Condition: Postpartum perineal pain
1. Etiology:
a. Trauma from delivery
b. Episiotomy
c. Anal Fissures
d. Swelling
e. Hemorrhoids
2. Pathophysiology or Related Physiology:
A. Detailed Explanation
a. Postpartum perineal pain from vaginal trauma during delivery has an effect on other parts of the woman’s body. It can affect sexual functioning. Between 22% and 86% of women have sexual difficulties following delivery. Even three months postpartum, about 30% of women have dyspareunia . Postpartum vaginal trauma can lead to urinary incontinence, bowel leakage and flatus due to weakened muscles from labor. Pain can lead to anxiety, stress, and shame about how their body looks and functions (Priddis, Dahlen & Schmied, 2013).
b. Postpartum tears are very
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common following spontaneous vaginal deliveries. A second-degree tear can be equal to or worse than the damage made from an episiotomy. About 91% of women with spontaneous vaginal deliveries showed perineal strain. Increased labor time has been shown to increase postpartum perineal pain (Mora-Hervás, Sanchez, Carmona, & Espuna-Pons, 2015). B. Summary to my patient a. Pain after delivery is normal however we will do our best to help you manage that pain. You did have a mild tear that is very common and should be rather easy to heal. To prevent excessive postpartum pain and potential bleeding, we would like you to wait six weeks before having sex. When you do have sex for the first time, it may still be a bit uncomfortable but shouldn’t be excruciating. Because of your tearing and weakened muscles, you may experience some incontinence, bowel leakage, or flatulence, however this is normal and should go away after a short time. Excess pain can cause you to feel anxious, stressed out, or ashamed of your body but please know that everything will return to normal. Many women experience this and if you need someone to talk to we can set you up with a counselor or support group. 3. Assessment of the Condition a. Clinical Manifestations 1. Symptoms that are usual to this disease. a. Swollen perineal area with discomfort for about a month. b. With a vaginal tear or episiotomy you can expect the wound to heal within two weeks but soreness to continue for at least six weeks. c. After a C-section most of the pain will be around the incision site but if the woman pushed for a while before the C-section they may have some discomfort. 2. Your patient’s manifestations a. Swollen perineal area with discomfort b. Spontaneous vaginal delivery with mild perineal tear b. Diagnostic Tests 1. If the patient was experiencing complications after delivery you could do a CBC and a UA. I would do a CBC to check for any infection that could be related to the delivery or episiotomy/tear site. I would also do a UA to check for a UTI, which is also common among pregnant and postpartum women. 2. My patient did not receive either a CBC or UA while I was there because she was not showing any signs that would require testing. 4. Psychosocial Effects a) Identify usual or expected patient and family emotional responses and/or lifestyle changes that result from this condition. a. Postpartum perineal pain can be stressful on the family. If possible, it would be good to have some extra help for a few weeks after delivery because you cannot be as active as you would like. This can make it difficult to take care of the infant as well as other children. b. Pain can also make you feel anxious, irritable and helpless b) Identify any issues relevant to your patient. a. My patient is in her late 20’s and this was her first child. Her husband does work full but she has a very loving, helpful family that will be helping her with the baby. This will take off some of the stress of being a new parent and relieve some of the anxiety. 5. Potential Complications of the Condition a) List the complications that may occur as a result of this condition. i. Infection at tear/episiotomy site ii. Stress on family iii. Strained sexual relationship b) List any complications your patient experienced. i. No complications 6. Therapeutic Regimen a) Nursing a. Ice pack to reduce swelling and discomfort b. Ibuprofen or acetaminophen c. Topical spray d. Prescription medication for more severe pain e. Squirt bottle with warm water while using bathroom f. Witch Hazel g. Drinking plenty of fluids to prevent constipation h. Stool softeners to make it easier to have a bowel movement causing less pain i. Sitz bath 24 hours after giving birth j. Change sanitary pads regularly b) List what regimen (s) were used for your patient a. Ibuprofen b. Benzocaine-menthol (topical spray) c. Squirt bottle with warm water d. Witch hazel e. Change sanitary pads every time she went to bathroom f. Docusate sodium (stool softener) g. Drinking plenty of fluids 7. Anticipated Nursing Diagnoses a) List at least three diagnoses that the nurse should anticipate when caring for a patient with this condition. a. Risk for infection related to tissue trauma b. Acute pain related to nursing and medical interventions to control bleeding c. Sexual dysfunction related to fear of postpartum pain b) List the three diagnosis that are individualized to your patient.
a. Risk for infection related to tissue trauma as evidence by perineal tear.
i. Goal: Have no postpartum infection.
ii. Intervention: Perform regular perineal hygiene and keep the wound clean and dry. This will prevent infection and skin irritation (Lowdermilk, Perry, Cashion & Alden, 2012)
b. Acute pain related to perineal tear and swelling as evidence by requesting medication.
i. Goal: Keep pain managed at hospital and after discharge.
ii. Interventions: Take prescribed pain medications. Apply ice packs the first 24 hours after delivery to reduce swelling and discomfort. Use sitz bath after 24 hours to help reduce swelling and increase circulation. Use witch hazel to reduce swelling (Lowdermilk, Perry, Cashion & Alden, 2012).
c) Impaired urinary elimination related to perineal trauma and residual effects of anesthesia as evidence by no urge to urinate 6 hours post delivery.
a. Goals: Have full bladder elimination after each trip to bathroom.
b. Interventions: Measure intake and output to make sure patient is voiding efficiently. Running warm water over perineal area to stimulate urination (Lowdermilk, Perry, Cashion & Alden,
2012).
