Professional Documents
Culture Documents
Outline
• Definition
• Classifications
• Anatomy and Physiology
• Causes
• Signs and Symptoms
• Risk factors
• Diagnostic procedure
• Complications
• Treatment
• Prevention & Risk for reoccurrance
• Nursing management
• References
Female genitalia
ETIOLOGY:
- OVER STRETCHING OF PERINIUM
- RAPID STRETCHING OF PERINIUM
- INELASTIC PERINIUM
Causes and Predisposing Factors:
• Obstetric injuries:
Malpresentations such as breech
Contracted pelvic outlet
spontaneous labour
operative vaginal deliveries( forceps or vaccum)
Macrosomic babies
• Non-obstetric injuries: rape, molestation, fall,
accidental injuries like RTA, bull horn injuries etc.
Degrees of Perineal tear:
First degree- limited to vaginal mucosa and skin of the
introitus.
Second degree- extends to the fascia and muscles of
the
perineal body.
Third degree- trauma involves the anal sphincter.
Fourth degree - extends into the rectal lumen,
through
the rectal mucosa.
“tearing sensation”
Fetal distress
Decreased brain perfusion
Renal failure
Oxygen
Intravenous fluids
Maternal vital signs
Uterine contractions
Uterine/vaginal blood loss
Measure and record fundal
height every 30 minutes
Deficient Fluid
Volume
Start or maintain an IV fluid as prescribed. Use a
hemodynamic monitoring.
Maintain bed rest to decrease metabolic
demands.
Insert Foley catheter, and moniter urine output
hourly or as indicated.
Obtain and administer blood products as
indicated.
Fear
Give brief explanation to the woman and her support
relaxation.
Remain with the woman until anesthesia has been
administered; offer support as needed.
Keep the family members aware of the situation
while the
woman is in surgery and allow time for them to
express
feelings.
Decreased cardiac
output
•Administer supplemental oxygen, blood/fluid
replacement, antibiotics, diuretics, inotropic
drugs, antidysrhythmics, steroids,
vassopressors, and/or dilators as ordered.
•Position HOB flat or keep trunk horizontal
while raising legs 20 to 30 degrees in shock
situation
•Activities such as isometric exercises, rectal
stimulation, vomiting, spasmodic coughing
which may stimulate Valsalva response should
be avoided; administer stool softener as
indicated.
Ineffective Tissue
Perfusion
Administer O2 using a face mask at 8-12 L/min or
as ordered to provide high oxygen concentration.
Apply pulse oximeter, and monitor oxygen
saturation as indicated.
Monitor ABG levels and serum electrolytes as
indicated to assess respiratory status, observing for
hyperventilation and electrolyte imbalance.
Continually monitor maternal and fetal vital
signs
to assess pattern because progressive changes may
indicate profound shock.
Risk for Infection
• Observe for localized signs of infection.
•Cleanse incision or insertion sites daily
and PRN with povidone iodine or
other appropriate solutions.
•Change dressings as needed or
indicated.
•Encourage early ambulation, deep
breathing, coughing and position
changes.
•Maintain adequate hydration and
provide.
•Provide perineal care.
MEDICAL MANAGEMENT
•Immediate stabilization of maternal
hemodynamics and immediate
caesarean delivery
•Oxytocin is given to contract the uterus
and the replacement .