 VISION MISSION

A premier university in historic Cavite State University shall provide

Cavite recognized for
excellence in the development
of morally upright and globally
competitive individuals.
Republic of the Philippines
CAVITE STATE UNIVERSITY
Don Severino Delas Alas Campus
Indang, Cavite
excellent, equitable and relevant
educational opportunities in the arts,
science and technology through
quality instruction and relevant
research and development activities.
It shall produce professional, skilled
and morally upright individuals for
global competitiveness.

College of Nursing

Postpartum Complications, Preventive, Care,

Comfort and Safety Measures of Postpartum
and Nursing Care/Responsibilities
Care of Mother, Child and Adolescent

Presented by:

LEVEL 2 / BSN 2-3 / GROUP 3

ARTISTA, MONIQUE
CRUDO, ERIELLE
DASMARINAS, REYMON
DE LEON, KRISHIA
DILI, JUAN RAPHAEL
NACOR, MARIA ANGELICA SALVACION D.
PERAS, LIENY
PEREZ, DAVE
RENIDO, MICHELLE
VIRAY, KRISHA MYRTLE

Presented to:

Prof. Ailene Maclid, RN, LPT, MAN, PhD©

Clinical Instructor, Level II

Date:
November 6, 2019

In Partial Fulfillment of the Requirement in NURS 08 for the Degree Bachelor of

Science in Nursing
Postpartum Depression
Postpartum depression is a mood disorder that can affect women after
childbirth. Mothers with postpartum depression experience feelings of extreme
sadness, anxiety, and exhaustion that may make it difficult for them to complete daily
care activities for themselves or for others.
Typically, the condition develops within 4 to 6 weeks after giving birth, but it
can sometimes take several months to appear.
Characteristics
 Onset- 2 to 12 months after delivery
 Duration- Weeks, months, or longer

Emotional Features

 Crying
 Feeling of overwhelming sadness, helplessness, and worthlessness
 Feeling of loss of control
 Intensive or excessive worry
 Forgetfulness, Inability to focus or concentrate
 Possible anxiety, panic attacks, and obsessive-compulsive behaviors
 Feeling of disconnected from baby

Sleep pattern

Feel tired, but can’t fall asleep within 30 minutes of retiring or wakes up in middle of
night and can’t fall back to sleep

Danger

 May be suicidal
 May have thoughts of harming self or baby

Causes
PPD is likely to be the result of multiple factors. However, its exact causes are
still not known.

After childbirth, the levels of hormones (estrogen and progesterone) in a

woman’s body quickly drop. This leads to chemical changes in her brain that may
trigger mood swings.

The following factors may contribute to PPD:

 the physical changes of pregnancy

 excessive worry about the baby and the responsibilities of being a parent
 a complicated or difficult labor and childbirth
 lack of family support
 worries about relationships
 financial difficulties
  loneliness, not having close friends and family around
 a history of mental health problems
 the health consequences of childbirth, including urinary
incontinence, anemia, blood pressure changes, and alterations in metabolism.
 hormonal changes, due to a sudden and severe drop
in estrogen and progesterone levels following birth
 changes to the sleep cycle

Symptoms

Some of the more common symptoms a woman may experience include:

 Feeling sad, hopeless, empty, or overwhelmed

 Crying more often than usual or for no apparent reason
 Worrying or feeling overly anxious
 Feeling moody, irritable, or restless
 Oversleeping, or being unable to sleep even when her baby is asleep
 Having trouble concentrating, remembering details, and making decisions
 Experiencing anger or rage
 Losing interest in activities that are usually enjoyable
 Suffering from physical aches and pains, including frequent headaches,
stomach problems, and muscle pain
 Eating too little or too much
 Withdrawing from or avoiding friends and family
 Having trouble bonding or forming an emotional attachment with her baby
 Persistently doubting her ability to care for her baby
 Thinking about harming herself or her baby

How can a woman tell if she has postpartum depression?

Only a health care provider can diagnose a woman with postpartum

depression. Because symptoms of this condition are broad and may vary between
women, a health care provider can help a woman figure out whether the symptoms
she is feeling are due to postpartum depression or something else.

Nursing care

 Refer patient for psychological evaluation by primary care provider, psychologist,

psychiatrist, psychiatric RN, counselor or social worker (particularly one trained in
special needs of women with PPD.
 Reassure patient she’s not alone and that what she’s feeling is real.
 Encourage patient to ask for help with baby, housework, and meals.
 Teach patient how to maximize sleep.
 Refer patient to public health nurse to assess baby in home and provide follow-up
care, as appropriate.
Postpartum Endometritis

Endometritis is an infection of the endometrium, the lining of the uterus.

