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101 Cards in this Set
- Front
- Back
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Fundus no longer palpable after:
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14 days
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POSTPARTUM FIRST 6 WEEKS AFTER BIRTH
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CHANGES THAT OCCURRED
DURING PREGNANCY ARE REVERSED BACK TO NONPREGNANCY STATE LACTATION IS INITIATED |
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Postpartum Vitals:
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TEMPERATURE LESS THAN 100.4
BP-NEAR BASELINE LEVEL DURING PREGNANCY PULSE—60-90 BEATS/MINUTE RESPIRATIONS-12-20 BREATHS/MINUTE 40 to 50 may occur Bradycardia reflects the increased amount of blood returning to the circulation. |
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Postpartum Vitals: Fetus-gestation 38-42 weeks
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Lower limit of 110-120 beats/minute and upper limit of 150 to 160 beats/minute at term. Rate may slow during contractions but should return
Amniotic fluid: clear (may have particles of white vernix) no foul odor. |
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UTERINE INVOLUTION
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CONTRACTION OF
MUSCLE FIBERS CATABOLISM REGENERATION OF UTERINE EPITHELIUM By 2nd day fundus descends 1cm or 1 fingerbreadth, per day. |
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Which of the following is true of sickle cell anemia?
a) It occurs as the result of a point mutation b) Weakness, shortness of breath and fatigue are common symptoms c) A hair on end radiographic appearance may occur d) All of the above e) A & C only |
All of the above
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DESCENT OF UTERINE FUNDUS
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IMMEDIATELY AFTER BIRTH OF
PLACENTA SIZE OF LARGE GRAPEFRUIT MIDWAY BETWEEN SYMPHYSIS AND UMBILICUS WITHIN 12 HOURS-BACK AT UMBILICUS |
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DESCENT OF UTERINE FUNDUS
FIGURE 17-1, PAGE 391 |
DECREASES 1 FB/DAY
14TH DAY-UNPALPABLE IF ABOVE UMBILICUS DEVIATED TO RIGHT OR LEFT CHECK FOR FULL BLADDER OR UTERINE ATONY |
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Uterine atony
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is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage. Clinically, 75-80% of postpartum hemorrhages are due to uterine atony.
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SUBINVOLUTION
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THE PROCESS OF
INVOLUTION DOES NOT OCCUR PROPERLY |
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AFTERPAINS
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INTERMITTENT
UTERINE CONTRACTIONS ^ MULTIPS ^ BREASTFEEDING WARMTH, ANALGESICS |
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LOCHIA
Days 1-3; Lochia Rubra |
Normal-bloody, small clots, fleshy, earth odor; red or redbrown.
Abnormal:large clots; saturated perineal pads; foul odor. |
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Lochia
Days 4-10: Lochia Serosa |
normal: decreased amount, sero-sanguineous; pink or brown tinged.
Abnormal:excessive amount; foul smell continued or recurrent reddish color |
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Lochia
Days 11-21; lochia alba (may last until sixth week for some women) |
normal: white, cream or light yellow color, decreasing amounts
Abnormal: Persistent lochia serosa; return to lochia rubra; fould odor; dishcharge continuing |
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CERVIX
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FLABBY AFTER DELIVERY
MANUAL EXTRACTION SMALL TEARS, EDEMA AFTER DELIVERY- INTERNAL OS CLOSES EXTERNAL OS – SLIT-LIKE Nulliparis-round Parous -slit like after birth |
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VAGINA
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STRETCHED, TEARS, EDEMA
REQUIRES 6 WEEKS TO HEAL MAY BE DRY WHILE BREASTFEEDING |
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Lacerations
1st degree |
Involves the superficial vaginal mucosa or perineal skin.
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Lacerations
2nd degree |
Involves the vaginal mucosa, perineal skin, and deeper tissues, which may include fascia and muscles of the perineum.
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Lacerations
3rd degree |
Same as second-degree lacerations but involves the anal sphincter.
