introduction h_-yiweve
TRANSCRIPT
INTRODUCTION
http://www.youtube.com/watch?v=qTH_-yIwevE
POSTPARTAL NURSING
Developed by
D. Ann Currie, R.N. ,M.S.N.
2012
POSTPARTAL PERIOD
PHYSICAL CHANGES
PSYCHOSOCIAL CHANGES
NURSING CARE OF THE POSTPARTAL CLIENT
HIGH-RISK POSTPARTAL CLIENTS
PHYSICAL CHANGES DURING THE POSTPARTAL PERIOD
REPRODUCTIVE SYSTEM
INVOLUTION-IS THE PROCESS OF THE REDUCTION IN SIZE OF THE UTERUS AFTER DELIVERY TO PREPREGNANT SIZE CAUSED BY UTERINE CONTRACTIONS THAT CONSTRICT AND OCCLUDE BLOOD VESSELS AT THE PLACENTA SITE
FACTORS THAT ENHANCE INVOLUTION
UNCOMPLICATED LABOR & DELIVERY
BREASTFEEDING
EARLY AMBULATION
COMPLETE EXPLUSION OF PLACENTA AND MEMBRANES
FACTORS THAT IMPEDE INVOLUTION
PROLONGED LABOR & DIFFICULT DELIVERY
ANESTHESIA
GRAND MULTIPARITY
RETAINED PLACENTAL FRAGMENTS OR MEMBRANES
FULL URINARY BLADDER
INFECTION
CONT.
OVERDISTENTION OF THE UTERUS
USE OF OXYTOCIN DURING LABOR
FUNDUS
TOP PORTION OF THE UTERUS
A PALPABLE INDICATOR OF INVOLUTION
BOGGY UTERUS-SOFT,RELAXED..CAN CAUSE HEMORRHAGE
FUNDUS SHOULD BE FIRM
Assessing Fundus
FUNDUSLOCATION
RIGHT AFTER DELIVERY THE FUNDUS IS MIDWAY BETWEEN SYMPHYSIS PUBIS AND UMBILICUS
ONE HOUR AFTER DELIVERY THE FUNDUS RAISES TO THE UMBILICUS OR SLIGHTLY ABOVE-1CM AND REMAINS THERE FOR 24 HRS.
FUNDUSLOCATION- FUNDAL HEIGHT DECREASES 1CM A DAY AFTER THE FIRST 24 HR..
BY DAY 10 AFTER THE DELIVERY THE FUNDUS CAN NO LONGER BE FELT
FUNDUS SHOULD BE MIDABDOMEN
DEVIATIONS ARE ABNORMAL AND SHOULD BE CHECKED
Deviation of Fundus Location
LOCHIA
IS THE DISCHARGE OF BLOOD AND DEBRIS FOLLOWING DELIVERY
TYPES-RUBRA, SEROSA, AND ALBA
SHOULD NOT CONTAIN LARGE CLOTS
TOTAL VOLUME-240-270 ML.
DAILY VOLUME GRADUALLY DECREASES
LOCHIA
AMOUNT MAY BE INCREASED BY EXCERTION OR BREASTFEEDING
POOLING WHEN CLIENT IS RECLINING CAN OCCUR
C/SECTION CLIENT MAY HAVE LESS BUT SHOULD HAVE LOCHIA
UNEXPLAINED INCREASE IN AMOUNT IS ABNORMAL
LOCHIA AMOUNTS
LOCHIA RUBRA
1-3 DAYS AFTER DELIVERY
DARK RED,BLOODY FLESHY,MUSTY ODOR
CLOTS SMALLER THAN NICKEL
BLOOD,MUCUS, SHREDS OF DECIDUA, EPITHELIAL CELLS
LOCHIA SEROSA
4-10 DAYS AFTER DELIVERY
PINK OR BROWNISH-WATERY-ODORLESS
SERUM,ERYTHROCYTES,SHREDS OF DEGENERATING DECIDUA,LEUKOCYTES, CERVICAL MUCOUS,BACTERIA
LOCHIA ALBA
11-21 DAYS AFTER DELIVERY
MAY PERIST TO 6 WEEKS
YELLOW TO WHITE- MAY HAVE STALE ODOR
LEUKOCYTES,DECIDUA CELLS,EPITHELIAL CELLS,FAT, CERVICAL MUCUS, CHOLESTEROL, BACTERIA
LOCHIA
UNEXPLAINED INCREASE IN AMOUNT OR REAPPEARANCE OF LOCHIA RUBRA IS ABNORMAL..
