The Postpartal Family at Risk

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The Postpartal Family at Risk
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Assessment of Postpartum Hemorrhage

• Fundal height and tone
• Vaginal bleeding
• Signs of hypovolemic shock
• Development of coagulation problems
• Signs of anemia

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Prevention of Postpartum Hemorrhage

• Adequate prenatal care
• Good nutrition
• Avoidance of traumatic procedures
• Risk assessment
• Early recognition and management of complications

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Causes of Postpartum Hemorrhage

• Uterine atony
• Lacerations of the genital tract
• Episiotomy
• Retained placental fragments
• Vulvar, vaginal, or subperitoneal hematomas

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Causes of Postpartum Hemorrhage (continued)

• Uterine inversion
• Uterine rupture
• Problems of placental implantation
• Coagulation disorders

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Nursing Interventions

• Uterine massage if a soft, boggy uterus is
  detected
• Encourage frequent voiding or catheterize the
  woman
• Vascular access
• Assess abnormalities in hematocrit levels
• Assess urinary output
• Encourage rest and take safety precautions

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Bimanual Compression
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Manual Removal of the Placenta
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Nursing Diagnoses Postpartum Hemorrhage

• Health-seeking Behaviors related to lack of
  information about signs of delayed postpartal
  hemorrhage
• Fluid Volume Deficit related to blood loss
  secondary to uterine atony, lacerations,
  hematomas, coagulation disorders, or retained
  placental fragments

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Self-Care Measures Postpartum Hemorrhage

• Fundal massage, assessment of fundal height and
  consistency
• Inspection of the episiotomy and lacerations if
  present
• Report
• Excessive or bright red bleeding, abnormal clots
• Boggy fundus that does not respond to massage
• Leukorrhea, high temperature, or any unusual
  pelvic or rectal discomfort or backache

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Prevention of Infection

• Good perineal care
• Hygiene practices to prevent contamination of the
  perineum
• Thorough handwashing
• Sitz baths
• Adequate fluid intake
• Diet high in protein and vitamin C

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Community Based Care Postpartum Hemorrhage

• Clear explanations about condition and the
  womans need for recovery
• Rise slowly to minimize orthostatic hypotension
• Woman should be seated while holding the newborn
• Encourage to eat foods high in iron
• Continue to observe for signs of hemorrhage or
  infection

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Endometritis
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Nursing Diagnoses Puerperal Infection

• Risk for Injury related to the spread of
  infection
• Pain related to the presence of infection
• Deficient Knowledge related to lack of
  information about condition and its treatment
• Risk for Altered Parenting related to delayed
  parent-infant attachment secondary to womans
  pain and other symptoms of infection

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Self-Care Measures Puerperal Infection

• Activity and rest
• Medications
• Diet
• Signs and symptoms of complications
• Importance of completion of antibiotic therapy

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Community Based Care Puerperal Infection

• May need assistance when discharged from the
  hospital
• May need a referral for home care services
• Instruct family on care of the newborn
• Instruct mother about breast pumping to maintain
  lactation if she is unable to breastfeed

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Mastitis
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Mastitis
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Breast Problems
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Community Based Care Mastitis

• Home care nurse may be the first to suspect
  mastitis
• Obtain a sample of milk for culture and
  sensitivity analysis
• Teach mother how to pump if necessary
• Assist with feelings about being unable to
  breastfeed
• Referral to lactation consultant or La Leche
  League

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Thromboembolic Factors
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Vitamin K Foods
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Nursing Diagnoses Thromboembolic Disease

• Pain related to tissue hypoxia and edema
  secondary to vascular obstruction
• Risk for Altered Parenting related to decreased
  maternal-infant interaction secondary to bed rest
  and intravenous lines
• Altered Family Processes related to illness of
  family member
• Deficient Knowledge related to self-care after
  discharge on anticoagulant therapy

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Community Based Care Thromboembolic Disease

• Instruct family members on care of mother and
  newborn
• Referral for home care if necessary
• Provide resources for follow-up or questions
• Teach all families to observe for signs and
  symptoms

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Postnatal Depression
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Assessment of Postpartum Psychiatric Disorders

