postpartal nursing
DESCRIPTION
POSTPARTAL NURSING. Developed by D. Ann Currie, R.N. ,M.S.N. POSTPARTAL PERIOD. PHYSICAL CHANGES PSYCHOSOCIAL CHANGES NURSING CARE OF THE POSTPARTAL CLIENT HIGH-RISK POSTPARTAL CLIENTS. PHYSICAL CHANGES DURING THE POSTPARTAL PERIOD. REPRODUCTIVE SYSTEM - PowerPoint PPT PresentationTRANSCRIPT
POSTPARTAL NURSING
Developed by D. Ann Currie, R.N. ,M.S.N.
POSTPARTAL PERIOD
PHYSICAL CHANGESPSYCHOSOCIAL CHANGESNURSING CARE OF THE POSTPARTAL CLIENTHIGH-RISK POSTPARTAL CLIENTS
PHYSICAL CHANGES DURING THE POSTPARTAL PERIOD
REPRODUCTIVE SYSTEMINVOLUTION-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 & DELIVERYBREASTFEEDINGEARLY AMBULATIONCOMPLETE EXPLUSION OF PLACENTA AND MEMBRANES
FACTORS THAT IMPEDE INVOLUTION
PROLONGED LABOR & DIFFICULT DELIVERYANESTHESIAGRAND MULTIPARITYRETAINED PLACENTAL FRAGMENTS OR MEMBRANESFULL URINARY BLADDERINFECTION
CONT.
OVERDISTENTION OF THE UTERUSUSE OF OXYTOCIN DURING LABOR
FUNDUS
TOP PORTION OF THE UTERUSA PALPABLE INDICATOR OF INVOLUTIONBOGGY UTERUS-SOFT,RELAXED..CAN CAUSE HEMORRHAGE FUNDUS SHOULD BE FIRM
Assessing Fundus
FUNDUSLOCATIONRIGHT AFTER DELIVERY THE FUNDUS IS MIDWAY BETWEEN SYMPHYSIS PUBIS AND UMBILICUSONE 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 FELTFUNDUS SHOULD BE MIDABDOMENDEVIATIONS ARE ABNORMAL AND SHOULD BE CHECKED
Deviation of Fundus Location
LOCHIAIS THE DISCHARGE OF BLOOD AND DEBRIS FOLLOWING DELIVERYTYPES-RUBRA, SEROSA, AND ALBASHOULD NOT CONTAIN LARGE CLOTSTOTAL VOLUME-240-270 ML.DAILY VOLUME GRADUALLY DECREASES
LOCHIA
AMOUNT MAY BE INCREASED BY EXCERTION OR BREASTFEEDINGPOOLING WHEN CLIENT IS RECLINING CAN OCCURC/SECTION CLIENT MAY HAVE LESS BUT SHOULD HAVE LOCHIAUNEXPLAINED INCREASE IN AMOUNT IS ABNORMAL
LOCHIA AMOUNTS
LOCHIA RUBRA
1-3 DAYS AFTER DELIVERYDARK RED,BLOODY FLESHY,MUSTY ODORCLOTS SMALLER THAN NICKELBLOOD,MUCUS, SHREDS OF DECIDUA, EPITHELIAL CELLS
LOCHIA SEROSA
4-10 DAYS AFTER DELIVERYPINK OR BROWNISH-WATERY-ODORLESSSERUM,ERYTHROCYTES,SHREDS OF DEGENERATING DECIDUA,LEUKOCYTES, CERVICAL MUCOUS,BACTERIA
LOCHIA ALBA
11-21 DAYS AFTER DELIVERYMAY PERIST TO 6 WEEKSYELLOW TO WHITE- MAY HAVE STALE ODORLEUKOCYTES,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 DELIVERYOCCUR IN ALL WOMENMORE PAINFUL IN MULTIPARIOUS AND BREASTFEEDING WOMANALSO IN WOMEN WHOSE UTERUS WAS OVERDISTENDED
CERVIXSOFT,IRREGULAR,AND EDEMATOUS, MAYBE BRUISED AND/OR SMALL LACERATIONSCLOSES TO 2-3 CM AFTER SEVERAL DAYS..FINGERTIP AFTER 1 WEEKMUST BE SLIGHTLY DILATED TO ALLOW LOCHIA TO DRAINAFTER FIRST DELIVERY SHAPE IS CHANGED
VAGINA
SMOOTH WALLS,EDEMATOUS WITH MULTIPLE SMALL LACERATIONSPERINEAL DISCOMFORT/PAIN SHOULD BE GONE BY 2 WEEKS AFTER DELIVERYLOW ESTROGEN LEVELS WILL TO DECREASED LUBRICATION FOR 6-10 WEEKS
ABDOMINAL WALL
SOFT & FLABBY WITH DECREASED MUSCLE TONESTRIAE(STRETCH MARKS) WILL FADE BUT STAYDIASTISIS RECTI-SEPERATION OF THE RECTUS MUSCLES OF THE ABDOMEN-MAY IMPROVE IN THE POSTPARTUM PERIOD
CARDIOVASCULAR SYSTEM
RETURNS TO PREPREGNANT STATE WITHIN 2 WEEKSTHE ELIMINATION OF THE INCREASED BLOOD VOLUME DURING PREGNANCY IS DONE BY DIURESISBLOOD PRESSURE SHOULD REMAIN STABLE
CV SYSTEM -CONT.
