Question

A- Postpartum hemorrhage
1.Indicates the factors that predispose postpartum hemorrhage.
2.Indicates the clinical manifestations of uterine atony.
3. Define uterine subinvolution.
4. Indicates therapeutic management for postpartum hemorrhage.
5. Indicates nursing considerations for postpartum hemorrhage.

B- Postpartum depression
1. Indicates the clinical manifestations of postpartum depression.
2. Indicates therapeutic management for postpartum depression.
3. Indicates nursing interventions with women presenting postpartum depression.
4. What is postpartum psychosis?

Answer 1

Postpartum hemorrhage

A. 1.Predisposing factors

• uterine atony [Tone]
• laceration,
• hematoma, i
• nversion,
• rupture [Trauma];
• retained tissue or invasive placenta [Tissue];
• and coagulopathy [Thrombin]).

2. The clinical manifestations of uterine atony

• excessive and uncontrolled bleeding following the birth of the baby.
• decreased blood pressure.
• an increased heart rate.
• pain.
• backache

3.Uterine subinvolution.

Uterus subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size.

4. Therapeutic management for postpartum hemorrhage.

The medications most commonly used in PPH management are uterotonic agents. These medications include oxytocin (Pitocin), misoprostol (Cytotec), methylergonovine maleate (Methergine,), carboprost tromethamine (Hemabate), and dinoprostone (Prostin E2).

5. Nursing considerations for postpartum hemorrhage.

• Assess the amount of bleeding.
• Assess maternal vital signs to establish baseline data.
• Assess for signs of shock.
• Assess the condition of the uterus.
• Assess vital signs and monitor for signs of shock

Decreased fluid volume will cause blood pressure to drop and patient will go into shock

• Monitor blood loss
  • Site
  • Type
  • Amount- should be no more than 1 perineal pad per hour
  • Presence of clots

Amount of blood loss and presence of blood clots can help determine treatment.

• Assess for hematoma

If bleeding is due to hematoma, rest and application of an ice pack may be sufficient treatment

• Monitor intake and output for 30ml – 50 ml/hr urine output; may require indwelling catheter insertion for accurate measurement

Decreased urine output may be a sign of hematomas that put pressure on the urethra, or may be a late sign of hypovolemic shock.

• Monitor lab values to determine need for transfusions or signs of complications

Watch hematocrit and clotting levels to know if blood transfusion is necessary and for signs and severity of DIC.

• Administer IV fluids, medications and blood products as necessary
  • Oxytocin
  • Antibiotics
  • Analgesics

• Fluid replacement may be necessary and, depending on amount of blood lost and hematocrit level, a blood transfusion may be required.
• Oxytocin is sometimes given to initiate contractions that will help stop bleeding.

• Perform uterine massage to stimulate contractions following delivery

Begin fundal massage and educate patient on how to massage abdomen to stimulate contractions. These contractions may help stop bleeding.

• Monitor and manage pain

Continued, unrelieved pain may be due to hematomas or lacerations

• Place patient on bed rest with legs elevated

Rest and elevation of legs helps venous return and slows bleeding

• Prepare patient for surgery if indicated; remain on NPO status

If bleeding can’t be managed otherwise, surgery may be required

B. Postpartum depression

1. cinical manifestations of postpartum depression.

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Fear that you're not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Restlessness
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

2.Therapeutic management for postpartum depression.

Treatment and recovery time vary, depending on the severity of your depression and your individual needs. If you have an underactive thyroid or an underlying illness, your doctor may treat those conditions or refer you to the appropriate specialist. Your doctor may also refer you to a mental health professional.

Postpartum depression is often treated with psychotherapy (also called talk therapy or mental health counseling), medication or both.

• Psychotherapy. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through therapy, you can find better ways to cope with your feelings, solve problems, set realistic goals and respond to situations in a positive way. Sometimes family or relationship therapy also helps.
• Antidepressants. Your doctor may recommend an antidepressant. If you're breast-feeding, any medication you take will enter your breast milk. However, most antidepressants can be used during breast-feeding with little risk of side effects for your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants.

3. Nursing interventions with women presenting postpartum depression

Nurses must be alert in sensing the current psychological state of the patient too. They must provide a precise data of the patient’s well-being to give way to a more accurate care plan for a woman with postpartum depression

Nursing Assessment

• Assess the woman’s psychological health even before the delivery.
• Assess her history of illnesses to determine if she needs any counseling prior to her delivery to avoid postpartum depression.

Nursing Interventions

• Assist the woman in planning for her daily activities, such as her nutrition program, exercise, and sleep.
• Recommend support groups to the woman so she can have a system where she can share her feelings.
• Advise the woman to take some time for herself every day so she can have a break from her regular baby care.
• Encourage the woman to keep in touch with her social circle as they can also serve as her support system.

4. Postpartum psychosis

Postpartum psychosis is an acute mental disorder or a psychotic reaction occuring in a woman following child birth , or abortion, usually begins 1 to 3 months of delivery