EPISIOTOMY

EPISIOTOMY- an incision of the perineum during delivery

• to spare the infant's head to pass out preventing prolonged pressure and pushing against the narrow perineum that may cause brain damage.
• to shorten the 2nd stage of labor

TYPES OF EPISIOTOMY:

1. Median-incision is made in the middle of the perineum and directed toward the rectum, and easy to repair and more comfortable for the patient during the healing process
2. Mediolateral (midline)- incision laterally in the perineum and distant from anal that could be enlarge if needed. mother feels uncomfortable during the healing process.

NURSING CARES:

• instruct the woman to cleanse from the front to the back every after voiding and defication
• infra red light focused to the perineum for 15 minutes 2 or 3 times at first 24 hours of delivery to promote fast healing
• explain proper handwashing after perineal care
• encourage to increase fruit juices that are rich in vitamin C to increase resistant against infection
• external antiseptic applied to the episiotomy wound every after perineal care or 2 times a day

reference: maternity book and my nursing notes

FORCEPS DELIVERY

FORCEPS DELIVERY- designed to rotate or for extracting the fetal head

TYPES OF FORCEPS:

1. low forceps operation-forceps applied after the head had reach the perineal floor with sagittal suture in the antero posterior diameter of the outlet
2. mid forceps delivery- applied before the criteria for low forceps are met but after engagement has taken place
3. high forceps operation- applied before engagement when taken place

]Forceps be applied if:

• pelvic is adequate without disproportion
• fetal head is engaged
• cervix is in full dilatation
  
• membrane is ruptured
• rectum and bladder should be empty

NURSING CARES:

• explain to the woman that forceps is to be applied to extract the baby
• emotional support to feel comfortable
• rest assured that it is safe to alleviate anxiety
• let her void to empty the bladder
• encourage relaxation between contraction and use of abdominal muscles and pushing with contraction
  

VACUUM EXTRACTION

VACUUM EXTRACTION- suctioning of the fetal head

INDICATION:

• fetal distress
• dysfunctional labor
• hypertensive disorder of pregnancy
• abruptio placentae
• maternal cardiopulmonary disease

NURSING CARES:

• explain the purpose of the procedure to the woman and tell her that there is nothing to worry to alleviate anxiety
• help the woman to relax during the application of suction to the fetal scalp
• encourage to push with contraction when needed
• after the delivery , examine the fetal scalp if there is an injury , laceration, hematoma, or intracranial hemorrhage
• examine the woman for cervical or vaginal laceration
• let her to void within several hours after delivery
  

CESAREAN DELIVERY AND CESAREAN HYSTERECTOMY

Cesarean Delivery_

• it is a removal of infant from uterus through an incision of the abdominal wall and the uterus

Indication of Cesarean Delivery:

• fetal distress
• prolapsed of the umbilical cord
• pre mature rupture of the placenta
• complete placenta previa
• active herpes infection
• malprsentation and malposition of the fetus
• tumors obstructing the birth canal
• cephalopelvic disproportion
• uterine dysfunction and cervix can not dilate

Types of Cesarean Delivery:

1. Low segment- incision made transversely in lower segment of the uterus. Usually this type of incision is as request of the patient
2. classical cesarean section -incision directly into the wall of the uterus for transverse lie position

Cesarean Hysterectomy- it is a cesarean section followed by the removal of uterus

INDICATIONS:

• ruptured uterus
• intrauterine infection
• severe dysplasia or carcinoma
• multiple fibro myomas
• defective uterine scar
• laceration of uterine vessels

PREOPERATIVE CARE FOR HYSTERECTOMY:

• Inform the patient, husband or direct member of the family and get the consent for operation
• remove jewelries, dentures and nail polish if there is any
  
• monitor vital signs of the patient and the fetal heart beat
• prepare for blood examinations and the results
• shave the patient from mid- breast line down to mid-thigh
  
• keep the patient nothing orally at least eight hours
  
• carry out pre operative medications as prescribed

POST OPERATIVE CARE FOR HYSTERECTOMY

• placed patient flat on bed and head turned on one side
• monitor vital signs, every 30 minutes for first hour
• check Intravenous fluid and regulate correctly
• check urinary catheter if flowing freely
• check dressing if there is a sign of hemorrhage
• if awake encourage deep breathing frequently
• after 8 hours may put pillow and lie on the side slowly and slightly and supported with pillow
• on the first day may sit on the bed
• sponge bath for hygiene and promote blood circulation
  
• on the second day , may stand at bed side with the presence and help of the nurse especially on the first time
• on the third day , may walk slowly around her bed with someone on her side for help in case of feeling dizziness or pain
• if catheter removed , encourage to void
• may take bath on the third day with assistant
  

MASTITIS

Mastitis-

• an inflammation of the tissues of the breast
• an infection of the ducts causing an stagnation of the milk in one or more lobules of the breast
  

Causes:

• due to transferring of organisms from the infected eye , skin, or mouth of the baby

Signs and Symptoms

• breast becomes tough and doughy
• dull pain in the affected region
• discharges from nipple like pus, serum
• breast engorgement
• chills
  
• fever
• tenderness of the breast
• breast pain

Nursing Cares:

• Promoting comfort by encouraging to wear supportive firm bra
• ice bag to decrease the pain
• encourage to follow hygiene for comfort and avoid further infection
• support breast with towels or pillows while on bed
• proper handwashing
• Emotional support by allowing to express her feeling regarding infection of her breast
• give some information and assure that there is a treatment
  

