Postpartum Care: Discharge Teaching Flashcards
Discharge Guidelines:
- SVD
- C/S
SVD: 24 hours without complications
C/S: 48+ hours without complications
- discharge orders signed by PHP for mother and neonate
- mother and infant are physiologically stable
- all discharge teaching complete
- Required follow-up/care planning is place for any variances. Mother is able to provide for and is confident in care for her newborn. Adequate support systems in place
- The nurse and health care provider are legally responsible for ensuring that the woman and neonate are not discharged before they are stabilized within normal limits
- Need a physicians order. usually signed in advance
- a communication form gets sent to public health nursing agency for follow up and to care provider (GP, Midwife) get faxed off and PHN receives variances. Variance plan is important
Transitions to Parenthood: Bonding
- Acquaintance
- Enjoyment of each other
- Proximity
- Interaction
Transitions to Parenthood: Attachment
Mutual meeting of needs
- parent gains confidence
- neonate experiences security
- behaviours can inhibit attachment
Positive Factors Affecting Bonding and Attachment
- Skin-to-skin contact
- Cultural practices
- parental supports
Skin-to-skin contact:
- assist physiological adaptation for mother and neonate
- may impact breastfeeding
- enhances familiarity with behavioural cues
- biorhythmicity
Cultural practices:
- inclusion of extended family
- infant feeding traditions
- co-sleeping and baby-wearing
- Spiritual practices and ceremonies
Parental supports
Negative Factors Affecting Bonding and Attachment
Physical complications
Psychosocial complications
Physical complications:
- prolonged labour, or birth trauma for mother or neonate
- PPH
- Pain
Psychosocial complications
- unmet expectations (ex. breastfeeding, emotional detachment)
- Lack of support
- neonate in NICU
Transition to Parenthood
- Process of role attainment and role transition
- Ongoing process as infants develop and change
Becoming a mother
- dependent behaviour - taking in
- dependent - independent behaviour - taking hold
- interdependent behaviour - letting go
Becoming a Father
Expectations, creating a role, father-infant relationship
Parenting among LGBTQ couples - non-judgemental, supportive caring environment
- challenges: lack of family acceptance, support, social invisibility
- judgemental attitudes, confusion or lack of understanding can affect quality of care provided (stigma from healthcare professionals)
Infant-parent adjustment
- Rhythm (sleep-wake patterns)
- Behavioural: gazing, vocalizing, facial expressions
- Responsivity: smiling, cooing
Diversity in Transitions to Parenthood
Age (adolescent mother or father, maternal age grater than 35 years, paternal/partner age greater than 35 years)
Social support
Culture
Indigenous families
Socioeconomic conditions
Personal aspirations
Parental Sensory Impairment: Visually impaired parent
- lack of sight does not have negative effect on parenting
- heightened sensitivity to other sensory output
- Skepticism from health care providers
- The infant will need sensory input from other people in the newborn’s environment
Parental Sensory Impairment: Hearing-Impaired Parent
- Mother and partner establish an independent household
- technological devices aid in parenting
- Young children acquire sign language readily
Sibling Adaptation
- Reactions can be manifested in behavioural changes
- Encourage involving siblings in planning and care
- There is an acquaintance process
- Strategies for facilitating sibling acceptance of a new baby
Nursing Care
Nurses provide care that focuses on the transition to parenting
- any plan of care needs to include family-centered needs and strategies to assist the family in adjusting to the baby
- Ability to care for herself and her new baby
Nursing Care Management: physical Needs
Combined dyad care
Ongoing physical assessment
- VS for mother and neonate
- BUBBLE LEP and related teaching
- new mothers need to know basic self-care and how to recognize if and when they should contact a care provider for themselves or their infants
Infection Prevention
- perineal care
- hand hygiene
Promotion of breastfeeding
Suppression of lactation
Promotion of nutrition
- Caloric intake is 180 to 2200 kcal/day; lactating women need to add 350 to 400 kcal/day
- takes more calories to breastfeed than to be pregnant
- Takes a lot of energy to recover from birth, recover iron stores, and if she is producing milk it takes energy to put into the milk and the process of generating the milk
