Nursing Diagnosis-Risk For Infection Related To 2nd Degree Episiotomy With the many degrees of episiotomies there is always

the risk for infection. It is important for one to not contaminate the incisional site with bacteria from the rectal area. To prevent this from taking place, cleansing from front to back will prevent a bacteria infection. When washing the perineum area do not rub with washcloth always pat instead. This will prevent suturing from coming undone and will help with discomfort as well. A peri-bottle will help provide comfort. Use after voiding and when ever comfort is needed. Best results occur when the bottle is filled with Luke warm water. The water should run down from perineal area to the anus. After use pat area dry with a washcloth or moist novelettes. Remembering to wipe from front to back. In addition, after using the peri-bottle it is always safe to change perineal pads, especially when there is a moderate amount of lochia (blood) present. The pad should fit snugly. A loosely worn pad will cause irritation from rubbing back and forth the perineum area. This to can cause a risk for infection. Nursing Diagnosis- At Risk For Pain Related To Trauma T o Perineum, As Manifested By Clients Request For Pain Medication To help Relieve pain to perineum area, several comfort measures may be used; The use of ice packs. (20 minutes on and 10 minutes off) Sitz bath. Which can provide warmth, comfort and increasing circulation to the tissues that help promote healing. It is advised that 20 minutes in a tub filled 4-6 inches will suffice. Assessing water temperature before getting in. If a feeling of dizziness comes over, call the nurse. Sitz bath helps with pain relief only and should not be used as a tub bath. Topical agents (Dermoplast spray or American Spray) may be used to relieve discomfort. Pain medications as prescribed by physician may be administered to help provide comfort and decrease pain. Over the counter medications can also be taken, such as Tylenol or Motrin. Evaluation-K.C. was able to define episiotomy and summarize about self-care needs to promote comfort and decrease the risk for infection. She was able to demonstrate the use of a peri-bottle, perineum care and she described the use of a sitz bath. Strengths-The strength of the teaching plan was in the use of take home pamphlets. (As seen in appendix). Areas of improvement-Taking more time in between each section of content to ask for any questions that she may have. Taking the opportunity to also make sure that she understands the content that was being discussed.

K.C. was given all props and pamphlets to take home for future needs. Fact sheets were given about the importance of Kegel exercises. These exercises as explained to her, but not covered under any of the nursing diagnosis, strength muscle control.

Bibliography: Johanson, R., (2000). Perineal massage for prevention of perineal trauma in childbirth. The Lancet. pgs: 335 and 250 Lade wig, P.A., London, M.L., Olds, S.B., (1999) Maternal-Newborn Nursing: A Family and Community Based Approach. New Jersey: Prentice Hall Health.

General:

Cleanse perineum with warm water each time after using the bathroom or after changing a sanitary pad; blot dry with toilet tissue; Remember to wipe from front to back.
Perineal Discomfort:

Apply an ice bag to the perineum for 20 minutes whenever necessary following delivery. Take a sitz bath for 20 minutes whenever necessary, beginning 24hrs. after delivery. Apply witch hazel pads to perineum whenever necessary. Apply anesthesia spray/ointment to perineum whenever necessary.
Anal Discomfort:

Apply an ice bag to the perianal area for 20 minutes whenever necessary following delivery. Take a sitz bath for 20 minutes whenever necessary, beginning 24hrs. after delivery. Apply witch hazel pads to perianal area whenever necessary.

Apply anesthesia spray/ointment to perianal area whenever necessary.

For hemorrhoid pain:

Pain may persist for 2-3 days after delivery; most severe within few hours after delivery. If you didnt have hemorrhoids prior to pregnancy, expect them to disappear within a few weeks after delivery. Use witch hazel pads or sitz baths to help alleviate pain. Also, drink adequate amounts of fluids to avoid constipation.
Episiotomy care:

Pain generally most severe immediately after delivery; pain persists for approximately 48-72hrs after delivery and decreases with time. Irritation or mild discomfort may be present for up to 2 weeks after delivery. Take a sitz bath for 20 minutes, 2-3 times a day beginning 24hrs. after delivery to help decrease pain and promote healing. Apply anesthesia spray/ointment to episiotomy stitches. Assess your perineum at home daily with a hand mirror. Swelling and discoloration are initially normal and will improve daily. Episiotomy stitches may feel tighter or start to itch around the third day after delivery; this is normal. Episiotomy stitches dissolve on their own. Usually healed by six weeks. Call physician if you notice separation in stitches or an increase in swelling or discoloration.
How to Take a Sitz Bath:

A sitz bath soaks the vaginal and/or rectal areas to keep them cleansed and promote healing. Sitz Bath Basin

Raise the toilet seat and place the sitz bath basin in the toilet bowl. Leave the seat up. Fill the sitz bath basin with warm water. Sit in the sitz bath basin for 20 minutes. The warm water should cover the entire vaginal and/or rectal area. Pat yourself dry with towels. Empty the sitz bath basin and clean it with cleanser. Rinse well and allow to dry. Sitz Bath Basin with Irrigation Raise the toilet seat and place the sitz bath basin in the toilet bowl. Leave the seat up. Fill the sitz bath basin with warm water. Fill the irrigation bag with warm water or the medicine ordered by your physician. Run the fluid through the tubing to remove any air. Close the valve. Hang the bag on a hook, and connect the end of the tubing to the sitz bath basin (see picture below). Make sure the hole at the end of the tubing is facing up. Sit in the sitz bath basin for 20 minutes, letting the irrigation fluid run slowly into the basin. Pat yourself dry with towels. Empty the sitz bath basin and clean it with cleanser. Rinse well and allow to air dry. Empty the irrigation bag, wipe it clean, and allow to air dry.
Lochia:

Similar to menstrual discharge; has a fleshy odor, but is not offensive. Amount gradually reduces over time. Heavier in the morning; increases after exercise or breastfeeding. Flow should not be heavier than regular menstrual flow after the second day following delivery. Color after delivery is dark red for approximately 3 days. Next, color lightens then turns brownish red for approximately 20 days. Afterwards, the discharge turns to a creamy white or yellow color, which may persist for an additional 1-2 weeks. Once the lochia stops, the cervix is considered closed and normal sexual relationships may resume.