01 Nov Presentation given in 2 separate PP documents as example. 8-10 slides on PowerPoint Topic (Cover Page and Reference Page EXCLUDED) Topic: Post Partum Hemorrhage PPH Note
Presentation given in 2 separate PP documents as example.
- 8-10 slides on PowerPoint Topic (Cover Page and Reference Page EXCLUDED)
- Topic: Post Partum Hemorrhage PPH Note: I have the content
- Must use 2-3 scholarly articles from LEARN (Given when Bid accepted)
- 2-3 in-text APA Citations (Citationmachine.net)
- Turn In It score MUST be less than 20%
- Slides must include
- Etiology,
- Nursing Interventions,
- Patient Education,
- Treatment (if applicable).
- Link a video in the last page as reference
First PP colors and presentation on file
Second PP given with the content
Davis Advantage for Maternal-Child Nursing Care, Third Edition.
Chapter 12
Caring for the Woman Experiencing Complications During the Postpartal Period
Copyright ©2022 F.A. Davis Company
Copyright ©2022 F.A. Davis Company
1
Postpartum Hemorrhage
Quantify blood loss immediately after birth
Remain alert to indicators of ongoing obstetric hemorrhage
Increased heart rate
Decreased blood pressure
Decreased oxygen saturation
Evaluating blood loss
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Recognizing Additional Indicators of Hemorrhage
Early vs. late postpartum hemorrhage
Uterine atony
Trauma
Tissue
Thrombin
Collaborative management of PPH
Copyright ©2022 F.A. Davis Company
Characteristics of Postpartal Bleeding
Color of blood
Character of blood
Consistency of blood
Dark red with clots: uterine atony
Bright red without clots: lacerations from the perineum, cervix, or vagina
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Blood Loss and Vital Signs
Signs of shock may not be present
Restlessness
Anxiety
Pallor
Cool, clammy skin
Increased pulse
Tachypnea
Shaking
Decreased blood pressure
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Hematomas
Localized collection of blood under the skin
Incidence
Risk factors include genital tract lacerations, episiotomies, operative vaginal deliveries, difficult or prolonged second stage of labor, and nulliparity
Signs and symptoms
Collaborative management
Copyright ©2022 F.A. Davis Company
Thrombophlebitis and Thrombosis
Describe an inflammation of the venous circulation and blood clot formation
Typically occur in the lower extremities
Superficial venous thrombosis
Deep venous thrombosis
Pulmonary embolism
Increased risk during the postpartum period
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Recognizing Signs and Symptoms of DVT
Unilateral leg pain
Calf tenderness
Swelling
May be asymptomatic
Symptoms depend on the size, location, degree of vessel occlusion, and development of collateral circulation
Positive Homans’ sign
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Venous Thrombosis
Lab test for venous thrombosis
D-dimer
Basic chemistry test
PT and aPTT
Collaborative management
Avoiding extremity massage when DVT is suspected
Patient education
Copyright ©2022 F.A. Davis Company
Puerperal Infections
Bacterial infection that occurs within 28 hours after miscarriage, induced abortion, or childbirth
Most commonly involve
Endometrium
Operative wound
Urinary tract
Breasts
Copyright ©2022 F.A. Davis Company
Risk Factors for Puerperal Infections
Poor hygiene
Low socioeconomic status
Smoking
Malnutrition
Obesity
Comorbidities
Infections in pregnancy
Copyright ©2022 F.A. Davis Company
Prevention of Infection
Hand washing
Squeeze bottle of water to cleanse perinium
Change peripad at least every 3 to 4 hours
Drink extra fluids to increase urine production
Wash incisions with soap and water
Maintain glycemic control
Lifestyle changes
Copyright ©2022 F.A. Davis Company
Essential Information
Notify your health-care provider if you develop pain, redness, or swelling at the site of any incision.
Notify your health-care provider if you develop a fever of 100.4°F (38°C). (If you are breastfeeding, a temperature elevation to 100.4°F [38°C] may occur when your milk production begins).
Copyright ©2022 F.A. Davis Company
Mitigating Risk for Infection
Education client and family that might be at risk for infection
Postpartum and newborn visit by a registered nurse
Notify lactation consultant or breastfeeding support group, newborn’s physician, or public health nurse of events during labor
Follow up
Copyright ©2022 F.A. Davis Company
Postpartum Psychosocial Complications
Emotional, spiritual, relational, and socioeconomic concerns
May not recognize need for help
May be reluctant to ask for help
Nurse can be a lifeline for the woman experiencing postpartum psychosocial complications
Copyright ©2022 F.A. Davis Company
Postpartum Blues
Common emotional response of periods of happiness followed by periods of tearfulness
Self-limiting and resolve by 10 days postpartum
Signs and symptoms: tearfulness, mood swings, anxiety, fatigue, sadness, insomnia, forgetfulness, and confusion
Alleviating factors
Copyright ©2022 F.A. Davis Company
Postpartum Depression (PPD)
Occurs within 6 months postpartum
Significant health effect on the woman, infant, and other family members
Those with a history of PPD are more likely to experience mental health disorders
Signs and symptoms
Assessment
Collaborative management
Copyright ©2022 F.A. Davis Company
Postpartum Psychosis
Rare but severe form of mental illness
Affects not only the new mother, but also the entire family
Greatest risk in those with pre-existing psychosis
Behavioral cues that signal postpartum psychosis
Collaborative management
Copyright ©2022 F.A. Davis Company
Childbirth-Induced Post-traumatic Stress Disorder
Reaction occurring after experiencing a highly stressful event
Characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of the event
Women at risk
Screening
Copyright ©2022 F.A. Davis Company
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Mariadelmar Grajales Mirirela Montesino Yordania Portella
Postpartum hemorrhage occurs when a woman loses more than 500 mL of blood in a normal delivery and more than 1000mL of blood in a cesarean delivery within 24 hours.
The four “Ts” serve as a reminder of factors associated with PPH: tone, trauma, tissue, and thrombin.
Early vs Late PPH
An early (primary) PPH occurs within the first 24 hours after childbirth.
The blood flow to the uterus is between 500 and 800 mL/minute, and the placental site contains multiple exposed venous areas and low resistance
A late (secondary) PPH occurs from 24 hours to 12 weeks after childbirth
Late PPH occurs in only 1% to 2% of all childbearing women, usually within the first 2 weeks after birth.
Retained placental fragments are the most common cause of late PPH.
A lack of uterine tone (atony) and genital tract trauma are the most common conditions that cause PPH
Signs and Symptoms
Nursing Diagnosis
Deficient fluid volume related to excessive bleeding after birth.
Save all perineal pads used during bleeding and weigh them to determine the amount of blood loss.
Place the woman in a side lying position to make sure that no blood is pooling underneath her.
Assess lochia frequently to determine if the amount discharged is still within the normal limits.
Assess vital signs, especially the blood pressure
References
Belleza, M., & R.N. (2017, January 18). Postpartum hemorrhage: A fatal yet common complication of pregnancy. Retrieved from https://nurseslabs.com/postpartum-hemorrhage/
Postpartum hemorrhage: Causes, risks, diagnosis & treatment. (n.d.). Retrieved from https://my.clevelandclinic.org/health/diseases/22228-postpartum-hemorrhage
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