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POSTPARTUM COMPLICATIONS

POSTPARTUM COMPLICATIONS. Mrs. G.SAVITHA M.Sc (N) Assistant Professor, OBG Department Annammal College of Nursing. CYSTITIS. An infection of the bladder ASSESSMENT Burning & pain on urination Lower abdominal pain Increased frequency of urination Costovertebral angle tenderness Fever

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POSTPARTUM COMPLICATIONS

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  1. POSTPARTUM COMPLICATIONS Mrs. G.SAVITHA M.Sc (N) Assistant Professor, OBG Department Annammal College of Nursing

  2. CYSTITIS • An infection of the bladder • ASSESSMENT • Burning & pain on urination • Lower abdominal pain • Increased frequency of urination • Costovertebral angle tenderness • Fever • Proteinuria, hematuria, bacteriuria, WBC in the urine.

  3. IMPLEMENTATION • Palpate bladder for distension • Palpate fundus • Obtain urine specimen for culture & sensitivity if prescribed • Institute measures to assist the client to void • Encourage frequent & complete emptying of the bladder • Force fluids to 3000ml per day • Administer antibiotics as prescribed after the urine culture is obtained • Instruct the client in the methods of prevention & treatment of cystitis

  4. HEMATOMA • Localized collection of blood into the tissues of the reproductive sac after the delivery • Predisposing conditions include operative delivery with forceps & injury to a blood vessel • Can be life- threatening condition

  5. Assessment • Abnormal severe pain • Pressure in the perineal area • Sensitive, bulging mass in the perineal area with discolored skin • Inability to void • Decreased hemoglobin & hematocrit levels • Signs of shock, such as pallor, tachycardia, & hypotenion, if significant blood loss has occurred

  6. IMPLEMENTATION • Monitor vital signs • Monitor client for abnormal pain, especially when forceps delivery has occurred • Place ice at the hematoma site • Administer analgesics as prescribed • Monitor I/O • Encourage fluids & voiding • Prepare for urinary catheterization if the client is unable to void • Administer blood products as prescribed • Monitor for signs, such of infection, such as increased temperature, pulse rate, & WBC count • Administer antibiotics as prescribed, as infection is common following hematoma formation • Prepare for incision & evacuation of hematoma if necessary

  7. HEMORRHAGE • Bleeding of 500ml or more following delivery • ASSESSMENT • EARLY • Hemorrhage occurs during the first 24 hrs after delivery • Caused by uterine atony, lacerations, or inversion of the uterus • LATE • Hemorrhage occurs after thr first 24 hrs following delivery • Caused by retained placental fragments

  8. IMPLEMENTATION • Massage fundus, with care not to overmassage • Notify physician if hemorrhage occurs • Monitor vital signs & fundus every 5 to 15 minutes • Remain with the client • Assess & estimate blood loss by pad count • Assess level of consciousness • Administer fluids & monitor I & O • Maintain asepsis, since hemorrhage predisposes to infection • Prepare for the administration of Oxytocin if prescribed • Prepare for blood transfusion if prescribed

  9. INFECTION • Any infection of the reproductive organs that occurs within 28 days of delivery or abortion • ASSESSMENT • Fever • Chills • Anorexia • Pelvic discomfort or pain • Vaginal discharge • Elevated WBC count

  10. IMPLEMENTATION • Monitor vital signs(temperature) • Make her comfortable;position for comfort & to promote drainage • Keep the mother warmed if chilled • Isolate the baby from the mother only if the mother can infect the baby • Provide nutritious, high calorie, protein diet • Force fluids to 3000 to 4000 ml per day, if not contraindicated • Encourage frequent voiding & monitor I &O • Monitor culture results • Administer antibiotics according to organism, as prescribed

  11. MASTITIS • Inflammation of the breast as a result of infection • Primarily seen in breastfeeding mothers 2 to 3 weeks after delivery but may occur at any time during lactation • ASSESSMENT • Localized heat & swelling • Pain • Elevated temperature • complaints of flu like symptoms

  12. IMPLEMENTATION • Instruct the mother in good hand washing & breast hygiene techniques • Promote comfort • Apply heat or cold to site as prescribed • Maintain lactation in breastfeeding mothers • Encourage manual expression of breast milk or use of breast pump every 4 hrs • Encourage mother to support breasts by wearing supportive bra • Administer analgesics & antibiotics as prescribed

  13. PULMONARY EMBOLISM • The passage of thrombus, often originating in one of the uterine or other pelvic veins, into the lungs, where it disrupts the circulation of the blood • ASSESSMENT • Dyspnea, tachypnea, & tachcardia • Cough & rales • Hemoptysis • Pleuritic chest pain • Feeling of impending doom

  14. IMPLEMENTATION • Administer oxygen as prescribed • Position client with the head of the bed elevated to promote comfort • Monitor vital signs frequently • Frequently assess respiratory rate & breadth sounds • Monitor for signs of respiratory distress & for signs of increasing hypoxemia • Administer IV fluids as prescribed • Administer anticoagulants as prescribed • Prepare to assist physician to administer streptokinase to dissolve the clot if prescribed

  15. SUBINVOLUTION • Incomplete involution or failure of the uterus to its normal size & condition • ASSESSMENT • Uterine pain on palpation • Uterus is larger than expected • Greater than normal vaginal bleeding

  16. IMPLEMENTATION • Assess vital signs • Assess uterus & fundus • Monitor for vaginal bleeding • Elevate the legs to promote venous return • Encourage frequent voiding • Monitor Hb & hematocrit • Prepare to administer Methergine as prescribed

  17. THROMBOPHLEBITIS • A condition in which a clot forms in a vessel wall as a result of the inflammation of the vessel wall • A partial obstruction of the vessel can occur • Increased blood clotting factors in the postpartum period place the client at risk • TYPES • Superficial thrombophlebitis • Femoral thrombophlebitis • Pelvic thrombophlebitis

  18. Assessment of the type of Thrombophlebitis

  19. IMPLEMENTATION • Assess lower extremities for edema, tenderness, varices & increased skin temperature • Evaluate the legs for Homan’s sign by extending the legs with the knees slightly flexed & dorsiflexing the foot • Maintain bed rest • Elevate the affected leg • Apply bed cradle & keep bedclothes off affected leg • Never massage the leg • Monitor for manifestations of pulmonary embolism

  20. Superficial thrombophlebitis • Provide bed rest • Apply hot packs to the affected site as prescribed • Apply elastic stockings • Administer analgesics as prescribed • Femoral Thrombophlebitis • Provide bed rest • Elevate affected leg • Apply moist heat continuously to affected area to alleviate discomfort • Administer analgesics & antibiotics as prescribed • Prepare to administer IV heparin sodium to prevent further thrombus formation

  21. Pelvic Thrombophlebitis • Provide bed rest • Administer analgesic & antibiotic as prescribed • Prepare to administer IV heparin sodium

  22. Client Education • Avoid pressure behind the knees • Avoid prolonged sitting • Avoid constrictive clothing • Avoid crossing the legs • Never massage the legs • Understand the importance of anticoagulant therapy as prescribed • Understand the importance of follow-up with the health care provider

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