Question

You are assuming care for Mrs. Jones, a 36-year-old G2 P1 who is status post-primary cesarean section.  The indication for the cesarean section was failure to progress in active labor secondary to Cephalopelvic disproportion. (20 points)

1.    Describe two risk factors for postpartum hemorrhage and provide three initial nursing interventions for postpartum hemorrhage from uterine atony.

2.    Identify three factors for the development of Deep Vein Thrombosis (DVT) in the post-partum patient, including two patient signs or symptoms that may indicate a possible DVT.

3.    Define two post-delivery risk factors for the development of endometritis, providing the signs and symptoms of endometritis.

4.    The nurse provides discharge teaching for Mrs. Jones; what would be provided information for the patient on the indicators of mastitis and its prevention?

5.    At discharge Mrs. Jones reports that she is concerned about postpartum depression. Explain two major risk factors for postpartum depression and provide Mrs. Jones two specific education points to decrease her risk for depression.

Answer 1

ANSWER 1: TWO RISK FACTORS FOR POSTPARTUM HEMORRAHGE:

1. 1. UTERINE ATONY: THE UTERUS STOPS CONTRACTING AND LEADS TO HEAVY BLOOD FLOW THAT OCCURS AFTER DELIVERY OF THE PLACENTA WHICH DO NOT STOP EVEN AFTER TRANSABDOMINAL MASSAGE.
2. 2.PREECLAMPSIA:IT REFERS TO THE PREGNANCY INDUCED HYPERTENSION.

THREE INITIAL NURSING INTERVENTIONS FOR POSTPARTUM HEMORRAGE FROM UTERINE ATONY:

1. 1. ALL THE PERINEAL PADS USED DURING BLEEDING SHOULD BE COLLECTED AND WEIGHED TO ESTIMATE THE AMOUNT OF BLOOD LOSS.
2. 2. MAKE THE PATIENT TO LIE ON HER SIDE SHOULD ENSURE THAT BLOOD IS NOT COLLECTED UNDERNEATH .
3. 3. MONITORING AND RECORDING OF THE VITAL SIGNS ESPECIALLY BLOOD PRESSURE.

ANSWER 2:THREE FACTORS FOR THE DEVELOPMENT OF DEEP VEIN THROMBOSIS (DVT) IN THE POSTPARTUM PATIENT:

• 1. PREECLAMPSIA-PREGNANCY INDUCED HYPERTENSION.
• 2.CAESARIAN SECTION.
• 3. SMOKING.

PATIENT SIGNS AND SYMPTOMS THAT MAY INDICATE POSSIBLE DVT:

• SWELLING, PAIN WARMTH AND REDNESS IN THE AFFECTED LEG.
• THE INVOLVED NERVE LOOKS LIKE THICKENED OR ROUGH CORD BENEATH THE SKIN.

ANSWER 3: TWO POST-DELIVERY RISK FACTORS FOR THE DEVELOPMENT OF ENDOMETRITIS, PROVIDING THE SIGNS AND SYMPTOM SOF ENDOMETRITIS:

1. THE AMNIOTIC FLUID STAINED BY THE POO OF THE FETUS (MECONIUM)
2. PREVIOUS INFECTIONS LIKE PELVIC INFLAMMATORY DISEASE, BACTERIAL VAGINOSIS, HIV IN THE GENITAL AREAS OF THE MOTHER.

SIGNS AND SYMPTOMS OF ENDOMETRITIS:

• FEVER
• PAIN IN THE LOWER ABDOMINAL AREA.
• INCREASE IN THE BLEEDING FROM THE VAGINA.
• SMELLY DISCHARGE FROM THE VAGINA.
• PAINFUL URINATION
• PAINFUL SEX.
• LETHARGY

ANSWER 4:TEACHING Mrs.JONES ABOUT THE INDICATORS OF MASTITIS AND ITS PREVENTION:

• PREVENT INFECTION AND CRACKING OF THE NIPPLE.
• CARE OF THE NIPPLES AFTER EVERY BREAST FEEDING
• REPORT TO CLINIC IF THERE IS ANY SIGN OF DISCHARGE AND TENDERNESS IN THE BREASTS.