nurs 319 ob/maternity exam guide

8/17/2019 NURS 319 OB/Maternity Exam Guide

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Chapter 19 Nursing Care of the Family During Labor and Birth

First Stage of Labor

• Begins with regular uterine contractions

• Ends with full cervical eacement and dilation

• Three phases: if the patient has an epidural the 3 phases won’toccur.

(1) Latent phase: up to 3 cm of dilation. he is fairl! comforta"le# ma!"e a"le to hide it($) %ctive phase: &' cm of dilation. he is uncomforta"le# cra""!# anddoesn’t want to tal to an!one.(3) *ransition phase: +'1, cm of dilation. he is mad and in pain and"e!ond read! to give "irth. ometime she will have vomiting.

• Assessment and Nursing Dx:

o -etermination if woman is in true la"or or false la"or

(contractions# cervi# fetus)o /"stetric triage and E0*%L% (Emergenc! 0edical

*reatment and %ctive La"or %ct). % woman is considered to"e in true la"or until a uali2ed provider determines she isnot.

o %dmission to the la"or unit

o Admission data

4renatal data: has !our "ag "roen5 (6hat time#amount# color# odor) 6hen the "ag "reas !ou havea time limit on la"or.

7nterview (spontaneous rupture of mem"ranes#"lood! or pin show): if the mucous plug presents asa "lood! show "efore la"or starts it’s not a "ig deal.

4s!chosocial factors (woman with 8 of seuala"use):

tress in la"or: 9ultural factors (woman ma! have a preconceived

idea of the right; wa! to "ehave# cultural and fatherparticipation# non'English speaing woman in la"or):

o Physical exam 5

?ital signs: if B4 is elevated# reassess 3, minuteslater. Encourage her to lie on her side to preventsupine h!potension and the resulting fetal h!poia.


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0onitor temperature to identif! signs of infection.he ma! have a drop in B4.

Leopold maneuvers: a"dominal palpation withwoman "rie@! l!ing on her "ac to help answer 3uestions. (1) 6hat fetal part is in the uterine

fundus5 ($) 6here is the fetal "ac located5 (3) 6hatis the presenting fetal part5 %ssessment of A8> and pattern: ?aria"ilit! and

accelerations are good# earl! decells are oa! "utlate are not good

%ssessment of uterine contractions: freuenc!#intensit! (mild# moderate# strong)# duration# restingtone. Ensure tach!s!stole isn’t happening

?aginal eamination: cervical eacement# dilation#fetal descent (station)

La"orator! and diagnostic tests:

%nal!sis of urine specimen Blood tests (group B streptococci)

%ssessment of amniotic mem"ranes and @uid

(*%9/): infection# =itraCine or fern test. The Nitrazine test involves placing small

amounts (a drop or two) of vaginal @uid ontopaper strips prepared with =itraCine d!e. %chemical reaction occurs and the strips changecolor# indicating the p8 of the vaginal @uid. 7fthe color shows the p8 is greater than D.# itFsliel! the mem"ranes have ruptured.

igns of potential pro"lems• Plan of are and inter!entions:

o Standards of are

o 4h!sical nursing care during la"or: general h!giene#

nutrient and @uid intae (oral and 7?)# elimination (will havea fole! with an epidural)# am"ulation and positioning.

o upportive care during la"or and "irth

=urse: help maintain control and participate to her

wishes# provide continuit! of care that isnonGudgmental and respectful of cultureHreligion#

meeting her epected outcomes# listening to herconcerns and encourage to epress feelings# actingas her advocate# helping her conserve her energ!and cope eectivel! with pain and discomfort#acnowledging her eorts including her strength andcourage as well as those of her partner# providingpositive reinforcement# protecting her privac!#modest!# and dignit!.


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AatherHpartner: >= must realiCe he is a person of

value# he can "e a partner in the woman’s care# andchild"earing is a team eort. (ta"le 1I'I)

-oulas: focus on the la"oring woman and provide

ph!sical and emotional support "! using soft#

reassuring words of praise and encouragementJtouchingJ stroingJ and hugging.


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aorta. % nonre"reather mas at 1, LHmin can administero!gen.

o upport of father or partner% woman needs continuous

support and coaching during second stage and this can "etiring# so the nurse oers the nourishment# refreshments#

and short "reas as needed.o upplies# instruments# and euipment% mae sure

ever!thing is woring "efore a woman arrives. (/!gen#tu"ing# 7? pump# etc.)