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ICE PACKS
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USE FOR 24 HOURS
ICE PACK IS COVERED BY A PAD, GAUZE OR WASHCLOTH AFTER 24 HOURS-SITZ BATHS ARE USED TO PROMOTE CIRCULATION & COMFORT |
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CARDIAC
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40-50% ^ IN BLOOD VOLUME AT TERM
COMPENSATES FOR EBL AT BIRTH RIDS ITSELF OF EXCESS VOLUME BY DIAPHORESIS & DIURESIS |
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How much blood lost in deliveries:
in C sections: |
500 ml
1000ml the rise in cardiac output, caused by an increase in stroke volume, persists for about 48 hours after childbirth. returns to norma by 6 to 12 weeks. |
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Diuresis facilitated by:
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a decline in adrenal hormone aldosterone, which is increased during pregnancy to counteract the salt wasting effect of progesterone. As alderosterone production decreases, sodium retention declines and fluid excretion accelerates.
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Decrease Oxytocin promotes:
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diuresis because oxytocin promotes reabsorption of fluid. a urinary output of 3000 ml per day is common espicially on days 2 through 5 postpartum.
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Coagulation
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3-4 WEEKS POSTPARTUM
BEFORE HEMOSTATIS RETURNS TO PREPREGNANCY LEVELS ^ RISK DVT’S COMPRESSION HOSE FOR C-SECTIONS C sections at higher risk on thrombosis-sequential devices are used. |
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Hemostasis
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is a complex process which causes the bleeding process to stop. It refers to the process of keeping blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). Most of the time this includes the changing of blood from a fluid to a solid state. Intact blood vessels are central to moderating blood's tendency to clot. The endothelial cells of intact vessels prevent blood coagulation by secretion of heparin-like molecule and thrombomodulin and prevent platelet aggregation by the secretion of nitric oxide and prostacyclin. When endothelial injury occurs, the endothelial cells cease secretion of coagulation and aggregation inhibitors and instead secrete von Willebrand factor and tissue thromboplastin which initiate the maintenance of hemostasis after injury. Hemostasis has three major steps: 1) vasoconstriction, 2) temporary blockage of a break by a platelet plug, and 3) blood coagulation, or formation of a clot that seals the hole until tissues are repaired.
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ORTHOSTATIC HYPOTENSION
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COMMON AFTER
DELIVERY-MAY C/0 DIZZINESS WITH 1ST AMBULATION : ASSIST PATIENT SIT DANGLE STAND AMBULATE |
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CONSTIPATION
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DECREASED BOWEL TONE
DEHYDRATION PERINEAL TRUMA EPISIOTOMY FEAR OF PAIN NO ENEMA IF 4TH DEGREE |
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URINARY SYSTEM
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SWELLING OF BLADDER
URETHA OVERDISTENTION RETENTION POSTPARTUM HEMORRHAGE UTI |
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Dyspareunia
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difficult or painful coitus in women
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Puerperium
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Period from the end of childbirth until involution of the reproductive organs is complete; approximately 6 weeks.
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URINARY SYSTEM
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Kidneys return to normal function within 2-3 months.
Dilation of renal pelvis, calyces, and ureters, ends by 6 to 8 weeks although may be as long as 16 weeks. Protein and acetone may be present in the urine in the first few postpartum days. Acetone suggests dehydration that often occurs during the exertion of labor. Proteinuria usually is the result of catabolic processes involved in uterine involution. Sugar in form of lactose is sometimes present |
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Urinary System
Causes of Uterine Atony |
Uterine ligaments stretched during pregnancy allow uterus to be displaced upward and laterally by the full bladder.
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SKIN CHANGES
Hair losse begins? |
STRETCH MARKS
MASK OF PREGNANCY & LINEA NIGRA FADE HAIR LOSS & REGROWTH EPISIOTOMY, LACERATIONS ABD INCISION hair loss begins at 3-4 weeks of delivery and is regrown in 4-6 months. (15 months for remainder) |
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NEUROLOGIC
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HEADACHE
EPIDURAL VS PIH AMBULATION DELAYED UNTIL Frontal and bilateral headaches are not common and could be a sign of changes in fluid and electrolytes. Severe headaches may be postpuncture resulting from regional anesthesia. most severe when patient is sitting up relieved assuming supine. Headache, along with blurred vision, photophobia, proteinuria, and addominal pain, also may indicate development or worsening of preeclampsia. FULL SENSATION RETURNS |
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Endocrine (hormone levels decrease)
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after expulsion of placenta, levels of estrogen, progesterone, and human placental lactogen decline fairly rapidly.
