chapter 12: postpartum nursing care Flashcards
support family dynamic
- include family members in teaching and care
- provide info about sibling rivalry
- observe interactions: identify problems, make recommendations and referrals
puerperium
period following delivery of placenta until reproductive organs return to a nonpregnant state
- usually about 6 weeks
body begins to change immediately after delivery
postpartum shivering: uncontrollable, exact cause unknown, provide w/ a warm blanket, reassure shivering will pass
uterus involution
process where oxytocin continues to be released after placenta delivery, causing uterus to contract and shrink
- size and weight decreases
- fundus descents
- afterpains (intermittent uterine contractions)
- exfoliation: sloughing of dead tissue at the placental site
lochia
vaginal discharge made up of blood, mucus, and tissue
- may last up to 6 wks
- should get lghter in color and amount over time
- cervical os closes slowly and by day 14 is barely dilated
- vagina: after delivery lacks tone, over 4 wks edema decreases and rugae appear
perineum
- bruised and edematous after delivery
- muscle tone restored over 4-6 wks
- kegel exercises promote the return of tone
ovaries and ovulation
- normal function after delivery variable and influenced by breastfeeding
- menstruation delayed and may not resume for weeks or months if breastfeeding
- not breastfeeding: may ovulate as early as 27 days after delivery
- menstruation begins 6-12 wks for bottle feeding women
breasts postpartum
- breasts secrete colostrum before milk is produced
- nipple stimulation causes prolactin to be released, intiating milk production
- between second and fourth day breasts engorged with milk
- breasts may feel warm and tender
- if not breastfeeding needs interventions to suppress milk production
integumentary system
- abdominal skin resumes its pre pregnancy state except for stretch marks
- linea nigra fadesbut may never go away
- melasma fades over days or weeks
- hair loss resolves
Gi system
- hungry and thirsty after delivery
- may have sluggish intestinal peristalsis and constipation
- hemorrhoids can cause pain w/ defecation: stool softener may be prescribed to prevent straining
cardiovascular system
60-80% increase in cardiac output after delivery
- loss of plasma volume causes temporary rise in HGB and HCT
fibrinogen levels increase and remain increased for several days after delivery: increases risk for blood clot development
removal of excess fluid stored during pregnancy:
- diuresis: secretion and passage of large amounts of urine
diaphoresis: excessive perspiration
respiratory system
- diaphragm returns to normal position
- respiratory rate returns to prepregnancy level
- pregnancy nasal congestion disappears quickly
urinary system
- bladder tone decreases
- bladder becomes distended and pushes uterus up andto the side
- displaced uterus can interfere w/ involution and can lead to hemorrhage
musculoskeletal system
- hormone relaxin begins to subside
- hip pain may continue for a few days
- diastis recti of abdominal muscles may occur: separation of abd wall muscles, corrected w/ exercises or surgery
uterine assessment
- palpate fundus: note position and location, never palpate without supporting lower segment
- assess consistency
boggy uterus
support lower uterine segment and massage in circular pattern with flattened other hand until uterus becomes firm
- if massage not effective, large blood clot or extreme uterine atony which can lead to postpartum hemorrhage
- full bladder can lead to uterine atony
lochia assessment
- inspect amount and character during uterine massage
- should be getting better not worse
- no big clots
lochia lasts…
3-6 wks, occurs in three stages:
lochia rubra
lochia serosa
lochia alba
lochia rubra
first discharge, dark red blood
lochia serosa
3-4th day, brownish red, lighter color
lochia alba
over 1-2 wks, lighter and yellowish color
amount of lochia
- scant: less than 1 in of lochia on pad
- light: less than 4 in of lochia on the pad
- moderate: less than 6 in of lochia on pad
- moderate: less than 6 in of lochia on the pad
- heavy: pad is saturated within an hr (should not happen)
nursing care during first hour after delivery
- most dangerous hour: due to risk of hemorrhage
- check vital signs every 15 min
- palpate fundus
- assess uterine tone and amount of vaginal bleeding
- when stable, transfer to postpartum or mother baby unit
Bubble
breasts, uterus, bladder, bowels, lochia, episiotomy/laceration, legs, and emotions
breasts
- assess for breast and nipple pain
- pt teaching guidelines: managing engorgement for the non breastfeeding pt
uterus
palpate for location and consistency: firm and in the midline
document location of fundus in relationship to umbilicus
bladder
palpate when assessing the fundus
distention should not be present
bowels
- auscultate bowel sounds
lochia
assess and document amount and type
episiotomy/laceration
inspect perineum for bruising, erythema, edema, hematoma (collection of blood in subcutaneous space), intactness of repair
legs
assess for leg pain, adequate circulation, edema, temp
emotions
- when placenta is expelled, sudden drop in progesterone
- notice emotions and postpartum blues
nursing care following cesarean birth
- monitor uterine involution and lochia
- postop care to prevent complications
- assess pain and cesarean incision
nursing care of the adolescent postpartum
- same assessment and physical care
- more structured teaching: care of the newborn and herself
- treat as an adult
- encourage questions
- direct teaching to teenager, not parents, and include father in teaching if present
- role model infant care
- encourage bonding during the taking in phase
- at higher risk for postpartum depression
nursing care for the woman who relinquishes her infant for adoption
- find out the pts birth plan: may want the adoptive parents present at the birth or called after the birth
- may want to hold the infant then ask infant be kept in nursery
- may not want to see or hold infant at all
- provide empathetic care
- requires same physical care and teaching as any postpartum pt
- higher than average risk of postpartum depression
three phases of postpartum adjustment
- taking in phase
- taking hold phase
- letting go phase
taking in phase
- mother centered on own needs
- feels dependent and needs mothering
- may not initiate interaction w/ the newborn
- use the en face position
- identify the infant
- begin the bonding process: start of lifelong relationship
- taking in phase may last a day or two
taking hold phase
- mother initiates care of the baby
- wants to be more independent
- concerned and anxious about own physical care, breastfeeding, and abby care
- requires praise and positive reinforcement
- open to learning
- may last up to 10 or more days
- may experience postpartum blues
letting go phase
- letting go of being childless and more independent
- attachment w/ newborn occurs
- learnsto understand her infant’s cries and body language
- receives positive feedback from the infant when needs are met
- learns to trust herself and instincts
development of family attachment
- family attachment may take more time
prep for discharge
- administer MMR to woman found suscpetible to rubella during pregnancy
- those in contact w/ newborn should have up to date Tdap
- teaching should occur in small segments throughout hospital stay
- self care instructions should be written and verbal
self care instructions
- sutures for lacerations and the episiotomy repair will dissolve
- perineal care: ibuprofen/acetaminohen for pain, sitz baths
- menstrual pad changes, no tampons or douche until follow up
- breast care: supportive bra
- hand hygiene before breastfeeding and every diaper change
