1. INTRODUCTION

2. Developed by D. Ann Currie, R.N. ,M.S.N. 2012
POSTPARTAL NURSING
Developed by
D. Ann Currie, R.N. ,M.S.N.
2012

3. POSTPARTAL PERIOD PHYSICAL CHANGES PSYCHOSOCIAL CHANGES
NURSING CARE OF THE POSTPARTAL CLIENT
HIGH-RISK POSTPARTAL CLIENTS

4. PHYSICAL CHANGES DURING THE POSTPARTAL PERIOD
REPRODUCTIVE SYSTEM
INVOLUTION-IS THE PROCESS OF THE REDUCTION IN SIZE OF THE UTERUS AFTER DELIVERY TO PREPREGNANT SIZE CAUSED BY UTERINE CONTRACTIONS THAT CONSTRICT AND OCCLUDE BLOOD VESSELS AT THE PLACENTA SITE

5. FACTORS THAT ENHANCE INVOLUTION
UNCOMPLICATED LABOR & DELIVERY
BREASTFEEDING
EARLY AMBULATION
COMPLETE EXPLUSION OF PLACENTA AND MEMBRANES

6. FACTORS THAT IMPEDE INVOLUTION
PROLONGED LABOR & DIFFICULT DELIVERY
ANESTHESIA
GRAND MULTIPARITY
RETAINED PLACENTAL FRAGMENTS OR MEMBRANES
FULL URINARY BLADDER
INFECTION

7. CONT.
OVERDISTENTION OF THE UTERUS
USE OF OXYTOCIN DURING LABOR

8. FUNDUS TOP PORTION OF THE UTERUS A PALPABLE INDICATOR OF INVOLUTION
BOGGY UTERUS-SOFT,RELAXED..CAN CAUSE HEMORRHAGE
FUNDUS SHOULD BE FIRM

9. Assessing Fundus

10. FUNDUS
LOCATION
RIGHT AFTER DELIVERY THE FUNDUS IS MIDWAY BETWEEN SYMPHYSIS PUBIS AND UMBILICUS
ONE HOUR AFTER DELIVERY THE FUNDUS RAISES TO THE UMBILICUS OR SLIGHTLY ABOVE-1CM AND REMAINS THERE FOR 24 HRS.

12. FUNDUS
LOCATION- FUNDAL HEIGHT DECREASES 1CM A DAY AFTER THE FIRST 24 HR..
BY DAY 10 AFTER THE DELIVERY THE FUNDUS CAN NO LONGER BE FELT
FUNDUS SHOULD BE MIDABDOMEN
DEVIATIONS ARE ABNORMAL AND SHOULD BE CHECKED

13. Deviation of Fundus Location

14. LOCHIA IS THE DISCHARGE OF BLOOD AND DEBRIS FOLLOWING DELIVERY
TYPES-RUBRA, SEROSA, AND ALBA
SHOULD NOT CONTAIN LARGE CLOTS
TOTAL VOLUME ML.
DAILY VOLUME GRADUALLY DECREASES

15. LOCHIA AMOUNT MAY BE INCREASED BY EXCERTION OR BREASTFEEDING
POOLING WHEN CLIENT IS RECLINING CAN OCCUR
C/SECTION CLIENT MAY HAVE LESS BUT SHOULD HAVE LOCHIA
UNEXPLAINED INCREASE IN AMOUNT IS ABNORMAL

16. LOCHIA AMOUNTS

17. LOCHIA RUBRA 1-3 DAYS AFTER DELIVERY DARK RED,BLOODY FLESHY,MUSTY ODOR
CLOTS SMALLER THAN NICKEL
BLOOD,MUCUS, SHREDS OF DECIDUA, EPITHELIAL CELLS

18. LOCHIA SEROSA 4-10 DAYS AFTER DELIVERY
PINK OR BROWNISH-WATERY-ODORLESS
SERUM,ERYTHROCYTES,SHREDS OF DEGENERATING DECIDUA,LEUKOCYTES, CERVICAL MUCOUS,BACTERIA