BRADYCARDIA BEGINS SECOND DAY-HR OF 50-70-CONT. FOR 6-10 DAYSTACHYCARDIA-BLOOD LOSS, TEMP.,OR OTHER PROBLEMSWBC’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 LOSS1ST 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 INFECTIONPOSTPATAL DIURESIS-2000-3000 ML.-ACCOUNTS FOR 5 LB WEIGHT LOSSA FULL BLADDER WILL DISPLACE THE UTERUS
RENAL SYSTEM
FULL BLADDER CAN LEAD TO UTERINE ATONY AND PP HEMORRHAGEFLUIDS 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 PLACENTAMENSTRUATION 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 MONTHSPLACENTAL HORMONES WHICH CAUSES INSULIN RESISTANCE WILL DECREASE BY 3-4 DAYS AFTER DELIVERY
ENDOCRINE CONT.
LACTATIONCOLOSTRUM/MILKPROLACTINOXYTOCIN
PSYCHOLOGICAL CHANGES IN THE POSTPARTAL PERIOD
PHASES OF MATERNAL ADJUSTMENTPHASES OF PATERNAL ADJUSTMENTBONDINGPOSTPARTUM BLUES
PHASES OF MATERNAL ADJUSTMENT
TAKING-IN/DEPENDENT PHASE-TAKING-HOLD/DEPENDENT-INDEPENDENT PHASE-LETTING-GO/INTERDEPENDENT PHASE-DEVELOPMENTAL TASK- MATERNAL ROLE ATTAINMENT1ST DICUSSED BY R.RUBIN
TAKING-INDEPENDENT PHASE
1ST 1-3 DAYS..CAN BE SHORTENPREOCCUPIED WITH OWN NEEDSPASSIVE AND DEPENDENTTOUCHES AND EXPLORES INFANTNEEDS TO DISCUSS LABOR & DELIVERY EXPERIENCETAKING IN FOOD ,H2O,REST, AND CARE
TAKING-HOLDDEPENEDENT-INDEPENDENT PHASE
3-10DAYS POSTPARTUMOBESSED WITH BODY FUNCTIONSRAPID MOOD SWINGSANTICIPATE GUIDANCE MOST EFFECTIVE NOW…GOOD TIME TO TEACHINTERESTED IN LEARNING CARE OF BABY
LETTING-GOINTERDEPENDENT PHASE
10 DAYS TO 6 WEEKS POSTPARTUMMOTHERING FUNCTIONS ESTABLISHEDSEES INFANT AS A UNIQUE PERSONREESTABLISHES RELATIONSHIP WITH HUSBAND
PATERNAL ROLE
EXPECTATIONSREALITYTRANSITION TO MASTERY
EXPECTATIONS
1ST STAGETHE FATHER HAS PRECONCEPTIONS ABOUT WHAT LIFE WILL BE LIKE AFTER THE BABY COMES HOMEMAY NOT BE REALISTIC
REALITY
2ND STAGEFATHER REALIZES THAT EXPECTATIONS ARE NOT ALWAYS BASED ON FACTCOMMON FEELINGS-SADNESS,AMBIVALENCEJEALOUSLYFRUSTATION
REALITY
OVERWHLMING DESIRE TO BE MORE INVOLVEDSOME ARE PLEASANTLY SURPRISED AT EASE AND FUN OF PARENTING
TRANSITION TO MASTERY
3RD STAGEFATHER MAKES CONSCIOUS DECISION TO TAKE CONTROL AND BECOME MORE ACTIVELY INVOLVED WITH INFANT