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Menstruation resumes at:
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7 to 9 weeks
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ENDOCRINE
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MENSTRUATION
NONNURSING MOTHERS 7-9 WEEKS NURSING MOTHERS-12 WEEKS-18 MONTHS ^ PROLACTIN WITH BREASTFEEDING OXYTOCIN PROMOTES MILK EJECTION OR LET-DOWN Prolactin may rise but estrogen and progesterone keep mother from lactating during term. After placenta discharge estrogen and progesterone decrease mother will begin feeding 2 to 3 days after delivery. |
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Oxytocin
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responsible for milk ejection or let down. this hormone, which is secreted by the posterior pituitary gland, causes milk to be expressed from the alveoli into the lactiferous ducts during suckling.
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WEIGHT LOSS
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10-12 LBS LOST AT BIRTH
FAT STORES FOR NURSING APPROACH PREPREGNANCY WEIGHT IN 6 MONTHS HEALTHY DIET EXERCISE |
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C-SECTION
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LUNGS
BREASTFEEDING GI URINARY AMBULATION PAIN INCISION LOCHIA |
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Paralytic Ileus
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Lack of movement in bowel.
Rare after C-section. Symptoms: abdominal distention, absent or decreased bowel sounds, failure to pass flatus or stools. |
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AMBULATE AFTER SURGERY TO PREVENT ABD DISTENTION
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AMBULATE AFTER SURGERY TO PREVENT ABD DISTENTION
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How would you check Fundal Height after C-section?
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CHECK FUNDAL HEIGHT AFTER C-SECTION THE SAME TECHNIQUE AS IN VAGINAL DELIVERY. PALPATE GENTLY
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BONDING
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STRONG EMOTIONAL
TIE OF A PARENT TO NEWBORN UNIDIRECTIONAL FROM PARENT TO CHILD |
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ATTACHMENT
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PROCESS BY WHICH
A BOND IS FORMED BETWEEN PARENT AND CHILD THRU PLEASURABLE INTERACTIONS RECIPROCAL |
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EN FACE
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EYE TO EYE
FACE TO FACE CONTACT FACILITATES PARENT- INFANT INTERACTION |
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TAKING IN PHASE
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FOCUSES ON OWN NEEDS
INTERGRATING HER BIRTH EXPERIENCE PASSIVELY ACCEPTS CARE, COMFORT AND DETAILS ABOUT THE NEWBORN |
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TAKING-HOLD
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MOTHER ASSUMES
OWN CARE & INITIATES CARE OF NEWBORN MAY VERBALIZE ANXIETY – MOTHERING ROLE |
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LETTING GO
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LET GO OF
FANTASTY BABY ACCEPT THE REAL INFANT BEGINS TO ACCEPT INFANT AS A SEPARATE INDIVIDUAL FROM HERSELF |
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MATERNAL ROLE ATTAINMENT
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PROCESS OF
BEING COMFORTABLE IN CARING FOR INFANT IDENTIFIES ONESELF AS A MOTHER |
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BABY BLUES & MOOD SWINGS
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NORMAL—1ST 2 WEEKS
INSOMNIA, IRRITABILITY, FATIGUE, TEARFULNESS MOOD INSTABILITY, ANXIETY UNRELATED TO EVENTS DOES NOT IMPAIR MOTHER’S ABILITY TO CARE FOR INFANT |
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BABY BLUES
