[removed]Mariadelmar GrajalesMirirela MontesinoYordani.docx

[removed]
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

https://youtu.be/SEQPKTceWp4
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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
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
Recognizing Additional Indicators of Hemorrhage
Early vs. late postpartum hemorrhage
Uterine atony
Trauma
Tissue
Thrombin
Collaborative management of PPH
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
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
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
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
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
Venous Thrombosis
Lab test for venous thrombosis
D-dimer
Basic chemistry test
PT and aPTT
Avoiding extremity massage when DVT is suspected
Patient education
Puerperal Infections
Bacterial infection that occurs within 28 hours after
miscarriage, induced abortion, or childbirth
Most commonly involve
Endometrium
Operative wound
Urinary tract
Breasts

Risk Factors for Puerperal Infections
Poor hygiene
Low socioeconomic status
Smoking
Malnutrition
Obesity
Comorbidities
Infections in pregnancy
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
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).

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
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
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

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
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
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

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CHAPTER 10
Moral Choices Facing Employees
Learning Objectives
After completing this chapter students should be able to:
to the
firm and appreciate some of the
difficult choices with which employees are faced.
-
related conflicts of interest.
and ethical framework on behalf of
their employers in ways that protect proprietary data, avoid
bribes and kickbacks, and other
perceived forms of impropriety.
challenge their employers, as well as
their rights and responsibilities if and when they believe that
wrongdoing has taken place.

third parties.
Glossary
1. conflict of interest: When someone has an interest that
conflicts with the interests of the company
and it's significant enough to have a chance of motivating
behavior that conflicts with the interests
of the company.
2. grease payments: Payments similar to bribes but intended to
get officials to do their normal job
duties rather than to do something illegal or unethical.
3. insider trading: Buying or selling stock using relevant
information that's not available to the public.
4. proprietary data: Information that isn't meant to be used
without permission, such as patents,
copyrighted data, and trade secrets. Proprietary date is meant to
give people or companies a
monopoly over the information so they benefit from their
inventions and discoveries. This is
expected to encourage people to be inventive by rewarding them
for their achievements.
5. whistle-blowing: Alerting the public of illegal or unethical
behavior done by a company by those
who work for the company or used to work for it.
Chapter Summary Points
1. The employment contract creates various obligations to one’s
employer. In addition, employees
often feel loyalty to the organization. Conflicts of interest arise
when employees have a personal

interest in a transaction substantial enough that it might
reasonably be expected to affect their
judgment or lead them to act against the interests of the
organization.
2. When employees have financial investments in suppliers,
customers, or distributors with whom
the organization does business, conflicts of interest can arise.
Company policy usually determines
the permissible limits of such financial interests.
3. Insider trading refers to buying or selling stocks based on
nonpublic information likely to affect
stock prices. Insider trading seems unfair; it can injure other
investors and undermine public
confidence in the stock market. In practice, determining what
counts as insider trading is not
always easy, but it typically involves misappropriating sensitive
information. Some writers
defend insider trading as performing a necessary and desirable
economic function.
4. Proprietary data refers to an organization’s information that
can't be used by others without
permission. Increasingly, problems arise as employees in high-
tech occupations with access to
sensitive information and trade secrets quit and take jobs with
competitors. Proprietary-data
© 2017 Cengage Learning. All rights reserved. May not be
scanned, copied or duplicated, or posted to a publicly accessible
website, in whole or in
part.
10-1

issues pose a conflict between two legitimate rights: the right of
employers to keep certain
information secret and the right of individuals to work where
they choose.
5. A bribe is payment in some form for an act that runs counter
to the work contract or the nature of
the work one has been hired to perform. The Foreign Corrupt
Practices Act prohibits corporations
from engaging in bribery overseas. Bribery generally involves
injury to individuals, competitors,
or political institutions and damage to the free-market system.
6. The following considerations are relevant in determining the
moral acceptability of gift giving and
receiving: the value of the gift, its purpose, the circumstances
under which it is given, the position
and sensitivity to influence the person receiving the gift,
accepted business practice, company
policy, and what the law says.
7. Employees have duties to their employers, and they may also
have more specific obligations based
on the business or professional roles and responsibilities they
have assumed. In addition, they
have the same elementary moral obligations that all human
beings have—including the obligation
not to injure others and to be truthful and fair.
8. Balancing our obligations to employer or organization, to
friends and coworkers, and to third
parties outside the organization can create conflicts and divided
loyalties. In resolving such moral
conflicts, we must identify the relevant obligations, ideals, and

effects and decide where the
emphasis among them should lie.
9. Whistle-blowing refers to an employee’s informing the public
about the illegal or immoral
behavior of an employer or organization. Whistle-blowers
frequently act out of a sense of
professional responsibility.
10. According to Norman Bowie, an act of whistle-blowing can
be presumed to be morally justified if
it is done from a moral motive; if the whistle-blower has, if
possible, exhausted internal channels
before going public; if the whistle-blower has compelling
evidence; if the whistle-blower has
carefully analyzed the dangers; and if the whistle-blowing has
some chance of success.
11. Prudential considerations based on self-interest can conflict
with moral considerations, which take
into account the interests of others. Some sacrifices of self-
interest would be so great that moral
considerations must give way to prudential ones. But
employees must avoid the temptation to
exaggerate prudential concerns, thereby rationalizing away any
individual moral responsibility to
third parties. Legislation and changes in corporate culture can
reduce the personal sacrifices that
whistle-blowers must make.
Other Resources
Video
Documentary by Alex Gibney

Film
Based on a true story of a big tobacco whistleblower
© 2017 Cengage Learning. All rights reserved. May not be
scanned, copied or duplicated, or posted to a publicly accessible
website, in whole or in
part.
10-2
CHAPTER 10 Moral Choices Facing Employees Learning
Objectives

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