Southern Luzon State University

College of Allied Medicine

Lucban, Quezon

FINAL EXAM
NCM O9 OB RISK
BSN LEVEL II

Jimenez, Aliyah Jewel P.

BSN 2B

Eassay:

1. Discuss the early postpartum hemorrhage and late post-partum hemorrhage comprehensively
citing their definition risk factor signs and symptoms and nursing interventions.
Postpartum Hemorrhage
What is postpartum hemorrhage?
Postpartum hemorrhage is more bleeding than normal after the birth of a baby. About 1 in 100
to 5 in 100 women have postpartum hemorrhage. It is more likely with a cesarean birth. It most
often happens after the placenta is delivered, but it can also happen later.

What causes postpartum hemorrhage?

Once a baby is delivered, the uterus normally contracts and pushes out the placenta. After the
placenta is delivered, these contractions help put pressure on the bleeding vessels in the area
where the placenta was attached. If the uterus does not contract strongly enough, these blood
vessels bleed freely. This is the most common cause of postpartum hemorrhage. If small pieces
of the placenta stay attached, bleeding is also likely.

Postpartum hemorrhage may also be caused by:

o Tear in the cervix or tissues of the vagina

o Tear in a blood vessel in the uterus

o Bleeding into a hidden tissue area or space in the pelvis. This mass of blood is called a
hematoma. It is usually in the vulva or vagina.

o Blood clotting disorders

o Placenta problems

Who is at risk for postpartum hemorrhage?

o Some women are at greater risk for postpartum hemorrhage than others. Conditions that
may increase the risk include:

o Placental abruption. This is the early detachment of the placenta from the uterus.

o Placenta previa. This is when the placenta covers or is near the opening of the cervix.

o Overdistended uterus. This is when the uterus is larger than normal because of too much
amniotic fluid or a large baby.

o Multiple-baby pregnancy

o High blood pressure disorders of pregnancy

o Having many previous births

o Prolonged labor

o Infection

o Obesity

o Use of forceps or vacuum-assisted delivery

o Being of Asian or Hispanic ethnic background

What are the symptoms of postpartum hemorrhage?

These are the most common symptoms of postpartum hemorrhage:

o Uncontrolled bleeding

o Decreased blood pressure

o Increased heart rate

o Decrease in the red blood cell count

o Swelling and pain in the vagina and nearby area if bleeding is from a hematoma

o The symptoms of postpartum hemorrhage may look like other health conditions. Always see
your healthcare provider for a diagnosis.

How is postpartum hemorrhage diagnosed?

Your healthcare provider will review your health history and do a physical exam. Lab tests often
help with the diagnosis. Other tests may include:

o Estimate of how much blood you have lost

o Measuring pulse and blood pressure

o Red blood cell count

o Clotting factors in the blood

 Postpartum hemorrhage can be divided into 2 types: early postpartum hemorrhage, which
occurs within 24 hours of delivery, and late postpartum hemorrhage, which occurs 24 hours to 6
weeks after delivery. Most cases of postpartum hemorrhage, greater than 99%, are early
postpartum hemorrhage.
2. Discuss and enumerate the general nursing care for high risk post partal clients
Bathing and Sitz Baths
To prevent infections after delivery, it is preferable to take showers rather than a tub baths for
two weeks. If showers are not possible, fill the tub with three to four inches of water, and leave
the drain open and the water running. This is called a sitz bath and may be continued as long as
needed for comfort.

Vaginal Bleeding
Normal bleeding after delivery is similar to a heavy menstrual period and it should decrease by
the third or fourth day after birth, but can last for up to four to six weeks. You may notice an
increase in bleeding or blood clots on your first or second day at home because your activity has
increased. If you experience a heavy bleeding (soaking a pad every hour for two to three hours)
or begin cramping, it is a sign of over-activity and you must rest. If the bleeding or cramping
continue, please call our office.

Menstrual periods often resume between 5 and 12 weeks after giving birth unless you are
breastfeeding. Nursing may suppress periods for some women, but breastfeeding is not a form
of birth control since it is still possible to become pregnant while nursing.

