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NCM 109 Midterms - Postpartal Complications L1
NCM 109 Midterms - Postpartal Complications L1
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 5: Post-partal Complications
NURSING IMPLICATIONS: involved to approximate edges. Large lacerations
are complications that occur most often:
□ Palpate the fundus at frequent intervals to
• With difficult or precipitate deliveries
ascertain that the uterus is remaining is a state of
• In primigravidas
contraction.
• With the birth of a large infant (over 9lbs)
□ Assess vital signs and lochia per protocol and
• With the use of a lithotomy position and
observe for signs of blood loss and shock.
instruments.
□ Perform gentle but firm uterine massage while
supporting the base of the uterus to encourage
uterine involution.
CERVICAL LACERATIONS
□ Perform a perineal pad count in given lengths of
time to assess better blood loss. → are usually found on the sides of the cervix near
□ Weigh perineal pads before and after use to the branches of the uterine artery. Because it is
measure vaginal discharge more accurately. arterial bleeding, the blood seen will be brighter
□ Be prepared to administer an intramuscular red than the venous blood lost with uterine atony.
injection of methergine or a dilute intravenous Blood may gush from the vaginal opening. If the
infusion of oxytocin to help the uterus maintain cervical laceration appears to be extensive or
tone. difficult to repair, it may be necessary for the
woman to be given a regional anesthetic for
relaxation of the uterine muscle and to prevent
pain.
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 5: Post-partal Complications
RETAINED PLACENTAL FRAGMENTS
ASSESSMENT FINDINGS:
NURSING IMPLICATIONS:
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 5: Post-partal Complications
small, bleeding may not be detected until the 6th
or 10th postpartum day.
□ Perform fundal checks after births and assess for
height, consistency, and uterine bleeding.
□ Assist with dilation and curettage to remove the
retained placental fragments.
□ Instruct the client to observe her lochia discharge
at home and report any tendency for the
discharge to change from lochia alba to rubra, or Dilation of cervix and curettage to remove fragments
a sudden discharge of a large amount of blood. of the placenta from the uterine wall.
→ is incomplete return of the uterus to its → Perineal hematoma is a collection of blood in the
prepregnant size and shape. With subinvolution, subcutaneous layer of tissue of the perineum.
at a 4 or 6 weeks postpartal visit, the uterus is still → As a rule, the overlying skin is intact with no
enlarged and soft. noticeable trauma.
→ Subinvolution may result from a small retained → Such collections may be caused by injury to blood
placental fragment, a mild endometritis, or an vessels in the perineum during birth; they are
accompanying problem, such as a myoma that is most likely to occur following rapid spontaneous
interfering with complete contraction. deliveries and in women who have perineal
varicosities,
→ It may occur at an episiotomy or laceration repair
site if a vein was pricked during repair.
→ They can cause the woman acute discomfort and
concern, but, fortunately, they usually represent
only minor bleeding.
ASSESSMENT FINDINGS:
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 5: Post-partal Complications
NURSING IMPLICATIONS: NURSING IMPLICATIONS:
□ Inspect the perineal area closely for presence of □ Administer antibiotic as prescribed.
hematoma. □ Provide sitz baths or warm compress as
□ Assess its size and degree of discomfort and notify prescribed to hasten drainage and cleanse the
the physician area.
□ Administer a mild analgesic as prescribed for pain □ Instruct the client to change perineal pads
relief. frequently because they may be contaminated by
□ Apply an ice pack to help prevent further discharge; if left in place for a long time, they
bleeding. might cause vaginal contamination.
□ Be aware that if the hematoma is large when □ Teach the client to wash her hands after handling
discovered, the client may have to be returned to perineal pads to prevent transmission of infection.
the delivery to have the site incised and the □ Instruct the client to wipe from front to back after
bleeding vessel ligated. a bowel movement to prevent bringing feces
□ Advise the client that the hematoma should be forward onto the healing area.
absorbed over the next 6 weeks.
□ If the episiotomy line is open to drain the
hematoma, anticipate the line being left open and
packed with gauze; prepare for packing removal in
24 to 48 hours.
