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Similar to abnormal puerperium puerperum complication
abnormal puerperium puerperum complication
- 1. COMPLICATION & MINOR AILMENTSOF PUERPERIUM PRESENTED BY:- ANUSHREE BHUNIA ASSISTANT PROFESSOR
- 2. INTRODUCTION: Puerperium, the periodof adjustment after childbirth during which the mother’s reproductive system returns to its normal prepregnant state. triggered by a sharp drop in the levels of estrogen and progesterone produced by the placenta during pregnancy. the uterus shrinks back to its normal size and resumes its prebirth position by the sixth week.
- 3. DEFINITION • It isthe period following child birth during which all the body tissue especially pelvic organs revert back to their pre pregnant stage both anatomically and physiologically. • It has 3 types: • Immediate- within 24 hrs • Recent- within 7 days • Remote- up to the end of 6 weeks
- 4. MINOR AILMENETS OF PUERPERIUM Afterpain:- It is infrequent, spasmodic pain felt in the lower abdomen after delivery for a variable period of 2-4 days. presence of blood clots or bits after birth leads to hypertonic contraction of the uterus in an attempt to expel them out.
- 5. NURSING MANAGEMENT • Itincludes in massaging the uterus with expulsion of clots followed by administration of analgesics & antispasmodics. • Effective relief from pain by emptying bladder. • Provide a prone position with pillow under her lower abdomen.( it provides a constant pressure against her uterus ,which keeps it contracted thus eliminates after birth pains)
- 6. PAIN ON THEPERINEUM •Never forget to examine the perineum when analgesic is given to relieve pain. -Early detection of vulvo- vaginal heamtoma can thus be made.
- 7. SIGNS AND SYMPTOMS •Severe, sharp perineal pain. • Appearance of a tense, sensitive mass of varying size covered by discolored skin. • Swelling in the perineal wall. • Often seen on the opposite side of the episiotomy. • Inability to void due to pressure/edema on or around the urethra. • Complaint of fullness or pressure in the vagina.
- 8. MEDICAL TREATMENT This isconsists of analgesics given for discomfort, opening the hematoma so blood clots can be evacuated and the bleeders can be ligated, and packing for pressure.
- 9. NURSING INTERVENTIONS. • Applyice to area of hematoma. • Observe for evidence of enlarged hematoma. • Flag the patient's chart if packing was inserted. • Sitz baths (hot or cold ) can give additional relief.
- 11. DEFINITION AN INFECTION OFTHE GENITAL TRACT WHICH OCCURS AS A COMPLICATION OF DELIVERY.
- 12. PREDISPOSING FACTORS ANTEPARTUM FACTORS:- Malnutrition& anemia Pre-eclampsia Pre mature rupture of membranes Chronic debilitating illness Sexual intercourse
- 13. INTRAPARTUM FACTORS • Sepsisduring internal examination • Dehydration & keto-acidosis • Traumatic operative delivery • Hemorrhage • Placenta praevia
- 14. INVESTIGATIONS collect the history clinicalexamination investigations include- urine culture blood culture vaginal swabs for culture
- 15. MEDICAL TREATMENT: •Ampicillin 500mg,I/M •Gentamycin 3-5 mg/kg body weight •Cefuroxime 750 mg,I/V •Metronidazole 0.5 gm,I/V
- 16. PROPHYLAXIS NURSING MANAGEMENT Certain measuresare undertaken before, during and postpartum period. Antenatal period- To detect and eradicate the septic focus. To maintain or improve the health status like hemoglobin level, prevent preeclampsia. Should take care about personal hygiene.
- 17. CONTD….. Intranatal period The deliveryshould be conducted taking full surgical asepsis. The patient is instructed not to touch the vulva during labour. Excessive blood loss should be replaced promptly. Prophylactic antibiotics.
- 18. Cont……. •Use caps, mask,gowns, and gloves when working in delivery rooms. • Use sterilized equipment within control dates. •Wash hands meticulously (staff). •Correct breaks in sterile techniques immediately. •Limit unnecessary vaginal exams during labor which increases the chances of introducing organisms from the rectum and vagina into the uterus.
- 19. POSTPARTUM PERIOD • Asepticprecautions should be taken during perineal care. • Too many visitors should not be allowed. • Sterilized pads should be used and changed. • Instruct the patient on hand washing and cleansing her perineum from front to back. • Restrict personnel with respiratory infections from working with patients. • Early ambulation postpartum. • Daily evaluation of fundal height to document involution
- 20. Nursing Care ofPuerperal Infection. -Isolation, if possible, the removal of the patient from the maternity ward. -Meticulous hand washing. -Patient placed in Fowler's position to facilitate drainage. -Reeducation of the patient on handwashing and peri-care. -Emotional support since the patient may be prevented from rooming in with her infant while her temperature is elevated. -Check the vital signs. -Maintain the fluid intake and output. -Anemia should be corrected by blood transfusion. -Sufficient rest is enforced by analgesics and sedatives.
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- 22. DEFINITION An elevation oftemperature to 38˚c (100.4˚f) or more occurring on two separate occasions at 24 hours apart (excluding the first 24 days ) following delivery is called puerperal sepsis.