Constipation and Hemorrhoids

After giving birth, it is essential to maintain normal bowel habits and avoid constipation.
Consume extra fluids and a healthy, high-fiber diet. If necessary, your physician may also
recommend a stool softener such as Colace® or Surfak®. If a laxative is needed, Colace and Milk
of Magnesia® are safe to take while nursing. If hemorrhoids are a problem, use medicated
cream or suppositories. To relieve additional discomfort from hemorrhoids try lying on your side
with your upper leg slightly bent, and take therapeutic Sitz baths.

Episiotomy
 To sooth an episiotomy incision, take Sitz baths while you heal. Stitches should dissolve within
four to six weeks and do not have to be removed. Over-the-counter or prescription pain
medications can also provide relief, but discomfort should decrease daily. However, if any
unusual pain develops, call your physician.

Nursing and Breast Care

Initial attempts at nursing can be painful, but tenderness and discomfort should decrease once
let-down (a tingling sensation that occurs in the breast right before and when milk comes into
the milk ducts, a sign you need to feed your baby) has occurred and should cease altogether
within a few days. However, if you have sore, cracked, or bleeding nipples, express a few drops
of breast milk on the nipples after nursing and allow to air dry. To prevent future irritation,
always keep your nipples clean, change the nursing pads when they become moist and avoid
wearing pads with plastic liners.

3. What nursing care of intervention must be provided for post partal psychiatrial disorders
capturing physical mental and social well-being as well as for their family member.
Nursing Interventions
o Assist the woman in planning for her daily activities, such as her nutrition program, exercise,
and sleep.
o Recommend support groups to the woman so she can have a system where she can share
her feelings.
o Advise the woman to take some time for herself every day so she can have a break from her
regular baby care.
o Encourage the woman to keep in touch with her social circle as they can also serve as her
support system.
Evaluation
o The patient engages more in social activities.
o The patient can express her feelings and insecurities.
o The patient can perform her activities of daily living.
o The patient recognizes the importance of counseling and regularly attends one.
o The psychological health of a mother has as much impact as well as her physical health. Her
well-being must also be ensured because she is the number caregiver of the infant, and the
 bonding between mother and child would only be possible if both of them are in a state of
good holistic health.

4. Discuss at least two disorders of the female reproductive tract definition, discuss the
pathophysiology nursing intervention and management.

Interstitial cystitis
Interstitial cystitis is a chronic condition causing bladder pressure, bladder pain and sometimes
pelvic pain. The pain ranges from mild discomfort to severe pain. The condition is a part of a
spectrum of diseases known as painful bladder syndrome.
Your bladder is a hollow, muscular organ that stores urine. The bladder expands until it's full and
then signals your brain that it's time to urinate, communicating through the pelvic nerves. This
creates the urge to urinate for most people.

With interstitial cystitis, these signals get mixed up — you feel the need to urinate more often
and with smaller volumes of urine than most people.

Interstitial cystitis most often affects women and can have a long-lasting impact on quality of
life. Although there's no cure, medications and other therapies may offer relief.
Some people with interstitial cystitis find symptom relief from these strategies:

Dietary changes. Eliminating or reducing foods in your diet that irritate your bladder may help to
relieve the discomfort of interstitial cystitis.

Common bladder irritants — known as the "four Cs" — include: carbonated beverages, caffeine
in all forms (including chocolate), citrus products and food containing high concentrations of
vitamin C. Consider avoiding similar foods, such as tomatoes, pickled foods, alcohol and spices.
Artificial sweeteners may aggravate symptoms in some people.

If you think certain foods may irritate your bladder, try eliminating them from your diet.
Reintroduce them one at a time and pay attention to which, if any, worsen symptoms.
Bladder training. Bladder training involves timed urination — going to the toilet according to the
clock rather than waiting for the need to go. You start by urinating at set intervals, such as every
half-hour — whether you have to go or not. Then you gradually wait longer between bathroom
visits.

During bladder training, you may learn to control urinary urges by using relaxation techniques,
such as breathing slowly and deeply or distracting yourself with another activity.

