THE COMPLICATED POSTPARTAL EXPERIENCE

THE COMPLICATED POSTPARTAL EXPERIENCE
Postpartum Hemorrhage
 Bleeding of 500mL of more following delivery
 Caused by uterine atony, lacerations and retained placental fragments
 Nursing interventions:
 Massage the fundus
 Monitor vital signs every 5 to 15 minutes
 Maintain asepsis
 Do pad counts
 Prepare to administer oxytocin if prescribed
 Administer fluids and monitor intake and output
Disseminated Intravascular Coagulation (DIC)
Assessment findings
 Bleeding may range from massive, unanticipated blood loss to localized bleeding (purpura and petechiae)
 Presence of special maternity problems
Interventions
 Assist with medical mgt. of underlying condition.
 Administer blood component therapy (white blood cells, packed cells, fresh frozen plasma, cryoprecipitate) as ordered.
 Observe for signs of insidious bleeding (oozing IV site, petechiae, lowered hematocrit).
 Institute nursing measures for severe bleeding /shock if needed.
 Provide emotional support to client and family as needed.
Postpartum Infection
 Any infection of the reproductive organs that occurs within 28 days of delivery or abortion
 Signs:
 Fever
 Chills
 Anorexia
 Pelvic discomfort or pain
 Vaginal discharge
 Elevated white blood cell count
Urinary tract infection (UTI)
Interventions
 Encourage high fluid intake
 Provide warm baths to relieve discomfort and promote perineal hygiene
 Administer and monitor intake of prescribed medications (antibiotics, urinary analgesics)
 Stress good bladder-emptying schedule
 Monitor for signs of premature labor from severe or untreated infection
Interventions for Postpartum Infection
 Monitor vital signs
 Make the mother comfortable as possible
 Keep the mother warm if chilled
 Encourage fluids to 3000 to 4000 mL per day if not contraindicated
 Encourage frequent voiding and monitor intake and output
 Administer antibiotics as prescribed
Interventions for Thrombophlebitis
 Avoid pressure behind the knees
 Avoid prolonged sitting
 Avoid constrictive clothing
 Avoid crossing of legs
 Never massage the legs
 Use support hose if prescribed
 Comply with an anticoagulant as prescribed
Interventions for Hematoma
 Monitor vital signs
 Place ice at the hematoma site
 Administer analgesics and antibiotics as prescribed
 Encourage fluids and voiding
 Prepare for incision and evacuation of hematoma if necessary
Mastitis
 Inflammation of the breast as a result of infection
 Primarily occurs in breast feeding mothers 2-3 weeks after delivery
 Signs:
 Localized heat and swelling
 Pain
 Elevated temperature
 Complains of flu-like symptoms
 Nursing interventions:
 Good hand washing
 Wear support bras
 Do manual expression of breast milk or use breast pump every 4 hours
 Administer pain relievers and antibiotics as prescribed