Postpartum Period Flashcards
Postpartum is also called as
Puerperium
6 weeks period after childbirth until the mother returns to its “ near non pregnant state “
Puerperium
During the 6 weeks period after childbirth, the mother would return to its
Near pregnant state
Some systems does not return to its normal state such as the
Cervix
Reproductive organs return to their non-pregnant state
Involution
2 kinds of Involution
a. involution for uterus
b. involution for lactogenesis
Failure of the uterus to return to its pre-pregnancy state after 6 weeks
Subinvolution
Complication that may occur if Subinvolution would occur
Hemorrhage
Leading causes of mortality to women
Hemorrhage
Afterpain complications
a. Contraction of uterus afterbirth
b. Intermittent crampings
c. Similar to having a patient experiencing dysmenorrhea
d. Experiences afterpain to those who are breastfeeding, to those who are not due to the hormone oxytocin since it is responsible for uterine contraction
e. Mulltipara mothers experiences the afterpain more than Primipara mother since the uterus stretches more
Breastfeeding mothers
Experiences after pain
Mothers that experience afterpains more
Multipara
Mothers that experience afterpains less
Primipara
Multipara mothers
Uterus stretches more which causes afterpain more
Fundus
a. Upper portion of the body of the uterus
b. Where to assess the location and height of the uterus during postpartum
Vaginal Discharges after birth
Lochia
Episiotomy
a. Incision to enlarge the vaginal opening
b. Rarely done today since there is a risk for extending the perineal lacerations
Dilitation
cervical opening increases
Crowning
when we see the head of the baby
Episiorrhapy
Repair of episiotomy
2 types of Episiotomy
a. midline - vertical
b. mediolateral - vertical and 45 degrees
Feelings of overwhelming sadness or “baby blues” due to changes in hormones
Postpartum Blues
Estrogen and progesterone decreases during this state
Postpartum Blues
Intense interest of fathers to their newborn or beginning of bonding
Engrossment
What Father’s do that increases bonding with newborn
a. direct eye contact
b. skin to skin contact
If well - baby it is placed in
Rooming-In
If not well - baby it is placed in
NICU to put in incubator
Infant remains with the mother in the room if
Well baby
Initiative of hospitals is to be
Mother baby friendly hospital
What is Postpartum
a. 4th trimester of pregnancy
b. It is the 6 week period after childbirth
c. Also called as puerperium which is a latin word
Latin for child
Puer
Latin for bring forth
Parere
Months of trimester
a. 1st trimester - 1- 2 months
b. 2nd trimester - 4 - 6 months
c. 3rd trimester - 7 - 9 months
d. 4th trimester - 6 week period after childbirth
It is the returning of the body to its pre-pregnancy state
Retrogressive
Changes that include in Retrogressive
a. Shrinking & descent of uterus to the symphysis pubis
b. Sloughing of the uterus lining
c. Development of lochia
d. Contractions
e. Recovery of vaginal and pelvic floor muscle
Is preparing the body for new changes in relation to postpartum
Progressive
Changes that include in Progressive
a. Production of breastmilk
b. Return of menstrual flow
c. Beginning of parental role
Physiologic changes during postpartum
B - REAST
U - TERUS
B - OWEL
B - LADDER
L - OCHIA
D - EEP VEIN THROMBOSIS
E - PISIOTOMY
S - IGNS
H - OMANS
E - MOTIONS
Organ to prepare for lactation
Breast
Primipara stresses in theses days since there is yet no breast milk
1st, 2nd, 3rd day
Breast milk occurs in these days
4th, 5th day
A way to release the oxytocin from posterior pituitary gland to have milk let down
suckling
Soft on Palpation on what day
1st and 2nd day
When does filling occur
3rd day
Begins to feel firm and warm
Filling
What day does breast appear large and reddened, taut, shiny skin, feels hard, tense and painful
3rd and 4th day
Engorgement
a. Firm module is palpated bilaterally and diffuse
b. Breast appears reddened and shiny, feels warm and tender
c. Usually relieved with latching and infant’s sucking
d. If there is mass upon palpation, there is clogged milk duct - breast milk was not released properly which would lead to mastitis since it nodule like when palpation
e. Increase in temperature or low grade fever due to engorgement, which can be relieve by medications or milk is released
When does engorgement occurs
3rd to 5th day
Mouth of baby for sucking is position properly in nipples and areola to release milk