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*ACKNOWLEDGE MOTHER’S FEELINGS*
SEEK CLARIFICATION OF HER FEELINGS BY ASKING NEUTRAL OPEN ENDED QUESTIONS OR STATEMENTS EMPATHY, SUPPORT, TIME FOR HERSELF, REASSURANCE ALLOW DISCUSSION OF HER FEELINGS |
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CULTURE
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BELIEFS PROVIDE A
SENSE OF SECURITY ACCEPT AND SUPPORT PRACTICES AS MUCH AS POSSIBLE |
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ASSESSMENT BUBBLE-HE
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BREASTS
UTERUS BLADDER BOWEL LOCHIA EPISIOTOMY HOMAN’S SIGN ENGAGEMENT/EMOTION |
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BREASTS (BUBBLE-HE)
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ASSESS Q SHIFT
SOFT, NONTENDER SUPPORT BRA LACTATING? CONDITION OF NIPPLES ENGORGEMENT |
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UTERUS (BUBBLE-HE)
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PALPATE FUNDUS Q 4H OR PRN
POSITION BOGGY OR FIRM C-SECTION-SAME TECHNIQUE START OUT MORE GENTLY |
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BLADDER (BUBBLE-HE)
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CHECK FOR DISTENTION
MEASURE 1ST 3 VOIDS AFTER DELIVERY AT RISK FOR UTI AFTER DELIVERY Ie frequent small voids pain on urination etc |
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BOWEL (BUBBLE-HE)
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STOOL SOFTNERS
^ FIBER DIET FORCE FLUIDS EARLY AMBULATION AFTER C-SECTION TO ENHANCE BOWEL MOTILITY DELAY REGULAR DIET |
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LOCHIA (BUBBLE-HE)
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AMOUNT
COLOR ODOR FIRST AMBULATION ICE PAD WATCH OUT FOR LARGE AMOUNTS OF RUBRA RETURNING AFTER DISCHARGE |
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REEDA
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REDNESS
EDEMA ECCHYMOSIS—BRUISING DISCHARGE APPROXIMATION |
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HOMAN’S SIGN USUALLY NOT DONE DUE TO POSSIBILITY OF DISLODGING A DVT
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REPORT POSITIVE SIGN TO MD/CNM
Positive result can be from muscle strain Can have a negative Homan’s Sign with a DVT ASSESS FOR REDNESS HEAT EDEMA TENDERNESS PEDAL PULSES |
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BLADDER (BUBBLE-HE)
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CHECK FOR DISTENTION
MEASURE 1ST 3 VOIDS AFTER DELIVERY AT RISK FOR UTI AFTER DELIVERY Ie frequent small voids pain on urination etc |
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BOWEL (BUBBLE-HE)
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STOOL SOFTNERS
^ FIBER DIET FORCE FLUIDS EARLY AMBULATION AFTER C-SECTION TO ENHANCE BOWEL MOTILITY DELAY REGULAR DIET |
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LOCHIA (BUBBLE-HE)
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AMOUNT
COLOR ODOR FIRST AMBULATION ICE PAD WATCH OUT FOR LARGE AMOUNTS OF RUBRA RETURNING AFTER DISCHARGE |
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REEDA
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REDNESS
EDEMA ECCHYMOSIS—BRUISING DISCHARGE APPROXIMATION |
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HOMAN’S SIGN USUALLY NOT DONE DUE TO POSSIBILITY OF DISLODGING A DVT
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REPORT POSITIVE SIGN TO MD/CNM
Positive result can be from muscle strain Can have a negative Homan’s Sign with a DVT ASSESS FOR REDNESS HEAT EDEMA TENDERNESS PEDAL PULSES |
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ENGAGEMENT/EMOTION
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TAKING ON MATERNAL ROLE
MOOD SWINGS, BLUES SIGNS OF MORE SEVERE MOOD DISORDER |
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COMFORT MEASURES
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ICE PACKS
