lochia amount
Give this one a try later!
, · descriptions for what appears on pad in 1 hour See Fig 17.4, p. 326
o Scant < 1 inch on pad
o Light--1-4 inches on pad
o Moderate--4-6 inches on pad
o Heavy--Saturated pad in 1 hour
o Excessive--Saturated pad in 15 minutes
o Always note presence of any clots
PP infections
Give this one a try later!
· Temp of 38 C or more after 1st 24 hours and occurring on at least 2 days
of the first 10 days postpartum
· Risks for infections: history of previous infections, urinary catheterizations,
prolonged rupture of membranes, cesarean section, trauma
· Endometritis
o Risk factors, C/S, PROM, multiple vaginal exams, PTL
o Symptoms—boggy uterus, tenderness, fever, malodorous &/or purulent
lochia, more crampy, abdominal pain
o Labs: elevation in the number of leukocytes (15,000/mm3 to
30,000/mm3).
o Remember: Leukocyte levels are normally elevated to as high as
30,000/mm3 during labor and early postpartum however, leukocytosis that
is not decreasing should prompt further evaluation. Blood culture.
o Management: IV antibiotics (Broad-spectrum antibiotics, such as the
cephalosporins, clindamycin plus gentamicin, or ampicillin plus an
aminoglycoside).
o Educate: change pad every time she gets up to go to the bathroom, even
if there is not much on the pad, give peri bottle to rinse of bottom
· Urinary Tract infections
o Risk factors: trauma, ascending infection.
o S/S: Pain (increasing), febrile > 100.4, flank pain, frequency, urgency,
burning, bladder cramping
o Prevention: Peri care: wiping front to back, reduce inflammation,
hydration, using peri bottle to rinse off their bottom
o Treatment: Oral antibiotics, unless progression to pyelonephritis, then IV.
· Wound Infection—Incision
, o The most common sites are cesarean surgical incisions, episiotomies, and
lacerations.
o Educate about these
o When looking at scar and incisions want to make sure it approximated, no
drainage coming from it, same color as rest of her skin, not big and swollen
and puffy, not sore
o Risk factors include obesity, diabetes, hemorrhage, anemia, malnutrition,
prolonged PROM, or labor before cesarean section.
o Signs of wound infection are edema, warmth, redness, tenderness and
pain, low grade fever.
o Educate: if there is a flap where the abdomen hangs over the incision we
might put towels or washcloths to absorb the moisture. Encourage moms
to take showers and not baths for the first few weeks (baths sitting in their
own dirt - don't need that on incision)
Mastitis - infection in milk duct
o Breast can become inflamed and sore, usually a large red spot with red
streaks running up, painful, feel like she has the flu, run a fever
o Need to be notified - antibiotic is needed for this
blood loss due to tissue trauma - collaborative care:
Give this one a try later!
o IV for fluids, initially ice, later-dry heat, warm bath
o Monitor for size and signs of infection and hypovolemia
o May require surgical treatment—excision, ligation, evacuation,
embolization (a minimally invasive surgical technique to stop bleeding.
uterine inversion
Give this one a try later!
, o Call help immediately, any infusion of uterotonic drug like oxytocin
STOPPED immediately (uterus must be relaxed before obstetric provider
attempts to replace it), nurse place two 16 or 18 gauge IV catheters and
infuse fluid to adequately support BP, bradycardia - 0,5 mg IV atropine if
ordered, nurse should anticipate blood collection for CBC, coagulation
studies, and administer blood products as ordered per protocol
o Provider attempts to replace immediately, uterine relaxants like
nitroglycerin and terbutaline are often required
§ Failure requires surgical intervention
o Once replaced usually given oxytocin to keep uterus contracted and
prevent from happening again
potential problems with lochia - cervical tear
Give this one a try later!
¡ can cause excessive bright red bleeding, sometimes can even see it
spirting
¡ Going to call rapid response team to get there, also going to have
provider there to suture up if there is possibly a tear
sexual activity
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o Sexual activity can safely resume after 2-6 weeks; when bleeding has
stopped and perineum is healed
Suppression of Lactation
Give this one a try later!
