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POSTPARTAL NURSING

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

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POSTPARTAL NURSING

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  1. POSTPARTAL NURSING Developed by D. Ann Currie, R.N. ,M.S.N.

  2. POSTPARTAL PERIOD • PHYSICAL CHANGES • PSYCHOSOCIAL CHANGES • NURSING CARE OF THE POSTPARTAL CLIENT • HIGH-RISK POSTPARTAL CLIENTS

  3. 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

  4. FACTORS THAT ENHANCE INVOLUTION • UNCOMPLICATED LABOR & DELIVERY • BREASTFEEDING • EARLY AMBULATION • COMPLETE EXPLUSION OF PLACENTA AND MEMBRANES

  5. FACTORS THAT IMPEDE INVOLUTION • PROLONGED LABOR & DIFFICULT DELIVERY • ANESTHESIA • GRAND MULTIPARITY • RETAINED PLACENTAL FRAGMENTS OR MEMBRANES • FULL URINARY BLADDER • INFECTION

  6. CONT. • OVERDISTENTION OF THE UTERUS • USE OF OXYTOCIN DURING LABOR

  7. FUNDUS • TOP PORTION OF THE UTERUS • A PALPABLE INDICATOR OF INVOLUTION • BOGGY UTERUS-SOFT,RELAXED..CAN CAUSE HEMORRHAGE • FUNDUS SHOULD BE FIRM

  8. Assessing Fundus

  9. FUNDUS • LOCATION • 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.

  10. FUNDUS • LOCATION- 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

  11. Deviation of Fundus Location

  12. 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

  13. 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

  14. LOCHIA AMOUNTS

  15. LOCHIA RUBRA • 1-3 DAYS AFTER DELIVERY • DARK RED,BLOODY FLESHY,MUSTY ODOR • CLOTS SMALLER THAN NICKEL • BLOOD,MUCUS, SHREDS OF DECIDUA, EPITHELIAL CELLS

  16. LOCHIA SEROSA • 4-10 DAYS AFTER DELIVERY • PINK OR BROWNISH-WATERY-ODORLESS • SERUM,ERYTHROCYTES,SHREDS OF DEGENERATING DECIDUA,LEUKOCYTES, CERVICAL MUCOUS,BACTERIA

  17. 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

  18. LOCHIA • UNEXPLAINED INCREASE IN AMOUNT OR REAPPEARANCE OF LOCHIA RUBRA IS ABNORMAL..

  19. 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

  20. CERVIX • SOFT,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

  21. 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

  22. 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

  23. 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

  24. 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.

  25. 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

  26. RENAL SYSTEM • INCREASED 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

  27. RENAL SYSTEM • FULL BLADDER CAN LEAD TO UTERINE ATONY AND PP HEMORRHAGE • FLUIDS ARE ALSO LOST THROUGH DIAPHORESIS..COMMONLY SEEN AT NIGHT

  28. 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

  29. GI SYSTEM CONT. • HEMORRHOIDS-BECAUSE OF PRESSURE OF PUSHING DURING 2ND STAGE OF LABOR.

  30. Assessment for Hemorrhoids

  31. 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

  32. 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

  33. ENDOCRINE CONT. • LACTATION • COLOSTRUM/MILK • PROLACTIN • OXYTOCIN

  34. PSYCHOLOGICAL CHANGES IN THE POSTPARTAL PERIOD • PHASES OF MATERNAL ADJUSTMENT • PHASES OF PATERNAL ADJUSTMENT • BONDING • POSTPARTUM BLUES

  35. 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

  36. 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

  37. 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

  38. LETTING-GOINTERDEPENDENT PHASE • 10 DAYS TO 6 WEEKS POSTPARTUM • MOTHERING FUNCTIONS ESTABLISHED • SEES INFANT AS A UNIQUE PERSON • REESTABLISHES RELATIONSHIP WITH HUSBAND

  39. PATERNAL ROLE • EXPECTATIONS • REALITY • TRANSITION TO MASTERY

  40. EXPECTATIONS • 1ST STAGE • THE FATHER HAS PRECONCEPTIONS ABOUT WHAT LIFE WILL BE LIKE AFTER THE BABY COMES HOME • MAY NOT BE REALISTIC

  41. REALITY • 2ND STAGE • FATHER REALIZES THAT EXPECTATIONS ARE NOT ALWAYS BASED ON FACT • COMMON FEELINGS-SADNESS,AMBIVALENCE • JEALOUSLY • FRUSTATION

  42. REALITY • OVERWHLMING DESIRE TO BE MORE INVOLVED • SOME ARE PLEASANTLY SURPRISED AT EASE AND FUN OF PARENTING

  43. TRANSITION TO MASTERY • 3RD STAGE • FATHER MAKES CONSCIOUS DECISION TO TAKE CONTROL AND BECOME MORE ACTIVELY INVOLVED WITH INFANT

  44. 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

  45. Face to Face with Eye Contact

  46. 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

  47. 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

  48. POSTPARTAL NURSING • EVALUATE PRENATAL AND INTRANATAL HISTORY FOR RISK FACTORS • POSTPARTUM ASSESSMENT-BUBBLE-HEB-AND PREECLAMPSIA SCREENING • VITAL SIGNS

  49. 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

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