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Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
Post Partum Hemorrhage
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Post Partum Hemorrhage

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  • 1.
  • 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. Risk Factors<br />Multiple gestation<br />Previous history<br />Uterine infection<br />Precipitous birth<br />Manuel removal of placenta<br />Pitocin induction<br />
  • 4. Etiology<br />Tone<br />Tissue<br />Trauma<br />Thrombosis<br />
  • 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.
  • 7. Bimanuel massage<br />
  • 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. 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.
  • 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. Pathophysiology of Hemorrhage<br />
  • 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. Thrombophlebitis<br />Clot within a blood vessel<br /> Superficial<br />saphenous<br /> Deep Vein Thrombosis<br />femoral and pelvic<br />
  • 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. 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. ETIOLOGY<br />Staphylococcus aureus<br />Escherichia coli<br />Group A or B hemolytic streptococci<br />Chlamydia trachomatis<br />
  • 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. WOUND INFECTIONS<br />Cesarean<br />Episiotomy<br />Lacerations<br />
  • 20. URINARY TRACT INFECTIONS<br />
  • 21. Nursing Care for UTI’s<br />Prevention<br />Hydration<br />Antibiotics<br />Gantrisin<br />
  • 22. MASTITIS<br />
  • 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. 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. Postpartum Emotional Disorders<br />Blues<br />Depression<br />Psychosis<br />
  • 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. 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. 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. Hallucinations and expressions of suicide are indicative of:<br />Postpartum psychosis<br />Postpartum anxiety disorders<br />Postpartum blues<br />Postpartum depression<br />
  • 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. 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. 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. Maceration<br />
  • 34. Anacephalic<br />
  • 35. HydropsFetalis<br />
  • 36. Domestic Violence<br />
  • 37. Cycle of Violence<br />
  • 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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