Today postpartum psychosis is known to be a serious psychiatric crisis that affects one to two women per thousand in the first few weeks following childbirth. Women tend to experience visual, aural, and olfactory delusions and hallucinations that enables a risk of self-harm,
Education of the patient will begin. Depending on the size of the abscess and how extensive the procedure was the patient may need a relative or friend to drive them back home. Not only would the patient need a ride back home, they may need to be watched for 24 hours. As part of pain management pain medication may be given to the patient to decrease pain. Antibiotics may be given to fight or prevent infection caused by the bacteria. The patient will also need to list all medications that they are taking so there will not be any contraindications with the medications that the patient is given. Advise the patient that more than one follow-up appointment will be necessary in order to properly treat the wound. Before the end of the appointment, the medical assistant should give the patient written instructions along with an emergency number and the number to the practice incase the patient has any questions or concerns. Advise the patient to return to the practice if they experience any fever, chills, or the abscess returns. If red streaks appear around the wound tell the patient to call the emergency department immediately. After the the procedure and patient education has been completed, make sure all the step of the procedure has been documented in the patient’s record and all follow-up procedures have been
Different studies had different result numbers or different percentage reduction rates which was primarily based on their indifferences in regards to study design utilized and sample size. As evidenced by research results (Magers, June 2013) and (Welden, 2013), these showed a reduction of urinary catheter days resulted in reduced CAUTI rates. Though different outcome results between the different research studies, they all strongly significantly supported the notion that a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter compared with a no protocol is essential to help in the reduction of CAUTIs. Interpreting these results, (Meddings et al., 2013) showed a drop greater than 52% in CAUTIs and a decrease in catheterization by 37%. The study results from the six scholarly research study articles showed nearly similar or corresponding outcomes. The results were significant enough to support the PICO question. In general, though the difference in sample size, the results still strongly supported excellent outcomes when a nurse-driven protocol is used to evaluate the necessity of continued urethral catheter use. (Chen et al., 2013, para.
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
...s: A List of Major Physical Complications Related to Abortion.” After Abortion. N.p., 23 Nov. 1999. Web. 15 Mar. 2012.
Opiods are the most popular class of drugs used for post-cesarean analgesia. They are most useful in treatment of somatic pain. Use of morphine, diamorphine, fentanyl, sufentanil, meperidine, nalbuphine and buprenorphine is well documented. The various opiods differ in their potency and severity of side effects. A discussion of the merits and de-merits of each is beyond the scope of this article. The common minor side effects include nausea, vomiting, pruritus, shivering and urinary retention. Respiratory depression, especially late-onset, is a more dreaded complication.
Postpartum depression is indeed a major psychological disorder that can affect the relationship between mother and baby. At this time, the cause of postpartum depression is unidentified, although several factors experienced during pregnancy can contribute to this disorder. Fluctuating hormone levels have been traditionally blamed for the onset of postpartum depression. Jennifer Marie Camp (2013), a registered nurse with a personal history of postpartum depression, states in the Intentional Journal of Childbirth Education that “current research demonstrates that PPD may be a compilation of numerous stressors encountered by the family, including biochemical, genetic, psychosocial factors and everyday life stress” (Camp, 2013, p. 1). A previous history of depression, depression during pregnancy, financial difficulties, a dif...
Postpartum depression: MedlinePlus Medical Encyclopedia (2012, September 19). In U.S National Library of Medicine. Retrieved April 8, 2014
Behavioral methods such as bladder training and timed voiding can help in treating urinary incontinence during and after pregnancy. This can be done at home and doesn’t have any serious side effects. In bladder training, you can prolong the intervals of urination as much as you can. Continue this pattern for some period and then extend the intervals for much longer periods until you’re able to manage the bathroom visits normally. Toileting assist...
In this paper we discuss about a labouring women named Mary Doe who is experiencing prolonged labour, she is a singleton pregnancy and having irregular contractions. Poor progress in labour is very common and has many associated complications following it. Unfortunately poor progress is the leading cause for procedures such as c-sections, instrumental deliveries, artificial rupture of membranes, and use of epidural analgesia. Despite this there are strategies that midwives can provide to enhance progress in prolonged labour. These strategies include different postures/ positions, hydration, ambulation in the first stage, water immersion and continuous support by a midwife. This paper discusses potential outcomes Mary Doe may face due to prolonged labour and midwifery strategies to enhance labour progress.
Whereas signs and symptoms to the mother can include: rapid uterine contractions, back and abdominal pain, vaginal bleeding, and uterine tenderness. Direct causes sometimes can correlate with direct injury to abdominal wall, rapid loss or excess of amniotic fluid, the mother’s lifestyle choices, hypertension, advanced maternal age, diabetes mellitus, and prior placental abruption. Although, preventive measures for placenta abruption is uncommon, attention to ongoing medical evaluation of fetal and maternal welfare connected with consideration of risk factors, outcomes can be
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally deliver after a cesarean delivery, as well as the risks and benefits if it. Delivering a child by a c-section also has a few advantages and disadvantages for both the mother and child; this will also be discussed in more depth a bit later.
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.
Generally speaking, lower back pain during pregnancy isn't a cause for concern, but it's still something that should be checked into, as in some cases it might be a warning sign of a serious abdominal problem, including miscarriage. So, before you panic, read through this information. It should help you determine whether or not your condition is normal.