Psychosis- onset within 3 wks, may need
  hospitalization, psychotic