Maintenance of uterine tone for prevention of excessive bleeding
- fundal massage and/or uterotonic medications
- a perineal pad saturated in 15 min or less, or pooling or blood under the buttocks is an indication of excessive blood loss
Promotion of normal bladder and bowel function
- First spontaneous void occurs in about 6-8 hours after delivery
- measure first voiding
- encourage frequent emptying to void distension
- Distension can contribute to uterine atony and excessive bleeding
- distension can prevent uterus from contracting
Promotion of normal bowel function: bowel care as needed
Promotion of comfort, rest, ambulation, and exercise
Comfort:
- non-pharmacological interventions
- pharmacological interventions
Rest
Ambulation:
- be present first time the woman is out of bed after birth
- prevention of clot formation
Exercise: Kegel exercises
Planning Future Pregnancies
- Sexual activity is at the discretion of the mother and her partner
- general guideline is six weeks due to closing of cervix and vulnerability to infection
- pelvic floor, abdomen and incision can be tender
- breastfeeding induces hormones that can lead to vaginal dryness
- contraindications due to perineal trauma
Contraception should be discussed with the Primary Healthcare Provider prior to discharge or at a follow-up appointment - perinatal nurses are required to have a working understanding of options
- Ovulation can occur prior to menses
Nursing Care: Psychosocial Needs
- Impact of birth experience
- Maternal self-image
- Adaptation to parenthood and parent-infant interactions
- Postpartum blues
- Family structure and functioning
- Impact of cultural diversity
Postpartum blues
- experienced by 50-80%
- temporary
- can affect both parents
- emotional lability
- sense of physical and psychological vulnerability
- exacerbated by comparison to intense feelings of joy and fulfillment following birth
- Affected by: sleep disruption, fatigue, physical demands of care, support
Postpartum Depression
- Experienced by 8% -20%
Actual occurrence could be higher due to lack of reporting - Longer lasting
- A moderate to severe mental health concern
- higher risk for women with previous experience of depression
- May also be referred to as perinatal depression, as it may not occur only after birth (much broader than feeling bad after having baby)
- someone with hx of depression is a risk factor for PPD
- people who experience PPD can develop different types of depression later in life
The Nurse’s Role is to Prepare the Family
- Self-care
- S&S of complications
- Infant feeding
- Sexual activity/contraception
- Prescribed medications
- Follow-up after discharge
Routine mother and baby checkups
PHN telephone follow-up
Home visits PRN
Public Health phone lines
Support groups
Referral to community resources
Nurse’s Role in Immunization Education- Educate, not pressure
- immunizations are one of the most effective global public health campaigns contributing to longevity and quality of life in the last two centuries
- parents are likely to have opinions regarding vaccines
- When you immunize your child, you’re also protecting the wider community. When more people are vaccinated, disease can’t spread as easily… and babies too young for vaccination, for example - are safer
- Serious side effects to immunizations are very rare. Choosing not to immunize is much more dangerous, since the risks of the disease are far greater than the risk of side effects
Purple crying & Shaken Baby Syndrome
- The Period of Purple Crying
- Infant crying is a normal part of every infant’s development that will pass
- The Period of PURPLE crying begins at about 2 weeks to about 3-4 mos of age
- All babies go through this period (some babies can cry a lot and some far less)
- baby often resists soothing
- Fathers often feel “i just want to fix the problem”
- The acronym PURPLE describes specific characteristics of infant’s crying during this phase
P
U
R
P
L
E
P - Peak of crying (your baby may cry more each week, the most in month 2, then less in months 3-5)
U - Unexpected (crying can come and go and you don’t know why)
R - Resists Soothing (your baby may not stop crying no matter what you try)
P - Pain-like Face (a crying baby may look like they are in pain, even when they are not)
L - Long-lasting (crying can last as much as 5 hours a day, or more)
E - Evening (your baby may cry more in the late afternoon and evening)