Give this one a try later!
, · descriptions for what appears on pad in 1 hour See Fig 17.4, p. 326
o Scant < 1 inch on pad
o Light--1-4 inches on pad
o Moderate--4-6 inches on pad
o Heavy--Saturated pad in 1 hour
o Excessive--Saturated pad in 15 minutes
o Always note presence of any clots
PP infections
Give this one a try later!
· Temp of 38 C or more after 1st 24 hours and occurring on at least 2 days
of the first 10 days postpartum
· Risks for infections: history of previous infections, urinary catheterizations,
prolonged rupture of membranes, cesarean section, trauma
· Endometritis
o Risk factors, C/S, PROM, multiple vaginal exams, PTL
o Symptoms—boggy uterus, tenderness, fever, malodorous &/or purulent
lochia, more crampy, abdominal pain
o Labs: elevation in the number of leukocytes (15,000/mm3 to
30,000/mm3).
o Remember: Leukocyte levels are normally elevated to as high as
30,000/mm3 during labor and early postpartum however, leukocytosis that
is not decreasing should prompt further evaluation. Blood culture.
o Management: IV antibiotics (Broad-spectrum antibiotics, such as the
cephalosporins, clindamycin plus gentamicin, or ampicillin plus an
aminoglycoside).
o Educate: change pad every time she gets up to go to the bathroom, even
if there is not much on the pad, give peri bottle to rinse of bottom
· Urinary Tract infections
o Risk factors: trauma, ascending infection.
o S/S: Pain (increasing), febrile > 100.4, flank pain, frequency, urgency,
burning, bladder cramping
o Prevention: Peri care: wiping front to back, reduce inflammation,
hydration, using peri bottle to rinse off their bottom
o Treatment: Oral antibiotics, unless progression to pyelonephritis, then IV.
· Wound Infection—Incision
, o The most common sites are cesarean surgical incisions, episiotomies, and
lacerations.
o Educate about these
o When looking at scar and incisions want to make sure it approximated, no
drainage coming from it, same color as rest of her skin, not big and swollen
and puffy, not sore
o Risk factors include obesity, diabetes, hemorrhage, anemia, malnutrition,
prolonged PROM, or labor before cesarean section.
o Signs of wound infection are edema, warmth, redness, tenderness and
pain, low grade fever.
o Educate: if there is a flap where the abdomen hangs over the incision we
might put towels or washcloths to absorb the moisture. Encourage moms
to take showers and not baths for the first few weeks (baths sitting in their
own dirt - don't need that on incision)
Mastitis - infection in milk duct
o Breast can become inflamed and sore, usually a large red spot with red
streaks running up, painful, feel like she has the flu, run a fever
o Need to be notified - antibiotic is needed for this
blood loss due to tissue trauma - collaborative care:
Give this one a try later!
o IV for fluids, initially ice, later-dry heat, warm bath
o Monitor for size and signs of infection and hypovolemia
o May require surgical treatment—excision, ligation, evacuation,
embolization (a minimally invasive surgical technique to stop bleeding.
uterine inversion
Give this one a try later!
, o Call help immediately, any infusion of uterotonic drug like oxytocin
STOPPED immediately (uterus must be relaxed before obstetric provider
attempts to replace it), nurse place two 16 or 18 gauge IV catheters and
infuse fluid to adequately support BP, bradycardia - 0,5 mg IV atropine if
ordered, nurse should anticipate blood collection for CBC, coagulation
studies, and administer blood products as ordered per protocol
o Provider attempts to replace immediately, uterine relaxants like
nitroglycerin and terbutaline are often required
§ Failure requires surgical intervention
o Once replaced usually given oxytocin to keep uterus contracted and
prevent from happening again
potential problems with lochia - cervical tear
Give this one a try later!
¡ can cause excessive bright red bleeding, sometimes can even see it
spirting
¡ Going to call rapid response team to get there, also going to have
provider there to suture up if there is possibly a tear
sexual activity
Give this one a try later!
o Sexual activity can safely resume after 2-6 weeks; when bleeding has
stopped and perineum is healed
Suppression of Lactation
Give this one a try later!
