Presentation on theme: "N106 Nursing Care of Post Partum Mother. Physical Changes cardiac & respiratory Cardiac Heart position output Fluid volume VS Respiratory Pulmonary function."— Presentation transcript:
N106 Nursing Care of Post Partum Mother
Physical Changes cardiac & respiratory Cardiac Heart position output Fluid volume VS Respiratory Pulmonary function BMR
Physiological Changes GU & Reproductive System Urinary Genitalia Involution of uterus Decent After pains Lochia Cervix, Vagina, Perineum Return of menses
Measurement of descent of fundus for the woman with vaginal birth.
Involution of the uterus. A, Immediately after delivery of the placenta, the fundus is midline and halfway between the symphysis pubis and the umbilicus. B, About 6 to 12 hours after birth, the fundus is at the level of the umbilicus. It then descends one finger breadth (approximately 1 cm) each day.
Suggested guideline for assessing lochia volume.
Psychosocial Needs Promoting bonding Rubin’s Phases Taking in – wants to be taken care of Taking hold – takes charge Letting go – more realistic
Post Partum Blues Is normal, mild, transient condition affects 50-70% of women Begins 3-4 days after childbirth, peaks on the 4-5 day and resolves within 2 wks Symptoms: insomnia, fatigue, tearfulness, mood instability, anxiety Nursing care: encouraged to rest, take care of self, discuss feelings, it is self-limiting
Cesarean Care TCDB NPO, ice chips usually 12 hrs Ambulate 12 hours Foley D/C after 24 hours IV until tolerating diet Dressing removed 24hours Sutures removed 1 week after delivery When home – rest, good nutrition, mild exercise
Nursing Care Review teaching info syllabus p Involution – 6-7 weeks Decent of uterus midline and descend 1cm/d Lochia – unique healing – no scar rubra 2-3 days - dark red with small clots serosa 4-10 days – pink to brownish alba 1-6 weeks – cream-white Cervix – never the same Perineum – if episiotomy, takes 3-6 weeks
Nursing Care - Teaching Bladder – diuresis first 24 hours Stomach – resume exercise after Dr says Menstruations – 6 weeks, delayed with lactating mothers, STILL ovulate Sex – resume after first menstruation, after episiotomy some loose interest for one year Rest, Rest, Rest
Breastfeeding Colostrum is produced during pregnancy and immediately after birth, contains antibodies Replaced in 2-4 days with milk Teach: clean breast first in shower, proper positioning, release suction with finger, avoid soap on nipples, disposable bra pads, S&S of complications – redness, swelling, fever, tenderness, cracked nipples – (usually mastitis unilateral)
LATCH was created to provide a systematic method for breastfeeding assessment and charting.
Complications Hemorrhage – Hgb < 9 requires Tx atony- most common cause is full bladder laceration – bleeding with firm uterus placenta fragments – bleeding returns to rubra or foul odor noted – more common with “Dirty Dunkin” Infection – Temp above F urinary mastitis Thrombophlebitis – pain and redness, +Homan – send for venous scan pulmonary embolism – sudden onset chest pain, SOB
Post Partum Hemorrhage Loss of blood more than 500 cc – vaginal birth, C/S 1000 cc lost Most common cause – uterine atony others are retained placenta fragments, or infection, hematoma, lacerations Tx – initial is fundal massage S & S – saturate more than one pad/hr, “boggy” uterus, increased lochia with clots, severe perineal pain (with hematoma), tachycardia, hypotension
Manual compression of the uterus and massage with the abdominal hand usually will effectively control hemorrhage from uterine atony.
Manual removal of placenta. Performed only by the medical clinician.
Nursing Care of PP hemorrhage Inspect placenta for missing parts Administer oxytocics Maintain IV line Apply ice to perineum Keep bladder empty Massage fundus if boggy Monitor lochia with amount and type Discharge teaching: report if return to rubra, fever over 100.4, foul smelling lochia, flu-like symptoms
Puerperal Infection Fever over after the first 24 hours and lasting 2 days or more Chills, flu-like symptoms, elevated WBC (over 30,000), tachycardia Types of infections reproductive tract: back ache, abd pain, foul smelling lochia, purulent discharge wound infection: erythema, warmth, swelling, tenderness, drainage.
Mastitis. Erythema and swelling are present in the upper outer quadrant of the breast. Axillary lymph nodes are enlarged and tender.
PP Infections UTI: pain, burning, urgency or freq of urine Mastitis – erythema, warmth in breast, flue-like symptoms Diagnosis with culture, vag exam, CBC Nursing care: assess VS, lochia, incisions, attend to pain, ensure food and fluid intake, obtain specimens, monitor response to antibiotic.
Thrombophlebitis Inflammation of vessel wall with thrombus Causes: stasis and hypercoagulability Types: superficial venous thrombus: reddened, warm, swollen deep vein thrombosis: occurs in larger veins, positive Homan’s, pain Risk factors: immobility, C/S, PIH, DM, smoking, over 40 yr, multiparity, anemia Prevent: early ambulation and hydration
Nursing Care Thrombophlebitis Bedrest with leg elevated Change positions frequently, not flexed knees Teach no to rub area Daily measurements of calf and thigh Support stockings, moist heat application Assess for complication: embolism, S&S of pulmonary embolism
Rh Incompatibility Antibodies cross placenta and attach to fetal red blood cells destroying them
Rh Incompatibility Mother Rh- negative and fetus Rh positive If Rh positive blood enters system of Rh negative mother reacts by developing antibodies to destroy RBCs with Rh positive antigens Blood may mix during third stage of labor First child not effected
Rh isoimmunization sequence. Rh-positive father and Rh-negative mother.
As the placenta separates, the mother is further exposed to the Rh-positive blood.
Anti-Rh-positive antibodies (triangles) are formed.
In subsequent pregnancies with an Rh-positive fetus, Rh- positive red blood cells are attacked by the anti-Rh- positive maternal antibodies, causing hemolysis of the red blood cells in the fetus.
RhoGAM Rh o (D) immune globulin suppresses the stimulation of active immunity by Rh- positive foreign RBC Given IM at 28 weeks antepartum and within 72 hours of delivery – 1 vial Before 13 weeks give ½ dose after amniocentesis, miscarriage, ectopic pregnancy
Before Administration Never administer intravenously Never administer to a neonate Never administer to an Rh negative patient who has been previously sensitized to the Rh antigen Confirm that the mother is Rh negative Confirm infant is Rh positive and assess direct coombs test
Coombs Test Indirect coombs test on mother to determine the presence of antibodies against fetal blood. If the test is positive, amniocenteses may be performed to determine the fetal Rh factor and degrees of hyperbilirubinemia. Direct coombs test is performed on the cord blood. Positive coombs test indicates that antibodies from the mother have attached to the infants RBC. Bilirubin levels are followed closely for changes that indicate that treatment should be initiated or changed.
Postpartum Depression/Psychosis Postpartum depression % - all ethnic groups affected. Cause unknown, may be r/t hormonal, exhaustion, anger, chronic stress S&S: starts first 4 wks and last several months, fatigue, loss of self, suicide thoughts crying TX: combination of psychotherapy, social, meds Postpartum psychosis- rare, bipolar disorder or major depression, frightening thoughts, delusions of dead baby and hallucinations, need psychiatric Tx, will not resolve itself
Infant Care Cord care Diapering feeding Stools Urine Baths How to take temp