Latching
Breast is painful upon palpation if
if not drink by baby since milk is not released to relieve discomfort
If baby is incubator and not in rooming in baby
breastmilk is released by “pumping or breast pumps“
Engorgement occurs immediately after birth for who
Multiparous Women
Nursing Care for Engorgement : Promote Breast comfort
a. Feed per demand since breast follow the law of supply and demand if accumulation of milk because milk that is not released to breastfeed or pumping inhibits further milk formation
b. Engorgement subsides in about 2 days
c. Apply cold compresses, 3-4 times daily during the period of engorgement
d. May take oral analgesics as prescribed for lactating mother
e. Wear snug-fitting bra or commercial breast binder
Check breast for consistency, size, shape, and symmetry
a. Best position is hands up
b. Consistency : soft, firm, presence of nodules
c. Size : small, large nipples, inverted, can be symmetrical if if one breast is empty is small, other breast if large, encourage the mother to empty breast on each side every 10-15 minutes
Best position for breast assessment
Hands up
Consistency of breast
May be soft, firm, presence of nodules
If one breast is empty which is small, other breast if large, what is the nursing intervention
Encourage the mother to empty breast on each side every 10-15 minutes
Size of breast
May be small, large nipples, inverted, can be symmetrical
localized tenderness indicates
Clogged ducts
Indications found in nipple assessment
a. redness
b. cracking
c. inverted
d. flat
e. presence of milk
Promoting Breast Comfort
a. Wear comfortable and good supporting bra
b. Use water only washing the breast since it removes oil which causes dryness in areola and nipple which would lead to fissure and wounds which would let microorganisms enter if using soap
Check every 8 hours for the following in the breast
a. Beginning of lactation
b. Presence of infection
c. Presence of breast mass
Nursing Care for Engorgement : Promote Breast hygiene
a. Assess the mother’s knowledge of regular breast examination
b. Use of good supporting bra
c. Encourage use of warm compress or standing under warm water
d. Wash breast and nipples with plain water
e. Encourage to insert gauze squares or commercial nursing pads into her bra for considerable discharges of colostrum or milk during the 72-96 hours after birth
f. Breastmilk - liquid god
Must occur to prevent postpartum hemorrhage
Uterine Involution
Uterine Involution changes
a. Reduction in size and weigh after birth
b. Uterine lining is shed when placenta detaches
c. Basal layer of uterus remains for future pregnancies
d. Placental side is healed of 6-7 weeks
e. Descends at a predictable rate
Uterus location in postpartum
midline or below the level of the umbilicus
Consistency of uterus if it is contracting
firm mass
Consistency of uterus if it is not contracting
soft and boggy
A sign of complication on the consistency of uterus
soft and boggy
What complication is indicated for a uterus if it is soft and boggy
bleeding which s a danger sign
Uterus location if there are variables
a. Found in the midline or below the level of the umbilicus (common)
b. Can be found in the right side due to the bulk of the colon of the mother ( during pregnancy )
c. Due to the bladder being distended ( during postpartum )
Frequency of uterus descending
descents about 1 finger breadth / finger width (1cm) each day
Why is Uterus NON-PALPABLE 10 days after postpartum
Due to the uterus being found in the symphysis pubis
When is uterus palpated at the level of umbilicus which the uterus would remain for 24 hours
1 hour after birth
When the uterus is palpated at the level of umbilicus 1 hour after birth
Uterus would remain for 24 hours
What examination is done to check for Internal and external OS (openings) are open
Internal Examination
Cervix consistency
soft and malleable
When does external OS narrowed only but not closes its size
End of 7 days
At childbirth the cervix appears
slit - like or stellate (star-shaped)
When does the openings of the cervix closes
a. Internal OS closed first after childbirth
b. External OS narrows until 1 week, it is important to do internal examination
Factors that retard uterine involution
a. Prolonged labor
b. Anesthesia
c. Difficult birth
d. Multiparity
e. Full bladder
f. Incomplete expulsion of placenta
g. Infection
h. Overdistention of uterus
Difficult Birth Nursing Interventions