POSTPARTUM HEMORRHAGE

POSTPARTUM HEMORRHAGE- 500 ml or more blood loss, usually on the first hour after deliver

CAUSES:

• retained Placenta due to manual removal of placenta, placenta acreta
  
• Uterine Atony-the relaxation of uterus due to excessive amniotic fluid, prolonged labor, overdose of anesthesia, and multiple pregnancy
• Laceration of the vagina, cervix or perineum during forcept delivery, size incompatibility of infant and the birth canal

SIGNS AND SYMPTOMS:

• uterus relax- soft to palpate ang boggy
• excessive bleeding
• patient is pale and weak

NURSING CARES:

• monitor vital signs every 30 minutes or one hour
  
• observe the amount and type of bleeding or the lochia if present, blood clots
• alleviate anxiety of the the patient due to her bleeding or condition
• provide information about her condition
• assist family support
  
• regulate IV fluids correctly as ordered
• crossmatched blood must be available in case needed for blood transfusion
  
• keep patient nothing per oral so as always be ready for emergency procedure specially if bleeding can' stop
• maintain the room calm and quiet atmosphere
• always use sterile gloves or instrument when doing vaginal examination to prevent further infection
• perineal care aseptically
• encourage voiding

source: maternal books and my nursing notes

THROMBOPHLEBITIS- POSTPARTUM COMPLICATION

THROMBOPHLEBITIS-

• one of the postpartum complication
• a condition in which a clot formation in the venous wall of the veins causing inflammation in the affected area.

SITES OF THROMBOPHLEBITIS:

FEMORAL THROMBOPHLEBITIS-infection of the endothelium with clot formation on the walls of the veins
Signs And Symptoms:

• pain and tenderness of the affected area
• fever
• chilly sensation
• edema of the legs
• it last for several weeks

PELVIC THROMBOPHELEBITIS- infection of the uterine wall and broad ligament with clot formation of the walls of the veins.
SiGNS And SYMPTOMS:

• pain in the affected area
• fever
• chilly sensation
• body weakness

NURSING CARES FOR THROMBOPHLEBITIS:

• never rub the affected area because of the danger of breaking the clot to form debris that causes embolus
• elevate the Legs
• apply hot compress on the affected area
• vital signs to be monitored regularly
• emotional support by giving explanation of her condition
• watch for any further discoloration of the affected sites
• move extremities carefully
• carry out prescribed medications correctly
  

ENDOMETRITIS

ENDOMETRITIS:

• postpartum infection of the endometrium

SIGNS AND SYMPTOMS:

• fever
  
• foul lochia
• chilly sensation
• body weakness due to fever

Nursing Cares:

• monitor vital signs specially temperature
  
• observe lochia its color, consistency , smell and record for evaluation
• increase fluid intake to lower down temperature
  
• encourage proper nutrition as needed by her body
• encourage fruit juices that are rich in Vitamin C to increase resistance against infection
• promotes personal hygiene for comfortable feeling
• ice compress over the head for high grade fever
• perineal cares should maintained
• explain the good hand washing technique to prevent cross contamination
  
• educate the patient about the endometritis to alleviate worries
• carry out medications as ordered by the physician

Postpartum Complication:Puerperal Infection

PUERPERAL INFECTION-

• it is an infection of the endometrium and the genitalia after delivery caused by bacterial organisms

Causes:

• ruptured membrane
• prolonged labor
• acquired through poor aseptic vaginal examination
• from infection of the other part of the body
• poor perennial hygiene

Sign and Symptoms:

• fever
• chilliness
• foul discharge from the genitalia
  

Source: Maternal nursing book and my nursing notes

POSTPARTUM DEPRESSION

POSTPARTUM DEPRESSION-

• due to over unexpected fatigue she had experienced during labor and delivery
• occurs on the first two weeks

SIGNS AND SYMPTOMS:

• inappropriate response toward her baby and the family
• rejects cuddling her baby
• looks very tired
• moody
• refuse to care for herself
• irritable

MANAGEMENT:

• Helps personal hygiene
• perennial care to prevent infection
• refer to psychiatric physician
  

POSTPARTUM SUB INVOLUTION

SUB INVOLUTION-

• is characterized by the presence of pelvic infection and retention of placental debris and tumors will disrupt the normal postpartum involution

SIGNS and SYMPTOMS:

• excessive lochia discharge
• pale
• low blood count
• weak
  
• pain over the pelvic area due to pressures of tumors or swelling caused by infection

'

• '
  

Postpartum Hematoma

POSTPARTUM HEMATOMAS -

• is the accumulation of blood under the skin of the genitalia or vaginal mucosa. it is bluish in color due to:

1. due to trauma during the labor and delivery
2. due to forcept delivery, the tendency of the instrument to traumatized the mucosa
3. due to suturing of the laceration done for delivery like episiotomy laceration

Signs and symptoms:

• pain over the area due to inflammation
  
• painful upon urination
• inability to urinate due to obstruction of the urethra cause by the inflammation of the mucusa

MANAGEMENT:

• Ultra red lamp to the perennial area for 15 minutes to promote healing of the wound
• Evacuation of the blood clot and resuturing
  

NURSING CARE:

• provide comfort by applying ice bag at the perennial area
• first time mother are innocent , so responsibility of nurse to explain the cause to understand to avoid worries on the part of the patient
• assist patient to void in comfort room or in a bed pan
• avoid pressures on the area to prevent further damage
• catheterize aseptically if not able to void
• vital signs regularly
• observed for any hemorrhage or swelling if there is any ang report to physician