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

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Presentation on theme: "POSTPARTAL NURSING Developed by D. Ann Currie, R.N.,M.S.N."— Presentation transcript:

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

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

3 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

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

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

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

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

8 Assessing Fundus

9 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.

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11 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

12 Deviation of Fundus Location

13 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

14 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

15 LOCHIA AMOUNTS

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

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

18 LOCHIA ALBA 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

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

20 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

21 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

22 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 WEEKS

23 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

24 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

25 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.

26 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

27 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

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

29 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

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

31 Assessment for Hemorrhoids

32 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

33 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

34 ENDOCRINE CONT. LACTATION COLOSTRUM/MILK PROLACTIN OXYTOCIN

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

36 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

37 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

38 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

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

40 PATERNAL ROLE EXPECTATIONS REALITY TRANSITION TO MASTERY

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

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

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

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

45 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

46 Face to Face with Eye Contact

47 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

48 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

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

50 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

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

52 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-

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

54 Kegal’s Exercise

55 ELIMINATION BOWEL URINARY

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

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

58 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

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60 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

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62 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

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

64 Mastisis

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68 DEEP VEIN THROMBOSIS

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