a. Fundal push to promote uterine inversion which can make the head of baby elongated at first
b. Vacuum assisted - if the mother does not have energy, vacuum is used to pull the baby
Multiparity
a. More prone to bleeding since there is no good muscle tone due to decreased muscle tone and muscles are relaxed due to many times being pregnant already
b. Decrease in tone due to always being stretched
c. Relax muscles due to always being stretched
Failure of the uterus to contract adequately following delivery
Uterine Atony
Full Bladder
a. Pushes the uterus to right side when the bladder is distended
Incomplete expulsion of placenta
a. Has placental fragments left
b. Must count the number of cotyledons which would indicate there is insufficient contractions which would lead to postpartal infections
Infections
a. has inflammation
Overdistention of uterus
a. When there is multiple gestation
b. When there is polyhydramnios
c. When there is macrosomia (very large baby ) which is common to patients who have gestational diabetes mellitus when sugar is raised during pregnancy - Fasting blood sugar is checked and HBsAG
An increase in the amniotic fluid in pregnancy
Polyhydramnios
Very large baby
Macrosomia
Common to patients who have gestational diabetes mellitus when sugar is raised during pregnancy
Macrosomia
Nursing care uterine assessment is done by
a. Position in supine, observe abdomen for contour
b. Palpate and check the consistency of the fundus of the uterus
c. Assess location and height of the uterus
d. Perform bimanual palpation
e. Never palpate a uterus without supporting the lower segment
f. Soft and boggy uterus (not firm ; non-contracting)
Positioning in supine and observing abdomen for contour is done how frequently
a. Every 30 minutes for 4 hours
b. Every 8 hours for 3 days
Palpating and checking the consistency of the fundus of the uterus would show
a. Firm
b. soft or boggy
What intervention is recommended if uterus is not contracting
Fundal massage
Why should we never palpate a uterus without supporting the lower segment
since the uterus may invert or the uterus would turn inside and out which may cause massive bleeding
Soft and boggy uterus (not firm ; non-contracting) would recommend what nursing interventions
a. Massage fundus gently
b. Administer oxytocin as prescribed
c. Encourage breastfeeding
d. Allow the mother to void or empty her bladder
What are the changes the mother would show
a. Diuresis due to increase in blood volume
b. Excessive urine formation
c. 2-3 ml
d. At risk for dehydration - increase the intake on fluids
What intervention is recommended when the patient is at risk for dehydration
Increase the intake on fluids
What are the characteristics the mother would show
a. Daily urine output increases during the 2nd - 5th day after birth
b. Transient loss of tone
c. Increase in size of ureters, kidneys and kidneys remains 4 weeks after birth
Changes in daily urine output which increases during the 2nd - 5th day after birth
a. From 1500 ml to 3000 ml per day
b. 30 ml per hour ( 720 ml per day ) is normal for an adult
Transient loss of tone is caused by
a. Fetal head pressure
b. Epidural anesthesia for painless delivery so catheter is used to let the patient void since if the patient did not void, there is a risk for UTI (urinary tract infection)
Transient loss of tone would lead to
Decrease ability to sense voiding
What nursing intervention is needed when Epidural anesthesia is used for painless delivery
Catheter is used to let the patient void since if the patient did not void, there is a risk for UTI (urinary tract infection)
Increase in size of ureters, kidneys and kidneys remains 4 weeks after birth would lead to
a. Increase possibility of urinary stasis and UTI
b. Hydronephrosis
Nursing Care for abdomen
a. Assess abdomen frequently
b. Assess height and location of uterus
c. Promote Urinary elimination
What to know when assessing bladder
a. Palpation: Hard or firm just above the symphysis pubis
b. Percuss: Resonant
When promoting urinary elimination
a. Encourage to void at the end of the first hour after birth
b. Promote privacy, run water at the sink
c. Encourage fluid intake
d. Promote Kegel exercises
e. Use warm tap water during perineal care
f. Urinary catheterization as ordered
What to do when encouraging the patient to void at the end of the first hour after birth
Offer bedpan with privacy
Promote Kegel Exercises
a. Pelvic floor muscle exercises