• Depression scales
• Anxiety and irritability
• Poor concentration and forgetfulness
• Sleeping difficulties
• Appetite change
• Fatigue and tearfulness

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Prevention of Postpartum Psychiatric Disorders

• Help parents understand the lifestyle changes and
  role demands
• Provide realistic information
• Anticipatory guidance
• Dispel myths about the perfect mother or the
  perfect newborn
• Educate about the possibility of postpartum blues
  
• Educate about the symptoms of postpartum
  depression

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Nursing Diagnoses Postpartum Psychiatric
Disorder

• Ineffective Individual Coping related to
  postpartum depression
• Risk for Altered Parenting related to postpartal
  mental illness
• Risk for Violence against self (suicide),
  newborn, and other children related to depression

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Self-Care Postpartum Psychiatric Disorders

• Signs and symptoms of postpartum depression
• Contact information for any questions or concerns
  

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Community Based Care Postpartum Psychiatric
Disorders

• Foster positive adjustments in the new family
• Assessment of maternal depression
• Teach families symptoms of depression
• Give contact information for community resources
• Make referrals as needed

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Assessment of Infection REEDA Scale

• R redness
• E edema
• E ecchymosis
• D discharge
• A approximation

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Assessment of Infection (continued)

• Fever
• Malaise
• Abdominal pain
• Foul-smelling lochia
• Larger than expected uterus
• Tachycardia

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Assessment of Overdistention of the Bladder

• Large mass in abdomen
• Increased vaginal bleeding
• Boggy fundus
• Cramping
• Backache
• Restlessness

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Prevention of Bladder Overdistension

• Frequent monitoring of the bladder
• Encourage spontaneously voiding
• Assist the woman to a normal voiding position
• Provide medication for pain
• Perineal ice packs

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Nursing Diagnoses Bladder Distention

• Risk for Infection related to urinary stasis
  secondary to overdistention
• Urinary Retention related to decreased bladder
  sensitivity and normal postpartal diuresis

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Assessment of Cystitis

• Frequency and urgency
• Dysuria
• Nocturia
• Hematuria
• Suprapubic pain
• Slightly elevated temperature

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Prevention of a UTI

• Good perineal hygiene
• Good fluid intake
• Frequent emptying of the bladder
• Void before and after intercourse
• Cotton underwear
• Increase acidity of the urine

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Nursing Diagnoses UTI

• Pain with voiding related to dysuria secondary to
  infection
• Health-seeking Behaviors related to need for
  information about self-care measures to prevent
  UTI

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Self-Care Measures UTI

• Good perineal hygiene
• Maintain adequate fluid intake
• Empty bladder when she feels the urge to void or
  at least every 2-4 hours while awake

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Assessment of Mastitis

• Breast consistency
• Skin color
• Surface temperature
• Nipple condition
• Presence of pain

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Prevention of Mastitis

• Proper feeding techniques
• Supportive bra worn at all times to avoid milk
  stasis
• Good handwashing
• Prompt attention to blocked milk ducts

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Nursing Diagnoses Mastitis

• Health-seeking Behaviors related to lack of
  information about appropriate breastfeeding
  practices
• Ineffective Breastfeeding related to pain
  secondary to development of mastitis

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Self-Care Measures Mastitis

• Importance of regular, complete emptying of the
  breasts
• Good infant positioning and latch-on
• Principles of supply and demand
• Importance of taking a full course of antibiotics
• Report flu-like symptoms

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Assessment of Thrombophlebitis

• Homans sign
• Pain in the leg, inguinal area, or lower abdomen
• Edema
• Temperature change
• Pain with palpation

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Prevention of Thrombophlebitis

• Avoid prolonged standing or sitting
• Avoid crossing her legs
• Take frequent breaks while taking car trips

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Homans sign. With the clients knee flexed to
decrease the risk of embolization, the nurse
dorsiflexes the clients foot. Pain in the foot
or leg is a positive Homans sign. SOURCE
Photographer, Elena Dorfman
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Self-Care Thromboembolic Disease

• Condition and treatment
• Importance of compliance and safety factors
• Ways of avoiding circulatory stasis
• Precautions while taking anticoagulants