The Postpartal Family at Risk
Assessment of Postpartum
Hemorrhage
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Fundal height and tone
Vaginal bleeding
Signs of hypovolemic shock
Development of coagulation problems
Signs of anemia
Prevention of
Postpartum Hemorrhage
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Adequate prenatal care
Good nutrition
Avoidance of traumatic procedures
Risk assessment
Early recognition and management of
complications
Causes of Postpartum
Hemorrhage
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Uterine atony
Lacerations of the genital tract
Episiotomy
Retained placental fragments
Vulvar, vaginal, or subperitoneal
hematomas
Causes of Postpartum
Hemorrhage (continued)
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Uterine inversion
Uterine rupture
Problems of placental implantation
Coagulation disorders
Nursing Interventions
• Uterine massage if a soft, boggy uterus is
detected
• Encourage frequent voiding or catheterize
the woman
• Vascular access
• Assess abnormalities in hematocrit levels
• Assess urinary output
• Encourage rest and take safety
precautions
Bimanual Compression
Manual Removal of the Placenta
Nursing Diagnoses:
Postpartum Hemorrhage
• Health-seeking Behaviors related to lack
of information about signs of delayed
postpartal hemorrhage
• Fluid Volume Deficit related to blood loss
secondary to uterine atony, lacerations,
hematomas, coagulation disorders, or
retained placental fragments
Self-Care Measures:
Postpartum Hemorrhage
• Fundal massage, assessment of fundal height
and consistency
• Inspection of the episiotomy and lacerations if
present
• Report:
– Excessive or bright red bleeding, abnormal clots
– Boggy fundus that does not respond to massage
– Leukorrhea, high temperature, or any unusual pelvic
or rectal discomfort or backache
Prevention of Infection
• Good perineal care
• Hygiene practices to prevent
contamination of the perineum
• Thorough handwashing
• Sitz baths
• Adequate fluid intake
• Diet high in protein and vitamin C
Community Based Care:
Postpartum Hemorrhage
• Clear explanations about condition and the
woman’s need for recovery
• Rise slowly to minimize orthostatic
hypotension
• Woman should be seated while holding
the newborn
• Encourage to eat foods high in iron
• Continue to observe for signs of
hemorrhage or infection
Endometritis
Nursing Diagnoses:
Puerperal Infection
• Risk for Injury related to the spread of infection
• Pain related to the presence of infection
• Deficient Knowledge related to lack of
information about condition and its treatment
• Risk for Altered Parenting related to delayed
parent-infant attachment secondary to woman’s
pain and other symptoms of infection
Self-Care Measures:
Puerperal Infection
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Activity and rest
Medications
Diet
Signs and symptoms of complications
Importance of completion of antibiotic
therapy
Community Based Care:
Puerperal Infection
• May need assistance when discharged
from the hospital
• May need a referral for home care
services
• Instruct family on care of the newborn
• Instruct mother about breast pumping to
maintain lactation if she is unable to
breastfeed
Mastitis
Mastitis
Breast Problems
Community Based Care:
Mastitis
• Home care nurse may be the first to
suspect mastitis
• Obtain a sample of milk for culture and
sensitivity analysis
• Teach mother how to pump if necessary
• Assist with feelings about being unable to
breastfeed
• Referral to lactation consultant or La
Leche League
Thromboembolic Factors
Vitamin K Foods
Nursing Diagnoses:
Thromboembolic Disease
• Pain related to tissue hypoxia and edema
secondary to vascular obstruction
• Risk for Altered Parenting related to decreased
maternal-infant interaction secondary to bed rest
and intravenous lines
• Altered Family Processes related to illness of
family member
• Deficient Knowledge related to self-care after
discharge on anticoagulant therapy
Community Based Care:
Thromboembolic Disease
• Instruct family members on care of mother
and newborn
• Referral for home care if necessary
• Provide resources for follow-up or
questions
• Teach all families to observe for signs and
symptoms
Postnatal Depression
Assessment of Postpartum
Psychiatric Disorders
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Depression scales