b. Kegel exercises will help prevent urinary incontinence
How frequent to do Kegel’s Exercise
10 - 25 times a day
What intervention is done if the mother cannot urinate 4-8 hours after birth
a. increase in bladder pressure b. catheterize
What are the 2 kinds of catheterization
a. Straight catheterization
b. Foley catheterization
This catheterization is a one time big time
Straight catheterization
This tube is connected to urinary bag; consistent urination
Foley catheterization
The least among the nursing care because it is an invasive procedure and pt is at risk for infection
Catheterization
Bowel Changes
a. Digestion & absorption is active immediately after birth
b. Presence of hemorrhoids
c. Active bowel sounds
d. Slow passage of stool
e. Difficult bowel
f. Evacuation/constipation
Why is there presence of hemorrhoids outside rectum
Because of the urge that the pt pushes during vaginal delivery (common)
Why is there active bowel sounds
For normal vaginal delivery
Why is there slow passage of stool
Due to relaxin which is a hormone that causes the slow passage of stool
Why is there difficult bowel evacuation/constipation
Due to displacement of the colon
Pain from episiotomy can cause
Can cause difficulty in bowel movements
Why Constipation occurs
Hormone relaxin that relaxes abdominal wall, presence of hemorrhoids, presence of perineal stitches
Nursing care for Bladder
a. Encourage establishment of regular bowel habits
b. Encourage early ambulation
c. Eat high
d. Encourage adequate fluid intake
e. Use of oral stool softeners (docusate sodium - Colace) as prescribed
f. Encourage use of Sitz Bath
g. Use of anesthetic sprays, when hazel or astringent preparations, or preparations such as hydrocortisone acetate (Proctofoam)
h. Gentle manual replacement of hemorrhoidal tissue
i. Assume Sim’s position several times a day
j. Increase fluid intake and use of stool softeners as prescribed
What does ambulation do
Increase peristaltic movement
Common prescribed drug for stool softening
Senokot
How many times a day is Senokot given
BID or TID for 7 days
What happens when we do Sit Bath
Sitting on a planggana with warm water; increases circulation which helps dilating the blood vessels; faster of healing of wounds
Vaginal discharge after childbirth
Lochia
Consists of blood, fragments of decidua, WBC, mucus and some bacterial
Lochia
How long does lochia show
1 - 3 weeks
How much lochia is present in Cesarean Section
No or less
How to evaluate lochia
a. Amount
b. Consistency - no large clots
c. Odor - no offensive odor
d. Absence - should never be absent
e. Pattern - rubra to serosa to alba
Why breastfeeding mothers have less lochia discharge
Because of the natural release of oxytocin
Strengthens uterine contraction; thus less vaginal discharges
Oxytocin
This is considered as abnormal heavy flow; report to physician immediately
Pad as saturated due to lochia
This can lead to infections
Tampons
Consistency : Large clots
Possibility of portion of placenta that helps uterine contractions; report immediately
This is suggested that the uterus is infected
Offensive Odor
This indicates bleeding and patient is not contracting properly
Lochia rubra more than 1-3 days
Lochia colors
a. Rubra
b. Serosa
c. Alba
Rubra
a. dark red
b. mostly blood, fragments, decidua and mucus
c. 1- 3 days
Serosa
a. pinkish to brownish
b. mostly blood, mucus, leukocytes
c. 3 - 10 days
Alba
a. yellowish - white
b. mostly mucus and leukocyte count is high
c. 10 - 14 days (last up to 6 weeks )
Amount of Lochia
a. Scant : <2.5 cm ( 1 inch ) stain
b. Light : 2.5 - 10 cm (1 - 4 inch ) stain
c. Moderate : 10 - 15 cm ( 4 - 6 inch stain )
d. Heavy : saturated in 1 - 2 hours
e. Excessive : saturation of a perineal pad within 15 minutes
When to apply and check pad
Every 15 minutes
One gram of weight is equal to
1 ml of blood
Formula for lochia
Used perineal pad – New perineal pad = weight (grams)
How frequent to assess lochia
a. every 15 mins for the 1st hour,
b. every hour for the next 4 hours
c. and every 8 hours
how to assess
Ask woman to turn to sides and inspect under her buttocks
What to avoid
Tampons
Uterus
Must be firm to prevent bleeding
Sign of placental fragments
Lochia that turns to bright red after it progresses to serosa or alba
Episiotomy
a. A cut or incision through the area b/w vaginal opening and anus (perineum)
b. Done to make vaginal opening larger for childbirth
c. Helps prevent lacerations
When is Episiotomy done?
