2. Post Partum Hemorrhage Blood loss greater than 500mL after a vaginal birth and 1000mL after a cesarean Early postpartum hemorrhage Late postpartum hemorrhage

3. Risk Factors Multiple gestation Previous history Uterine infection Precipitous birth Manuel removal of placenta Pitocin induction

4. Etiology Tone Tissue Trauma Thrombosis

5. TONE Related to over distention multifetal macrosomia hydramnios retained placental fragments Other causes bladder distention anesthesia tocolytics

7. Bimanuel massage

8. TISSUE Failure of complete separation and expulsion of the placenta does not allow the uterus to fully contract Uterine subinvolution

9. TRAUMA Any damage to the genital tract that occurs during birth either spontaneously or through manipulation cesarean uterine rupture vigorous labor, pitocin induction manipulation lacerations

11. THROMBOSIS Blood clots help to prevent postpartum hemorrhage Coagulation problems: Idiopathic Thrombocytopenia Purpura von Willebrand Disease DIC

12. Pathophysiology of Hemorrhage

13. Nursing Interventions for Postpartum Hemorrhage Uterine massage Downward pressure to expel clots Pitocin, methergine IV line, blood transfusion Pad count Vitals, LOC Empty bladder Patient teaching

14. Thrombophlebitis Clot within a blood vessel Superficial saphenous Deep Vein Thrombosis femoral and pelvic

15. Nursing Interventions for Thrombophlebitis Prevention Education Leg exercises, compression devices, elevation, rest Anticoagulants (heparin and coumadin),NSAID Antiembolic stockings Prevent trauma Monitor for complications-Pulmonary Embolism

16. POSTPARTUM INFECTION Occurs in 8 % of all births Higher incidence in cesarean births Defined as: fever of 38 C or 100.4 F or higher after the first 24 hours after birth occurring on at least two of the first ten days postpartum

17. ETIOLOGY Staphylococcus aureus Escherichia coli Group A or B hemolytic streptococci Chlamydia trachomatis

18. Metritis or Endometritis Involves endometrium Extension can result in parametritis which involves the broad ligaments, ovaries and fallopian tubes OR Septic pelvic thrombophlebitis which results when infection spreads along venous routes into the pelvis

19. WOUND INFECTIONS Cesarean Episiotomy Lacerations

20. URINARY TRACT INFECTIONS

21. Nursing Care for UTI’s Prevention Hydration Antibiotics Gantrisin

22. MASTITIS

23. Nursing Interventions for Mastitis Administer NSAID, antibiotics Warm compresses Encourage her to increase feedings Increase fluids Review proper breastfeeding techniques

24. Nursing Diagnosis for Post Partum Infections Ineffective thermoregulation R/T bacterial invasion Acute Pain R/T infectious process R/F impaired parental/infant attachment R/T the effects of postpartum infection

25. Postpartum Emotional Disorders Blues Depression Psychosis

26. Postpartum Depression Affects entire family Early identification improves outcomes Gradual onset evident by 6 weeks of birth Antidepressants, antianxiety medications, psychotherapy

27. POSTPARTUM PSYCHOSIS 1:1000 births Seen within 3 weeks of birth Symptoms escalate to delirium, hallucinations, anger toward herself and or infant, bizarre behavior, mania, thoughts of hurting herself and baby, suicide, infanticide Hospitalized psychotrophic drugs and psychotherapy

28. A postpartum mom is pale and states that she is bleeding heavily. The nurse should first: Call the doctor STAT Assess fundus and voiding pattern Set up IV for fluid replacement Reassure her that his is a normal finding

29. Hallucinations and expressions of suicide are indicative of: Postpartum psychosis Postpartum anxiety disorders Postpartum blues Postpartum depression

30. Critical Thinking Exercise MrsGriffen labored 12 hours in the hospital before a cesarean birth. Her membranes ruptured 6 hours before she came to the hospital. Her fetal monitor showed late decelerations so an internal monitor was inserted. Her most recent blood tests indicate that she is anemic. What postpartum complications is this patient at risk for? Why? What assessments need to be done to detect potential complications? What nursing measures will the nurse use to prevent complications?

31. Child Abuse and Neglect Nurses are legally obligated to report ALL suspected cases of abuse and neglect Abuse physical, mental, emotional, sexual Neglect failure to meet the child’s needs Munchausen Syndrome by Proxy

32. Fetal Demise Diagnosis: no fetal heart on sonogram falling estriol levels Spalding sign Nursing Interventions listen, encourage grieving, support give opportunity to see, feel ,hold the baby offer photo, lock of hair, footprints assist with religious ceremonies

33. Maceration

34. Anacephalic

35. HydropsFetalis

36. Domestic Violence

37. Cycle of Violence

38. The primary goal of intervention in working with abused women is to: Set up an appt with a mental health counselor for the victim Convince them to leave this unsafe situation before they really get hurt Help them to develop courage and financial support to leave their abuser Empower them and improve their self esteem to regain control of their lives