• Birth in a delivery room or birthing room

• echanism of birth: verte presentation

o 9rowning

o =uchal cord: um"ilical cord wrapped around the "a"!#

t!picall! around the nec.

• !se of f"ndal press"re# pushing on a women’s fundus. Mouwill never do this

• Immediate assessments and care of newborn#

• Perineal tra"ma r$t childbirth#

o Lacerations:

4erineal ?aginal and urethral 9ervical inGuries

o Episiotom!:

hould "e avoided if at all possi"le

• %mergency childbirth: giving "irth in an unepected place

with no proper euipment. Nust catch the "a"!

Third Stage of Labor

• Birth of the baby "ntil the placenta is expelledo Airml! contracting fundus

o 9hange in uterus

o udden gush of dar red "lood from the introitus

o %pparent lengthening of the um"ilical cord

o ?aginal fullness

o 4lacental eamination and disposal

9ultural preferencesFourth stage of Labor

• Care management

o Airst 1'$ hours after "irth

o %ssessment of maternal ph!sical status. 4h!siologic

changes "ac to pre'pregnanc! status.o igns of potential pro"lems

Ecessive "lood loss: %lterations in vital signs and consciousness


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o 9are of new mother and her famil!

&ey Points /nset of la"or ma! "e diOcult to determine for nulliparous and

multiparous women Aamiliar environment of home is most often the ideal place for a

woman during latent phase of 2rst stage of la"or =urse assumes much of the responsi"ilit!

• %ssessing progress of la"or• Peeping primar! health care provider informed a"out

progress in la"or and deviations from epected 2ndings A8> and pattern reveal fetal response to stress of la"or process

%ssessment of la"oring woman’s urinar! output and "ladder is

critical to ensure progress and prevent inGur! to "ladder 6oman’s level of aniet! ma! increase when she does not

understand the medical terminolog! used or "ecause of alanguage "arrier

9oaching# emotional support# and comfort measures assistwoman to use energ! constructivel! in relaing and woring withthe contractions

4rogress of la"or is enhanced when a woman changes her

position freuentl! during the 2rst stage of la"or -oulas provide continuous supportive presence during la"or that

can have a positive eect on child"irth 9ultural "eliefs and practices of woman and her signi2cant

others can have a profound in@uence on their approach to la"orand "irth

=urse who is aware of particular sociocultural aspects of helpingand coping acts as an advocate for the woman or couple duringla"or

Qualit! of the nurse'client relationship is a factor in the woman’s

a"ilit! to cope with the stressors of the la"or process 6omen with a histor! of seual a"use often eperience profound

stress and aniet! during child"irth 7na"ilit! to palpate the cervi during vaginal eamination

indicates complete eacement and full dilation and is the onl!certain# o"Gective sign that second stage has "egun

6omen ma! have an urge to "ear down at various times during

la"or• Before cervi is full! dilated• =ot until active phase of second stage of la"or

6hen responding to rh!thmic nature of the second stage of

la"or# the woman normall!:• 9hanges "od! positions• Bears down spontaneousl!


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• ?ocaliCes (open'glottis pushing) when she perceives urgeto push (Aerguson re@e)

6omen should "ear down several times during a contraction

using open'glottis pushing method• ustained closed'glottis pushing should "e avoided

"ecause o!gen transport to fetus will "e inhi"ited =urses can use the role of advocate to prevent routine use of

episiotom! and to reduce incidence of lacerations• Empowering women to tae an active role in their "irth• Educating health care providers a"out approaches to

managing child"irth that reduce incidence of perinealtrauma

/"Gective signs indicate that the placenta has separated and is

read! to "e epelled• Ecessive traction on um"ilical cord "efore placenta has

separated can result in maternal inGur!

i"lings present for la"or and "irth need preparation and supportfor the event

-uring the fourth stage of la"or# the woman’s fundal tone# lochia#

and vital signs should "e assessed freuentl! 0ost parentsHfamilies enGo! "eing a"le to handle# hold# eplore#

and eamine the "a"! immediatel! after "irth =urses o"serve the progress in the development of parent'child

relationships and are alert for warning signs during theimmediate postpartum period

