adaptasi fisiologis pada post partumpostpartum c/ puerpural sepsis, endometritis, mastitis tekanan...
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ADAPTASI FISIOLOGIS padaPOST PARTUM
Oleh
Lutfatul Latifah
Materi Kuliah Keperawatan
Universitas Jenderal Soedirman (Unsoed)
www.unsoed.ac.id
Postpartum
Postpartum = puerperium
The 6 weeks periods after childbirth
A time of rapid physiological changes within
the womens’s body as it returns to a pre
pregnant state
Adaptasi Tanda-Tanda Vital
Suhu
Maksimal 38 C k/ kerja otot meningkat, dehidrasi dan perubahan hormonal
Apabila panas lebih dari 24 jam komplikasi postpartum c/ puerpural sepsis, endometritis, mastitis
Tekanan Darah
Terjadi penurunan 20 mmHg k/ orthos hipotensi
Apabila terjadi peningkatan preeklamsi puerpuralis Peningkatan sistole 30 mmHg
Peningkatan diastole 15 mmHg
Adaptasi Kardio Vaskuler
Bradikardia 50-70x/menit (normal)
k/ toleransi dan kompensasi penurunan vaskuler resistensi
Tachikardia pd partus lama dan perdarahan
Diaphoresis (pada malam hari) dan menggigil instabilitas vasomotor ‘normal’ bila tanpa demam
Komponen darah
Hb & Ht nilainya normal meningkat bila pendarahan
Leukosit : 15.000 – 30.000
Pembekuan darah meningkat hati2 tromboemboli
Adaptasi Sistem Perkemihan
Kandung kemih edema & penurunan sensitivitas
K/ over distensi, tidak lampias dan urinary incompetence
Diuresis dalam 24 jam pertama
K/ udema pada waktu hamil
Hematuria trauma kandung kencing
Acetonuria dehidrasi dan partus lama
Proteinuria
K/ involusi uterus proses katabolisme tubuh
Adaptasi Sistem Endokrin
Setelah plasenta lahir penurunan prolaktin,
estrogen dan progesteron
Prolaktin meningkat LAKTASI sucking
Non laktasi prolaktin menurun dan estrogen
meningkat fase follicular 3 mg post partum
menstruasi 12 mg
Laktasi menstruasi pd mg 36
Perubahan Payudara
Colostrum minggu I
Warna kuning kental
Protein banyak
Tinggi fat globules
Tinggi antibodi
ASI hari ke 3
‘breast engorgement’
k/ vaskularisasi meningkat
Adaptasi Sistem Pencernaan
Minggu I
Motilitas usus menurun (pengaruh progesteron saat hamil)
Kekurangan cairan
Perineum tidak nyaman
Penurunan tonus otot abdomen
KONSTIPASI enema
Adaptasi Muskulus Skeletal
Otot abdominalis tonus <
Diastasis Rectus Abdominalis
Sensasi ekstremitas bawah
menurun k/ efek anestesi
Tromboplebitis k/ aktifitas
menurun & protrombin meningkat
Edema berkurang
Adaptasi Organ Reproduksi
Perubahan perineum
Episiotomi sakit sampai 5-6 mg postpartum
Perubahan vagina
Segera setelah melahirkan edema, luka dan biru, laserasi dan rugae tidak ada
Rugae kembali mulai 3 mg postpartum, 6 mg PP normal
Mukosa atropi kembali dengan dimulainya menstruasi
Cervical Changes
Following birth it is spongy and flabby and
formless and may appear bruised.
Original form is regained in a few hours
The shape is permanently changed by the
first childbearing.
Goes from dimple like to a lateral slit (fish
mouth)
Involusi Uterus
The rapid reduction in size of the uterus and it’s
return to a condition similar to its pre-pregnancy
state.
The uterus remains slightly larger than it was before
the first pregnancy.
Process is complete at 3 weeks except at the
placental site (6 to 7 weeks)
Subinvolution (the failure of the uterus to return to
the nonpregnant state) may be caused by an
infection or retained placenta fragments
Posisi Fundus Uterus
Waktu Posisi fundus Berat
Uterus
Lochea
1-2 jam Pertengahan umbilikus 1000 gr Rubra
12-24 jam 1 cm dibawah umbilikus 1000 gr Rubra
3 hari 3 cm dibawah umbilikus
( turun 1 cm/hari)
1000 gr serosa
9 hari Tidak teraba 500 gr alba
5-6 mg Tidak teraba 350 gr Tida ada
Lochia: Rubra, Serosa, Alba
Rubra (day 1-3): dark red in color, contains elemen
of amnion, chorion, decidua, vernix, lanugo &
meconium, should not contain clots, a few small
clots are considered normal.
Serosa (day 4-10) days: pinkish to brownish in
color, contain blood, wound exudates, erythrcytes,
leukocytes & cervical mucose.
Alba (day 10-14): creamy or yellowish in color,
contains decidual cells, mucus, bacteria, &
epithelial cells
Weight Loss
An initial weight loss of 10 to 12 lbs(5-6 kg)
occurs as a result of the birth of the infant,
placenta and amniotic fluid.
Puerperal diuresis accounts for loss of an
additional 5 lbs(2,5 kg) during the early
postpartum period.
Normally return to pre-pregnant weight by 6
weeks postpartum.
Afterpains or Afterbirth pains
Occur more commonly in multiparas than the primiparas.
Caused by intermittent contractions.
May cause severe discomfort for the first 2-3 days.
Breastfeeding may increase the severity.
Oxytocins may increase severity. (Pitocin, Methergine)
Mild analgesic may be indicated for pain relief. (Ibuprofen)