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LaceraLlon PemaLoma
MosL common slLes of laceraLlon are
erlneum vaglna cervlx and Lhe area around Lhe ureLhral meaLus
lf Lhe fundus ls flrm buL bleedlng ls excesslve
laceraLlons of Lhe cervlx or blrLh canal maybe resenL
concealed bleedlng hemaLoma
Assess
for dee severe elvlc or recLal aln
vlLal slgns or skln changes suggesL hemorrhage buL excesslve bleedlng ls noL obvlous
Assess vulva for bulglng masses or dlscoloraLlon of Lhe skln
SublnvoluLlon of Lhe uLerus
refers Lo a slowerLhanexecLed reLurn of Lhe uLerus Lo lLs nonregnanL slze
uLerus descends aL Lhe raLe of aroxlmaLely 1 cm or one flngerbreadLh/ day
non alable by 2 weeks
LndomeLrlal llnlng has sloughed off
SlLe of lacenLal aLLachmenL ls healed aL 6 weeks
mosL common causes
reLalned lacenLal fragmenLs
elvlc lnfecLlon
5lqos to wotcb oot
rolonged lochla
lrregular or excesslve uLerlne bleedlng
someLlmes rofuse hemorrhage
elvlc aln or feellngs of elvlc heavlness
backache faLlgue and erslsLenL malalse
1herapeut|c Management
correcL Lhe cause of sublnvoluLlon
Cral meLhylergonovlne maleaLe (MeLherglne)
AnLlmlcroblal Lheray
-urs|ng Cons|derat|ons
Leach Lhe moLher and her famlly how Lo assess for Lhe
condlLlon and how Lo recognlze lLs occurrence
demonsLraLe how Lo alaLe Lhe fundus
how Lo esLlmaLe fundal helghL ln relaLlon Lo Lhe umblllcus
AssessmenL of normal lochlal flow duraLlon

Metritis
ectios o the uterus
so coed edometritis edomyometritis edoporometritis
tiooqy
coused by orqoisms thot ore ormo ihobitots o the voqio od cervix
Orqoisms most ote oud icude qroup 8 streptococcieterococci scherichio coi
kebsieo peumoioe
Proteus 8octeroides od Prevoteo
chomydio trochomotis ossocioted with ote oset iectio



fever chllls malalse anorexla
abdomlnal aln and Cramlng
uLerlne Lenderness urulenL foulsmelllng lochla
Lachycardla and sublnvoluLlon
S Sx occur wlLhln Lhe flrsL 24 Lo 48 hours afLer dellvery LaboraLory daLa may conflrm Lhe
dlagnosls
conLlnued elevaLlon of leukocyLes
urlne seclmen obLalned Lhrough sLralghL caLheLer


troveous odmiistrotio of anLlbloLlcs
roadsecLrum anLlbloLlcs such as cllndamycln lus genLamlcln
Amlclllln cehalosorlns and meLronldazole
CLher drugs lnclude anLlyreLlcs for fever and oxyLoclcs such as meLhylergonovlne
woud ectio
any break ln Lhe skln or mucous membrane rovldes
a orLal for bacLerla
mosL common slLes
cesarean surglcal lnclslons Lhe erlneum where elsloLomles and laceraLlons are common and
Lhe vaglna


Moiestotios
5iqs o woud iectio
demo warmLh redness Lenderness aln
edges of Lhe wound may ull aarL and serourulenL dralnage may be resenL
fever and malalse
1heropeutic Mooqemet
nc|s|on and dra|nage of Lhe affecLed area
roadsecLrum anLlbloLlcs
Analgeslcs
warm comresses or slLz baLhs
Nursiq cosiderotios
woud iectios ore poiu and annoylng Lo Lhe moLher ouL of roorLlon Lo Lhelr slze
erlneal lnfecLlons cause dlscomforL durlng many acLlvlLles
such as walklng slLLlng or defecaLlng
Wound lnfecLlons may requlre readmlLLance Lo Lhe hoslLal
1each moLher abouL slLz baLhs warm comresses and frequenL roer erlneal care
Cood handwashlng Lechnlques
AdequaLe fluld lnLake and dleL
AcLlvlLy may be modlfled deendlng on Lhe slLe severlLy and LreaLmenL of Lhe wound lnfecLlon
AnLlclaLory guldance
slde effecLs of medlcaLlon slgns of worsenlng condlLlon selfcare measures and Lhe lmorLance
of handwashlng




uriory 1roct ectios
tiooqy
1raumat|zed b|adder urethra
nsert|on of catheter
Dr|nary stas|s retent|on
es|dua| ur|ne ref|ux of ur|ne
commo couse
Collform bacLerla such as coll
Moiestotios
ymptoms typ|ca||y beg|n on the 1st or 2nd osLarLum day
dysurla urgency and frequency of urlnaLlon
A lowgrade fever
uer urlnary LracL lnfecLlon such as yelonehrlLls may develo on Lhe 3rd or 4Lh day
wlLh chllls slklng fever cosLoverLebral angle Lenderness flank aln and nausea and vomlLlng
1heropeutic Mooqemet
u1l can be LreaLed wlLh anLlbloLlcs on an ouLaLlenL basls
osLarLum woman ls only moderaLely lll LreaLed wlLh oral anLibiotic
Nursiq cosiderotios
MoLher should be lnsLrucLed Lo Lake Lhe medlcaLlon for Lhe enLlre Llme lL ls rescrlbed and noL
Lo sLo when symLoms abaLe
lncrease oral fluld lnLake aL leasL 3000 ml of fluld each day
Acldlfy urlne such as arlcoL lum rune or cranberry [ulces
an lnfecLlon of Lhe lacLaLlng breasL
occurs durlng Lhe 2nd and 3rd weeks afLer chlldblrLh
lL usually affecLs only one breasL