19. LOCHIA ALBA 11-21 DAYS AFTER DELIVERY MAY PERIST TO 6 WEEKS
YELLOW TO WHITE- MAY HAVE STALE ODOR
LEUKOCYTES,DECIDUA CELLS,EPITHELIAL CELLS,FAT, CERVICAL MUCUS, CHOLESTEROL, BACTERIA

20. LOCHIA
UNEXPLAINED INCREASE IN AMOUNT OR REAPPEARANCE OF LOCHIA RUBRA IS ABNORMAL..

21. AFTERPAINS
CAUSED BY INERTMITTENT UTERINE CONTRACTIONS FOLLOWING DELIVERY
OCCUR IN ALL WOMEN
MORE PAINFUL IN MULTIPARIOUS AND BREASTFEEDING WOMAN
ALSO IN WOMEN WHOSE UTERUS WAS OVERDISTENDED

22. CERVIX
SOFT,IRREGULAR,AND EDEMATOUS, MAYBE BRUISED AND/OR SMALL LACERATIONS
CLOSES TO 2-3 CM AFTER SEVERAL DAYS..FINGERTIP AFTER 1 WEEK
MUST BE SLIGHTLY DILATED TO ALLOW LOCHIA TO DRAIN
AFTER FIRST DELIVERY SHAPE IS CHANGED

23. VAGINA SMOOTH WALLS,EDEMATOUS WITH MULTIPLE SMALL LACERATIONS
PERINEAL DISCOMFORT/PAIN SHOULD BE GONE BY 2 WEEKS AFTER DELIVERY
LOW ESTROGEN LEVELS WILL TO DECREASED LUBRICATION FOR 6-10 WEEKS

24. ABDOMINAL WALL SOFT & FLABBY WITH DECREASED MUSCLE TONE
STRIAE(STRETCH MARKS) WILL FADE BUT STAY
DIASTISIS RECTI-SEPERATION OF THE RECTUS MUSCLES OF THE ABDOMEN-MAY IMPROVE IN THE POSTPARTUM PERIOD

25. CARDIOVASCULAR SYSTEM
RETURNS TO PREPREGNANT STATE WITHIN 2 WEEKS
THE ELIMINATION OF THE INCREASED BLOOD VOLUME DURING PREGNANCY IS DONE BY DIURESIS
BLOOD PRESSURE SHOULD REMAIN STABLE

26. CV SYSTEM -CONT.
BRADYCARDIA BEGINS SECOND DAY-HR OF CONT. FOR 6-10 DAYS
TACHYCARDIA-BLOOD LOSS, TEMP.,OR OTHER PROBLEMS
WBC’S ELEVATED IN POSTPARTUM PERIOD..LOOK FOR INCREASE OF OVER 30% IN 6 HRS.

27. CV SYSTEM CONT. DECREASED HGB IS RELATED TO AMOUNT OF BLOOD LOSS
1ST 48 HRS POSTPARTUM ARE THE GREATEST RISK OF COMPLICATIONS FOR CLIENTS WITH HEART DISEASE

28. RENAL SYSTEM
INCREASED BLADDER CAPACITY AND DECREASED BLADDER TONE LEAD TO DECREASED SENSATION AND INCREASED RISK OF URINARY RETENTION AND INFECTION
POSTPATAL DIURESIS ML.-ACCOUNTS FOR 5 LB WEIGHT LOSS
A FULL BLADDER WILL DISPLACE THE UTERUS

29. RENAL SYSTEM FULL BLADDER CAN LEAD TO UTERINE ATONY AND PP HEMORRHAGE
FLUIDS ARE ALSO LOST THROUGH DIAPHORESIS..COMMONLY SEEN AT NIGHT

30. GASTROINTESTINAL SYSTEM
HUNGER AND THRIST ARE COMMON FOLLOWING BIRTH OR IN THE 1ST PP DAY.
CONSTIPATION-DECREASED PERISTALSIS, USE OF NARCOTIC ANALGESICS,DEHYDRATION, DECREASED MOBILITY DURING LABOR , AND FEAR OF PAIN

