Chapter 16 Nursing care of Postpartum Abnormality Postpartum

第十六章 產後期異常的護理 Chapter 16 Nursing care of Postpartum Abnormality

Postpartum hemorrhage (PPH) PPH 是產婦死亡的第一大原因 b Early PPH óbleeding within 24 hrs ótotal bleeding amount > 500 c. c. ó 1~2 hrs after childbirth: immediate PPH, most dangerous b Late PPH óHappens in 6~10 days after childbirth óalso called delayed PPH

Postpartum hemorrhage Causes b Uterine Atony 子宮張力不全: ó最常見，造成early PPH的主因 b Laceration 產道撕裂傷 b Hematoma 血腫 b Retained Placental Fragments 胎盤碎片殘留 ó造成 late PPH 的主因 b Diffuse Intravascular Coagulation (DIC) 瀰漫 性血管內凝血

Postpartum hemorrhage b Uterine Atony 子宮張力不全 óPPH最常見的原因 óInterventions õEnhance uterus contraction: Uterine massage, medication (oxytocin, methergin, ergonovine, prostaglandin) õ動脈結紮術、子宮切除術 (hysterectomy)

Postpartum hemorrhage b Laceration 產道撕裂傷 óEpi wound suture ócompression to stop bleeding 24~48 hrs ó 3º~4º laceration – stool softener to prevent constipation

Postpartum hemorrhage b Hematoma 血腫 óPerineal area bleeding – hematoma ó會陰受到壓迫而極度疼痛 óearly stage –cold pack to stop bleeding (止血) ólate stage –warm pack to remove hematoma (消腫)

Postpartum hemorrhage b Retained Placental Fragments 胎盤碎片殘留 ó阻礙子宮的收縮，引起 PPH õ 殘留碎片大—early PPH õ 殘留碎片小—late PPH óInterventions õ placenta examination õD&C õ Hysterectomy

Postpartum hemorrhage b Diffuse Intravascular Coagulation (DIC) 瀰漫性血管內凝血 óAbruptio Placenta óMissed abortion 過期性流產 óIUFD óAmniotic fluid embolism (AFE) 羊水栓塞 óPregnant Induced Hypertension (PIH)

Postpartum infection Puerperal fever 產褥熱 b BT over 38 ºC any 2 days from 24 hrs ~ 10 days after childbirth Classification b Genital Tract Infection 生殖道感染 b Urinary Tract Infection (UTI) b Mastitis 乳腺炎

Postpartum infection Genital Tract Infection órisk factor: ROM over 24 hrs óbacteria: E. coli, Staphylococcus ófungus: Candida albicans b wound infection b endometritis 最常見 ó 48~72 hrs after childbirth ófever over 38~39ºC, PR 100 -120 bpm óabnormal lochia

Postpartum infection Urinary Tract Infection b Urine retention 引起 b bacteria: E. Coli b Interventions

Postpartum infection Mastitis b happen 1~4 wks after childbirth b bacteria: staphylococcus (最常見), E. coli b Causes: ó乳頭破裂，細菌侵入 ó過渡按摩乳房使乳房組織受傷，或乳房有受傷 ó乳房鬱積或過渡膨脹

Postpartum infection

Postpartum infection b Medical intervention óAntibiotic: symptom usually relieved after 48 hrs óPain killer: ease painful symptoms ó膿腫切開術 õ乳房有膿腫，盡可能穿刺引流使膿流出 õ必要時需做切開引流，引流管並需放置 3天

Thrombophlebitis 血栓靜脈炎 Causes b 產後血小板增多、凝血因子增加 Classification b 血栓性靜脈炎 óSuperficial Thrombophlebitis óDeep Vein Thrombophlebitis (DVT)

Thrombophlebitis Symptoms b Superficial Thrombophlebitis ó產後3 -4天症狀明顯 ó表淺靜脈出現紅腫 b Deep Vein Thrombophlebitis (DVT) ó「white leg」: 下肢變得僵硬、皮膚蒼白、水腫 脹大， 末梢脈搏減慢 ó較易引發 Pulmonary Embolism

Thrombophlebitis b Diagnostic examination óPhysical assessment: õ 觀察下肢水腫、肌肉疼痛、壓痛 õ Homan’s sign õ Doppler detector 超音波血流偵測器 b Medical intervention óAnti-coagulant: heparin, warfarin óPain killer: 不使用aspirin óAntibiotics