AFTERPAINS
CAUSED BY INERTMITTENT UTERINE CONTRACTIONS FOLLOWING DELIVERY
OCCUR IN ALL WOMEN
MORE PAINFUL IN MULTIPARIOUS AND BREASTFEEDING WOMAN
ALSO IN WOMEN WHOSE UTERUS WAS OVERDISTENDED
CERVIXSOFT,IRREGULAR,AND EDEMATOUS, MAYBE BRUISED AND/OR SMALL LACERATIONS
CLOSES TO 2-3 CM AFTER SEVERAL DAYS..FINGERTIP AFTER 1 WEEK
MUST BE SLIGHTLY DILATED TO ALLOW LOCHIA TO DRAIN
AFTER FIRST DELIVERY SHAPE IS CHANGED
VAGINA
SMOOTH WALLS,EDEMATOUS WITH MULTIPLE SMALL LACERATIONS
PERINEAL DISCOMFORT/PAIN SHOULD BE GONE BY 2 WEEKS AFTER DELIVERY
LOW ESTROGEN LEVELS WILL TO DECREASED LUBRICATION FOR 6-10 WEEKS
ABDOMINAL WALL
SOFT & FLABBY WITH DECREASED MUSCLE TONE
STRIAE(STRETCH MARKS) WILL FADE BUT STAY
DIASTISIS RECTI-SEPERATION OF THE RECTUS MUSCLES OF THE ABDOMEN-MAY IMPROVE IN THE POSTPARTUM PERIOD
CARDIOVASCULAR SYSTEM
RETURNS TO PREPREGNANT STATE WITHIN 2 WEEKS
THE ELIMINATION OF THE INCREASED BLOOD VOLUME DURING PREGNANCY IS DONE BY DIURESIS
BLOOD PRESSURE SHOULD REMAIN STABLE
CV SYSTEM -CONT.
BRADYCARDIA BEGINS SECOND DAY-HR OF 50-70-CONT. FOR 6-10 DAYS
TACHYCARDIA-BLOOD LOSS, TEMP.,OR OTHER PROBLEMS
WBC’S ELEVATED IN POSTPARTUM PERIOD..LOOK FOR INCREASE OF OVER 30% IN 6 HRS.
CV SYSTEM CONT.
DECREASED HGB IS RELATED TO AMOUNT OF BLOOD LOSS
1ST 48 HRS POSTPARTUM ARE THE GREATEST RISK OF COMPLICATIONS FOR CLIENTS WITH HEART DISEASE
RENAL SYSTEMINCREASED BLADDER CAPACITY AND DECREASED BLADDER TONE LEAD TO DECREASED SENSATION AND INCREASED RISK OF URINARY RETENTION AND INFECTION
POSTPATAL DIURESIS-2000-3000 ML.-ACCOUNTS FOR 5 LB WEIGHT LOSS
A FULL BLADDER WILL DISPLACE THE UTERUS
RENAL SYSTEM
FULL BLADDER CAN LEAD TO UTERINE ATONY AND PP HEMORRHAGE
FLUIDS ARE ALSO LOST THROUGH DIAPHORESIS..COMMONLY SEEN AT NIGHT
GASTROINTESTINAL SYSTEM
HUNGER AND THRIST ARE COMMON FOLLOWING BIRTH OR IN THE 1ST PP DAY.
CONSTIPATION-DECREASED PERISTALSIS, USE OF NARCOTIC ANALGESICS,DEHYDRATION, DECREASED MOBILITY DURING LABOR , AND FEAR OF PAIN
GI SYSTEM CONT.