% woman "ene2ts from reviewing her child"irth eperience with

the nurse who managed her care during la"or and "irth

Chapter 1& Fetal Assessment During Labor Basis for $onitoring

• 'etal responseo 0aintenance of o!gen suppl! to prevent fetal compromise

o -ecrease in o!gen suppl! can "e due to:

>eduction of "lood @ow through maternal vessels(8*=# h!povolemia# supine maternal positon)

>eduction in o!gen content in maternal "lood

(hemorrhage or anemia) %lterations in fetal circulation (cord compression#a"ruption# vagal nerve stimulation)

>eduction in "lood @ow to intervillous space inplacenta (tach!s!tole# 8*=# -0# post'term)

• (ormal ')* patterns described as reass"ring (wa!s to talto the doctor over the phone)

o 9ategor! 7 (the "estR something going on "ut it’s all good)


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Baseline A8> in the normal range of 11,'1D, "pm Baseline fetal 8> varia"ilit!: moderate Late or varia"le decelerations: a"sent Earl! decelerations: ma! "e present or a"sent %ccelerations either present or a"sent

o 9ategor! 77 (not the "est# "ut oa!R)• Abnormal ')* patterns described as non+reass"ring

o 9ategor! 777 ( now)

$onitoring Tehni'ues

• 7ntermittent auscultation (7%)

o Listening to fetal heart sounds at periodic intervals to

assess A8>o 7% of the fetal heart can "e performed with:

Le scope -eLee'8illis fetoscope

Sltrasound deviceo Eas! to use# inepensive# less invasive then EA0

o -iOcult to perform on women who are o"ese

o Does not (ro!ide a (ermanent reord if needed for a

lawsuit

• %lectronic fetal monitoring ,%'- to meas"re how strongthe contractions are

o Eternal monitoring2rst line 7f there’s %=M dou"t# use an

internal device A8>: ultrasound transducer

S9s: tocotransducero 7nternal monitoring

piral electrode 7S49

o -ispla!

0onitor paper 9omputer screen

Fetal )eart *ate Patterns

• Baseline ')*

o %verage rate during a 1,'minutes segment that ecludes:

4eriodic or episodic changes 4eriods of mared varia"ilit! egments of the "aseline that dier "! more than $

"pm 0ust "e at least $ minutes of interpreta"le data

o ?aria"ilit!

7rregular @uctuations in A8> of two c!cles per minuteor greater


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inusoidal pattern is not included in the de2nition ofvaria"ilit!

o *ach!cardia: "aseline A8> greater than 1D, "pm

o Brad!cardia: "aseline A8> less than 11, "pm

• Changes in ')*

o 4eriodic changes occur with S9so Episodic (non'periodic changes) not associated with S9s

o %ccelerations caused "! dominance of s!mpathetic

nervous responseo -ecelerations:

Earl! decelerations in response to fetal headcompression (earl! isn’t a "ad thing# "enign# nopro"lem)

Late decelerations due to SteroplacentalinsuOcienc! (late is not good Mou don’t want late)

?aria"le decelerations due to umbilial ord

om(ression 4rolonged decelerations

Care $anagement

• %' pattern recognition and interpretation

o =798- 6orshop $,,+ proposed a three'tie s!stem for EA0

interpretation 9ategor! 7: normal 9ategor! 77: intermediate 9ategor! 777: a"normal (top the 4itocin# give '1,L

o!gen on a nonre"reather# R.)o Aetal monitoring standards

o =ursing management of non'reassuring patters

• .ther methods of assessment and interventions

o A8> response to stimulation

o Aetal o!gen pulse oimetr!

o %mnioinfusion: if the "a"! is showing variations that

usuall! mean cord compression# this will "e done so thereis more @uid and the cord is less liel! to get compressed.

o *ocol!tic therap!

o Sm"ilical cord acid'"ase determination

&ey Points Aetal well'"eing during la"or is gauged "! response of the A8> to

S9s tandardiCed de2nitions for common A8> patterns have "een

adopted "! %9=0# %9/ over time


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0onitoring of fetal well'"eing

• A8> assessment• Sterine activit! assessment• %ssessing maternal vital signs

=urse must:

•%ssess A8> patterns

• 7mplement independent nursing interventions• >eport a"normal patterns to ph!sician or nurse'midwife