Bacteria gain access to the uterus through the vagina and enter the uterus either at
the time of birth or during the postpartal period.

Assessment

A woman with endometritis has a rise in temperature over 100.4°F (38°C) that
occurs on the third or fourth day postpartum.

Depending on the severity of the infection, a woman may have accompanying

chills, loss of appetite and general malaise. Her uterus usually not contracted and is
painful to touch. Lochia is usually dark brown and has a foul odor.

Signs and Symptoms

 Rise in temperature
 Pain and uterine tenderness
 Abnormal vaginal discharge
 Abdominal pain
 Offensive smelling lochia

Therapeutic Management

Treatment of endometritis consists of the administration of the appropriate

antibiotics, such as clindamycin, as determined by the culture of the lochia. An
oxytocic agent such as Methergine may be prescribed to encourage uterine
contraction.

Sitting in a fowler’s position or walking encourages lochia drainage by gravity

and helps prevent pooling of infected secretions.

As with any infections, endometritis can be controlled if it is discovered early.

Client can interpret lochia discharge through color, quantity and odor.

Woman may be at home when signs of infection occur, client teaching of

endometritis is essential.

Respiratory Complications

Atelectasis is a complete or partial collapse of the entire lung or area (lobe)

of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated
or possibly filled with alveolar fluid.
Prevention

 Encourage movement and deep breathing in anyone who is bedridden for

long periods.
 Maintain deep breathing after anesthesia.

Care after giving birth

 Get plenty of rest

 Seek help
 Eat healthy meals
 Exercise

Nursing Care\ Responsibilities

 Spirometer which can encourage you to take deep breaths to prevent and
treat atelectasis.
 Maintain proper posture and mobility.
 Cough regularly.
 Follow a healthy diet and manage your weight.
 Drink plenty of water.
 Do not smoke.
 Live sensibly
 See a doctor at least once per year.

Urinary Tract Infection (UTI)

 Urinary Tract Infection (UTI) is an infection in any part in the urinary system.
 Most infections involve the lower urinary tract.
 Victims - mostly women, post partum.
 Mostly 2%–4% of all deliveries are affected in having UTI.
 May discontinued breast feeding due to intake of antibiotics.

Uterine Infections

During postpartum:

 Placenta
 retained placenta
Amniotic Sac

 Flu-like symptoms
 High fever
 Rapid heart rate
 Abnormal high WBC count
 Swollen, tender uterus

Kidney Infections

During postpartum:

 Kidney infection
 Urinary frequency
 Strong urge to urinate
 High fever
 Sick feeling
 Pain in the lower back
 Constipation
 Painful urination

Perineal Pain

During postpartum

 Stretch perineum area

 Swollen
 Bruised
 Sore

Risk Factors of UTI in Women

 Female Anatomy
 Sexual Activity
 Certain types of birth control
- spermicidal agents
 Menopause
Ways on How to Treat UTI

 Cranberry Juice

- drink within eight hours every day (optional)

- best organic drink to prevent UTI

 Antibiotics

- Ampicilin

- Gentamicin

- some antibiotics may effect breastfeeding

PUERPERAL INFECTION

Infection of the reproductive tract is another leading cause of maternal

mortality (Pavone, Purinton, & Petersen, 2007). Factors that predispose women to
infection in the postpartal period are shown in Box 25.5. When caring for a woman
who has any of these circumstances, be aware that the risk for postpartal infection is
greatly increased. Theoretically, the uterus is sterile during pregnancy and until the
membranes rupture. After rupture, pathogens can invade. The risk of infection is
even greater if tissue edema and trauma are present. If infection occurs, the
prognosis for complete recovery depends on:

• Virulence of the invading organism

• The woman’s general health

CONDITIONS THAT INCREASE A WOMAN’S RISK FOR POSTPARTAL

INFECTION

1. Rupture of the membranes more than 24 hours before birth (bacteria may have
started to invade the uterus while the fetus was still in utero)

2. Placental fragments retained within the uterus (the tissue necroses and serves as
an excellent bed for bacterial growth)

3. Postpartal hemorrhage (the woman’s general condition is weakened)

4. Pre-existing anemia (the body’s defense against infection is lowered)

5. Prolonged and difficult labor, particularly instrument births (trauma to the tissue
may leave lacerations or fissures for easy portals of entry for infection)