PERINEAL CARE-squirt bottle-wipe front to back TOPICAL MEDICATIONS SITTING-SQUEEZE BUTTOCKS, SIT SLOWLY SITZ BATHS ANALGESICS PROMOTE BLADDER ELIMINATION |
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PROVIDE FLUIDS AND FOOD
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FORCE FLUIDS
HEARTY APPETITE FROM CHILDBIRTH & NURSING OFFER CULTURALLY APPROPRIATE FOODS & FLUIDS |
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CLIENT EDUCATION
POST PARTUM DISCHARGE TEACHING TOPICS |
UTERINE MASSAGE
LOCHIA NORMS INVOLUTION EPISIOTOMY CARE CARE OF ABDOMINAL INCISIONS BREAST CARE FOR LACTATING AND NONLACTING WOMEN BOWEL FUNCTION URINARY FUNCTION NUTRITION REST EXERCISE SEXUAL ACTIVITY CONTRACEPTION POSTPARTUM DANGER SIGNS FOLLOW UP CARE MEDICATIONS EMOTIONAL RESPONSES INFANT CARE AND FEEDING FAMILY ADJUSTMENT AVAILABLE RESOURCES |
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COMMON NURSING DIAGNOSISES
FOR POSTPARTUM WOMEN |
ANXIETY
RISK FOR INEFFECTIVE HEALTH MAINTENANCE RISK FOR INEFFECTIVE SEXUALITY PATTERNS RISK FOR INJURY IMBALANCED NUTRITION: MORE (OR LESS) THAN BODY REQUIREMENTS IMPAIRED URINARY ELIMINATION URINARY RETENTION CONSTIPATION READINESS FOR ENHANCED CHILDBEARING PROCESS INFEFFECTIVE BREASTFEEDING PARENTAL ROLE CONFLICT SLEEP DEPRIVATION |
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TEACHING
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PROCESS OF INVOLUTION
SELF-CARE HANDWASHING BREAST CARE ABD AND PERINEAL INCISION PERINEAL CARE KEGEL EXERCISES REST & SLEEP NUTRITION, DIET, SEX ETC DANGER SIGNS….ie heavy lochia rubra………… |
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DOCUMENTATION
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SEE PAGE 410 IN MURRAY & MCKINNEY
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DISCHARGE PLANNING
SIGNS AND SYMPTOMS |
SIGNS AND SYMPTOMS TO REPORT:
FEVER LOCALIZED AREA OF REDNESS, SWELLING OR PAIN IN EITHER BREAST PERSISTENT ABDOMINAL TENDERNESS FEELINGS OF PELVIC FULLNESS OR PELVIC PRESSURE PERSISTANT PERINEAL PAIN FREQUENCY URGENCY OR BURNING ON URINATION ABNORMAL CHANGE IN CHARACTER OF LOCHIA (INCREASED AMOUNT, RESUMPTION, OF BRIGHT RED COLOR, PASSAGE OF CLOTS, FOUL ODOR) |
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RUBELLA VACCINE
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CHECK PRENATAL RECORD
IF NON-IMMUNE GIVE IMMEDIATELY PRIOR TO DISCHARGE PREVENT FROM GETTING DURING FUTURE PREGNANCIES |
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COMMON NURSING DIAGNOSES FOR POSTPARTUM WOMEN
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ANXIETY
RISK FOR INEFFECTIVE HEALTH MAINTENANCE RISK FOR INEFFECTIVE SEXUALITY PATTERNS RISK FOR INJURY IMBALANCED NUTRITION: MORE (OR LESS) THAN BODY REQUIREMENTS IMPAIRED URINARY ELIMINATION URINARY RETENTION CONSTIPATION READINESS FOR ENHANCED CHILDBEARING PROCESS INEFFECTIVE BREASTFEEDING PARENTAL ROLE CONFLICT SLEEP DEPRIVATION |
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POSTPARTUM HEMORRHAGE
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BLOOD LOSS GREATER THAN 500CC VAGINAL
BLOOD LOSS GREATER 1000CC C-SECTION OR HGB DECREASES 10% OR NEED TO TRANSFUSE EARLY—1ST 24 HOURS LATE-AFTER 24 HOURS |
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EARLY POSTPARTUM HEMORRHAGE
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UTERINE ATONY
TRAUMA TO BIRTH CANAL HEMATOMAS, RETAINED PLACENTAL FRAGMENTS OTHER ABNORMALITIES—PLACENTAL ACCREDA, DIC INVERTED UTERUS ETC |
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PREDISPOSING FACTORS FOR PP HEMORRHAGE
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OVERDISTENTION OF UTERUS
GRAND MULTIP PRECIPITOUS OR PROLONGED LABOR FORCEPS OR VACUUM EXTRACTOR C-SECTION MANUAL REMOVAL OF PLACENTA PLACENTAL PREVIA, ACCREDA ETC GENERAL ANESTHESIA, MAG SULFATE CHRIOAMNIONITIS OXYTOCIN, PROSTAGLANDINS, TOCOLYTICS, MAGNESIUM SULFATE GENERAL ANESTHESIA CHORIOAMIONITIS CLOTTING DISORDERS PREVIOUS POSTPARTUM HEMORRHAGE OR UTERINE SURGERY DISSEMINATED INTRAVASCULAR COAGULATION UTERINE LEIOMYOMOS (FIBROIDS) |