BONDING
FINGERTIPS,PALMS AND THEN ENFOLING OF INFANTEN FACE POSITIONMOTHER USES A SOFT HIGH-PITCHED TONE OF VOICENURSE SHOULD ASSIST BOTH MOM AND DAD WITH BONDING-TIME/ISSUES
Face to Face with Eye Contact
POSTPARTUM BLUES
A MATERNAL ADJUSTMENT REACTIONTRANSIENT DEPRESSION USUALLY OCCURS BETWEEN 2ND-3RD PP DAY AND/OR WITHIN THE 1ST 2 WEEKS PPRELATED TO HORMONAL CHANGES,FATIGUE, AND STRESSALL WOMEN EXPERIENCE IT
PP BLUES CONT.CHARACTERIZED BY MOOD SWINGS,ANGER, TEARFULNESS, FEELINGS OF LET-DOWN,ANOREXIA, AND SLEEING PROBLEMSUSUALLY RESOLVES SPONTANEOUSLYIF CONT. OR WOMAN HAS DEEPENING DEPRESSION MAY HAVE PP DEPRESSION
POSTPARTAL NURSING
EVALUATE PRENATAL AND INTRANATAL HISTORY FOR RISK FACTORSPOSTPARTUM ASSESSMENT-BUBBLE-HEB-AND PREECLAMPSIA SCREENINGVITAL SIGNS
PP NURSING-CONT.
PREVENTING PP HEMORRHAGEASSESS FOR RISK FACTORSASSESS FUNDUS & LOCHIAMASSAGE FUNDUS AS NEEDEDKEEP BLADDER EMPTYADMINSTER 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 HRSSITZ BATHS-COOL OR WARM TID AFTER 12-24 HRS…MGSO4 CRYSTRALSPERICARE- AFTER USING BATHROOM OR PRNAPPLY TOPICAL ANALGESICS-
COMFORT
TEACH CLIENT TO TIGHTEN BUTTOCKS THE SITTING…LAY ON SIDEADMINSTER ANALGESICSKEGAL’SH2O,FIBER,& STOOL SOFTNERS,AMBULATE
Kegal’s Exercise
ELIMINATION
BOWELURINARY
INFANT CARE
SUCCESSFUL FEEDINGBATHINGSAFETYADL’SPOSITIONSFOLLOW UP VISITS
SELF CARENUTRITIONRESTCOMFORTDISCOMFORTSACTIVITIESF/UWARNING SIGNSCONTRACEPTION
RHOGAM
ASSESS RH NEG WOMANNEG INDIRECT COOMBSRH POS BABY WITH NEG DIRECT COOMBSNO ALLERGIES TO GLOBULIN PREPARATIONSADMINSTER 300UG IM WITHIN 72 HRS
RUBELLA VACCINE
RUBELLA TITER LESS THAN 1:8-NONIMMUNENO ALLERGY TO NEOMYCINADMINISTER O.5 ML SC PRIOR TO DISCHARGECLIENT SHOULD NOT GET PREGNANT FOR 3-4 MONTHSNOT WITH RHOGAM
PP WARNING SGNS
BRIGHT RED BLEEDING MORE THAN 1 PAD/HOUR OR PASSING LARGE CLOTsTEMPERATURE GREATER THAN 100.4 F AFTER 1ST 24 HRS.CHILLSEXCESSIVE PAIN ANYWHEREREDDENED AREAS ON BREAST
PP WARNING SIGNS
REDDENED OR GAPING EPISIOTOMYFOUL SMELLING LOCHIAINABLE TO VOID..BURNING..ETCCALF PAIN, TENDERNESS,REDNESS, SWELLINGFLU-LIKE S/S.
Mastisis
DEEP VEIN THROMBOSIS