31. GI SYSTEM CONT.
HEMORRHOIDS-BECAUSE OF PRESSURE OF PUSHING DURING 2ND STAGE OF LABOR.

32. Assessment for Hemorrhoids

33. ENDOCRINE SYSTEM
ESTROGEN AND PROGESTERONE LEVELS DROP RAPIDLY AFTER DELIVERY OF THE PLACENTA
MENSTRUATION USUALLY RESUMES 7-9 WEEKS FOR NONLACTATING WOMEN- 90% BY 12 WEEKS-1ST CYCLE IS USUALLY ANOVULATORY

34. ENDOCRINE CONT.
OVULATION AND MENSTRUATION RETURN TIME IS PROLONGED WITH LACTATING WOMEN-DEPENDS WHETHER SHE IS SUPPLEMENTING WITH FORMULA-VARY 2 TO 18 MONTHS
PLACENTAL HORMONES WHICH CAUSES INSULIN RESISTANCE WILL DECREASE BY 3-4 DAYS AFTER DELIVERY

35. ENDOCRINE CONT.
LACTATION
COLOSTRUM/MILK
PROLACTIN
OXYTOCIN

36. PSYCHOLOGICAL CHANGES IN THE POSTPARTAL PERIOD
PHASES OF MATERNAL ADJUSTMENT
PHASES OF PATERNAL ADJUSTMENT
BONDING
POSTPARTUM BLUES

37. PHASES OF MATERNAL ADJUSTMENT
TAKING-IN/DEPENDENT PHASE-
TAKING-HOLD/DEPENDENT-INDEPENDENT PHASE-
LETTING-GO/INTERDEPENDENT PHASE-
DEVELOPMENTAL TASK- MATERNAL ROLE ATTAINMENT
1ST DICUSSED BY R.RUBIN

38. TAKING-IN DEPENDENT PHASE
1ST 1-3 DAYS..CAN BE SHORTEN
PREOCCUPIED WITH OWN NEEDS
PASSIVE AND DEPENDENT
TOUCHES AND EXPLORES INFANT
NEEDS TO DISCUSS LABOR & DELIVERY EXPERIENCE
TAKING IN FOOD ,H2O,REST, AND CARE

39. TAKING-HOLD DEPENEDENT-INDEPENDENT PHASE
3-10DAYS POSTPARTUM
OBESSED WITH BODY FUNCTIONS
RAPID MOOD SWINGS
ANTICIPATE GUIDANCE MOST EFFECTIVE NOW…GOOD TIME TO TEACH
INTERESTED IN LEARNING CARE OF BABY

40. LETTING-GO INTERDEPENDENT PHASE
10 DAYS TO 6 WEEKS POSTPARTUM
MOTHERING FUNCTIONS ESTABLISHED
SEES INFANT AS A UNIQUE PERSON
REESTABLISHES RELATIONSHIP WITH HUSBAND

41. PATERNAL ROLE
EXPECTATIONS
REALITY
TRANSITION TO MASTERY

42. EXPECTATIONS
1ST STAGE
THE FATHER HAS PRECONCEPTIONS ABOUT WHAT LIFE WILL BE LIKE AFTER THE BABY COMES HOME
MAY NOT BE REALISTIC

43. REALITY
2ND STAGE
FATHER REALIZES THAT EXPECTATIONS ARE NOT ALWAYS BASED ON FACT
COMMON FEELINGS-SADNESS,AMBIVALENCE
JEALOUSLY
FRUSTATION

44. REALITY OVERWHLMING DESIRE TO BE MORE INVOLVED
SOME ARE PLEASANTLY SURPRISED AT EASE AND FUN OF PARENTING

45. TRANSITION TO MASTERY 3RD STAGE
FATHER MAKES CONSCIOUS DECISION TO TAKE CONTROL AND BECOME MORE ACTIVELY INVOLVED WITH INFANT

