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Post Partum Hemorrhage<br />Blood loss greater than 500mL after a vaginal birth and 1000mL after a cesarean<br />Early pos...
Risk Factors<br />Multiple gestation<br />Previous history<br />Uterine infection<br />Precipitous birth<br />Manuel remov...
Etiology<br />Tone<br />Tissue<br />Trauma<br />Thrombosis<br />
TONE<br />Related to over distention<br />        multifetal<br />       macrosomia<br />       hydramnios<br />       ret...
Bimanuel massage<br />
TISSUE<br />Failure of complete separation and expulsion of the placenta does not allow the uterus to fully contract<br />...
TRAUMA<br />Any damage to the genital tract that occurs during birth either spontaneously or through manipulation<br />   ...
THROMBOSIS<br />Blood clots help to prevent postpartum hemorrhage<br />Coagulation problems:<br />             Idiopathic ...
Pathophysiology of Hemorrhage<br />
Nursing Interventions for Postpartum Hemorrhage<br />Uterine massage<br />Downward pressure to expel clots<br />Pitocin, m...
Thrombophlebitis<br />Clot within a blood vessel<br />     Superficial<br />saphenous<br />     Deep Vein Thrombosis<br />...
Nursing Interventions for Thrombophlebitis<br />Prevention<br />Education<br />Leg exercises, compression devices, elevati...
POSTPARTUM  INFECTION<br />Occurs in 8 % of all births<br />Higher incidence in cesarean births<br />Defined as:<br />    ...
ETIOLOGY<br />Staphylococcus aureus<br />Escherichia coli<br />Group A or B hemolytic streptococci<br />Chlamydia trachoma...
Metritis or Endometritis<br />Involves endometrium<br />Extension can result in parametritis which involves the broad liga...
WOUND INFECTIONS<br />Cesarean<br />Episiotomy<br />Lacerations<br />
URINARY TRACT INFECTIONS<br />
Nursing Care for UTI’s<br />Prevention<br />Hydration<br />Antibiotics<br />Gantrisin<br />
MASTITIS<br />
Nursing Interventions for Mastitis<br />Administer NSAID, antibiotics<br />Warm compresses<br />Encourage her to increase ...
Nursing Diagnosis for Post Partum Infections<br />Ineffective thermoregulation R/T bacterial invasion<br />Acute Pain R/T ...
Postpartum Emotional Disorders<br />Blues<br />Depression<br />Psychosis<br />
Postpartum Depression<br />Affects entire family<br />Early identification improves outcomes<br />Gradual onset evident by...
POSTPARTUM PSYCHOSIS<br />1:1000 births<br />Seen within 3 weeks of birth<br />Symptoms escalate to delirium, hallucinatio...
A postpartum mom is pale and states that she is bleeding heavily. The nurse should first:<br />Call the doctor STAT<br />A...
Hallucinations and expressions of suicide are indicative of:<br />Postpartum psychosis<br />Postpartum anxiety disorders<b...
Critical Thinking Exercise<br />MrsGriffen labored 12 hours in the hospital before a cesarean birth.  Her membranes ruptur...
Child Abuse and Neglect<br />Nurses are legally obligated to report ALL suspected cases of abuse and neglect<br />Abuse<br...
Fetal Demise<br />Diagnosis:<br />       no fetal heart on sonogram<br />       falling estriol levels<br />       Spaldin...
Maceration<br />
Anacephalic<br />
HydropsFetalis<br />
Domestic Violence<br />
Cycle of Violence<br />
The primary goal of intervention in working with abused women is to:<br />Set up an appt with a mental health counselor fo...
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Post Partum Hemorrhage

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Transcript of "Post Partum Hemorrhage"

