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POSTPARTAL THROMBOPHLEBITIS Superficial thrombophlebitis is seen more often during the postpartal period than during pregnancy and is more  common in women with preexisting varices. Postpartal deep vein thrombosis (DVT) and superficial thrombophlebitis  have been attributed to trauma to pelvic veins from pressure of the presenting fetal part, sluggish circulation caused by  mechanical edema, and alterations in coagulation related to the large amounts of estrogens produced during pregnancy.  Thrombosis that involves only the superficial veins of the leg or thigh is unlikely to generate pulmonary emboli (PE).  While approximately 50% of clients with DVT  are  asymptomatic,  DVT  is  more  serious  in  terms  of  potential  complications, including PE, postphlebotic syndrome, chronic venous insufficiency, and vein valve destruction. (This plan of care is an adjunct to the regular postpartal plans of care.) CLIENT ASSESSMENT DATA BASE Activity/Rest History of prolonged sitting, either work-related or as a result of activity restrictions Current immobility associated with bedrest and anesthesia Activity/prolonged standing limited by pain Fatigue/weakness of affected extremity, general malaise Circulation Varicose veins; thrombosis may be palpable, bumpy/knotty. Slight elevation of pulse rate (superficial). History of previous venous thrombosis, heart disease, hemorrhage, PIH, diabetes mellitus, hypercoagulability in early  puerperium. Peripheral pulses diminished, positive Homans’ sign may or may not be noted (indicators of DVT). Lower extremity (calf/thigh) may be warm and pinkish-red in color, or affected limb may be cool, pale, edematous. Food/Fluid Excessive weight gain/obesity. Poor skin turgor, dry mucous membranes (dehydration predisposes to hypercoagulability). Milk supply may occasionally be reduced in lactating client. Edema of affected extremity (dependent on location of thrombus). Pain/Discomfort Throbbing, tenderness, aching pain in affected area (e.g., calf or thigh) aggravated by standing or movement Lower abdominal pain (involvement of ovarian vein) Guarding of affected extremity Safety Presence of postpartal endometritis or pelvic cellulitis. Temperature may be slightly elevated; progression to marked elevation and chills (signs of DVT); high fever (septic  pelvic thrombophlebitis). Sexuality Multiparity; hydramnios Prolonged labor associated with fetal head pressure on pelvic veins, use of stirrups or faulty positioning of extremities  during intrapartal phase/operative delivery Teaching/Learning Use of oral contraceptives Use of estrogen for suppression of lactation
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DIAGNOSTIC STUDIES Hematocrit (Hct):  Identify hemoconcentration.
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