Emotional# informational# and comfort needs must "e addressed

when the mother and fetus are "eing monitored -ocumentation is initiated and updated according to institutional

protocol

Chapter 1/ $aximizing Comfort for the Laboring +omanPain During Labor and Birth

• (e"rological originso ?isceral: during the 2rst stage of la"or. Sterine

contractions cause cervical dilation and eacement. 4ainimpulses are transmitted via *1 to *1$ spinal nervesegment and accessor! lower thoracic and upper lum"ars!mpathetic nerves# which originate in uterine "od! andcervi.

o >eferred: occurs when pain that originates in the uterus

radiates to the a"dominal wall# lum"osacral area of the"ac# iliac crests# gluteal area# thighs# and lower "ac.

o omatic: during the second stage of la"or and is descri"ed

as intense# sharp# "urning and well localiCed. 7t results from(1) distention and traction on the peritoneum anduterocervical supports during contractions ($) pressureagainst the "ladder and rectum (3) stretching anddistention of perineal tissues and the pelvic @oor to allowpassage of the fetus (&) lacerations of soft tissue. 6omenreport a decrease in pain when the! "ear down.

• Perception of pain: fear and lac of information can increasepain. Pnowledge# a positive attitude# and support result indecreased pain perception. 4ain tolerance is how much pain awomen will endure. Aactors that in@uence her tolerance level

include her desire for a natural# vaginal "irthJ her preparation forchild"irthJ her aniet! levelJ the nature of her supportJwillingness and a"ilit! to receive non'pharmacologic measuresJhistor!Heperience from other "irths.

• %xpression of pain: s!mpathetic nervous s!stem activit! is

stimulated in response to intensif!ing pain# resulting in increasedcatecholamine levels. B4 and 8> increase# maternal respirator!pattern changes in response to an increase in o!gen


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consumption. 8!perventilation# sometimes accompanied "!respirator! alalosis# can occur when rapid# shallow "reathingtechniues are used.


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2rm o"Gect or the 2st or heel of the hand. 4ressure can also "eapplied to "oth hips# or to the nees.

• "sic

• 3ater therapy ,hydrotherapy-: with warm water

• Transc"taneo"s electrical nerve stim"lation: $ pairs of @at

electrodes on either side of the women’s thoracic and sacralspine to provide continuous low'intensit! electricalimpulsesHstimuli.

• Ac"press"re of heat and cold: not accepta"le for some

cultures. %cupressure on certain points in the hand and feet can"e used to relieve pain.

• Ac"p"nct"re: used more in Eastern than 6estern area.

• To"ch and massage

o *herapeutic touch

• )ypnosis: deep relaation# similar to da!dreaming or

meditation

Non,(harmaologi $anagement of Disomfort

• Biofeedbac4: "ased on a theor! that if a person can recogniCeph!sical signals# certain internal ph!siologic events can "echanged.

• Aromatherapy

• Intradermal water bloc4

Pharmaologi Pain $anagement

• 5edatives: relieve aniet! and induce sleep. Bar"iturates#

phenothiaCines# "enCodiaCepines. Epidurals are "etter thansomething s!stemic "ecause it’s regional.

• Analgesia and anesthesiao !stemic analgesia: o(ioids can "e administered as

intermittent 7? or 70 doses "! the 894 or 49% pumps.o /pioid (narcotic) analgesics: (1) opioid agonists ($) opioid

agonist'antagonist (3) opioid antagonists

• (erve bloc4 analgesia and anesthesiao Local perineal in2ltration anesthesiama! "e used when

an episiotom! is to "e performed or when lacerations must

"e sutured after "irth in a woman who does not haveregional anesthesia.o 4udendal nerve "locadministered late in the second

stage of la"or and is useful if an episiotom! is to "eperformed or if forceps or a vacuum etractor is to "eused.

o pinal anesthesia ("loc)

4ostdural puncture headaches


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Epidural "lood patcho Epidural anesthesiaHanalgesia ("loc)

Lum"ar epidural anesthesiaHanalgesia pinal analgesia ide eects include ("o 1'): h!potension# local

anesthetic toicit!# fever# urinar! retention# pruritus#limited movement# longer second stage la"or#increased use of o!tocin# increased lielihood offorceps' or vacuum'assistance

8igh or total spinal anesthesiao 9ontraindications to epidural "locs

%ctive or anticipated serious maternal hemorrhage.%cute h!povolemia leads to increased s!mpathetictone to maintain B4. %n! anesthetic techniues that"loc s!mpathetic 2"ers can produce signi2cant#dangerous h!potension.

