Chapter 21

2. Chapter 21 Nursing Care During theFourth Trimester

3. Nursing Care of the Postpartum Woman • Nurse provides care that focuses on transition to parenting • Woman’s physiologic recovery • Psychologic well-being • Ability to care for herself and her new baby • Needs of other family members include strategies in plan of care to assist family in adjusting to baby

4. Transfer from Recovery Area • In traditional setting woman is moved to postpartum room after recovery • In LDRP setting woman and infant remain together in room where birth occurred • Postanesthesia recovery • Regardless of obstetric status, no woman should be discharged from recovery area until completely recovered from anesthesia • Transfer from recovery area

5. Discharge—Before 24 Hoursand After 48 Hours • Terms for decreasing length of stay of mothers and newborns after low risk birth • Early postpartum discharge • Shortened hospital stay • 1-day maternity stay • Laws relating to discharge • Newborns’ and mothers’ Health Protection Act of 1996 • Advantages and disadvantages to early postpartum discharge

6. Discharge—Before 24 Hoursand After 48 Hours—cont’d • Criteria for early discharge • Woman recovered and able to care for self and baby • Provider and nurse are still responsible if the woman is discharged before her condition is stable

7. Nursing Care Management—Physical Needs • Couplet or mother-baby care • Infant security • Prevention of infection • Prevention of excessive bleeding • Maintenance of uterine tone • Prevention of bladder distention

8. Nursing Care Management—Physical Needs—cont’d • Promotion of comfort • Nonpharmacologic interventions • Pharmacologic interventions • Promotion of comfort • Promotion of rest • Promotion of ambulation • Promotion of exercise

9. Nursing Care Management—Physical Needs—cont’d • Promotion of nutrition • Promotion of normal bladder function • Promotion of normal bowel function • Promotion of lactation • Suppression of lactation

10. Planning Future Pregnancies • Rubella vaccination • If woman is not immune, vaccination is recommended • Must use contraception for 1 month • Rh Isoimmunization • Rh immune globulin should be given within 72 hours for R-negative women who deliver an Rh-positive infant

11. Nursing Care Management—Psychosocial Needs • Impact of birth experience • Maternal self-image • Adaptation to parenthood and parent-infant interactions • Family structure and functioning • Impact of cultural diversity

12. Discharge Teaching • Self-management and signs of complications • Sexual activity/contraception • Prescribed medications • Routine mother and baby checkups • Dealing with activities of daily living at home • Dealing with visitors

13. Discharge Teaching—cont’d • Follow-up after discharge • Home visits • Telephone follow-up • Warm lines • Support groups • Referral to community resources

14. Key Points • Postpartum care modeled on concept of health • Cultural beliefs and practices affect patient’s response to puerperium • Nursing plan of care includes: • Assessment to detect deviations from normal • Comfort measures to relieve discomfort or pain • Safety measures to prevent injury or infection

15. Key Points—cont’d • Teaching/counseling to promote woman’s feelings of competence in self- and baby care • Common nursing interventions include: • Evaluating and treating boggy uterus and the full urinary bladder • Pharmacologic and nonpharmacologic relief of pain and discomfort associated with episiotomy or lacerations • Measures to promote or suppress lactation

16. Key Points—cont’d • Meeting psychosocial needs of new mothers involves planning care that considers composition and functioning of entire family • Early postpartum discharge will continue to be trend as result of: • Consumer demand • Medical necessity • Discharge criteria for low risk childbirth • Cost-containment measures

17. Key Points—cont’d • Effective means to prevent crisis and facilitate physiologic and psychologic adjustments in combination include: • Early discharge classes • Telephone follow-up • Home visits • Warm lines • Support groups