6. Internal fetal heart monitoring (contamination may have been introduced with
placement of the scalp electrode)

7. Local vaginal infection was present at the time of birth (direct spread of infection
has occurred)

8. The uterus was explored after birth for a retained placenta or abnormal bleeding
site (infection was introduced with exploration)

• Portal of entry
• Degree of uterine involution at the time of the microorganism invasion
• Presence of lacerations in the reproductive tract

A puerperal infection is always potentially serious, because, although it

usually begins as only a local infection, it can spread to involve the peritoneum
(peritonitis) or the circulatory system (septicemia). These conditions can be fatal in a
woman whose body is already stressed from childbirth. Management for puerperal
infection focuses on the use of an appropriate antibiotic after culture and sensitivity
testing of the isolated organism. Organisms commonly cultured postpartally include
group B streptococci and aerobic gramnegative bacilli such as Escherichia coli.
Staphylococcal infections also are becoming more common. Staphylococcal
infections are the cause of toxic shock syndrome, an infection similar to puerperal
infection in its ability to cause death and morbidity.

NURSING DIAGNOSES AND RELATED INTERVENTIONS

Nursing Diagnosis: Risk for infection related to loss of uterine sterility with
childbirth

Outcome Evaluation: Client’s temperature remains below 100.4° F or 38° C orally,

excluding the first 24 hours after birth; lochia is present without foul odor.

To help prevent infection, any articles such as gloves or instruments that are
introduced into the birth canal during labor, birth, and the postpartal period should be
sterile. In addition, adherence to standard infection precautions is essential.

Instruct a postpartal woman in proper perineal care, including wiping from

front to back so that she does not bring E. coli organisms forward from the rectum.
Use good handwashing technique before, during, and after any client care, to
prevent cross-contamination. When giving perineal care, both wash your hands and
wear gloves. Each postpartal woman should have her own bedpan and perineal
supplies and should not share them, to prevent transfer of pathogens from one
woman to another.
 Intravenous antibiotics usually are prescribed for a postpartal infection.
Frequently used antibiotics include ampicillin, gentamicin, and third-generation
cephalosporins such as cefixime (Suprax). If the woman will be continuing drug
therapy at home, stress that she must take the full course to prevent the infection
from recurring. Be certain that women who are breastfeeding are not prescribed
antibiotics incompatible with breastfeeding. Alert them to observe for problems in
their infant, such as white plaques or thrush (oral Candida) in their infant’s mouth.
This occurs because a portion of the maternal antibiotic passes into breast milk and
can cause an overgrowth of fungal organisms (opportunistic infection) in the infant.
The infant also should be assessed for easy bruising. A decrease of microorganisms
in the bowel caused by an antibiotic passed in breast milk may lead to insufficient
vitamin K formation and, consequently, decreased blood-clotting ability.

Nursing Diagnosis: Social isolation related to precautions necessary to protect

baby and others from expo-sure to infectious microorganisms

Outcome Evaluation: Client describes agency policy regarding precautions and

states plans for diversional activities to pass time; demonstrates bonding behaviors,
such as asking about newborn and expressing desire to see infant.

Most hospitals have well-defined guidelines on whether a woman who has an

infection should be separated from other women or allowed to feed and care for her
baby (Box 25.6). It is difficult for many women to accomplish their new role change
even when things are going well. If a woman is segregated from others, frightened
by her condition, and denied the pleasure of holding and feeding her baby, her
situation may seem overwhelming. Women who are isolated this way need friendly,
understanding support from hospital personnel who give them care. Fortunately,
because modern antibiotics work quickly to reduce the possibility of contagion, the
required period of separation may be as short as 24 hours. Encourage women who
are breastfeeding to pump their breasts to maintain their milk supply during this time.
Often, the choice to breastfeed is culturally influenced. If a postpartal complication
interferes with breastfeeding, a woman who feels that breast feedingis very important
can be expected to react less favor-ably than a woman from a culture in which
formula feeding is preferred.

COMMON GUIDELINES FOR THE WOMAN WITH A POSTPARTAL INFECTION

1.As a rule, the baby of a mother with an increased temperature (100.4°F [38°C]) for
two consecutive24-hour periods exclusive of the first 24 hours is kept in an isolation
nursery until the cause of the infection is determined. The mother may have an
upper respiratory tract or gastrointestinal infection that is unrelated to childbearing
but transmittable to a newborn.
2.If the cause of the fever is found to be related to childbirth but involves a closed
infection, such as thrombophlebitis, with no danger of the baby contracting the
disease, the woman may care for her child as long as she maintains bed rest in the
pre-scribed position while doing so.