7f a woman is receiving anticoagulant therap! or hasa "leeding disorder# inGur! to a "lood vessel ma!cause formation of a hematoma that ma! compressthe cauda euina or the spinal cord and lead toserious 9= complications.

7nfection at inGection site 7ncreased 794 caused "e a mass lesion %llerg! to anesthesia drug 0aternal refusal or ina"ilit! to cooperate ome maternal cardiac conditions

o Epidural eects on the new"orn: there is no evidence of a

lasting eect on the new"orno


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dela!ed# ($) higher doses of medication are reuired# and(3) medication is released at an unpredicta"le rate fromthe muscle tissue and is availa"le for transfer across theplacenta to the fetus.

>egional anesthesia

•5afety and general care: assess and monitor pain level as wellas ph!siologic signs of pain# advocate for the patient# educationpatient and famil! when necessar!# ensure safet!.

&ey Points =onpharmacologic pain and stress management strategies alone

or in com"ination with pharmacologic methods help managediscomfort

*he


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o igns of ris for 9? pro"lems

*ach!cardia: greater than 1D, "pm Brad!cardia: less than 11, "pm 9olor

o *he "a"! must initiate "reathing. *he lungs epand as the

"a"! is "orn and turns the "a"! pin during la"or (the"a"! is "lue inside mom). -uctus arteriosus closes o dueto pressure during la"or#

o >espirations at "irth should "e 3,'D, "pm

• )ematopoietic system

o >B9shigher >B9s and 8


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% ver! sic "a"!

• An infant sho"ld void within the 8rst 6 ho"rs of life

• 9& of infants void within 7; ho"rs of lifeo 7f a new"orn has not voided within &+ hours of life it ma!

indicate a renal impairmento =urses should eep careful 7T/ records

•


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• )epatic systemo 9ar"oh!drate meta"olism'h!pogl!cemiaafter "irth when

the new"orn is cut o from maternal glucose suppl!# theglucose level can drop "etween 3, and I, minutes after

"irth then gradual! rise.o 9onGugation of "iliru"in

o 4h!siologic Gaundice

Pernicterus: a ver! serious pro"lem# "iliru"indeposits in the "rain. >efers to the irreversi"le# long'term conseuences of "iliru"in toicit! such ash!potonia (aa @opp! "a"! s!ndrome from reducedmuscle strength)# dela!ed motor sills# hearing loss#cere"ral pals!# and gaCe a"normalities.

o Naundice associated with "reatfeeding

o 9oagulation de2ciencies can "e developed "! infants# so

circumsiCed males must "e o"sereved closel!. 8emorrhagecan also "e caused "e a clotting defect indicatedhemophilia. Ba"ies lac vitamin P which we get from the 3pounds of "acteria that we carr!# so the! have a wea a"ilit!to coagulate.

• Imm"ne 5ystemo >is for infection is high within the 2rst months of life.

Letharg!# irrita"ilit!# poor feeding# vomiting# diarrhea#decreased re@ees# and pale or mottled sin color are somesHs that suggest infection. >espirator! s!mptoms includeapnea# tach!pnea# grunting# or retracting can "e associatedwith infection such as pneumonia.

• Integ"mentary systemo ?erni caseosaa cheeselie# whitish su"stance that is

fused with the epidermis and serves as a protective coveringafter 3 wees of gestation.

o weat glandsinfants don’t sweat in the 2rst $& hours# "ut

"! da! 3 sweating "egins on the face and progresses to thepalms.

o -esuamation(peeling) of the sin of the term infant doesnot occur until a few da!s after "irth.

o 0ongolian spots"luish "lac areas of pigmentation can

appear over an! part of the eterior surface of the "od!. *he! should "e documented careful to prevent confusionwith "ruises.

o =evialso nown as salmon patches# are the result of

super2cial capillar! defect and commonl! found on upper


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e!elids# nose# upper lip# and nape of nec. *he! have noclinical signi2cance and reuire no treatment. Birth mars.

o Er!thema toicuma transient rash that appears within $&'

$ hours of life and is thought to "e an in@ammator!response and has no clinical signi2cance reuiring no

treatment. Loos lie the "a"! has acne.o igns of ris for integumentar! pro"lemscolor# an! palor#

plethora (deep purplish color from increased circulating>B9s)# petechiae# central c!anosis# or Gaundice.