- 23. CAUSES • Puerperal sepsis •Urinary tract infection: cystitis, pyelonephritis. • Breast infection • Infection of laparotomy wound (caesarean section) • Intercurrent infection : acute bronchitis, pneumonia, influenza, acute appendicitis & enteric fever
- 24. NURSING MANAGEMENT • Isolation,. •Hand washing. • Patient placed in fowler's position to facilitate drainage. • education of the patient on handwashing and peri-care. • Emotional support. • Check the vital signs. • Maintain the fluid intake and output. • Sufficient rest is enforced by analgesics and sedatives.
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- 26. DEFINITION • Sub involutionof uterus is impaired and deficient involution of the uterus following delivery • When the uterus is not reverted back to the pre-pregnant both anatomically & physiology.
- 27. CAUSES • Predisposing factors •Grand multiparity • Over-distention of uterus as in twins & hydromnios • Maternal ill health • Cesarean section • Prolapse of the uterus • Uterine fibroids • No sucking of the baby
- 28. CLINICAL FEATURES • Excessiveor prolonged discharge of lochia • Irregular or excessive uterine bleeding • Irregular cramp like pain • Uterine height more than normal for the particular day of post partum
- 29. MANAGEMENT • Sub involutionis managed by treating the causes. • Antibiotics for sepsis. • Exploration of the uterus for retained products. • pessary( Supportive device) in prolapse or retroversion. • Early ambulation postpartum. • daily evaluation of fundal height to document involution.
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- 33. INVERTED NIPPLES DEFINITION- It isa condition in which nipple instead of pointing outwards get retracted into the breast.
- 34. METHODS- • Use ofbreast pump. • Hospital grade electric pump. • Use of nipple shield. • Frequent stimulation
- 35. CONT.. OTHER METHODS- • Plasticsurgery • Nipple piercing • Regular stimulation • Suction cups or clamps • Homemade nipple protractor.
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- 38. CRACKED NIPPLES DEFINITION- It isa condition in which there is loss of surface epithelium with the formation of raw area on the nipple along with fissure situated either at the tip or of the base of nipple.
- 39. CAUSE: Improper hygiene resultingin crust formation, retracted nipples, trauma due to incorrect breast feeding. SYMPTOMS- Painful breast feeding, it may progress to mastitis. PROPHYLAXIS- Maintaining hygiene. TREATMENT- Correct attachment of infant, purified lanonin application(3-4 times), usage of breast pump and shields(if severe), application of miconazole lotion, biopsy.
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- 41. MASTITIS DEFINITION- It isthe inflammation of parenchyma of the mammary gland TYPES- PATHOGENS- Staphylococcus, Streptococcus, gram negative bacilli such as Escherichia coli, Salmonella, Mycobacterium, Candida, Cryptococcus (rarely) PUERPERAL MASTITIS NON PUERPERAL MASTITIS
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- 43. CONT… CAUSES- PUERPERAL MASTITIS BLOCKED MILKDUCTS MILK EXCESS CRACKED NIPPLES TIGHT CLOTHING MICROORGANISM TRANSFERENCE BY PATIENT AND INFANT. CAUSES- NON PUERPERAL MASTITIS HYPERPROLACTINEMIA THYROID DISORDERS BREAST TRAUMA, SURGERY NIPPLE PIERCING MEDICATIONS .
- 44. CONT… SYMPTOMS PUERPERAL MASTITIS TOUGH, DOUGHY TEXTURE DULLTO SEVERE PAIN FLU-LIKE SYMPTOMS ABSCESS (RARE) SYMPTOMS NON PUERPERAL MASTITIS REDNESS, SWELLING DIFFUSED TENDERNESS, PAIN HOT SPORTS ABSCESS NIPPLE DISCHARGE.
- 45. TREATMENT PUERPERAL MASTITIS BREAST FEEDING. USEOF SUCTION DEVICES HEAT APPLICATION (PRIOR TO FEEDING) COLD COMPRESSES (SEVERE) ANTIBIOTICS TREATMENT NON PUERPERAL MASTITIS SYMPTOMATIC MANAGEMENT BROAD SPECTRUM ANTIBIOTICS.
- 46. BREAST ENGORGEMENT DEFINITION- Itis a condition which occurs in mammary glands by expanding veins and the pressure of new breast milk contained with in them. CAUSE- It is due to exaggerated normal venous and lymphatic engorgement of breasts which precedes lactation.it involves primiparous women and women with inelastic breast.
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- 48. CONT…. SYMPTOMS- Pain, feelingof heaviness, generalized malaise, transient rise of temperature, painful breast feeding. PREVENTION- To avoid prelacteal feeds, to initiate early and unrestricted breast feeding, exclusive breast feeding on demand, feeding in correct position.
- 49. CONT… MANAGEMENT -To support thebreast with brassiere -Mannual expression of any remaining milk after each feed -To administer analgesics for pain -Put baby on breast feed regularly and at frequent intervals -Gentle use of breast pump (if severe)
- 50. FAILING LACTATION CAUSES:- • Debilitatingstate of the mother • Early primigravidae • Failure to suckle the baby regularly • Depression or anxiety state in the puerperium • Apprehension to nursing • Premature baby, who is too weak to suck • Painful breast lesions
- 51. MANAGEMENT ANTENATAL • Education regardingthe advantages of breast feeding • Correction of abnormalities like retracted nipples • Breast hygiene • Improving the general health status of mother
- 52. CONT… POSTNATAL • Encourage adequatefluid intake • Nurse the baby regularly • Treat painful lesions promptly • Express residual milk after each feeding • Drugs like thyroid extract or prolactin are useful.
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