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Pathophysiology: (include etiology, pathogenesis, diagnostic procedures, medical interventions, nursing

interventions, prognosis and citation) Briefly summarize in your own words to demonstrate understanding
OR draw a schematic

Risk Factors
Depression experienced
during pregnancy
Family history of
depression
Mental illness/alcoholism
Personality dysfunction
such as low self esteem
Preexisting depression
Difficult birth
Teen pregnancy
Low socioeconomic status

Medications
and
Treatments
A strong support system
consisting of family, friends,
and professional couselors.
Antidepressant medication

Diagnosis
Postpartum Depression
Postpartum Depression often occurs after a birth of a
child. It is a serious depressive disorder that often in
extreme cases has newborn mothers thinking of
harming themselves or their newborn child. Postpartum
depression is described as depression that lasts more
than 2 weeks and begins after childbirth. It more often
occurs within the first 3 months but can also occur up
to a year after the birth of the child. The biggest issue in
dealing with this problem is that families are not
educated in signs to look out for in someone who might
be dealing with depression. This causes families to not
recognize depression and seek help. As nurses, it is
important that prenatal teaching involves discussion of
physical and emotional changes that occur throughout
pregnancy. Part of this teaching includes being aware of
signs of postpartum depression and steps needed to
seek professional help.
The cause of postpartum depression remains unknown
but seems to be related to biochemical, genetic,
psychosocial, and everyday life stressors.

Diagnostic
Tests
First step is to identify risk
factors of PPD.
Next step is the use of
screening tools such as:
Edinburgh Postnatal
Depression scale
Postpartum Depression
Predictor Inventory
Postpartum Depression
Screening Scale
A mental health referral for
further evaluation if
needed.

Signs/Sx
Changes in mood or
emotional state that
interfere with daily living.
Increased or decreased
appetite
Insomnia
Agitation

Alternative/Holistic
therapies
Cognitive Behavior Therapy

Fatigue

References: Camp, J. M. (2013). Postpartum Depression 101:


Teaching and Supporting the Family. International Journal Of
Childbirth Education, 28(4), 45-49.

Feelings of worthlessness
Thoughts of suicide
Hypersomnia
Inability to concentrate

Complications

Isolation

PPD affects the entire


family unit and the bonding
between mother and baby
and developmental delays.
In a worst case scenario,
mother can harm self or her
newborn if prompt
identification and treatment
is not initiated.

Difficulty bonding with


baby
Loss of pleasure in things
they once enjoyed
Extreme anxiety/worry
Feelings of Incompetency
in being a parent
It is the frequency, duration
and intensity of these
feelings that indicate a
problem.

Teaching Plan for Postpartum Depression

Postpartum blues or baby blues often occurs within the first few days of giving birth to your child and often
resolves by the tenth day. It is ok to feel stressed and tired from having a baby but please call your doctor or seek
professional help if five or more of these feelings persist for more than two weeks.

I am not interested in activities I usually enjoy

I feel hopeless about the future

I cant make decisions

I feel sluggish or restless

I feel guilty or blame myself if anything goes wrong

I am gaining or losing weight

I feel unhappy

I am sleeping too much, or cant sleep even when the baby does

I feel irritable or anxious for no good reason.

References:

Pathophysiology: (include etiology, pathogenesis, diagnostic procedures, medical interventions, nursing


interventions, prognosis and citation) Briefly summarize in your own words to demonstrate understanding
OR draw a schematic

Risk Factors

Diagnosis

Previous history of VTE


Venous stasis and
hypercoagulation that
occurs during pregnancy
Operative vaginal birth
Cesarean birth
Obesity
Maternal age over 35
Multiparity
Infection
Immobility
Smoking

Venous Thromboembolism in Pregnancy


The risk of venous thromboembolism is increased by 4-5 fold during
pregnancy when compared to a non-pregnant state. It is often
manifested as either a deep vein thrombosis (DVT) or Pulmonary
Embolism (PE). A thrombosis often results from a formation of a
blood clot/clots inside a blood vessel caused by either inflammation
or partial obstruction of the vessel. This can eventually lead to
pulmonary hypertension, post-thrombotic syndrome, and venous
insufficiency. In the past 20 years, the incidence of thromboembolic
disease has decreased significantly, in part, to early ambulation of the
postpartum patient.

Anticoagulants
NSAIDS
Elastic stockings
Rest with elevation of leg

Positive Homans sign


Venography
Doppler Ultrasound
Cardiac auscultation
Electrocardiogram

Nursing interventions include:


Continued assessments such as inspection and palpation of the
affected area, palpation of peripheral pulses, checking Homans sign,
measurement and comparison of leg circumferences, inspecting for
signs of bleeding, monitoring signs for pulmonary embolism such as
chest pain, coughing, dyspnea, tachypnea, and presence of crackes
during respiratory inspection.
Nursing teaching includes:

Medications
and
Treatments

Diagnostic
Tests

Signs/Sx
Pain and tenderness in the
lower extremity
Warm, red, and enlarged
hardened vein over the site
of the thrombosis

Encouraging patient to change positions frequently while on bed rest

Unilateral leg pain, calf


tenderness, and swelling

Avoid placing knees in a flexed position which could cause pooling


of blood

Dyspnea and tachypnea

Avoid rubbing the affected area which could cause the clot to
dislodge
Proper use of elastic stockings
Elevation of the leg
Importance of taking anticoagulant medication

Tachycardia
Apprehension
Cough
Elevated temperature
Abrupt onset of chest pain

Teaching patient on how to administer subcutaneous medication


injections and importance of site rotation
Patient meeting followup care with health care provider to monitor
clotting times and correct dose of anticoagulant therapy is maintained

Complications
Venous insufficiency
Pulmonary Hypertension
Post Thrombotic Syndrome
Death

Encouraging early ambulation


Discourage use of oral contraceptives because of increased risk of
thrombosis
Use a reliable method of contraceptive if taking warfarin
Reference: Lowdermilk, D. & Perry S. (2013). Maternity &
Womens Health Care (8th ed.). St. Louis: Mosby.

Causes
Pulmonary Embolism
Deep Venous Thrombosis
Superficial Venous
Thrombosis

Teaching Plan for Prevention of Thromboembolism


During Pregnancy

Avoid prolonged periods of standing, sitting, or immobility.


Walk frequently
Elevate legs while sitting and avoid crossing your legs which will
reduce circulation and worsen venous stasis
Drink 2 to 3 liters of water each day to prevent dehydration, which
causes blood circulation to be sluggish
Quit smoking