Module 3 Postpartum Complications
Module 3 Postpartum Complications
Module 3 Postpartum Complications
I. CYSTITIS
- An infection on the bladder
ASSESSMENT
5. Fever
6. Proteinuria, hematuria, bacteriuria, white blood cells in the urine
INTERVENTIONS
1. Palpate bladder for distention.
2. Palpate fundus.
3. Obtain urine specimen for culture and sensitivity if prescribed.
4. Institute measures to assist the client to void. Encourage frequent and complete
emptying of the bladder.
5. Encourage frequent and complete emptying of the bladder.
6. Force fluids to 3000 mL per day.
7. Administer antibiotics as prescribed after the urine culture is obtained.
8. Instruct the client in the methods of prevention and treatment of cystitis.
II. HEMATOMA
1. Hematoma is a localized collection of blood into the tissues of the reproductive sac
after the delivery.
2. Predisposing conditions include operative delivery with forceps and injury to a
blood vessel.
- The use of an epidural anesthesia, prolonged second stage of labor, and forceps
delivery are predisposing factors for hematoma formation, and a collection of up
to 500 ml of blood can occur in the vaginal area. Immediate action for such
condition is- surgery to stop the bleeding.
3. Hematoma can be a life-threatening condition.
ASSESSMENT
INTERVENTIONS
1. Monitor vital signs, (unusual changes may indicate the presence of hematoma).
2. Monitor client for abdominal pain, especially when forceps delivery has occurred.
3. Place ice at the hematoma site.
4. Administer analgesic as prescribed.
5. Monitor intake and output.
6. Encourage fluid and voiding.
7. Prepare for urinary catheterization if the client is unable to void.
8. Administer blood products as prescribed.
9. Monitor for signs and infection, such as increased temperature, pulse rate, and
white blood cell count.
10. Administer antibiotics as prescribed because infection is common following
hematoma formation.
11. Prepare for incision and evacuation of hematoma if necessary.
III. HEMORRHAGE
- Bleeding of 500 mL or more following delivery.
ASSESSMENT
1. Early
a. Hemorrhage occurs during the first 24 hours after delivery.
- It may lead to hypovolemia; IMMEDIATE NSG ACTIONS would be: Assess for
hypovolemia and notify the physician.
- S/Sx of hypovolemia include cool, clammy skin, pale skin, sensation of anxiety or
impending doom, restlessness, and thirst. WHEN THESE SYMPTOMS are
present, the nurse should further assess for hypervolemia and notify the health
care provider
b. hemorrhage is caused by uterine atony, lacerations, or inversion of the uterus.
2. Late
a. Hemorrhage occurs after the first 24 hours following delivery.
b. hemorrhage is caused by retained placental fragments.
INTERVENTIONS
- In assessing the client in the fourth stage of labor: if the fundus is firm but that
bleeding is excessive, THE INITIAL NSG ACTION is to notify the physician.
IV. INFECTION
- Any infection of the reproductive organs that occurs within 28 days of delivery
or abortion.
ASSESSMENT
1. Fever
2. Chills
3. Anorexia
4. Pelvic discomfort or pain
5. Vaginal discharge
6. Elevated white blood cell count.
INTERVENTION
1. Monitor vital signs and temperature every 2 to 4 hours.
2. Make the mother as comfortable as possible; position the mother for comfort and to
promote drainage.
3. Keep the mother warmed if chilled.
4. Isolate the baby from the mother only if the mother can infect the baby.
5. Provide nutritious, high-calorie, protein diet.
6. Encourage fluids to 3000 to 4000 mL per day, if not contraindicated.
7. Encourage frequent voiding and monitor intake and output.
8. Monitor culture results if cultures were prescribed.
9. Administer antibiotics according to organism, as prescribed.
V. PULMONARY EMBOLISM
ASSESSMENT
VI. SUBINVOLUTION
VII. THROMBOPHLEBITIS
Precipitating factors
blood clotting abnormality-increased fibrinogen
dilated veins
pooling (accumulation of blood in the parts of the venous system.)
stasis and clotting of blood in LEG-prolonged in stirrups
TYPES
SUPERFICIAL
- Severe chills
- Dramatic body temperature changes
- Occurrence of pulmonary embolism may be the first sign.
INTERVENTION
10.Pelvic thrombophlebitis
a. Provide bed rest.
b. Administer analgesic as prescribed.
c. Administer antibiotics if prescribed.
d. Prepare to administer heparin sodium intravenously.
VIII. Endometritis
- Inflammation of the lining of the uterus – endometrium,
often at the site of placental implantation.
Assessment:
1. 3rd or 4th day puerperium
2. Chills
3. Loss of appetite
4. WBC: 20,000 – 30,000
5. General body malaise
6. Abdominal tenderness
7. “Boggy” uterus
8. Temperature over 38OC
9. Strong after pains
10. Lochia – dark brown, foul
Nursing Management:
IX. Peritonitis
inflammation of the peritoneal cavity- it happens when the
thin layer of tissue inside the abdomen becomes inflamed,
the tissue layer is called the peritoneum. it usually happens
due to an infection from bacteria or funji.
extension of endometritis
1/3 of all post partal deaths
spread thru lymphatic system
abcess formed in the Cul-de-Sac of Douglas – the lowest point
of the peritoneal cavity
Assessment:
Signs/Symptoms:
- rigid abdomen
- abdominal pain
- high fever
- rapid pulse
- nausea and vomiting
Management
X. Mastitis
- inflammation of the breast as result of infection.
- Mastitis primary occurs in breast-feeding mothers 2 to 3 weeks after
delivery but may occur at any time during lactation/ breastfeeding.
- pathologic organisms coming from infant’s nasal-oral
cavity(staphylococcal/streptococcal) enter cracked nipples (tissues)
milk good culture media
- S/S: scanty BM, high fever, mastitis (unilateral)
ASSESSMENT
Management:
9. Breastfeeding can be continued if the breasts are not too sore. (other
breast and keep other breast empty to prevent bacterial growth),.
13. Assure client that this is not breast cancer a permanent disease;
XI. Salpingitis
- inflammation of the fallopian tubes.
- Is a common cause of female infertility because it can
damage the fallopian tube.
Assessment:
1.Sudden abdomino-pelvic pain; tenderness, pressure
2. vaginal discharges
3.fever; malaise
Diagnostic:
I.Gram staining or secretions from endocervix or cul-de-sac
II.Ultrasound
III.Culdocentesis
Dystocia
Difficult labor(placenta, cord, membranes, and amniotic fluid)
Refers to any labor which does not advance normally