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INTERVENTIONS FOR PP HEMORRHAGE
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GREATER -- 1 PAD/HOUR OR 1 PAD IN 15 MINUTES
OR CONSTANT STEADY TRICKLE MASSAGE UTERUS TILL FIRM EXPRESS CLOTS PREVENT UTERINE INVERSION CHECK FOR DISTENDED BLADDER ** PRIMARY MEDICATION: ** IV WITH OXYTOCIN*** METHERGINE, HEMABATE, CYTOTEC BIMANUAL COMPRESSION RETURN TO OR FOR D&C LIGATION OF ARTERIES HYSTERCTOMY |
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TRAUMA PP
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VAGINAL, CERVICAL, OR PERINEAL LACERATIONS
BRIGHT RED BLEEDING SHOULD BE SUSPECTED WITH BLEEDING WITH A FIRM UTERUS SURGICAL REPAIR NECESSARY |
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LATE POST PARTUM HEMORRHAGE
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SUBINVOLUTION-DELAY OF RETURN OF UTERUS
TO NONPREGNANT SIZE RETAINED PLACENTAL FRAGMENTS CAN OCCUR 7-14 DAYS POSTPARTUM FAMILIES NEED TO BE TAUGHT FUNDAL MASSAGE PRIOR TO D/C |
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SUBINVOLUTION
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SLOWER THAN NORMAL RETURN TO NORMAL
RETAINED PLACENTAL FRAGMENTS PELVIC INFECTION TREAT CAUSE---ANTIBIOTICS OR METHERGINE |
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HYPOVOLEMIC SHOCK
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MOTHER CAN TOLERATE 1500-2000CC BLOOD LOSS
BODY COMPENSATES—MASKS SYMPTOMS TACHYCARDIA, ^ RESP RATE, ANXIETY, PALE, COOL DECREASED URINARY OUTPUT INSUFFICIENT CIRCULATORY VOLUME===DEATH |
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ACUTE MANAGEMENT HYPOVOLEMIC SHOCK
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CONTROL BLEEDING & FLUID REPLACEMENT
VITAL SIGNS & PULSE OX q 5 minutes IVF REPLACEMENT, BLOOD PRODUCTS MEDICATIONS FOLEY ICU PRN |
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HEMATOMAS
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VULVAR VAGINAL RETREPERITONEAL
NOT EASILY SEEN RAPID FILLING SEVERE PAIN EXAM IN STIRRUPS ….TO OR TO DRAIN & REPAIR |
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ENDOMETRITIS
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INFECTION OF THE MUSCLE & INNER LINING
OF THE UTERUS POLYMICROBIAL FEVER, CHILLS, MALAISE FOUL SMELLING LOCHINA ANTIBIOTICS—PREVENT SPREAD OF INFECTION |
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WOUND INFECTION
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MOST COMMON—C SECTION INCISION
PAIN, REDNESS, EDEMA, SEPARATION, SEROPURULENT DRAINAGE IV ANTIBIOTICS, GOOD HANDWASHING, USUALLY OK TO BREASTFEED CHECK WITH PEDIATRICIAN |
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URINARY TRACT INFECTION
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TRAUMATIZED FROM DESCENT OF BABY
CATH DURING LABOR BLADDER, URETHA HYPOTONIC RESIDUAL URINE |
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MASTITIS
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FEELS LIKE SHE HAS THE FLU
ANTIBIOTICS CONTINUE NURSING & EMPTYING THE BREAST IF ABSCESS FORMS & RUPTURES—PUMP ONLY BEDREST, FORCE FLUIDS, SUPPORT BREASTS HOT & COLD PACKS |
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SEPTIC PELVIC THROMBOPHLEITIS
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INFECTION & BLOOD CLOTS FORM IN THE
PELVIC VENOUS SYSTEM USUALLY OCCURS IN WOMEN WITH WOUND INFECTION FEVER, PAIN, TACHYCARDIA, GI DISTRESS IV ANTIBIOTICS, ANTICOAGULANTS |
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THROMBOPHELBITIS
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THROMBUS—COLLECTION OF PLATELETS, FIBRIN,
BLOOD PRODUCTS IN A VESSEL |
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THROMBOPHELEPITIS
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–INFLAMMATION OF VESSEL