These self-care measures also may help:

Wear loose clothing. Avoid belts or clothes that put pressure on your abdomen.
Reduce stress. Try methods such as visualization and biofeedback.
If you smoke, stop. Smoking may worsen any painful condition, and smoking contributes to
bladder cancer.
Exercise. Easy stretching exercises may help reduce interstitial cystitis symptoms

HIV/AIDS
HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight
infection, making a person more vulnerable to other infections and diseases. It is spread by
contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex
(sex without a condom or HIV medicine to prevent or treat HIV), or through sharing injection
drug equipment.
The plan of care for a patient with AIDS is individualized to meet the needs of the patient.

Promote skin integrity. Patients are encouraged to avoid scratching; to use nonabrasive,
nondrying soaps and apply nonperfumed moisturizers; to perform regular oral care; and to clean
the perianal area after each bowel movement with nonabrasive soap and water.
Promote usual bowel patterns. The nurse should monitor for frequency and consistency of
stools and the patient’s reports of abdominal pain or cramping.
Prevent infection. The patient and the caregivers should monitor for signs of infection and
laboratory test results that indicate infection.
 Improve activity intolerance. Assist the patient in planning daily routines that maintain a balance
between activity and rest.
Maintain thought processes. Family and support network members are instructed to speak to
the patient in simple, clear language and give the patient sufficient time to respond to
questions.
Improve airway clearance. Coughing, deep breathing, postural drainage, percussion and
vibration is provided for as often as every 2 hours to prevent stasis of secretions and to promote
airway clearance.
Relieve pain and discomfort. Use of soft cushions and foam pads may increase comfort as well
as administration of NSAIDS and opioids.
Improve nutritional status. The patient is encouraged to eat foods that are easy to swallow and
to avoid rough, spicy, and sticky food items.

5. Discuss infertility among males and females its definition signs and symptoms risk factors and
management. cite important nursing care that must be provided for couples with infertility
problem.

A diagnosis of infertility means you haven’t been able to get pregnant after a year of trying. If
you’re a woman over 35, it means you haven’t been able to get pregnant after 6 months of
trying.

Women who are able to conceive but not carry a pregnancy to term may also be diagnosed with
infertility.

A woman who’s never been able to get pregnant will be diagnosed with primary infertility. A
woman who’s had at least one successful pregnancy in the past will be diagnosed with
secondary infertility.

Infertility isn’t just a woman’s problem. Men can be infertile too. In fact, men and women are
equally likely to have fertility problems.
According to the Office on Women’s HealthTrusted Source, about one-third of infertility cases
can be attributed to female infertility while men’s problems account for another third of
infertility cases.

The remaining third of cases may be caused by a combination of male and female infertility, or
they may have no known cause.

Causes of male infertility

Generally speaking, infertility in men is related to issues with the following:

o effective production of sperm

o sperm count, or the number of sperm
o shape of the sperm
o movement of the sperm, which includes both the wiggling motion of the sperm themselves
and the transport of the sperm through the tubes of the male reproductive system
There are a variety of risk factors, medical conditions, and medications that can also affect
fertility.

Risk factors
Risk factors associated with infertility in men include, but aren’t limited to:

o older age
o smoking cigarettes
o heavy use of alcohol
o being overweight or obese
o exposure to toxins, such as pesticides, herbicides, and heavy metals
Medical conditions
Some examples of medical conditions that can cause male infertility include:

o retrograde ejaculation
o varicocele, or the swelling of the veins around the testicles
o testicles that haven’t descended into the scrotum
o having antibodies that attack your sperm and destroy them
o a hormonal imbalance, such as low testosterone production

Fertility challenges can lead to emotional trauma and put strain on a partnership. While fertility
treatments in the medical field may be able to help improve the likelihood of conception,
entering therapy while undergoing these treatments can be a helpful way to work through grief,
anxiety, worry, and other emotions that may be experienced as a result of fertility issues,
especially in the event that treatments fail.

Many counselors and therapists, especially marriage and family therapists, may be aware of the
challenges that accompany fertility issues and the common treatments for infertility. Some
counselors may even specialize in therapy for fertility issues. In therapy, those faced with
infertility will be able to discuss options and make decisions about how to proceed, whether
through adoption, fertility treatments, artificial insemination, surrogate parenting, or even
separation. Therapy can also help couples deal with the feelings of guilt or anger that may arise
between two partners when only one person is infertile.

PREPARED BY:
PROF. BERNARDITA E. BRILLON RN RM MAN