HEMORRHOIDS-BECAUSE OF PRESSURE OF PUSHING DURING 2ND STAGE OF LABOR.
Assessment for Hemorrhoids
ENDOCRINE SYSTEM
ESTROGEN AND PROGESTERONE LEVELS DROP RAPIDLY AFTER DELIVERY OF THE PLACENTA
MENSTRUATION USUALLY RESUMES 7-9 WEEKS FOR NONLACTATING WOMEN- 90% BY 12 WEEKS-1ST CYCLE IS USUALLY ANOVULATORY
ENDOCRINE CONT.
OVULATION AND MENSTRUATION RETURN TIME IS PROLONGED WITH LACTATING WOMEN-DEPENDS WHETHER SHE IS SUPPLEMENTING WITH FORMULA-VARY 2 TO 18 MONTHS
PLACENTAL HORMONES WHICH CAUSES INSULIN RESISTANCE WILL DECREASE BY 3-4 DAYS AFTER DELIVERY
ENDOCRINE CONT.
LACTATION
COLOSTRUM/MILK
PROLACTIN
OXYTOCIN
PSYCHOLOGICAL CHANGES IN THE POSTPARTAL PERIOD
PHASES OF MATERNAL ADJUSTMENT
PHASES OF PATERNAL ADJUSTMENT
BONDING
POSTPARTUM BLUES
PHASES OF MATERNAL ADJUSTMENT
TAKING-IN/DEPENDENT PHASE-
TAKING-HOLD/DEPENDENT-INDEPENDENT PHASE-
LETTING-GO/INTERDEPENDENT PHASE-
DEVELOPMENTAL TASK- MATERNAL ROLE ATTAINMENT
1ST DICUSSED BY R.RUBIN
TAKING-INDEPENDENT PHASE
1ST 1-3 DAYS..CAN BE SHORTEN
PREOCCUPIED WITH OWN NEEDS
PASSIVE AND DEPENDENT
TOUCHES AND EXPLORES INFANT
NEEDS TO DISCUSS LABOR & DELIVERY EXPERIENCE
TAKING IN FOOD ,H2O,REST, AND CARE
TAKING-HOLDDEPENEDENT-INDEPENDENT PHASE
3-10DAYS POSTPARTUM
OBESSED WITH BODY FUNCTIONS
RAPID MOOD SWINGS
ANTICIPATE GUIDANCE MOST EFFECTIVE NOW…GOOD TIME TO TEACH
INTERESTED IN LEARNING CARE OF BABY
LETTING-GOINTERDEPENDENT PHASE
10 DAYS TO 6 WEEKS POSTPARTUM
MOTHERING FUNCTIONS ESTABLISHED
SEES INFANT AS A UNIQUE PERSON
REESTABLISHES RELATIONSHIP WITH HUSBAND
PATERNAL ROLE
EXPECTATIONS
REALITY
TRANSITION TO MASTERY
EXPECTATIONS
1ST STAGE
THE FATHER HAS PRECONCEPTIONS ABOUT WHAT LIFE WILL BE LIKE AFTER THE BABY COMES HOME
MAY NOT BE REALISTIC
REALITY
2ND STAGE
FATHER REALIZES THAT EXPECTATIONS ARE NOT ALWAYS BASED ON FACT
COMMON FEELINGS-SADNESS,AMBIVALENCE
JEALOUSLY
FRUSTATION
REALITY
OVERWHLMING DESIRE TO BE MORE INVOLVED
SOME ARE PLEASANTLY SURPRISED AT EASE AND FUN OF PARENTING
TRANSITION TO MASTERY
3RD STAGE
FATHER MAKES CONSCIOUS DECISION TO TAKE CONTROL AND BECOME MORE ACTIVELY INVOLVED WITH INFANT
BONDING
FINGERTIPS,PALMS AND THEN ENFOLING OF INFANT
EN FACE POSITION
MOTHER USES A SOFT HIGH-PITCHED TONE OF VOICE
NURSE SHOULD ASSIST BOTH MOM AND DAD WITH BONDING-TIME/ISSUES
Face to Face with Eye Contact
POSTPARTUM BLUES
A MATERNAL ADJUSTMENT REACTION
TRANSIENT DEPRESSION USUALLY OCCURS BETWEEN 2ND-3RD PP DAY AND/OR WITHIN THE 1ST 2 WEEKS PP
RELATED TO HORMONAL CHANGES,FATIGUE, AND STRESS
ALL WOMEN EXPERIENCE IT
PP BLUES CONT.
