Post partum nursing care Flashcards
period immediately after birth & extending for 6 - 8 wks after delivery
mother’s body returns to its pre-pregnant state
Nursing care should focus on
helping mother & her family adjust to changes
easing transition to the parenting role
postpartum period/puerperium
phases of puerperium
- Taking in
- Taking hold
- Letting go
First 3 days post partum
Focus on self, not infant, on her own needs for sleep and rest
Passive, dependent and can’t make decisions
Need to discuss labor experiences
Sense of wonderment when looking at the neonate
taking in phase (dependent phase)
Dependent - Independent Phase
from 3rd to 10th day postpartum
focus on infant
active, independent and can make decisions
initiates self care activities, focus on bowels, bladder and breastfeeding
responds to instruction about infant care and self care
may express lack of confidence in caring for the neonate
taking hold (dependent-independent phase)
10 days to 6 weeks postpartum
readjustment
mother may feel deep loss over separation of baby from her body
wanting to feel safe and secure yet wanting to make decisions
finally redefines her new role
see self as separate from infant
gives up fantasized image of her child and accepts real one
letting go phase (interdependent)
Postpartum Maternal concerns and feelings
- abandonmemnt
- disappointment
- postpartal blues
mother may feel confused by a sensation very close to jealousy
shared responsibility for infant care can help alleviate these feelings
abandonment
difficult for mother to feel positive immediately about a child who does not meet their expectations
disappointment
show up 3 to 4 days after birth and may last few weeks after delivery
50% of women experience some feelings of overwhelming sadness
mood swings, sudden crying episodes, irritability, anxiety, loneliness
feeling of happiness and love for newborn may be accompanied by feelings of helplessness, sadness and anxiety sudden and quick change in hormones
emotional and physical stress of giving birth
postpartal blues
moderate to severe depression in a woman after she has given birth
may occur soon after delivery or up to a year later caused by changes in hormone levels
postpartum depression
rare compared to postpartum anxiety or depression
requires immediate attention, especially if with suicide thoughts or harms herself or baby
postpartum psychosis
rapid decrease in uterine size as it returns to the nonpregnant state
weight decreases
fundic height decreases about 1cm per day
endometrium regenerates
by 10 days postpartum, uterus cannot be palpated abdominally
flaccid fundus indicates uterine atony and should be massaged until firm
tender fundus indicates infection
uterine involution
uterine discharge consists of blood from placental site and debris from decidua
fleshy in odor, smells like normal menstruation
discharge decreases daily in amount but may increase with ambulation
lochia
complete involution may take 3 – 4months
after 1 week the muscle begins to regenerate but is still about 1 cm dilated
permanent change cause by childbirth – the os becomes slit-like or elongated
cervix
distention decreases
smooth and swollen
rugae reappear by 3 – 4 weeks
muscle tone is never restored to pregravid state
vagina
rapid decrease in Estrogen & Progesterone and increase in prolactin
colostrum is present at time of delivery
breast milk is produced by 3rd or 4th day
sucking of newborn triggers release of OXYTOCIN – milk letdown and contraction of the uterus
average amount of milk produce in 24 hours increases with time
breast
when does menses resume in non-breastfeeding mothers and breastfeeding mothers
Menses resume:
Within 8 weeks in non-breastfeeding mothers
Within 3 – 4 months in breastfeeding mothers
Women may ovulate without menstruating, so breastfeeding is not a reliable method of birth control
skin changes during pregnancy gradually disappear during postpartum
striae gravidarum do not disappear and assumes a silvery white appearance
hyperpigmentation of areola may not disappear completely
some women are left with a wider and darker areola after pregnancy.