PUERPERAL INFECTIONS
ENDOMETRITIS
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 5: Post-partal Complications
ASSESSMENT FINDINGS: → Women most prone to thrombophlebitis are
those with varicose veins, those who are obese,
ʘ Elevated temperature (38ºC) for 2
those who had a previous thrombophlebitis,
consecutive 24-hour periods
women over 30 years old with increased parity
ʘ Large, tender, poorly contracted uterus
who were in a stirrups position for a longtime
ʘ Severe postpartum cramping
during birth, and those who have high incidence
ʘ Brownish, red, foul-smelling lochia
of thrombophlebitis in their family.
→ With femoral thrombophlebitis, it often occurs on
the 10th postpartum day.
→ With pelvic thrombophlebitis, it often occurs on
the 14th or 15th day of the puerperium.
→ With pelvic thrombophlebitis, an abscess may
form (necessitating incision by laparotomy), which
NURSING IMPLICATIONS: may cause tubal scarring and interfere with future
pregnancies.
□ Inspect the perineum at least twice daily for
redness, edema, ecchymosis, and discharge.
□ Assess fundal size, consistency, and tenderness
for changes indicating poor involution.
□ Evaluate for abdominal pain, fever, and malaise.
□ Assess lochia for color, quantity, and odor; report
any foul-smelling lochia.
□ Obtain culture and sensitivity of lochia.
□ Administer appropriate antibiotic as prescribed.
□ Provide additional fluid to combat fever.
□ Administer an analgesic as ordered to relieve
severe cramping and discomfort.
ASSESSMENT FINDINGS:
□ Urge the client to use Fowler’s position and
ambulation to encourage lochia drainage by Femoral Thrombophlebitis
gravity and prevent pooling of infected secretions.
ʘ Elevated temperature and chills
THROMBOPHLEBITIS ʘ Stiffness, pain and redness in the affected leg
ʘ Leg edema with shiny skin (milk leg)
→ Thrombophlebitis is inflammation of the lining of ʘ (+) Homans’ sign
a blood vessel with the formation of clots.
→ When thrombophlebitis occurs in the post-partal Pelvic Thrombophlebitis
period, it is usually an extension of an endometrial ʘ Feeling of sudden, extreme illness
infection. ʘ High fever
→ Thrombophlebitis is prone to occur in the post- ʘ Chills
partal period when blood-clotting ability is high ʘ General malaise
because of increased fibrinogen; dilation of lower ʘ Pelvic abscess
extremity veins owing to pressure of fetal head
during pregnancy and birth; and the relative NURSING IMPLICATIONS:
inactivity of the period that leads to pooling,
□ Provide prevention of endometritis and
stasis, and clotting of blood in the lower
thrombophlebitis by using good aseptic
extremities.
technique.
□ Encourage early ambulation to increase
circulation in the lower extremities and decrease
the possibility of clot formation.
□ Be certain that client does not remain in a
lithotomy and stirrups position for more than an
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 5: Post-partal Complications
hour, and be certain to pad the stirrups to prevent
any sharp pressure against the calf of the legs in
this position.
□ Provide support stockings to the postpartum
client who has varicose veins to increase venous
circulation and help prevent stasis.
□ Encourage bed rest with the affected leg elevated
for the client with femoral thrombophlebitis.
□ Obtain daily blood coagulation levels before
administering any anticoagulants.
□ Administer anticoagulants, analgesics, and
antibiotics as prescribed.
□ Apply heat applications such as heat lamp or
moist, warm compress as prescribed.
□ Obtain a record of lochia and weigh perineal pads
to assess bleeding if the client is on anticoagulant
therapy.
□ Assess for other possible bleeding signs, such as
bleeding gums, ecchymotic spots on the skin, or
oozing from an episiotomy suture line.
□ Reassure the client receiving heparin that she may
continue to breast-feed as this medication will not
be present in breast milk.
□ Be prepared to administer protamine sulfate as an
antagonist for heparin.
□ Prepare the client with pelvic thrombophlebitis
for surgery.
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