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Assess lochia for color, amount, and clots (1gm = 1 mL)No more than 1 pad/hour, no large clotsContinuous trickle of bright red blood = bleeding lacerationoAssess vital signs, including painoApply ice pack to perineumoSensation and movement if regional anesthesia givenoFullness of bladder/catheter careFull bladder prevents uterine contractionsHemorrhageLacerationsoUncontrolled tear of the tissues of an around the vaginaFirst degreeoSuperficial vaginal mucosa or perineal skinSecond degreeoFirst degree plus deeper tissue of the perineumThird degreeoAdds the anal sphincterFourth degreeoExtends through to the rectumNursing Care for Episiotomy and LacerationsoIceFor first 12--24 hoursoWarm sitz bathsCan start sitz bath after 12 hoursoMild analgesiaoPerineal spray bottlePrevents infectionTo squirt the area while voidingThe perineal pad should be changed after each elimination and may be changed in betweenWipe front to backoAvoid constipationUterotonicsoOxytocin (Pitocin)oMethylergonovine (Metherine)oCarboprost (Hemabate)oMisoprostol (Cytotec)High Risk DeliveriesAbnormal LaboroDystociaAbnormal or difficult laboroThere is a problem with the 5 “Ps” of laboroFor any abnormalities, always monitor fetal heart rateoProblems with the powers of labor
Hypertonic labor/Hypertonic Uterine DysfunctionFrequent, painful, uncoordinated contractionsContractions are frequent but ineffective in promoting dilation and effacementUterus remains tense between contractionsReduced blood to placenta/fetusTreatmentRelaxationAdministration of pain medicationsTerbutaline (Brethine)Hypotonic labor/Hypotonic Uterine DysfunctionUterine contractions are insufficient to promote more cervical dilation and effacementUsually occurs in the active phase of laborTreatmentHydrateAmniotomyAugment with oxytocin (Pitocin)C-sectionInadequate Expulsive ForcesOccurs in the second stage of labor when the woman is not able to push or bear downCausesWoman is tired or may not feel the urge to pushFetal dystociaExcessive fetal size (macrosomia) or malpresentationPelvic dystociaAbnormal pelvic shapeTreatmentSit woman uprightAugment with oxytocinUse of assistive devicesForcepsCurved blades that are used to gently guide/pull thefetal head out of the vaginaVacuumSuction cup device which provides gentle suction tohelp deliver the headApplied over the posterior fontanelC-sectionoProblems with the fetusFetal sizeFetal position and presentationoProblems with the pelvis and soft tissueoAbnormal durationPrecipitous BirthLabor less than three hours
At risk for postpartum hemorrhage related to uterine atony or lacerationsRisk FactorsGrand multiparityHistory