Question

I. When assessing Susan on your shift she complains that her left calf is sore. You notice redness and swelling on her left calf.

 A. What do you think this is?

 B. What test will be ordered?

  C. What are some of the treatments that the Dr. will prescribe?

  D. Why are womwn prone to this in the postpartum period?

II. Sara is breastfeeding and is in for her 2 week check- up. She tells you she is "not feeling well and that her left breast is red and painful.

 A. What doe Sara have?

 B. what are some treatments for this?

 C. Can she continue to breastfeeed?

Answer 1

(1 )A.The given patient may have Deep vein thrombisis,

Deep vein thrombosis is the formation of clot in vein that lies in deep inside the body.It is a common and serious complication in puerperium.

B.Investigations for deep vein thrombosis

• Doppler ultrasound-to detect the velocity of blood flow in the femoral vein.
• Venous ultra sonography-It is done by placing the transducer over the femoral vein and then gradually it is moved to the greater saphenous vein,popliteal vein and to its branches with deep vein of calf.
• Doppler USG-The most accurate ultrasound criteria for diagnosis of venous thrombosis.
• Venography-By injecting nonionic water soluble radiopaque dye to note the filling defect in the venous lumen is a reliable method ans carefully interpreted.
• Magnetic resonance imaging(MRI)-It is found superior to VUS and equivalent to contrast venography in the diagnosis DVT.
• D-dimer assay-D-dimer is a product of degradation of fibrin by plasmin.The test is of limited value because of false positive result in pregnancy.

C.Treatment for deep vein thrombosis

• Use of elastic compression stockings to wear to reduce swelling
• Analgesics if required-to reduce pain
• Advise to stay active
• Heparin administation to prevent cloting

D.Reasons for deep vein thrombosis in post partum

• Venous stasis-it is increased due to compression of gravid uterus to the inferior venacava and illiac vein.This stasis cause damage to epithelial cells.
• Hypercoagulability of blood-There is rise in coagulation factors .
• Alteration in blood constituents-Increased number of young platelets and their adhesiveness.
• Cessarian section.(surgical procedure)
• Immobility
• Hyperemisis
• Obesity

(2.)The above given symptoms of sara is suggestive of Acute mastitis.

Acute mastitis is a infection involvedd in breast parenchymal tissue leading to cellulitis .latiferous duct remains unaffected.The onset is ussually first 2-4 weeks of postpartum.The main clinical features  includes redness in the overlying skin ,malaise.

There are 2 types of mastitis (a)-due to infection of staphylococcus (b)-due to milk stasis.

Treatment for acute mastitis

• Breast support
• Plenty of oral fluids
• Breast feeding and mannual empting of brest milk(if you cannot breast feed)
• Dicloxacillin-is the drug of choice for 6 days.
• Erythromycin for 7 days.
• Analgesics (ibuprofen ) are given

(3. ) She can breast feed her baby and breast feeding prevent poliferation of staphylococcus in stagnant milk .The ingestion of staphylococcus will be digested without any harm.if you can't breast feed your baby it is very important to pump the milk mannually because stagnant milk will worse the problem.