46. BONDING FINGERTIPS,PALMS AND THEN ENFOLING OF INFANT EN FACE POSITION
MOTHER USES A SOFT HIGH-PITCHED TONE OF VOICE
NURSE SHOULD ASSIST BOTH MOM AND DAD WITH BONDING-TIME/ISSUES

47. Face to Face with Eye Contact

48. POSTPARTUM BLUES A MATERNAL ADJUSTMENT REACTION
TRANSIENT DEPRESSION USUALLY OCCURS BETWEEN 2ND-3RD PP DAY AND/OR WITHIN THE 1ST 2 WEEKS PP
RELATED TO HORMONAL CHANGES,FATIGUE, AND STRESS
ALL WOMEN EXPERIENCE IT

49. PP BLUES CONT.
CHARACTERIZED BY MOOD SWINGS,ANGER, TEARFULNESS, FEELINGS OF LET-DOWN,ANOREXIA, AND SLEEING PROBLEMS
USUALLY RESOLVES SPONTANEOUSLY
IF CONT. OR WOMAN HAS DEEPENING DEPRESSION MAY HAVE PP DEPRESSION

50. POSTPARTAL NURSING
EVALUATE PRENATAL AND INTRANATAL HISTORY FOR RISK FACTORS
POSTPARTUM ASSESSMENT-BUBBLE-HEB-AND PREECLAMPSIA SCREENING
VITAL SIGNS

51. PP NURSING-CONT. PREVENTING PP HEMORRHAGE ASSESS FOR RISK FACTORS
ASSESS FUNDUS & LOCHIA
MASSAGE FUNDUS AS NEEDED
KEEP BLADDER EMPTY
ADMINSTER MEDICATIONS IF NEEDED-PITOCIN,METHERGINE ERGOTRATE

52. CONT.
PUT BABY TO BREAST EARLY AND FREQUENTLY
`MONITOR VS

53. COMFORT ICE TO PERINEUM 20 MINUTES ON/1O-2O MINUTES OFF-1ST 24 HRS
SITZ BATHS-COOL OR WARM TID AFTER HRS…MGSO4 CRYSTRALS
PERICARE- AFTER USING BATHROOM OR PRN
APPLY TOPICAL ANALGESICS-

54. COMFORT TEACH CLIENT TO TIGHTEN BUTTOCKS THE SITTING…LAY ON SIDE
ADMINSTER ANALGESICS
KEGAL’S
H2O,FIBER,& STOOL SOFTNERS,AMBULATE

55. Kegal’s Exercise

56. ELIMINATION
BOWEL
URINARY

57. INFANT CARE SUCCESSFUL FEEDING BATHING SAFETY ADL’S POSITIONS
FOLLOW UP VISITS

58. SELF CARE NUTRITION REST COMFORT DISCOMFORTS ACTIVITIES F/U
WARNING SIGNS
CONTRACEPTION

59. RHOGAM ASSESS RH NEG WOMAN NEG INDIRECT COOMBS
RH POS BABY WITH NEG DIRECT COOMBS
NO ALLERGIES TO GLOBULIN PREPARATIONS
ADMINSTER 300UG IM WITHIN 72 HRS

61. RUBELLA VACCINE RUBELLA TITER LESS THAN 1:8-NONIMMUNE
NO ALLERGY TO NEOMYCIN
ADMINISTER O.5 ML SC PRIOR TO DISCHARGE
CLIENT SHOULD NOT GET PREGNANT FOR 3-4 MONTHS
NOT WITH RHOGAM

63. PP WARNING SGNS
BRIGHT RED BLEEDING MORE THAN 1 PAD/HOUR OR PASSING LARGE CLOTs
TEMPERATURE GREATER THAN F AFTER 1ST 24 HRS.
CHILLS
EXCESSIVE PAIN ANYWHERE
REDDENED AREAS ON BREAST

64. PP WARNING SIGNS REDDENED OR GAPING EPISIOTOMY FOUL SMELLING LOCHIA
INABLE TO VOID..BURNING..ETC
CALF PAIN, TENDERNESS,REDNESS, SWELLING
FLU-LIKE S/S.

65. Mastisis

66. QUESTIONS

67. THANK YOU