Assess lochia for color amount and clots 1 gm 1 mL No more than 1 padhour no

Assess lochia for color amount and clots 1 gm 1 ml no

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Assess lochia for color, amount, and clots (1 gm = 1 mL) No more than 1 pad/hour, no large clots Continuous trickle of bright red blood = bleeding laceration o Assess vital signs, including pain o Apply ice pack to perineum o Sensation and movement if regional anesthesia given o Fullness of bladder/catheter care Full bladder prevents uterine contractions Hemorrhage Lacerations o Uncontrolled tear of the tissues of an around the vagina First degree o Superficial vaginal mucosa or perineal skin Second degree o First degree plus deeper tissue of the perineum Third degree o Adds the anal sphincter Fourth degree o Extends through to the rectum Nursing Care for Episiotomy and Lacerations o Ice For first 12--24 hours o Warm sitz baths Can start sitz bath after 12 hours o Mild analgesia o Perineal spray bottle Prevents infection To squirt the area while voiding The perineal pad should be changed after each elimination and may be changed in between Wipe front to back o Avoid constipation Uterotonics o Oxytocin (Pitocin) o Methylergonovine (Metherine) o Carboprost (Hemabate) o Misoprostol (Cytotec) High Risk Deliveries Abnormal Labor o Dystocia Abnormal or difficult labor o There is a problem with the 5 “Ps” of labor o For any abnormalities, always monitor fetal heart rate o Problems with the powers of labor
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Hypertonic labor/Hypertonic Uterine Dysfunction Frequent, painful, uncoordinated contractions Contractions are frequent but ineffective in promoting dilation and effacement Uterus remains tense between contractions Reduced blood to placenta/fetus Treatment Relaxation Administration of pain medications Terbutaline (Brethine) Hypotonic labor/Hypotonic Uterine Dysfunction Uterine contractions are insufficient to promote more cervical dilation and effacement Usually occurs in the active phase of labor Treatment Hydrate Amniotomy Augment with oxytocin (Pitocin) C-section Inadequate Expulsive Forces Occurs in the second stage of labor when the woman is not able to push or bear down Causes Woman is tired or may not feel the urge to push Fetal dystocia Excessive fetal size (macrosomia) or malpresentation Pelvic dystocia Abnormal pelvic shape Treatment Sit woman upright Augment with oxytocin Use of assistive devices Forceps Curved blades that are used to gently guide/pull the fetal head out of the vagina Vacuum Suction cup device which provides gentle suction to help deliver the head Applied over the posterior fontanel C-section o Problems with the fetus Fetal size Fetal position and presentation o Problems with the pelvis and soft tissue o Abnormal duration Precipitous Birth Labor less than three hours
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At risk for postpartum hemorrhage related to uterine atony or lacerations Risk Factors Grand multiparity History
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