The Postpartal Family: Adaptation and Nursing Assessment Needs and Care

1. The Postpartal Family: Adaptation and Nursing AssessmentNeeds and Care

2. Postpartum Uterine Changes • Uterine cells will atrophy • Uterine debris in the uterus is discharged through lochia • Lochia rubra is red (first 2-3 days) • Lochia serosa is pink (day 3 to day 10) • Lochia alba is white (continues until the cervix is closed)

3. Involution of the uterus. Immediately after delivery of the placenta, the top of the fundus is in the midline and approximately two thirds to three-fourths of the way between the symphysis pubis and the umbilicus

4. Postpartum Cervical and Vaginal Changes • Cervix is spongy, flabby, and may appeared bruised • External os may have lacerations and is irregular and closes slowly • Shape of the external os changes to a lateral slit • Vagina may be edematous, bruised with small superficial lacerations • Size decreases and rugae reappear within 3-4 weeks • Returns to prepregnant state by 6 weeks

5. Perineal Changes and Return of Menstruation • Perineum may be edematous, with bruising • Lacerations or an episiotomy may be present • Menstruation generally returns between 6 and 10 weeks (nonbreastfeeding

6. Postpartum Abdominal and Breast Changes • Loose and flabby but will respond to exercise • Uterine ligaments will gradually return to their prepregnant state • Diastasis recti abdominis • Striae will take on different colors based on the mother’s skin color • Breasts are ready for lactation

7. Postpartum Bowel Changes • Bowels will be sluggish • Episiotomy, lacerations, or hemorrhoids may delay elimination

8. Postpartum Bladder Changes • Increased bladder capacity • Swelling and bruising of tissues around the urethra • Decrease in sensitivity to fluid pressure • Decrease in sensation of bladder filling • Urinary output is greater due to puerperal diuresis • Increased chance of infection due to dilated ureters and renal pelves

9. Postpartum Changes in Vital Signs • Temperature may be elevated to 38C for up to 24 hours after birth • Temperature may be increased for 24 hours after the milk comes in • BP rises early and then returns to normal • Bradycardia occurs during first 6-10 days

10. Postpartum Changes in Lab Values • Nonpathologic leukocytosis occurs in the early postpartum period • Blood loss averages 200-500 mL (vaginal), 700-1000 mL (cesarean) • Plasma levels reach the prepregnant state by 4-6 weeks postpartum • Platelet levels will return to normal by the 6th week • Diuresis • Cardiac output returns to normal by 6-12 weeks

11. Postpartum Weight Changes • Initial weight loss of 10-12 lbs • Postpartum diuresis causes a loss of 5 lbs • Return to their prepregnant weight by the 6th to 8th week

12. Maternal Psychological Adjustment • “Taking In” • “Taking Hold”

13. The mother has direct face-to-face and eye-to-eye contact in the en face position.

14. Postpartum Blues • Transient periods of depression; sometimes occurs during the first few days postpartum • Mood swings • Anger • Weepiness • Anorexia • Difficulty sleeping • Feeling let down

15. Causes of Postpartum Blues • Changing hormones • Lack of supportive enviornment

16. Cultural Influence in the Postpartum Period • Non-Western cultures emphasize postpartum period • Food and liquids after birth • Hot-cold balance • Role of grandmother

17. Principles of Conducting a Postpartum Assessment • Selecting the time that will provide the most accurate data • Providing an explanation of the purpose of the assessment • Ensuring that the woman is relaxed before starting • Recording and reporting the results clearly • Body fluid precautions

18. Postpartum Assessment • B – Breasts • U – Uterus • B – Bowel • B – Bladder • L – Lochia • E – Episiotomy/Lacerations

19. Postpartum Assessment (continued) • H – Homans’/Hemorrhoids • E – Emotions

21. Breast Assessment • Size and shape • Abnormalities, reddened areas, or engorgement • Presence of breast fullness due to milk presence • Assess nipples for cracks, fissures, soreness, or inversion

22. Abdominal Assessment • Position of fundus related to umbilicus • Position of fundus to midline • Firmness • Assess incision for bleeding, approximation, and signs of infection

23. Measuring the descent of the fundus for the woman having a vaginal birth. The fundus is located two fingerbreadths below the umbilicus. Always support the bottom of uterus during any assessment of fundus

24. The uterus becomes displaced and deviated to the right when the bladder is full.

26. Assessment of Lochia and Perineum • Assess lochia for amount, color, and odor • Presence of any clots • Wound is assessed for approximation, redness, edema, ecchymosis, and discharge • Presence of hemorrhoids • Level of comfort/discomfort • Efficacy of any comfort measures

29. Assessment of Extremities, Bowel, and Bladder • Homan’s sign • Assess calf for redness and warmth • Adequacy of urinary elimination • Bladder distention and pain during urination • Intestinal elimination • Maternal concerns regarding bowel movements

30. Assessment of Psychological Adaptation and Nutrition • Adaptation to motherhood • Fatigue • Nutritional status • Cesarean birth • Return of bowel function • Tolerance of dietary progression

32. Physical and Developmental Tasks • Gain competence in caregiving • Confidence is role as parent • Return of all physical systems to prepregnant state

34. The father experiences strong feelings of attraction during engrossment.

35. Factors that Influence Parent-Infant Attachment • Family of origin • Relationships • Stability of the home environment • Communication patterns • The degree of nurturing the parents received as children

36. The Postpartal Family: Needs and Care

37. Nursing Responsibilities for Client Teaching • Assess educational needs • Develop and implement a teaching plan • Evaluate client learning • Revise plan as needed

38. Postpartal Teaching • Mom topics • Baby topics

40. Uterine Well-Being and Comfort Measures • Assess uterus • Assess lochia • Afterpains • Positioning • Ambulation • Analgesics

41. Perineal Well-Being and Comfort Measures • Assess perineum • Perineal care • Ice packs • Surgigator® • Analgesics

42. Comfort Measures • Diaphoresis • Suppression of lactation • Well-fitting bra • Cold compresses or cabbage leaves • Anti-inflammatory medication

43. Pharmacologic Interventions • Rubella vaccine • RhoGAM

44. Emotional Stress Interventions • Encourage mothers to tell birth stories • Maternal role attainment

45. Rest and Activity • Provide opportunities for rest • Encourage frequent rest periods • Resumption of activity • Avoid heavy lifting • Avoid frequent stair climbing • Avoid strenuous activity

46. Postpartal Family Wellness • Family-centered care • Information • Time for interaction • Supportive environment

47. Resumption of Sexual Activity • Resume after episiotomy healed and lochia stopped • Lubrication may be required • Contraception • Potential limiting factors • Fatigue • Demands of the infant

48. Parent-Infant Attachment • Incorporate family goals in care plan • Postpone eye prophylaxis for 1 hour after delivery • Provide private time for the family to become acquainted • Encourage skin-to-skin contact • Encourage mother to tell her birth story

49. Parent-Infant Attachment • Encourage involvement of the sibling • Prepare parents for potential problems with adjustment • Initiate and support measures to minimize fatigue • Help parents identify, understand, and accept feelings

50. Care of the Mother after Cesarean Birth • Minimize complications • Deep breathing and incentive spirometry • Ambulation • Pain management • Rest • Minimize gas pains