Post Partum Period Chapters 15 & 16

1. Post Partum PeriodChapters 15 & 16 Mary L. Dunlap MSN Fall 2014

2. Post Partum • Begins immediately after child birth through the 6th post partum week • Reproductive track returns to nonpregnant state • Adaptation to the maternal role and modification to the family system

3. Safety for Mother and Infant • Prevent infant abductions • Check ID bands • Educate mother about safety measures

4. Infant ID Bands

5. Security Band

6. Clinical Assessment • Receive report • Review Antepartum and Intrapartum history • Determine educational needs • Consider religious and cultural factors • Assess for language barriers

7. Lochia Episiotomy Extremities Emotion Post Partum AssessmentBUBBLE-EE • Breast • Uterus • Bladder • Bowel

8. Vital signs • Temperature • Pulse • Blood pressure • Respirations

9. Pain Assessment • Determine source/location and pain level • Interventions- based on pain • Document location, type, pain level and intervention • Reassess in 30 min and document pain level

10. Breast Initial assessment • Inspect for size, contour, and asymmetry • Note if nipples are flat, inverted or erect Ongoing assessments • Check for cracks, redness, or fissures • Engorgement • Mastitis

13. Breast Care Lactating Mother • Supportive bra • Clean areola & nipples with water • Air dry • Express colostrum apply to areola & nipple • Change breast pads frequently

14. Breast CareNon-Lactating Mother • Avoid stimulation • Wear support bra 24hrs • Ice packs or cabbage leaves • Mild analgesic for discomfort

15. Assessment of Uterus • After birth midline between umbilicus and the symphysis pubis • Within 1h returns to the umbilicus • Descends 1 cm/day • Consistency- firm/boggy • Height- measured in fingerbreadths • Fundal massage procedure 22.1 p 753

20. Nursing care • Boggy fundus- massage until firm • Medications- Pitocin, Methergine, Hemabate • Teach new mom to massage her fundus

21. Afterpains • Intermittent uterine contractions due to involution • Primiparous-mild • Multipara- more pronounced • Breastfeeding causes an increase in contractions due to release of oxytocin

22. Nursing Interventions • Patient in a prone position and place a small pillow to support her abdomen • Ambulation • Medicate with a mild analgesic

23. Bladder • Monitor for bladder distention and displacement of uterus • Assess for voiding difficulty • Monitor output • Postpartum Diuresis

24. Nursing care • Encourage frequent voiding every 4-6 hours • Monitor intake and output for 24 hrs • Early ambulation • Void within 4-6 hrs after birth • Catheterize if unable to void

25. Preventing Stress Incontinence • Vaginal delivery causes direct pelvic muscle trauma and disruption of fascial support contributing to the development of urinary stress incontinence. • Prevention strategies: Loss weight, avoid bladder irritates, decrease fluid intake • Kegal exercises Teaching Guidelines 16.3. 502 pg

26. Bowel • Relaxin depresses bowel motility • Progesterone ↓ muscle tone • Diminished intra-abdominal pressure • Incontinence if sphincter lacerated (4th degree) • Spontaneous BM 2nd to 3rd post partum day • Normal bowel pattern 8-14 days

27. Nursing Care • Increase fiber in diet • 6-8 glasses of water or juice • Stool softener- especially 4th degree • Laxative • Sitz bath for discomfort • Medications for hemorrhoids

28. Lochia • Rubra • Serosa • Alba • Documentation

29. Lochia Assessment

30. Scant • 1-2 in • About 10 ml

31. Small • 2-4 in • About 10-25 ml

32. Moderate • 4-6in • About 25-50 mL

33. Heavy • Saturated pad greater than 6 in • About 50-80 mL within 1 hr.

34. Nursing Care • Educate on the stages of lochia • Increase in lochia, foul odor or return to Rubra lochia is not normal • Change Peri pad frequently • Peri care after each voids to decrease risk of infections

35. Episiotomy • 1-2 inch incision in the muscular area between the vagina and the anus • Assess REEDA • Lacerations • Episiotomy care

38. Nursing Care • Peri care • Ice packs • Dry heat • Topical medications • Sitz bath Teaching guidelines 16.1 p. 499

40. Extremities • Increases the risk of thromboembolic disorders • Risk factors venous stasis, altered coagulation and vascular damage due to birth process increase risk of clot formation

41. Assess for Thrombosis • Homan’s sign • Assess extremities • Monitor for signs of PE

43. Post Partum Assessment • Post Partum Assessment Video

44. Emotional Status • Bonding is a vital component of the attachment process. It helps establish parent infant attachment and a healthy loving relationship. • Bonding takes during the first 30 to 60 min. after birth

45. Emotional Status Bonding process helps to lay the foundation for nurturing care • Touch- skin to skin • Eye contact • Breastfeeding • Engrossment • Factors that interrupt bonding

46. Engrossment Seven Behaviors • Visual awareness • Tactile awareness • Perception NB is perfect • Focus is on NB • Aware of NB’s distinct features • Extreme Elation • Increase sense of self esteem- proud

47. Tactile Awareness

48. Bonding Factors that may interfere with bonding process • Stress over finances • Lack of support • Cultural beliefs • Interruption of process-sick child NICU

49. Transitioning to parenthood • Difficult and challenging • Provide emotional support • Accurate information • Nursing goal create a supportive teaching environment

50. Assuming the mothering role Rubin’s three phases • Taking –in • Taking –hold • Letting-go