tiooqy
ote coused by 5tophyococcus oureus
carrled on Lhe hands of Lhe moLher or agency sLaff or ln Lhe mouLh of Lhe newborn Lo Lhe
ln[ured area of Lhe nlle crack or bllsLer
LngorgemenL and sLasls of mllk
bra LhaL ls Loo LlghL
moLher who ls faLlgued or sLressed
WlLh healLh roblems LhaL mlghL lower her lmmune
sysLem
Moiestotios
itio symptoms moy be uike with faLlgue and achlng muscles
fever of 384 C (1011 l) or hlgher chllls malalse and
Peadache
locallzed area of redness and lnflammaLlon
1heropeutic Mooqemet
tibiotic theropy
cotiued emLylng of Lhe breasL
WlLh early anLlbloLlc LreaLmenL masLlLls usually resolves wlLhln 24 Lo 48 hours
AroxlmaLely 3 of women develo a breasL abscess whlchls LreaLed wlLh surglcal dralnage
and anLlbloLlcs
allcaLlon of heaL or lce acks breasL suorL and analgeslcs
conLlnue Lo breasLfeed from boLh breasLs
a breasL um can be used
8egular emLylng of Lhe breasL ls lmorLanL ln revenLlng abscess formaLlon
lsconLlnue lf abscess ruLures breasLfeedlng on LhaL slde should be dlsconLlnued

Nursiq cosiderotios
lscharge lan
rovlde lnformaLlon for revenLlon
Measures Lo revenL masLlLls
correcL oslLlonlng of Lhe lnfanL
avoldlng nlle Lrauma
mllk sLasls
moLher should breasLfeed every 2 Lo 3 hours
avold formula sulemenLs and nlle shlelds
change nurslng ads as ofLen as needed
avold conLlnuous ressure on Lhe breasLs from LlghL bras or lnfanL carrlers
hel Lhe moLher malnLaln lacLaLlon
MolsL heaL shower or hoL acks before feedlng or umlng Lhe breasLs
Cold acks Lo reduce edema
llnlsh Lhe enLlre course of anLlbloLlcs
1he breasL should be comleLely emLled aL each feedlng
reasLfeed or um every 11/2 Lo 2 hours
Massage over Lhe affecLed area
sLay ln bed durlng Lhe acuLe hase of her lllness
lncrease fluld lnLake aL abouL 3000 ml/day
Analgeslcs




1nM8M8C DD
5opetflclol veooos tbtombosls Jeep veooos tbtombosls ooJ polmoooty embollsm
tloloqy
Ienous sLasls
ypetcooqolotloo
looJ vessel lojoty
loctors 1hot creose the kisk or 1hrombosis
lnacLlvlLy
CbeslLy
Cesarean blrLh
Smoklng
PlsLory of revlous Lhrombosls
Iarlcose velns
labeLes melllLus
rolonged Llme ln sLlrrus ln second sLage of labor
MaLernal age older Lhan 33 years
arlLy greaLer Lhan 3
uperf|c|a| Venous 1hrombos|s
Moiestotios
ofLen seen ln assoclaLlon wlLh varlcose velns usually llmlLed Lo Lhe calf area
Slgns symLoms
swelllng of Lhe lnvolved exLremlLy
redness Lenderness and warmLh
wlLh alable enlarged hardened veln
aln when walklng
1heropeutic Mooqemet
ooqesics rest od eostic support
evotio o the ower extremity
worm pocks
couroqe mother to moy ombuote qroduoy
ovoid stodiq or oq periods
cotiue to weor support hose
ueep veous 1hrombosis
5iqs od symptoms o deep veous thrombosis ore ote obset or diuse
preset it is coused by o iommotory
process od obstructio o veous retur
Leq sweiq {more tho 2 cm orqer tho the opposite co%
erythemo heot
1ederess
demo
positive nomos siq
Mik eq eq to becomes poe coo to the touch with decreosed periphero puses
poi o ombuotio chis qeero mooise
od stiess o the oected eq
uioqostic vouotio
uioqostic vouotio
utrosooqrophy o the deep veis o the upper eqs
Moqetic resooce imoqiq {Mk% moy be used or pevic veis
veoqrophy
1heropeutic Mooqemet
Prevetiq 1hrombus lormotio
wome with history o uv1 or Pumoory mboism
they moy be poced o prophyoctic hepori
nepori is discotiued duriq obor od birth od resumed 4 to 12 hours oter chidbirth
uuriq chidbirth stirrups shoud be podded to prevet prooqed pressure oqoist the
popiteo oqe duriq the secod stoqe o obor
possibe decreose the time i stirrups to o more tho 1 hour
mbuotio roqeomotio qete eq exercise
void shorp exio o kess
tiemboism stockiqs { with history%
itio 1reotmet
bed rest with the oected eq eevoted
ombuote qroduoy with eostic bodoqe i with o symptoms
ticooquot theropy
Moitor ctivoted portio thromboposti
ooqesics
otibiotic theropy os ecessory
Moist heot