During Crowning at 10 cm dilatation
Done without anesthesia because
Not felt by the pt, because they feel more the fetal pressure, since the pressure puts pressure on the perineal nerve, thus numbing the area
Episiorrhaphy
a. surgical repair of injury to the vulva by suturing
b. Done with anesthesia
Types of Episiotomy
a. midline
b. medio - lateral
Midline Episiotomy
a. Incision from the vagina straight down toward the anus
b. Prevents laceration
Pros and Cons of Midline Episiotomy
PROS
a. Shorter incision
b. Faster wound healing
c. Less painful
d. Decreased problems/pain while sexual intercourse
CONS
a. May extend to the anus
Medio - lateral Episiotomy
a. Incision that extends from the vagina at a 45 degree angle to the vaginal orifice
b. Incision may be made on either the left or right side
Pros and Cons of Medio - lateral Episiotomy
PROS
a. Not on the anal area
CONS
a. Longer incision
b. Increased blood loss
c. Increased pain
d. Difficult and longer to repair
e. Prolong discomfort during sexual activity
Is often edematous, tender, and bruised
Perineum
What part of the mother would ecchymosis be present
Perineum
What happens to Labia Minor and Labia Majora after birth
Remains atrophic and softened after birth
What happens to the hemorrhoids of women during birth
Temporarily worsen
Nursing Care for Perineum
a. Position woman to her side and lift buttocks
b. Assess incision on the perineum for REEDA
REEDA
a. Redness
b. Edema
c. Ecchymosis
d. Discharge
e. Approximation
How many indications does REEDA have
4
2nd row
R : <0.25 cm of incision bilaterally
E : Perineal, <1 cm from incision
E : <0.25 cm bilaterally or 0.5 cm unilaterally of incision
D : serous
A : skin preparation <3mm
1st row
R : none
E : none
E : none
D : none
A : closed
3rd row
R : <0.5 cm of incision bilaterally
E : Perineal, 1-2 cm form incision
E : 0.25 - 1 cm bilaterally or 0.5 - 2.0 cm unilaterally of incision
D : serosanguinous
A : skin & subcutaneous fat preparation
4th row
R : >0.5 cm of incision bilaterally
E : perineal, 2 cm from incision or affects vulvar area
E : >1 cm bilaterally or 2 cm unilaterally of incision
D : Bloody, Purulent
A :skin & subcutaneous fat & fascial separation
Scoring for REEDA
Healed: 0
Moderately Healed: 1-5
Mildly Healed: 6-10
Not Healed: 11-15
In exposing the perineum, have the patient in what position
a. raise / flex the leg
b. sidelying
Length of redness in the episiotomy
Redness
Length of swelling in the episiotomy
Edema
Ecchymosis
a. bruises
b. are there bruises on both sides
c. length of the bruise
Discharge
a. discharge from the episiotomy
b. is there presence of purulent
Approximation
a. Is the wound intact
b. Intact? Closed? Open? Separation?
c. Wound dehiscence - suture again opens
d. Report immediately in case of wound dehiscence
Nursing Care for Perineum
a. Applying an ice or cold pack to the perineum during the first 24 hours
b. Applying warm compress (perineal hot pack) after 24 hours from birth
c. Use of sitz bath
d. Practice perineal exercises (kegel’s exercises) 3-4x a day
e. Use of local creams or oral analgesics as prescribed (NSAIDs)
What happens when applying an ice or cold pack to the perineum during the first 24 hours
a. Reduce perineal edema
b. Lower chances of hematoma formation
c. Decreases pain (cold will numb from pain)
d. ICE NOT DIRECTLY ON WOUND!! e. Wrap around towel, or disposable pad
What happens when applying warm compress (perineal hot pack) after 24 hours from birth
a. Promote faster wound healing
b. Relaxes the tensed muscles
c. Dilates the blood vessels, increase the circulation in affected area, fastens the wound healing
What happens when we recommend Sitz Bath
a. Promote comfort
b. Fastens wound healing
c. Decreases chances of hemorrhoids
Reasons when we use local creams or oral analgesics as prescribed (NSAIDs)
a. For pain relief or help decrease the inflammation of edema
b. Last in nursing care, prioritize suggesting comfort measures
Non-pharmacologic measure when mother sit