  1. 1.
  2. 2. Post Partum Hemorrhage<br />Blood loss greater than 500mL after a vaginal birth and 1000mL after a cesarean<br />Early postpartum hemorrhage<br />Late postpartum hemorrhage<br />
  3. 3. Risk Factors<br />Multiple gestation<br />Previous history<br />Uterine infection<br />Precipitous birth<br />Manuel removal of placenta<br />Pitocin induction<br />
  4. 4. Etiology<br />Tone<br />Tissue<br />Trauma<br />Thrombosis<br />
  5. 5. TONE<br />Related to over distention<br /> multifetal<br /> macrosomia<br /> hydramnios<br /> retained placental fragments<br />Other causes<br /> bladder distention<br /> anesthesia<br /> tocolytics<br />
  6. 6.
  7. 7. Bimanuel massage<br />
  8. 8. TISSUE<br />Failure of complete separation and expulsion of the placenta does not allow the uterus to fully contract<br />Uterine subinvolution<br />
  9. 9. TRAUMA<br />Any damage to the genital tract that occurs during birth either spontaneously or through manipulation<br /> cesarean<br /> uterine rupture<br /> vigorous labor, pitocin induction<br /> manipulation<br /> lacerations<br />
  10. 10.
  11. 11. THROMBOSIS<br />Blood clots help to prevent postpartum hemorrhage<br />Coagulation problems:<br /> Idiopathic Thrombocytopenia Purpura<br /> von Willebrand Disease<br /> DIC<br />
  12. 12. Pathophysiology of Hemorrhage<br />
  13. 13. Nursing Interventions for Postpartum Hemorrhage<br />Uterine massage<br />Downward pressure to expel clots<br />Pitocin, methergine<br />IV line, blood transfusion<br />Pad count<br />Vitals, LOC<br />Empty bladder<br />Patient teaching<br />
  14. 14. Thrombophlebitis<br />Clot within a blood vessel<br /> Superficial<br />saphenous<br /> Deep Vein Thrombosis<br />femoral and pelvic<br />
  15. 15. Nursing Interventions for Thrombophlebitis<br />Prevention<br />Education<br />Leg exercises, compression devices, elevation, rest<br />Anticoagulants (heparin and coumadin),NSAID<br />Antiembolic stockings<br />Prevent trauma<br />Monitor for complications-Pulmonary Embolism<br />
  16. 16. POSTPARTUM INFECTION<br />Occurs in 8 % of all births<br />Higher incidence in cesarean births<br />Defined as:<br /> fever of 38 C or 100.4 F or higher after the first 24 hours after birth occurring on at least two of the first ten days postpartum<br />
  17. 17. ETIOLOGY<br />Staphylococcus aureus<br />Escherichia coli<br />Group A or B hemolytic streptococci<br />Chlamydia trachomatis<br />
  18. 18. Metritis or Endometritis<br />Involves endometrium<br />Extension can result in parametritis which involves the broad ligaments, ovaries and fallopian tubes<br />OR<br />Septic pelvic thrombophlebitis which results when infection spreads along venous routes into the pelvis<br />
  19. 19. WOUND INFECTIONS<br />Cesarean<br />Episiotomy<br />Lacerations<br />
  20. 20. URINARY TRACT INFECTIONS<br />
  21. 21. Nursing Care for UTI’s<br />Prevention<br />Hydration<br />Antibiotics<br />Gantrisin<br />
  22. 22. MASTITIS<br />
  23. 23. Nursing Interventions for Mastitis<br />Administer NSAID, antibiotics<br />Warm compresses<br />Encourage her to increase feedings<br />Increase fluids<br />Review proper breastfeeding techniques<br />
  24. 24. Nursing Diagnosis for Post Partum Infections<br />Ineffective thermoregulation R/T bacterial invasion<br />Acute Pain R/T infectious process<br />R/F impaired parental/infant attachment R/T the effects of postpartum infection<br />
  25. 25. Postpartum Emotional Disorders<br />Blues<br />Depression<br />Psychosis<br />
  26. 26. Postpartum Depression<br />Affects entire family<br />Early identification improves outcomes<br />Gradual onset evident by 6 weeks of birth<br />Antidepressants, antianxiety medications, psychotherapy<br />
  27. 27. POSTPARTUM PSYCHOSIS<br />1:1000 births<br />Seen within 3 weeks of birth<br />Symptoms escalate to delirium, hallucinations, anger toward herself and or infant, bizarre behavior, mania, thoughts of hurting herself and baby, suicide, infanticide<br />Hospitalized <br />psychotrophic drugs and psychotherapy <br />
  28. 28. A postpartum mom is pale and states that she is bleeding heavily. The nurse should first:<br />Call the doctor STAT<br />Assess fundus and voiding pattern <br />Set up IV for fluid replacement<br />Reassure her that his is a normal finding <br />
  29. 29. Hallucinations and expressions of suicide are indicative of:<br />Postpartum psychosis<br />Postpartum anxiety disorders<br />Postpartum blues<br />Postpartum depression<br />
  30. 30. Critical Thinking Exercise<br />MrsGriffen labored 12 hours in the hospital before a cesarean birth. Her membranes ruptured 6 hours before she came to the hospital. Her fetal monitor showed late decelerations so an internal monitor was inserted. Her most recent blood tests indicate that she is anemic. <br />What postpartum complications is this patient at risk for? Why?<br />What assessments need to be done to detect potential complications?<br />What nursing measures will the nurse use to prevent complications? <br />
  31. 31. Child Abuse and Neglect<br />Nurses are legally obligated to report ALL suspected cases of abuse and neglect<br />Abuse<br /> physical, mental, emotional, sexual<br />Neglect<br /> failure to meet the child’s needs<br />Munchausen Syndrome by Proxy<br />
  32. 32. Fetal Demise<br />Diagnosis:<br /> no fetal heart on sonogram<br /> falling estriol levels<br /> Spalding sign<br />Nursing Interventions<br /> listen, encourage grieving, support<br /> give opportunity to see, feel ,hold the baby<br /> offer photo, lock of hair, footprints<br /> assist with religious ceremonies<br />
  33. 33. Maceration<br />
  34. 34. Anacephalic<br />
  35. 35. HydropsFetalis<br />
  36. 36. Domestic Violence<br />
  37. 37. Cycle of Violence<br />
  38. 38. The primary goal of intervention in working with abused women is to:<br />Set up an appt with a mental health counselor for the victim<br />Convince them to leave this unsafe situation before they really get hurt<br />Help them to develop courage and financial support to leave their abuser<br />Empower them and improve their self esteem to regain control of their lives<br />

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