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.
Hematomas:
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
REEDA
R redness
E edema
E ecchymosis
D discharge
A approximattion
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
Documenting IPV
· 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
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.
Prophylactic Treatments
· SEXUALLY TRANSMITTED INFECTIONS (STIs)
Infection/Condition ➡ Recommended Treatment With 5 Days
Neisseria gonorrhoeae: Ceftriaxone 500 mg IM as a single dose
Chlamydia trachomatis: Azithromycin 1 g as a single dose or doxycycline 100 mg twice once a day for 7 days
Trichomoniasis: Metronidazole 2 g orally in a single dose
Human Papillomavirus (HPV) Recommended for females ages 9–26: Administer first dose of HPV vaccine series
· HUMAN IMMUNODEFICIENCY VIRUS
· PREGNANCY TESTING AND PROPHYLAXIS
Mental Health Care
SA can significantly affect the health and well-being of victims. Victims may face both short- and long-term medical and mental health disorders. These affect day-to-day function and can lead to unhealthy behaviors.
Victims who have sustained an SA have significantly higher rates of PTSD. Often, these adverse psychological outcomes are multifaceted and occur in conjunction with one another, including PTSD as well as depression, anxiety, suicidal ideation, and substance use and abuse.
Discharge Instructions
Discharge instructions are an essential component of post-assault care. Given the risk for STDs, all women should be instructed on signs and symptoms of STIs, and written instructions should be given for reinforcement. The patient should be instructed on the signs and symptoms to monitor and contact a health-care provider if they experience these signs and symptoms. They may need to return for further STD testing if symptoms develop. Support and information on advocacy services should also be provided. If a woman must return home to the person who assaulted her, it can affect her ability to seek health care or continue with prescribed medications. If the perpetrator is an acquaintance outside the patient’s home, she may be fearful of further assaults.
Mandatory Reporting
In most states, health-care providers are not required to report an SA to law enforcement. Cases were the patient is a minor, elder, or protected disabled person warrant the health-care provider to file a mandatory report. Some states may require the SANE to file a report in certain circumstances, such as if a minor was present in the home where the assault occurred. In other cases, strangulation may be classified as an attempt at homicide, which in some states falls under mandatory reporting. Nurses need to be aware of local reporting laws so they can follow specific laws and regulations regarding mandatory reporting.
PMS vs. PMDD: signs and symptoms:
PMS Premenstrual Syndrome:
Is the presence of behavioral, emotional, and physical symptoms that occur during the second half, or luteal phase, of the menstrual cycle and cease at or within a few days after the onset of menses.
S&S: Back pain, Insomnia, Increased appetite, Abdominal pain, Fatigue, Sensitive breast, Acne, Abdominal bloating, Nausea, Headache, Constipation, Diarrhea.
Occur in a cyclical pattern.
In other words, PMS syndrome are the signs and symptoms prior menses and the days afterwards.
Symptoms last from 9 to 10 days. Affects 95% of women
For most women with PMS, symptoms develop from 2 to 12 days prior to menstruation and resolve within 24 hours following the onset of menses.
PMDD Premenstrual Dysphoric Disorder:
A severe, sometimes disabling form of PMS.
Most frequently report: Abdominal bloating, anxiety, tension, Breast tenderness, crying episodes, Depression, Fatigue and lack of energy, Irritability, Difficult concentrating, Appetite changes, Thirst, and swelling of the extremities.
Populations at Highest Risk for PMS Women in their late 20s to late 40s most frequently report symptoms of premenstrual disorders. Symptoms often worsen as the woman approaches the menopausal transition. Also, women with a body mass index of 30 or above, those who have at least one child, those with a personal or family history of major depression, and those with a history of postpartum depression or an affective mood disorder are most often affected. It is important to note that premenstrual disorders:
• Occur only in ovulatory women
• Occur only during the luteal phase of the menstrual cycle
• Resolve within 4 days following the onset of menses
The occurrence of premenstrual disorders is not dependent on the presence of monthly menses. Interestingly, women who have had a hysterectomy without bilateral salpingo-oophorectomy (removal of both ovaries) can still have cyclical PMS symptoms.
Patient education PMS / PMDD Women who seek care for symptoms associated with premenstrual disorders should be given a complete physical examination and thorough clinical evaluation to rule out illness that may be the source of the symptoms. A detailed health history is the cornerstone in the accurate diagnosis of PMS/PMDD .
Nurses should inquire about risk factors such as emotional stress; poor nutritional habits;
Side effects noted when taking combined hormonal contraceptives (if indicated); increased intake of alcohol, salt, and caffeine; tobacco use (women who smoke cigarettes are more than twice as likely to have more severe symptoms); personal history of depression; pre-eclampsia or eclampsia; and family history of PMS.
Women at risk:
When evaluating a patient with PMS/PMDD symptoms, the nurse must always take any report of suicidal thoughts or other indicators of extreme mood change most seriously. The woman will need appropriate medications, close follow-up, and referral to a qualified mental health professional. In the ideal situation, mental examinations are timed to occur during both the luteal and follicular phases of the menstrual cycle. If the patient experiences significant mood symptoms (e.g., suicidal ideation) during both the luteal and follicular phases, referral to a psychiatrist is indicated.