CHARACTERIZED BY MOOD SWINGS,ANGER, TEARFULNESS, FEELINGS OF LET-DOWN,ANOREXIA, AND SLEEING PROBLEMS
USUALLY RESOLVES SPONTANEOUSLY
IF CONT. OR WOMAN HAS DEEPENING DEPRESSION MAY HAVE PP DEPRESSION
POSTPARTAL NURSING
EVALUATE PRENATAL AND INTRANATAL HISTORY FOR RISK FACTORS
POSTPARTUM ASSESSMENT-BUBBLE-HEB-AND PREECLAMPSIA SCREENING
VITAL SIGNS
PP NURSING-CONT.
PREVENTING PP HEMORRHAGE
ASSESS FOR RISK FACTORS
ASSESS FUNDUS & LOCHIA
MASSAGE FUNDUS AS NEEDED
KEEP BLADDER EMPTY
ADMINSTER MEDICATIONS IF NEEDED-PITOCIN,METHERGINE ERGOTRATE
CONT.
PUT BABY TO BREAST EARLY AND FREQUENTLY
`MONITOR VS
COMFORT
ICE TO PERINEUM 20 MINUTES ON/1O-2O MINUTES OFF-1ST 24 HRS
SITZ BATHS-COOL OR WARM TID AFTER 12-24 HRS…MGSO4 CRYSTRALS
PERICARE- AFTER USING BATHROOM OR PRN
APPLY TOPICAL ANALGESICS-
COMFORT
TEACH CLIENT TO TIGHTEN BUTTOCKS THE SITTING…LAY ON SIDE
ADMINSTER ANALGESICS
KEGAL’S
H2O,FIBER,& STOOL SOFTNERS,AMBULATE
Kegal’s Exercise
ELIMINATION
BOWEL
URINARY
INFANT CARE
SUCCESSFUL FEEDING
BATHING
SAFETY
ADL’S
POSITIONS
FOLLOW UP VISITS
SELF CARENUTRITION
REST
COMFORT
DISCOMFORTS
ACTIVITIES
F/U
WARNING SIGNS
CONTRACEPTION
RHOGAM
ASSESS RH NEG WOMAN
NEG INDIRECT COOMBS
RH POS BABY WITH NEG DIRECT COOMBS
NO ALLERGIES TO GLOBULIN PREPARATIONS
ADMINSTER 300UG IM WITHIN 72 HRS
RUBELLA VACCINE
RUBELLA TITER LESS THAN 1:8-NONIMMUNE
NO ALLERGY TO NEOMYCIN
ADMINISTER O.5 ML SC PRIOR TO DISCHARGE
CLIENT SHOULD NOT GET PREGNANT FOR 3-4 MONTHS
NOT WITH RHOGAM
PP WARNING SGNS
BRIGHT RED BLEEDING MORE THAN 1 PAD/HOUR OR PASSING LARGE CLOTs
TEMPERATURE GREATER THAN 100.4 F AFTER 1ST 24 HRS.
CHILLS
EXCESSIVE PAIN ANYWHERE
REDDENED AREAS ON BREAST
PP WARNING SIGNS
REDDENED OR GAPING EPISIOTOMY
FOUL SMELLING LOCHIA
INABLE TO VOID..BURNING..ETC
CALF PAIN, TENDERNESS,REDNESS, SWELLING
FLU-LIKE S/S.
Mastisis
QUESTIONS
THANK YOU
http://www.youtube.com/watch?v=EEqj2BdVerg