• *eprod"ctive systemo Aemale usuall! has slightl! swollen genitals from maternal

hormoneso 0ale can also have swollen genitals

o Both male and female can have a "lood! diaper after a few

da!so welling of "reast tissue for "oth male and femaleo igns of ris for reproductive s!stem pro"lems

%m"iguous genitalia: chromosome testing necessar!to determine gender of "a"!

8!pospadias: opening of the penis is opened alongthe shaft# not on the tip. 0a! cause infertilit! later.

• 54eletal systemo igns of ris for seletal pro"lems:

0olding: cone head

9aput succedaneum: crosses the suture lines# @uidgets rea"sor"ed "ut it gives Gell!'lie feeling to top of head

9ephalhematoma: "lood 2lled. 4uts "a"! at greaterris for Gaundice "ecause the! have more >B9 to"rea down

-evelopmental d!splasia of the hip: >= assess forhip to clic; and need to move it "ac into place

Aractured clavicle: easiest "one to "rea in the "od!and can "rea during "irth# "ut it heals uicl!

•

(e"rom"sc"lar systemo =ew"orn re@ees: "a"! should "e s!mmetricall! @eed

o igns of ris for neuromuscular pro"lems

Beha!ioral Charaterists

• 5leep+wa4e states: deep sleep light sleep drows! uiet

alert active alert cr!ing

• .ther factors in0"encing behavior of newborns


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o


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Each new"orn has a uniue personalit!

Chapter 6; Post(artum Physiologi Changes-stimated Date of Deli!ery

• )"man gestation lasts 6== days

• 9onception ocurs approimatel! $ wees after the L04• ince due dates are "ased on length since L04# the length of

pregnanc! is counted as $+, da!s.

*e(roduti!e System and Assoiated Strutures

• PP period is the interval "etween "irth and return of the

reproductive organs to their nonpregnant state

• !ter"so 7nvolution process: the uterus graduall! shrins to prepare

for the net pregnanc!o 9ontractions: happen even after the "a"! is "orn

o %fterpains: after multiple "a"ies the! "ecome more intense

o 4lacental site: all the "lood vessels that remain in the mom

after the placenta is released and the uterus clamps themo to stop the placental site from "leeding. 7f !ou seeecessive "leeding "ut she has a strong contracted uterus#the doctor should assess for a tare.

o Lochia: comes out of uterus# starts out dar red and slowl!

lightens to "ecome pale pin# then white. >u"ra: red erosa: pin

%l"a: white (taes a couple wees)

• Cervix: will contract "ac and will not "e as pinpoint as it wasprior to the "a"!

• >agina and perine"m: go "ac to normal# ma! tae a couplewees if a tare or episiotom! occured

• Pelvic m"sc"lar s"pporto 4elvic relaation

o Pegel eercises

-ndorine System

• Placental hormones

o Estrogen and progesterone levels decrease

o 7nhi"ition of mil "! estrogen and progesterone levels

• Pit"itary hormones and ovarian f"nctiono 4rolactin remains elevated in women who "reastfeed

o /vulation in $ da!s after "irth for nonlactating women


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o /vulation in , to da!s in lactating women

Abdomen

• *et"rns to prepregnancy state = wee4s after birth

o triae ma! persist

o >eturn of muscle tone 4revious tone 4roper eercises %dipose tissue

o -iastasis recti a"dominis

/rinary System

• !rine components

o >enal gl!cosuria disappears "! 1 wee postpartum

• Postpartal di"resis

o -iuresis of etracellular @uid

• !rethra and bladder

o 7mmediatel! after "irth ecessive "eeding can occur if

"ladder "ecomes distended

0astrointestinal System

• Appetite: the! are hungr! right awa!