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NURSING IMPLICATIONS SIGNS & SYMPTOMS OF POST PARTUM INFECTION
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FEVER, CHILLS
PAIN OR REDNESS OF WOUNDS PURULENT WOUND DRAINAGE OR WOUND EDGES NOT APPROXIMATED TACHYCARDIA UTERINE SUBINVOLUTION ABNORMAL DURATION OF LOCHIA, FOULD ODOR ELEVATED WHITE BLOOD CELL COUNT FREQUENT OR URGENT URINATION, DYSURIA, OR HEMATURIA SUPRAPUBIC PAIN LOCALIZED AREA OF WARMTH, REDNESS, OR TENDERNESS IN THE BREASTS BODY ACHES, GENERAL MAILAISE PREVENT INFECTION GOOD HYGIENE HANDWASHING, PERICARE, BREAST CARE WOUND CARE PREVENT URINARY STASIS PROVIDE INFORMATION |
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DVT’S RISK FACTORS
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Inactivity prolonged bed rest
Obesity Cesarean Birth Sepsis Smoking History of previous thrombosis varicose veins diabetes mellitus trauma prolonged labor prolonged time in stirrups in second stage of labor maternal age older than 35 increased parity dehydration first-degree relative with thrombosis use of forceps antiphospholipid antibody syndrome inherited thrombophilias air travel |
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Homans' sign
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is a sign of deep vein thrombosis (DVT). A positive sign is present when there is pain in the calf or popliteal region with examiner's abrupt dorsiflexion of the patient's foot at the ankle while the knee is flexed to 90 degrees[1][2] This sign is frequently elicited in clinical practice because of the ease of use, although it is falling into disfavor because of poor reliability and because it is frequently positive in individuals without DVT. A positive Homans' sign does not positively diagnose DVT (poor positive predictive value), and a negative Homans' sign does not rule out the DVT diagnosis (poor negative predictive value). It is named for the American physicians Fredsen S. and John Homans.[3]
TREATMENT: BEDREST, ANTICOAGULANTS, ^ LEG MONITOR FOR BLEEDING, COMPRESSION HOSE EDUCATE RE DVT’S, MEDS, ETC |
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PULMONARY EMBOLISM
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BLOOD CLOTS OR AMNIOTIC FLUID LODGE
IN A VESSEL IN LUNGS LETHAL & SUDDEN OR SMALL: DYSPNEA, CP, TACHYCARDIA, RALES, FROTHY SPUTUM, COUGH, CYANOTIC, LOW PULSE OX |
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Postpartum Depression
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Depression during pregnancy or previous PPD (strong predictions)
First pregnancy Hormonal fluctuations that follow childbirth Medical problems during pregnancy or after birth, such as preeclampsia, preexisting, diabetes mellitus, anemia, or postpartum thyroid dysfunction. Personal or family history of depressioin, mental illness, or alcoholism personality characteristics, such as immaturity and low self esteem Marital dysfunction or difficult relationship with the significant other, resulting in lack of support Anger or ambivelence about pregnancy single status young maternal age feelings of isolation , lack social support, or support that does not meet the mothers needs fatigue, lack of sleep financial worries child care stress (infant who is ill, has anomalies, or has a difficult temperament multifetal pregnancy chronic stressors unwanted or unplanned pregnancy |
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POSTPARTUM PSYCHOSIS
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SLEEP DISTURBANCES, CONFUSTION,
AGITATION, IRRITABILITY, HALLUCINATIONS, DELUSIONS, SUICIDE, INFANT HOMOCIDE BIPOLAR DISORDER ^RISK |
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NURSING IMPLICATIONS
Postpartum Psychosis |
EARLY IDENTIFICATION
DEMONSTRATE CARING ANTICIPATORY GUIDANCE HELP MOTHER VERBALIZE FEELINGS ENHANCE SENSITIVITY TO INFANT CUES ASSIST FAMILY MEMBERS MEDICAL REFERRAL |