Anxiety and irritability
Poor concentration and forgetfulness
Sleeping difficulties
Appetite change
Fatigue and tearfulness
Prevention of Postpartum
Psychiatric Disorders
• Help parents understand the lifestyle changes
and role demands
• Provide realistic information
• Anticipatory guidance
• Dispel myths about the perfect mother or the
perfect newborn
• Educate about the possibility of postpartum
blues
• Educate about the symptoms of postpartum
depression
Nursing Diagnoses:
Postpartum Psychiatric Disorder
• Ineffective Individual Coping related to
postpartum depression
• Risk for Altered Parenting related to
postpartal mental illness
• Risk for Violence against self (suicide),
newborn, and other children related to
depression
Self-Care: Postpartum
Psychiatric Disorders
• Signs and symptoms of postpartum
depression
• Contact information for any questions or
concerns
Community Based Care:
Postpartum Psychiatric Disorders
• Foster positive adjustments in the new
family
• Assessment of maternal depression
• Teach families symptoms of depression
• Give contact information for community
resources
• Make referrals as needed
Assessment of Infection:
REEDA Scale
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R: redness
E: edema
E: ecchymosis
D: discharge
A: approximation
Assessment of Infection
(continued)
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Fever
Malaise
Abdominal pain
Foul-smelling lochia
Larger than expected uterus
Tachycardia
Assessment of Overdistention
of the Bladder
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Large mass in abdomen
Increased vaginal bleeding
Boggy fundus
Cramping
Backache
Restlessness
Prevention of Bladder
Overdistension
• Frequent monitoring of the bladder
• Encourage spontaneously voiding
• Assist the woman to a normal voiding
position
• Provide medication for pain
• Perineal ice packs
Nursing Diagnoses:
Bladder Distention
• Risk for Infection related to urinary stasis
secondary to overdistention
• Urinary Retention related to decreased
bladder sensitivity and normal postpartal
diuresis
Assessment of Cystitis
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Frequency and urgency
Dysuria
Nocturia
Hematuria
Suprapubic pain
Slightly elevated temperature
Prevention of a UTI
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Good perineal hygiene
Good fluid intake
Frequent emptying of the bladder
Void before and after intercourse
Cotton underwear
Increase acidity of the urine
Nursing Diagnoses: UTI
• Pain with voiding related to dysuria
secondary to infection
• Health-seeking Behaviors related to need
for information about self-care measures
to prevent UTI
Self-Care Measures: UTI
• Good perineal hygiene
• Maintain adequate fluid intake
• Empty bladder when she feels the urge to
void or at least every 2-4 hours while
awake
Assessment of Mastitis
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Breast consistency
Skin color
Surface temperature
Nipple condition
Presence of pain
Prevention of Mastitis
• Proper feeding techniques
• Supportive bra worn at all times to avoid
milk stasis
• Good handwashing
• Prompt attention to blocked milk ducts
Nursing Diagnoses: Mastitis
• Health-seeking Behaviors related to lack
of information about appropriate
breastfeeding practices
• Ineffective Breastfeeding related to pain
secondary to development of mastitis
Self-Care Measures: Mastitis
• Importance of regular, complete emptying
of the breasts
• Good infant positioning and latch-on
• Principles of supply and demand
• Importance of taking a full course of
antibiotics
• Report flu-like symptoms
Assessment of
Thrombophlebitis
• Homan’s sign
• Pain in the leg, inguinal area, or lower
abdomen
• Edema
• Temperature change
• Pain with palpation
Prevention of
Thrombophlebitis
• Avoid prolonged standing or sitting
• Avoid crossing her legs
• Take frequent breaks while taking car trips
Homans’ sign. With the client’s knee flexed to decrease the risk of
embolization, the nurse dorsiflexes the client’s foot. Pain in the foot or
leg is a positive Homans’ sign. SOURCE: Photographer, Elena
Dorfman
Self-Care: Thromboembolic
Disease
• Condition and treatment
• Importance of compliance and safety
factors
• Ways of avoiding circulatory stasis
• Precautions while taking anticoagulants