Use donut pillow to prevent pressure in buttocks
Do we need to remove sutures
No, since it dissolves within 10 days
Reflects the internal adjustment when body returns to its pre-pregnancy state
Vital Signs
Where is temperature taken during gate postpartum period
a. orally
b. tympanic
Do not take temperature where
a. rectum ( contraindicated due to infection risk)
b. armpit ( less accurate )
What is the temperature for the first 24 hours
Slightly increase in temperature due to hydration
What temperature is considered as febrile
38 C (100.4 F)
Beyond 24 hours with 38 C indicates
Infection
What happens to temperature during the 3rd and 4th postpartum day
Temperature increases for a period of hours due to increased vascular activity in lactation
Major cause of postpartal mortality and morbidity
Infection
Pulse
a. Pulse rate is slightly slower than normal
b. After birth: increase blood volume return, stroke volume increases
c. Increase stroke volume reduces the PR between 60-70 bpm
d. Diuresis diminishes the BV & BP decrease causing the increase of PR accordingly
e. End of 1st week: PR is normal
f. Evaluate pulse rate conscientiously in the postpartal period
g. Rapid and thready pulse could be a sign of hemorrhage
h. Check manually the pulses for the quality of the beats
What happens when there is an increase in stroke volume
Reduces the PR between 60-70 bpm
What could be a sign of hemorrhage
Rapid and thready pulse
When there is an increase in stroke volume
Take note and report to physician if PR is less than 60 bpm
What happens to the PR after 1st week
Normal : 60-70 bpm
Blood Pressure
a. A decrease can indicate bleeding
b. An elevation above 140 mmHg or 90 mmHg: postpartal hypertension in pregnancy (PH)
c. Oxytoxic drugs can increase BP
d. Orthostatic Hypotension or dizziness - due to lack of adequate BV to maintain supply in the brain
e. If woman develops postural hypotension, inform physician immediately
f. Advice to always sit up slowly and “dangle” on the side of her bed before attempting to walk
g. Do not let the mother hold the baby until her cardiovascular status improves
A decrease in Blood Pressure indicates
Bleeding
An elevation above 140 mmHg or 90 mmHg indicates
Postpartum hypertension in pregnancy (PH)
What pharmacologic measure could increase blood pressure
Oxytoxic drugs
What may be a reason there is occurrence of orthostatic hypotension or dizziness
Due to lack of adequate BV to maintain supply in the brain
What nursing intervention is needed when mother develops postural hypotension
Inform physician immediately
When should we recommend the mother to hold the baby while walking and standing
Until her cardiovascular status improves
Forced foot dorsiflexion causes discomfort behind the knee
Homan’s Sign
What causes discomfort during dorsiflexion Homan’s Sign?
calf muscles compress the tibial veins
What does Homan’s Sign assess for?
Deep Vein Thrombosis
Pregnant women get this blood clot type often
Deep Vein Thrombosis
Symptoms of DVT
a. heavy painful feeling on the leg
b. tenderness, warmth, redness when thigh is palpated
c. slight to severe swelling
DVT can lead to what kind of blockage
pulmonary embolism (PE)
Symptoms of PE
a. chest pain
b. unexplained shortness of breath
c. coughing of blood
d. irregular HR
For Homan’s Sign, where should you assess for edema
ankle and over tibia on lower legs
What are the characteristics of a vein with a DVT patient
swollen and reddened that’s hard or solid to touch
How often should you check for peripheral circulation
once every 8 hours
Nursing Care for Homan’s Sign
a. assess for edema at ankle and over tibia
b. inspect for swollen and reddened vein that’s hard/solid to touch
c. assist pt to perform feet dorsiflexion
d. check for adequate peripheral circulation q8h
e. allow pt to dangle legs before getting up
f. provide exercises for circulation in lower extremities
If there is assumed thrombus
a. elevate affected limb with pillows
b. do not massage area
c. notify physician
Mother’s emotional status?
