Avoid sitting in one position or standing for a prolonged period of time
Early ambulation is important; If ambulation is not possible, perform active and passive leg exercises. do not place pillows under your knees
Postpartum Psychosocial (PPD/Psychosis, Blues)
• Medications/contraindications/interactions, interventions, etc.
Postpartum Depression PPD
10% to 20% of postpartum women progress beyond the baby blues into postpartum depression (PPD), Occurs within 6 months postpartum.
S & S: Symptoms of PPD include
· depressed mood or decreased interest/pleasure in previously enjoyable activities,
· insomnia or hypersomnia,
· lack of appetite or weight loss,
· restlessness, anxiety,
– inability to cope, and feelings of hopelessness
Risk factors should begin with the first prenatal visit.
Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have been shown to be beneficial in treating perinatal depression. CBT is an action-oriented approach that treats maladaptive thinking as the cause of pathological behavior and “negative” emotions.
Exercise has been shown to increase levels of neurotransmitters (Dopamine) that communicate with brain cells to increase feelings of euphoria.
Medication for PPD:
SSRIs “lopran” suffix Anxiety/Depression
SNRIs “faxine” suffix Anxiety/Depression
TCAs/heterocyclics “pramine” “ptyline” suffix Anxiety/Depression
Mood stabilizer Lithium Bipolar/Postpartum psychosis
Postpartum Psychosocial (PPD/Psychosis/ Blues)
• Medications/contraindications/interactions, interventions, etc.
· Rare but severe form of mental illness.
· Affects not only the new mother but the entire family
· Greatest risk in those with pre-existing psychosis
· Behavioral cues that signal postpartum psychosis
· Collaborative management. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT)
*IMPORTANT: Postpartum Psychosis may present with PPD symptoms; However, the distinguishing signs of Psychosis are Hallucinations, delusions, agitation, confusion, disorientation, sleep disturbances, suicidal and homicidal thoughts, and, loss of touch reality.
This condition may also resemble a sudden maniac attack. Mothers who are in a maniac state, require constant supervision when caring for the infant; they are frequently too preoccupied to tend to their infant’s needs.
N.I: Examples of bonding-oriented nursing care include rooming-in, decreasing sensory stimuli so that the family can focus on one another, and limiting visitors (if the patient desires).
· Common emotional response of periods of happiness followed by periods of tearfulness
· Self-limiting and resolve by 10 days postpartum.
· Signs & Symptoms:
· – Tearfulness, Mood swings, anxiety, fatigue, sadness, insomnia, forgetfulness and con fusion.
· Alleviating factors
Is a blood loss greater than 500 mL after a vaginal birth 1gr and, 1,000 mL (2gr) or more after a cesarean birth.
Is a serious condition.
Early Postpartum Hemorrhage: An early (primary) PPH occurs within the first 24 hours after childbirth.
Late Postpartum Hemorrhage: A late (secondary) PPH occurs from 24 hours to 12 weeks after childbirth.
When bleeding is associated with uterine atony or retained placental fragments, the blood is dark red with clots and the uterus is soft and boggy.
When the bleeding is associated with lacerations from the perineum, cervix or vagina, the blood is bright red, often without clots, and the uterus is firmly contracted.
Methylergonovine (Methergine) Contraindicated for HTN
Carboprost tromethamine (Hemabate) Contraindicated in Asthma, Cardiac, hepatic, renal pts
Dinoprostone (Prostin E2)
Labs for PPH: Include, CBC. PT & PTT Electrolytes, BUN
N.I: Patients who are experiencing PPH hemorrhage from genital tract lacerations need one or two large-bore IV sites, frequent recording of vital signs, accurate measurements of intake and output from all sources (including blood), laboratory work, an indwelling urinary catheter, oxygen, and pain medication.
Help the patient assume a lithotomy position, obtain bright lighting and examination instruments, and prepare suction equipment.
A hematoma is a localized collection of blood in connective or soft tissue under the skin that follows injury of or laceration to a blood vessel without injury to the overlying tissue.
Sign & Symptom of a hematoma is
· unremitting pain and pressure, the pain and pressure worsen if active bleeding continues.
· sensation of “heaviness” in the vagina and/or rectal pressure
· Tachycardia and hypotension
Storing breastmilk/ breast pumping
Store breast milk if prematurity of baby or illness.
Freshly pumped breast milk can be safely stored at room temperature 77°F (25°C) for 4 hours or refrigerated at 40°F (4°C) for 4 days after collection. Milk kept in a deep freezer at 0°F (–18°C) can be stored for 6 to 12 months
IPV: Economic, Isolation, emotional, threats
Categories of IPV
· Physical abuse: The intentional use of physical force with the potential for causing death, disability, injury,
or harm. Direct acts include slapping, punching, kicking, biting, strangulation, burns, attacking with weapons, throwing objects, and depriving the partner of sleep. Indirect acts include abuse in which physical effects can result such as subjecting the person to reckless driving or withholding medical attention.
· Sexual coercion: Includes the use of physical force to compel a person to engage in a sexual act against their will, whether or not the act is completed; attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act (e.g., owing to illness, disability, or the influence of alcohol or other drugs or because of intimidation or pressure); and abusive sexual contact. Other acts include forcing the person to engage in sexual activities with others, pregnancy coercion, and subjecting the person to sexually transmitted infections.
· Threats: A type of abuse in which words, gestures, or weapons are used to communicate the intent to cause death, disability, injury, or physical harm. These can include threats to harm the partner, partner’s family, friends, pets, property, and/or children (or threat to take the children away), as well as indirect acts and threats to kill themselves.
· Emotional abuse: Emotional abuse constitutes a range of various tactics, name calling, threats of acts, coercive tactics, publicly humiliating partners, convincing the partner they have mental health problems, and gaslighting. Stalking, which refers to harassing or threatening behavior that an individual engages in repeatedly (e.g., following a person, appearing at a person’s home or place of business, making harassing phone calls, vandalizing a person’s property) is frequently included among the types of IPV.
· Isolation: Isolation includes cutting partner off from friends and family; denying privacy; preventing them from leaving the house; denial of communication from other people; preventing the person from learning the language spoken in the country where they live; and controlling social media, phone calls, and e-mails.
· Economic abuse: Occurs when the perpetrator controls all money, prevents the partner from working, or forces the partner to work excessively and takes the earnings. Related types of abuse include interfering with the partner’s job or ruining credit ratings so that the person is financially distressed. increase
IPV: priority interventions for each type of abuse
Phases of IPV (honeymoon, tension, etc.)
1. Tension-building phase
· Period of increasing tension
2. Acute violence/explosion
· Abuser discharges pent-up tension
· May be triggered by an internal response in the abuser or by an external crisis
3. Honeymoon period
· Tranquil, loving period of calm and remorse
· Description of the person who abused the patient
· Date and time of incident or abusive situation
· Patient’s account of what happened, all detail should be included
· Specific details about the abuse, using quotations to indicate when the statements represent exactly what the patient said
· Injuries should be documented with detailed descriptions and measurements and pictures should be taken if possible
· Note patient’s coping and responses to the abuse
· Type of injuries sustained or official reports
· Note safety measures taken and safety assessment
· Note referrals made for follow-up
· Mandatory reporting and corresponding safety planning
Sexual assault treatments/ therapeutic communication
Medical treatment of SA patients always begins with treating life-threatening conditions such as strangulation.
Depending on the injury, treatment may include a complete trauma panel with x-rays and CT scans. Many victims of SA may not be fully aware of the complete acts that were committed against them.