• Bowel evac"ationo /ccurs $ to 3 da!s after child"irth

o %nal sphincter lacerations are associated with postpartum

incontinence

Breasts

• Breastfeeding mothers

o 9olostrum: has lots of anti"odies for the new"orn

o 0il in $ to ID hours

• (onbreastfeeding motherso Engorgement resolves in $&'3D hours after mil comes in

Cardio!asular System

• Blood vol"me decreases then increases# "! elimination of

placental circulation# less vasodilation# and movement ofetrvascular water

• Cardiac o"tp"t "ac to normal in D'+ wees

• >ital signs show onl! minor alterations

• Blood components

o 8ematocrit and hemoglo"in 6=L "! + wees

o ?aricosities


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&ey Points Sterus involutes rapidl! after "irth# returning to true pelvis within

$ wees >apid decrease in estrogen and progesterone levels after

epulsion of the placenta is responsi"le for triggering anatomic

and ph!siologic changes in puerperium >eturn of ovulation and menses determined in part "! whether

the woman "reastfeeds her infant %ssessment of lochia and fundal height is essential to monitor

progress of normal involution and to identif! potential pro"lems Snder normal circumstances# few alterations in vital signs are

seen after child"irth 8!percoagula"ilit!# vessel damage# and immo"ilit! predispose

woman to throm"oem"olism 0ared diuresis# decreased "ladder sensitivit!# and

overdistention of "ladder can lead to pro"lems with urinar!

elimination 4regnanc! ph!siologic changes allow woman to tolerate

considera"le "lood loss at "irth

Chapter 61 Nursing Care of the Family During the Post(artum Period

Nursing Care of the Post(artum +oman

• =urse provides famil!'centered care that focuses on assessment

and support of a woman’s ph!siologic and emotional adaptationafter "irth

• 9are is wellness oriented

• *!pical hospital sta! is 1 to $ da!s after vaginal "irth# $'& da!s

after cesarean

Transfer from the *eo!ery Area

• 4ostanesthesia recover!

o >egardless of o"stetric status# no woman should "e

discharged from recover! area until completel! recoveredfrom anesthesia

o 6omen who have received general or regional anesthesiashould "e cleared "! a mem"er of the anesthesia team

o *ransfer from recover! area

o 7n L->4 settings nurse provides the same level of care

without moving the client

Planning for Disharge


22/23

• Laws relating to discharge

o =ew"orns’ and 0others’ 8ealth 4romotion %ct of 1IDD

o %dvantages and disadvantages of earl! postpartum

discharge

• 9riteria for earl! dischargeo 0other recoveredJ a"le to care for self and "a"!

o *hose at low ris for complications ma! "e discharged as

earl! as D hours from a "irth center# $&'3D hours from thehospital

Care $anagement

• 4h!sical needs

o 9ouplet care

• >outine la"orator! tests

•

4revention of infection• 4revention of ecess "leeding

• 0aintenance of uterine tone

• 4revention of "ladder distention

• 4romotion of comfort# rest# am"ulation# eercise

• 4romotion of nutrition

• 4romotion of normal "ladder and "owel patters

• 4romotion of "reastfeeding and lactation suppression

• 8ealth promotion for future pregnancies and children

o >u"ella vaccination

o 4revention of >h isoimmuniCation>hogam• 4s!chosocial needs

o Eect of "irth eperience

o 0aternal self'image

o %daptation to parenthood and parent'infant interactions

o Aamil! structure and functioning

o Eect of cultural diversit!

Disharge Teahing

• elf'managementJ signs of complications

• eual activit! and contraception

• 4rescri"ed medications

• >outine mother and "a"! checups

• Aollow'up after discharge

o 8ome visits

o *elephone follow'up

o 6arm lines

o upport groups


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o >eferral to communit! resources

&ey Points 4ostpartum care is modeled on the concept of health

9ultural "eliefs and practices aect the client’s response to the

puerperium =ursing plan of care includes:

o %ssessments to detect deviations from normal

o 9omfort measures to relieve discomfort or pain

o afet! measures to prevent inGur! or infection

=urse provides teaching and counseling to promote the woman’s

feelings of competence in self and "a"! care 9ommon nursing interventions

o Evaluating and treating the "ogg! uterus and the full

urinar! "laddero 4roviding for pharmacologic and nonpharmacologic relief of

pain and discomfort associated with the episiotom! orlacerations

o 7nstituting measures to promote or suppress lactation

0eeting ps!chosocial needs of new mothers involves planning

care that considers the composition and functioning of the entirefamil!

Earl! postpartum discharge continues to "e the trend as a result

of:o 9onsumer demand

o 0edical necessit!

o -ischarge criteria for low ris child"irtho 9ost'containment measures

Eective means to prevent crisis and facilitate ph!siologic and

ps!chologic adGustments used in com"ination include:o 8ome visits

o *elephone follow'up

o 6arm lines

o upport groups

o >eferral to communit! resources

nurs 319 ob/maternity exam guide

Documents