Adapting to new role and attending to infant’s needs
Common issues
a. breast soreness
b. body image
c. housework demands
d. partner’s expectations
e. children management
f. coping with emotional tension and sibling jealousy
g. fatigue
During the 1st 24 hours, mother…
a. is preoccupied with own needs
b. may talk about labor and birth experience
c. could be talkative, elated, or very quiet
By 12 hours, what is the mother’s usual emotional status
a. begins to assume responsibility
b. some may be eager to learn
c. others may easily feel overwhelmed
Nursing Care for Emotional Status
a. provide adequate rest opportunities
b. provide physical comfort measures
c. provide nutritious foods that align with woman’s desires
d. provide opportunities to discuss birth experience non-judgmentally if desired by pt
When mother feels that baby is more important than her postpartum
Abandonment
Nursing Care for Abandonment
a. encourage to verbalize feelings
b. provide reassuring words that the experience is normal
c. examine competitive feelings between mother and baby
d. encourage caring as a shared responsibility
e. praise positive parenting, self-care, and warm infant response behaviors
Baby does not meet expectations leading to difficulty in feeling positive
Disappointment
Feeling overwhelming sadness
Postpartal Blues
Symptoms of Postpartal Blues
a. mood swings
b. anger
c. weepiness
d. anorexia
e. difficulty sleeping
f. feeling of letdown
Causes of Postpartal Blues
a. change in hormone levels
b. unsupportive environment
c. low self-esteem
d. physical discomfort
Postpartal Blues can potentially lead to
Postpartum Depression (PD)
How long for Postpartal Blues to turn into PD
10-14 days
Nursing Care for Postpartal Blues
a. provide anticipatory guidelines and individualized support
b. encourage to verbalize feelings
c. provide physical comfort measures
d. provide supportive measures
e. determine mother’s available support
consider referral for evidence of PD
What are the 3 phases of Reubin’s Phases of Puerperium
- Taking-in
- Taking-hold
- Letting-go
Phase where nurse attends and make decisions for mother
Taking-in phase
What is the primary focus of the taking-in phase
recovery from birth, food and fluid supplement, and deep restorative sleep
Phase where mother begins to initate action and assumes self-care needs
Taking-hold phase
The best phase to give mother health teaching and baby care demonstrations
Taking-hold phase
Phase where mother redefines her new role
Letting-go phase
Phase where mother gives up her fantasy and accepts reality
Letting-go phase
Time when newborn stays with mother after delivery
Rooming-In
How long is rooming-in
23-24 hours a day
Mother successfully created a link with newborn postpartum
Attachment/Bonding
Sign of beginning effective attachment
En Face Position
Father experiences same feelings of attachment as mother towards newborn
Engrossment
Mother’s children visit after sibling’s birth
Sibling Visitation
Preparation for new changes in the body postpartum
Progressive changes
Progressive changes examples
a. Production off breastmilk
b. Beginning of parenteral role
Process of milk production and release from mammary glands
Lactation
Breastmilk’s first form after giving birth
Colostrum
Benefits of colostrum
nutrient-dense; high in antibodies and antioxidants; builds baby’s immune system
Series of cellular changes in breast throughout lactation
Stages of Lactogenesis
Stage with secretory differentiation
Stage 1
Stage with secretory activation
Stage 2
Stage with Galactopoiesis
Stage 3
Stage with Involution
Stage 4
When does menstrual cycle resume, if not breastfeeding
6-8 weeks
When does menstrual cycle resume, when breastfeeding
3-4 months
Goals of postpartum care
maintain an environment that is conducive to mother’s physical recovery, fosters relationships, and learning child care
Monitor Uterine Status
a. check lochia’s amount consistency, color and odor
b. fundal massage, clot expression, bladder emptying, nipple stimulation, breastfeeding
c. methylergonovine maleate (methergine), IV infusion of oxytocin
Relief of Perineal Discomfort
a. set good perineal care
b. use perineal ice packs, perineal pads, and topical pain relief
c. sitz bath for 20 min
Relief of Hemorrhoidal Discomfort
a. sitz bath, topical anesthetics, cool packs, witch hazel pads applied to anal area
b. increase fiber and fluids, exercise moderately, use stool softeners
c. maintain side-lying position and avoid prolonged sitting
Relief of Afterpains
a. lie in prone with small pillow under lower abdomen
b. analgesic agent (i.e. ibuprofen or acetaminophen)
Relief of Discomfort from Immobility and Muscle Strain
a. encourage early ambulation
b. assist first few times getting up postpartum
c. use of emergency call button
Nutrition Promotion
a. encourage healthy, well-balanced diet
b. breastfeeding mother requires 500kcal/day more than average
c. continue prenatal vitamin and iron supplements until postpartum check-up
Activity Resumption
a. avoid strenuous activity and excessive stair climbing
b. encourage sleep when baby sleeps
c. encourage light household activities
Sexual Activity Resumption
a. abstain until episiotomy is healed and ceased lochia flow (1-2 weeks postpartum)
b. encourage lubrication (vaginal dryness)
c. decreased libido = normal
Contraception
discuss available contraceptive methods with both partners
