Nursing Care During the Postpartum Period Flashcards
In the postpartum period nursing care is provided in the context of the family unit and focuses on assessment and support of the woman’s physiologic and emotional adaptation
after birth (during the early postpartum period) Components of nursing care
Nursing care of the postpartum woman
Assist mother with rest and recovery after birth
Assessment of physiologic and psychologic adaptation
Prevention of complications
Education regarding self-management and infant care
Support of mother and her partner during transition to parenthood
Transfer from Recovery Area
after birth (during the early postpartum period) Components of nursing care
Ideally discharge planning and education begins during pregnancy
extending into the fourth trimester (the first three months after birth) - after the initial recovery period or this fourth stage the woman is transferred to a postpartum room
if she does not then I transfer report or a handoff communication is exchanged between the labor nurse and the postpartum nurse and many times that is in the form of an actual bedside report in front of the patient
begins with that first interaction among the nurse the woman and her family and continues until they leave the hospital or birthing facility as nurses we are always thinking about the end result the outcome and so we need to gear our teaching efforts to the entire visit these are all the criteria for discharge postpartum
Length of stay
Newborns’ and Mothers’ Health Protection Act of 1996
Criteria for discharge
American Academy of Pediatrics recommendations
Planning for discharge
Allows for a minimum of 48 hours stay after a vaginal birth and 96 hours after cesarean birth
provided minimum federal standards for Health Plan coverage for mothers in their newborns under this act all health plans are required to allow the new mother and newborn to remain in the hospital for a minimum of 48 hours after an uncomplicated vaginal birth and for 96 hours following the Caesarean birth unless he attending provider and consultation with the mother decides on early discharge the health of the mother and her newborn should be stable the mother should be able and confident to provide care for her infant and there should be adequate support systems in place and access to follow up care
Newborns’ and Mothers’ Health Protection Act of 1996
includes periodic assessment to detect deviations from normal physical changes measures to relieve discomfort or pain safety measures to prevent injury and infection and education and counseling measures designed to promote the woman’s feelings of competence and self-management and infant care direct physical care and education of new mothers is one of those two essential roles of a nurse in the postpartum time - they tend to nurture the mother by providing encouragement and support
Blood loss after birth can also be caused by vaginal or vulver hematomas or unrepaired lacerations of the vagina or cervix these potential sources might be suspected if excessive vaginal bleeding occurs in the presence of a firmly contracted uterine fundus
Weighing the clots and items saturated with blood - qbl that we’re actually gathering at this point now and it’s recommended as the most accurate way to objectively determine blood loss when assessing blood loss the nurse asks the woman how long has it been since her parental pad was changed nurses in general like I said tend to overestimate but it’s important to note - imp to know when just changed it - how often changing it
Blood pressure is not a reliable indicator of impending shock from early postpartum Hemorrhage because what what have we learned about the woman’s cardiovascular system adaptations and pregnancy we’ve got some built-in compensatory mechanisms that prevent that significant drop in blood pressure however once a woman has lost 30 to 40% of her blood then you’re going to start seeing those signs of shock so we need to maintain uterine tone a major intervention - gently massaging the fundus until firm; can do medications
Ongoing physical assessment
Nursing interventions
Maintenance of uterine tone
Prevention of infection
Promotion of comfort
Promotion of rest
Promotion of ambulation
Reduction of venous thromboembolism
Promotion of exercise
Promotion of nutrition
Promotion of normal bladder function
Promotion of normal bowel function
Promotion of breastfeeding
Lactation suppression
Care management physical needs
the ongoing assessments are performed throughout the hospitalization in addition to Vital Signs and physical assessment of the postpartum woman you’re focusing on the evaluation of the breasts the uterine fundus lochia her perineum bladder and bowel function and then of course her lower extremities
going to be interpretation and communication of routine laboratory tests hemoglobin and hematocrit values are often evaluated on the first postpartum day to assess blood loss during birth with rh status
Ongoing physical assessment
Prevention of excessive bleeding
Uterine atony
failure of the uterine muscle to contract
Nursing interventions
two most important interventions for preventing excessive bleeding are maintaining good uterine tone and preventing bladder distension so this is prevention
Fundal massage
Prevention of bladder distention
Maintenance of uterine tone
prevention of infection nurses in the postpartum setting are acutely aware of the importance of preventing infection bed linen should be changed as needed disposable pads and draw sheets or change frequently hand hygiene hand hygiene hand hygiene staff members with colds cops or skin infections need to follow Hospital protocol when in contact with postpartum women especially during flu season peroneal lacerations and episiotomies can increase the risk for infection - lack of skin integrity
Educating the woman to wipe from front to back is important additionally we offer women squeeze bottles just plastic squeeze bottles that are typically just filled with warm water and some places will actually include an antiseptic solution to that water and we asked them to use that after each boy and that’s just to keep the perineum clean and then of course to tell her to wash her hands immediately afterwards
Prevention of infection
intended to eliminate the pain sensation entirely or reduce it to a tolerable level that allows women to care for herself and for her newborn
Nonpharmacologic interventions
Pharmacologic interventions
Promotion of comfort
are used to reduce postpartum discomfort switch can include distraction imagery Therapeutic Touch and relaxation with those Associated risk factors sore nipples and breastfeeding mothers are most likely related to ineffective latch technique assessment and assistance with feeding can help alleviate the cause if it’s because of a poor latch then we need to work on improving that latch for the newborn breast engorgement can occur
Nonpharmacologic interventions
use a lot of NSAIDs that’s the most common ibuprofen is preferred for breastfeeding women because it has a low milk maternal plasma drug concentration ratio and a really short half life
Pharmacologic interventions
Postpartum fatigue
are very tired of long stressful labor so we need to be advocates for for rest for them lack of sleeping fatigue or common complaints of new parents so we need to protect that diet fatigue could also be associated with anemia infection or thyroid dysfunction so if sleep isn’t necessarily the issue and need to assess other factors that maybe disrupted sleep and fatigue
Promotion of rest
early ambulation is associated with a reduced incidence of venous thromboembolism which we all know it promotes the return of strength also in the early postpartum period some women feel light-headed or dizzy when standing the rapid decrease in that enter abdominal pressure after birth results in a dilation of blood vessels supplying the intestines and causes blood to pool in that viscera - risk for orthostatic hypotension
Promotion of ambulation
blood is hypercoagulable in the postpartum
especially during these first 48 hours after birth
Reduction of venous thromboembolism
