Emoraji Aprè Akouchman: Masaj An Premye, Apre Medikaman yo

🧠 Poukisa sa enpòtan

EMORAJI APRÈ AKOUCHMAN se yon pèt san 1,000 mL oswa plis, oswa nenpòt pèt ak siy ipovolemi; ATONI MATRIS se kòz ki pi komen, sitou apre yon travay akouchman ki long, yon gwo tibebe, jimo, itilizasyon oxytocin oswa yon vesi plen. Fundus la ta dwe FÈM, NAN MITAN epi nan oswa toupre lonbrit la touswit apre akouchman an (apeprè 1 cm anwo li nan 12 èdtan), apre sa li desann apeprè 1 cm (yon lajè dwèt) pa jou. Yon fundus MOU jwenn MASAJ FUNDUS an premye, ak yon men k ap soutni pati anba matris la; yon fundus ki devye sou kote anjeneral vle di yon VESI PLEN, kidonk fè pasyan an pipi oswa mete yon katetè. Medikaman: OXYTOCIN an premye, apre METHYLERGONOVINE (kontr-endike nan tansyon wo), CARBOPROST (kontr-endike nan asthma) ak MISOPROSTOL. Yon fundus fèm ak senyen wouj klè ki kontinye sijere yon LASERASYON oswa fragman ki rete, ki bezwen founisè a. Evalye LOCHIA: rubra (wouj, jou 1 a 3), serosa (woz-mawon, jou 4 a 10), alba (blan-jòn, jiska apeprè 6 semèn); yo rapòte si yon sèvyèt tranpe nan 15 minit, gwo kayo oswa yon move odè. Evalyasyon BUBBLE-HE a kouvri tete yo, matris, vesi, trip, lochia, epiziyotomi oswa perine, emowoyid ak janm yo (tcheke anfle nan yon sèl bò, chalè oswa sansiblite; siy Homans pa fyab), ak emosyon yo. BABY BLUES (dlo nan je nan premye 2 semèn yo) nòmal; DEPRESYON APRÈ AKOUCHMAN dire pi lwen pase 2 semèn epi li deranje fonksyònman; PSIKOZ APRÈ AKOUCHMAN, ak alisinasyon oswa panse pou fè tibebe a mal, se yon ijans. Chak pasyan ansent Rh-NEGATIF ki pa sansibilize resevwa imunoglobulin Rh nan 28 semèn, epi ankò nan 72 èdtan apre akouchman si tibebe a Rh-pozitif.

POSTPARTUM HEMORRHAGE is blood loss of 1,000 mL or more, or any loss with signs of hypovolemia; UTERINE ATONY is the most common cause, especially after a long labor, a large baby, twins, oxytocin use or a full bladder. The fundus should be FIRM, MIDLINE and at or near the umbilicus right after birth (about 1 cm above it by 12 hours), then descend about 1 cm (one fingerbreadth) a day. A BOGGY fundus gets FUNDAL MASSAGE first, with one hand supporting the lower uterus; a fundus deviated to the side usually means a FULL BLADDER, so have the client void or catheterize. Medications: OXYTOCIN first, then METHYLERGONOVINE (contraindicated in hypertension), CARBOPROST (contraindicated in asthma) and MISOPROSTOL. A firm fundus with continued bright red bleeding suggests a LACERATION or retained fragments, which need the provider. Assess LOCHIA: rubra (red, days 1 to 3), serosa (pink-brown, days 4 to 10), alba (white-yellow, to about 6 weeks); saturating a pad in 15 minutes, large clots or a foul odor are reported. The BUBBLE-HE assessment covers breasts, uterus, bladder, bowels, lochia, episiotomy or perineum, hemorrhoids and legs (check for unilateral swelling, warmth or tenderness; Homans' sign is unreliable), and emotions. BABY BLUES (tearfulness in the first 2 weeks) are normal; POSTPARTUM DEPRESSION lasts beyond 2 weeks and impairs function; POSTPARTUM PSYCHOSIS, with hallucinations or thoughts of harming the infant, is an emergency. Every unsensitized Rh-NEGATIVE pregnant client receives Rh immune globulin at 28 weeks, and again within 72 hours after birth if the baby is Rh-positive.

🏥 Nan lavi reyèl

👐 De èdtan apre yon travay akouchman ki long fundus la mou epi li deplase sou dwat. Enfimyè a masaje jiskaske li vin fèm, apre li ede pasyan an ale nan twalèt; 700 mL pipi pita, fundus la retounen nan mitan epi senyen an ralanti. Oxytocin koule jan yo te òdone a. Sekans la te men, vesi, medikaman. Egzamen an pral ofri medikaman an an premye ak apèl telefòn lan an dezyèm; tou de pa bon kòm premye etap la.

👐 Two hours after a long labor the fundus is boggy and displaced to the right. The nurse massages until it firms, then helps the client to the bathroom; 700 mL of urine later, the fundus returns to midline and the bleeding slows. Oxytocin runs as ordered. The sequence was hands, bladder, drug. The exam will offer the drug first and the phone call second; both are wrong as the first step.

📌 Sa pou retni

• Fundus fèm, nan mitan, k ap desann 1 cm pa jou; mou vle di masajFundus firm, midline, descending 1 cm a day; boggy means massage
• Fundus deplase vle di yon vesi plenDisplaced fundus means a full bladder
• Oxytocin an premye; methylergonovine pa ak tansyon wo; carboprost pa ak asthma; imunoglobulin Rh nan 72 èdtanOxytocin first; methylergonovine not with hypertension; carboprost not with asthma; Rh immune globulin within 72 hours

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