Question: Give The Interventions Of The Following Common Deviations From The Norm That May Occur During Puerperium. See The Table Below. Focus Listing COMMON DEVIATIONS RISK FACTORS IDENTIFYING WOMEN AT RISK INTERVENTIONS Elevated Temperature Dehydration Exertion Of Labor Possible Puerperal Infection Breast Engorgement Dehydration – If Urine Is Dark Yellow …

COMMON DEVIATIONS

RISK FACTORS

IDENTIFYING WOMEN AT RISK

INTERVENTIONS

Elevated Temperature

5. Dehydration
6. Exertion of Labor
7. Possible puerperal infection
8. Breast engorgement

5. Dehydration – if urine is dark yellow or the woman is urinatingless
6. Puerperal infection – loss of appetite, pale skin, chills,headache

Feeling of extreme sadness or unreality

5. Stress
6. Fluid and electrolyte imbalance
7. Anxiety

5. Examine for history of previous depression, prenatal anxietyand depression, low self-esteem, poor marital relationship, andinadequate social supports

Pallor

5. Anemia
6. Excessive loss of blood
7. Postpartum hemorrhage

5. Review adequacy of iron and folic acid intake duringpregnancy
6. Postpartum hemorrhage – estimate blood loss, measure pulse rateand blood pressure as needed, examine hematocrit and clottingfactors in the blood

Thready, rapid, weak pulse

5. Puerperal bradycardia
6. Hypovolemia
7. Decreased cardiac strain
8. Decreased blood volume following placental separation
9. Increased stroke volume
10. Undue blood loss
11. Infection
12. Anxiety

5. Hypovolemia – assess for incidence of postpartumhemorrhage
6. Decreased cardiac strain – assess during prenatal for heartproblems or anomalies

Pain and swelling

5. Breast engorgement
6. Plugged ducts
7. Mastitis
8. Infection

5. Assess for breast anomalies such as breast fissure and invertednipples

Decreased blood pressure

5. Preeclampsia
6. Excessive blood loss

5. Examine history of preeclampsia, chronic hypertension, obesity,age and multiple pregnancy
6. Estimate blood loss, measure pulse rate and blood pressure asneeded

Relaxed uterus

5. Prolonged time of contraction during labor
6. Prolonged labor
7. Labor lasting less than 3 hours
8. Uterine inversion
9. Extended use of oxytocin

5. Observe for time of contraction during labor and length oflabor
6. Assess for uterine inversion
7. Take note of the use of oxytocin during labor

Uterine hemorrhage

5. Placental abruption
6. Placenta previa.
7. Overdistended uterus
8. Multiple pregnancy.
9. Gestational hypertension or preeclampsia.
10. Prolonged labor
11. Infection
12. Obesity
13. Blood clotting disorders

5. Assess for placental abruption, placenta previa, overdistendeduterus, multiple pregnancy, preeclampsia, length of labor,infection, obesity, and blood clotting disorders

Abdominal pain

5. Uterus contracts to shrink back to its normal size
6. Compresses blood vessels to avoid too much bleeding
7. Certain pain medications that may also slow down the work ofthe digestive system
8. Possible infections such as endometritis, bacterial vaginosis,UTI, appendicitis

5. Check for multiparity
6. Rule out presence of possible infections such as endometritis,bacterial vaginosis, UTI, appendicitis

Pain of symphysis pubis on walking

5. Broken or bruised tailbone
6. Swelling or bleeding when the ligaments (between the two bonesat the front of the pelvis) are stretched and the bones come apartas in walking

5. Assess women who are primigravida, those who have multiplegestations, and those who had a prolonged active labor

Perineal pain

5. Perineal tears
6. Episiotomy
7. Swelling of the perineum

5. Assess risk factors that contribute to perineal tears likeforceps delivery, high birth‐weight, nulliparity, episiotomy,induced labour and abnormal fetal presentation

Lochia with foul odor

5. Infection

5. Determine patients with low socioeconomic status undergoingcesarean section, those who have had prolonged labor and rupture ofmembranes, UTI

Pain and tenderness in calf of leg

5. Superficial venous thrombosis
6. Extreme extension at the ankle joint

5. Assess previous history of VTE, increased maternal age,varicose veins, mode of delivery, and family history of VTE

Positive Homan’s sign

5. Deep Vein Thrombosis (DVT)
6. Intervertebral disc herniation
7. Ruptured Baker’s cyst
8. Neurogenic claudication
9. Gastrocnemius spasm
10. Cellulitis

5. DVT – Assess for pain, redness, swelling, or warmth in one leg,shortness of breath or trouble breathing
6. Assess for family history of DVT
7. Assess for diabetes, high blood pressure, and high cholesterollevel