3.If the infection involves drainage such as can occur with endometritis or a perineal
abscess, newborn visiting may be contraindicated. If rooming-in is continued, the
mother should wash her hands thoroughly before holding her infant. She should
never place her baby on the bottom bed sheet, where there may be some infected
drainage from her perineal pad (furnish a clean sheet to spread over the covers).

4.Most hospitals are reluctant to return a baby to a central nursery after a baby has
visited in a room where there is an infection. The hospital should pro-vide a small
nursery that may be used as an isolation nursery for these situations, or the baby
can be placed in a closed Isolate in a central nursery or continue to be cared for in
the woman’s room.

5.If the woman has a high fever, breast milk may be deficient. With modern
antimicrobial therapy, puerperal infections are limited, and the period of high fever
usually is transient. If the mother is too ill to nurse her baby during this time or if she
is receiving an anticoagulant or antibiotic that is passed in breast milk and would be
harmful to the baby, the infant should be fed by a supplementary milk formula. The
woman’s breastmilk can be manually expressed or pumped to maintain the
production of milk so it will be available when she is again able to nurse. You may
need to assist herwith this, because she fatigues easily and her energy level may not
be enough to support her good intentions. If it appears that the course of the
infection will be long, a woman may choose to discontinue breast-feeding.

6.If it is necessary for a woman to discontinue breast-feeding, she needs to be

assured that she can meet the needs of the child through bottle feeding.

7.If a woman is going to be hospitalized beyond the usual time, she may have to
make arrangements for the discharge and care of her baby. She may be interested
in a homemaker service or temporary foster care if she has no close friends or
family. If she has older children at home, she needs to keep in close contact with
them, calling them on the telephone or writing them short notes if possible. If the
infant is housed in a high-risk nursery, she needs to see a photograph of the
newborn (a Polaroid or digital camera should be a piece of equipment on every
postpartal unit) and hear daily reports of his or her progress and well-being.

Postpartum Thyroiditis

Postpartum thyroiditis is an uncommon condition in which a previously normal-

functioning thyroid gland becomes inflamed within the first year after childbirth.
Postpartum thyroiditis may first make your thyroid overactive. But over time the
condition leads to an underactive thyroid.

WHAT CAUSES POSTPARTUM THYROIDITIS?

• Experts don’t know what causes this condition. But it is a lot like the
autoimmune disease Hashimoto thyroiditis. It is hard to tell the two conditions
apart.
SYMPTOMS

During postpartum thyroiditis, you might experience two phases. The inflammation
and release of thyroid hormone might first cause mild signs and symptoms similar to
those of an overactive thyroid (hyperthyroidism), including:

• Anxiety, Irritability, Rapid heartbeat or palpitations, Unexplained weight loss,

Increased sensitivity to heat, Fatigue, and Tremor
• Typically occur one to four months after delivery and lasts 1-3 months
Later, as thyroid cells become impaired, mild signs and symptoms of underactive
thyroid (hypothyroidism) might develop, including:

• Lack of energy, increased sensitivity to cold, constipation, dry skin, weight

gain, and depression
• Typically occur 4-6 weeks after symptoms of hyperthyroidism resolve
and lasts 6-12 months
PREVENTION

Prevention of hypothyroidism can be achieved with the following:

• Increase in iodine intake. Iodine intake is the foremost prevention strategy in

hypothyroidism.
• Early detection. Undergoing thyroid tests after a thyroid surgery or therapy
could result in early detection and prompt treatment of hypothyroidism.
COMPLICATIONS

Hypothyroidism can be a life-threatening disease if left unchecked.

• Myxedema coma. This is the decompensated state of severe hypothyroidism

in which the patient is hypothermic and unconscious.

NURSING MANAGEMENT (HYPOTHYROIDISM)

• Protect against coldness.

• Mind the temperature.
 • Increase fluid intake.
• Manage respiratory symptoms.
• Pulmonary exercises.
• Orient to present surroundings
NURSING MANAGEMENT (HYPERHYROIDISM)

• Weigh daily. Encourage chair rest or bedrest. Limit unnecessary activities.

• Monitor BP lying, sitting, and standing, if able. Note widened pulse pressure.
• Assess pulse and heart rate while patient is sleeping.