Linea nigra will be barely detectable in 6 weeks time
integumentary system
Depends on the rapidity with which pituitary function is restored
ovarian function and menstruation
may have urinary retention as a result of loss of elasticity and tone
loss of sensation in the bladder from trauma, medications, anesthesia and lack of privacy
diuresis begins within the first 12 hours of delivery
urinary system
women are usually very hungry after delivery due lo lack of food during labor
constipation occurs due to decreased intestinal muscle tone, perineal discomfort and pain from episiotomy, hemorrhage and laceration
bowel sounds are active, but passage of stool through bowel may be slow
hemorrhoids are common
gastrointestinal system
may have urinary retention as a result of loss of elasticity and tone
loss of sensation in the bladder from trauma, medications, anesthesia and lack of privacy
diuresis begins within the first 12 hours of delivery
urinary system
ambulation may be encouraged 4 – 8 hours after delivery
done to avoid complications, promote involution and improve emotional outlook
musculoskeletal system
advantages of early ambulation
prevent constipation
prevent thrombophlebitis
prevent urinary problems
promote rapid recovery and return of woman’s strength
hastens drainage of lochia
improves GIT & GUT function
provides a sense of well-being
rest & sleep as much as needed during early postpartum period
promote healing by reducing BMR and allowing O2 & nutrients to be utilized for tissue growth, healing & regeneration
instruct mother to avoid heavy lifting and strenuous activity after discharge
woman may resume light housekeeping on second week and can go back to normal activities by 4 to 6 weeks
rest and sleep
resumption of sexual activity
can be resumed 3 to 4 weeks after vaginal delivery if :
bleeding has stopped
perineum is healed
it does not cause pain
assessment
monitor VS
assess height, consistency and location of fundus
monitor color, odor, & amount of lochia
assess for breast engorgement
monitor perineum for swelling or discoloration
monitor episiotomy for healing
assess incisions or dressings of CS birth client
monitor bowel status and I&O
encourage ambulation and frequent voiding
assess bonding with newborn infant
assess emotional status
nursing responsibilities
Instruct to come back immediately if with:
Heavy vaginal bleeding or bright red vaginal discharge
Fever
Foul smelling lochia
Swollen, tender, hot area on her leg
Burning sensation on urination
Persistent pelvic or perineal pain
client teaching
Occurs as a result of contraction of the uterus
Are more common in multiparas, those with overdistended uterus, breastfeeding mothers & clients treated with oxytocin
afterbirth pains
apply iced napkin to the perineum during first 24 hours to reduce swelling
apply iced pack on hypogastrium
sitz bath after the first 24 hours
administer perineal care after each voiding
analgesics as prescribed
perineal discomfort
breastfeed frequently
apply warm packs before feeding; ice packs between feedings
wearing of support bra
expose to nipples to air 10 – 20 minutes after feeding
rotate the position of the baby for each feeding
be sure that the baby is latched on to areola
breast discomfort
bleeding 500 ml or more following delivery
post partum hemorrage
During the 1st 24 hours after delivery
Caused by uterine atony, lacerations or inversion of the uterus
early post partum hemorrhage
After the 1st 24 hours after delivery
Caused by retained placental fragments
late postpartum hemorrage
inability of myometrium to contract and constrict blood vessels, resulting in open sinuses at site of placental separation
cause of 80 – 90% of early hemorrhage
may be slow & steady or sudden & massive
BP and PR may not change until it’s too late
uterine atony
medications to stimulate uterine contractions
IM Methergine and IM or IV Oxytocin
surgical removal of the uterus
Hysterectomy
uterus remains large, and soft at 4 to 6 weeks postpartum
incomplete return of uterus to its prepregnant size and shape
Lochia is still present
subinvolution
infection of the urinary bladder
burning pain on urination
lower abdominal pain
urinary frequency
fever
forced fluids up to 3L/day
institute measures to assist void, encourage frequent and complete emptying of the bladder
urinalysis
antibiotics as prescribed
cystitis
localized collection of blood into tissues of the reproductive sac after delivery
severe pain, pressure in perineal area with discolored skin
signs of shock (pallor, tachycardia, hypotension)
monitor VS, place ice at hematoma site, prepare for incision and evacuation of hematoma, ligation of bleeders
administer analgesics, antibiotics or blood products as required
vulvar hematoma
inflammation of breast as a result of infection
seen in breastfeeding mothers 2-3 weeks after delivery but may occur anytime during lactation
localized heat and swelling, pain, elevated temperature, flu-like symptoms
advise good handwashing and breast hygiene techniques
warm or cold packs
encourage breastfeeding
use of support bra
analgesic and antibiotics as prescribed
mastitis
passage of thrombus, often originating in one of the uterine or pelvic veins, into the lungs, where it disrupts circulation of blood
Dyspnea, tachypnea, tachycardia, cough, rales, hemoptysis, pleuritic chest pain, feeling of impending doom
Give O2, head levated, monitor VS, streptokinase and anticoagulants as prescribed
pulmonary embolism
formation of a clot in vessel wall due to inflammation of vessel wall
partial obstruction of vessel can occur
increased blood-clotting factors
superficial, femoral, pelvic
elevate legs, never massage, monitor for signs of pulmonary embolism
warm packs, analgesics and heparin as prescribed
thrombophlebitis
