ch. 21 nursing care of the postpartum family

Question 1

nursing care of the postpartum woman

Answer 1

• nursing care that focuses on assessment and support of a woman’s physiologic and emotional adaptation after birth
• care is wellness oriented
• best provided by an interprofessional team
• typical hospital stay is 1-2 days after vaginal birth

TIP:
- can stay up to 48H
- c section: 72H

Question 2

transfer from the recovery area

Answer 2

• transfer to postpartum room once maternal condition is stable
• LDRP settings: nurse provides the same level of care without moving the client
• postanesthesia recovery: women who have recieved general/regional anesthesia should be cleared by a member of the anesthesia team or a nurse

Question 3

planning for discharge

Answer 3

1) from initial contact w/ postpartum women, nurses prepare the mother for her return home

2) length of stay (LOS) depends on many factors:
- physical condition of mother and infant
- mental and emotional status of the mother
- social support at home
- client education needs (esp. 1st time moms)
- financial constraints (support!)

3) criteria for discharge: length of stay depends on many factors
- mother recovered; able to care for self and baby
- those at low risk for complications may be discharged within a few hours from a birth center; 24-36 hours from the hospital
- typical stay in the hospital after vaginal birth is approximately 48H

Question 4

care mgmt: physical needs

Answer 4

1) ongoing physical assessment
- routine laboratory tests
- nursing intervention: individualizing care plan

2) education:
- preventing excessive bleeding
- maintaining uterine tone
- preventing bladder distention
- preventing infection

3) promote:
- comfort (nonpharm/pharm interventions)
- rest
- ambulation (risk dvt)
- exercise sit up, knee roll, leg roll, arm raises, kegel
- nutrition
- normal bladder and bowel function (Q4H) -> bowel function at risk of constipation (stool softners)
- breastfeeding: initiate 1-2H from delivery, skin to skin contact

4) lactation suppression
- engorgement: supportive bras, tylenol, warm water, ice packs, cabbage leaves

5) health promotion for future pregnancies and children
- rubella vaccination: do NOT become pregnant for 28 days (risk still birth)
- varicella vaccination
- tetanus-diphtheria-acellular pertussis (Tdap) vaccine
- preventing of rH isoimmunization
- mmr postpartum, DO NOT get pregnant for month -> anomalies/miscarriage

Question 5

care mgmt: psychosocial needs

Answer 5

1) psychosocial needs: assessment
- their reactions to the birth experience
- feelings about themselves
- interactions with the new baby
- interactions with other family members
- current emotional status and needs

2) perinatal mood disorders
- nurses should be knowledgeable about PPD (peaks 2-3 weeks post birth)
- edinburgh postnatal depression scale (screening, hospital standard)

3) effect of birth experience (direct relationship to how she treats infant)

4) adaptation to parenthood and parent-infant interactions

5) family structure and functioning (f/u on family)

6) effect of cultural beliefs and practices

TIP:
- minimize risk of PTSD

Question 6

discharge teaching

Answer 6

1) self care and signs of complications
- redness, foul odor, fever, burning of urination, pus from infusion

2) sexual activity and contraception:
- 3 1/2 to 4 weeks (vaginal birth)
- 6 weeks (c section)

3) medications:
- iron
- motrin
- tylenol
- ladolin for cracked nipples

4) follow up discharge
- routine schedule of care (set appointment)
- home visits
- telephone follow up
- warm lines
- support groups
- referral to community resources