ATTACHMENT PSYCHOLIGICAL RESPONSE

I. Taking- In Phase

Phase Characteristics Management

 1-3 days after deliver  Talkative  Assist mother in meeting
 Dependent Phase  Verbalizes delivery physical needs
experiences  Allow verbalization
 Concerned with own needs  Listening to her needs
( food, attention, care,  Not the best time on
comfort) teaching baby care
 Self-centered
 Passive
 Dependent

II. Taking-hold Phase

Phase Characteristics Management

 3days- 2weeks after  Impatient to have control  Teaching about baby care
delivery over bodily functions  Stay during care to provide
 Striving for independence  Learn mothering tasks positive reinforcement
phase  Strive for independence  Guard against fatigue
 May have mood swings  Compliment always for the
 Responds to positive mother is sensitive about
reinforcement doing things
 More in control

III. Letting- Go Phase

Phase Characteristics Management

 5th- 6th
week  Gives up carefree lifestyle  Allow verbalization of new
 Interdependent Phase and integrate her new role roles
as a mother  Provide positive
 Achieves independence reinforcement as she
 Show pattern of lifestyle defines her roles with her
that includes new baby but support system
still focuses on entire family  Be understanding and
as unit supportive
 Reestablishment of
husband-wife relationship
 Mother may still feel tired
and overwhelmed by
responsibility and
conflicting demands on her
time and energies
 Psychosocial Development
1. Adaptation to Parenthood
Motor e Skills – new parents must learn new
physical skill to care for the infants. (e.g. feeding,
holding, burping, changing diapers, skin care)
ATTACHMENT SKILLS
BONDING
The development of a caring relationship with the
baby which includes:
a. Claiming- identifying the way in which the baby looks
or acts like members of the family
b. Identification - establishing the baby’s unique
nature ( assigning the his or her own name )
c. Attachment – facilitated by positive feedback
between baby and caregiver
 Promote bonding early
 Allow eye-to-eye contact
 Touching
 Stroking
 Cuddling
 Allow breastfeeding on the DR table
2. Sensual Response
 Touch – important communication with the baby
 Eye to eye contact - forms a trusting relationship
 Voice – baby respond to higher pitched voice that
parent use in talking to the baby
 Odor – baby quickly identify their own mothers
breast milk and scent.
3. Maternal Behavior
 Note post partal blues which may be caused by a
drop in maternal hormones on the 4th or 5th day
 It may last up to 6 weeks
Characteristics:
o Upset, depressed at times, insomnia,
anorexia, may cry, loss of energy and
general fatigue, anxiety and fear, maternal
concerns focused on her body
Management:
o Encourage verbalization, reassure that
crying is healthy, meet dependency needs,
prevent discomfort, promote bonding
MATERNAL RESPONSE
 Get to know the newborn
 Independent in her ability to care for the infant on
her own
 Puts her infants need first
 Observes her partner as he interacts with their child
 Maintaining and fostering her relationship with her
child’s father
FATHER’S RESPONSE
 Devotion to his child = engrossment
 Wants to be involved in child care
 Interested in how the infant looks and responds to
him
 Nurse should include the father in the teaching
regarding infant care
MOTHER-FATHER’S RESPONSE
 Time and effort devoted to infant care can stain the
mother-father relationship
 Father may become jealous of the mother-neonate
bond
 Parents should consider baby-sitting arrangements
to allow private time for themselves
SIBLING’S RESPONSE
 Depends on his age and development level
 Toddlers = lack of understanding may become
competitive for attention
 Bedwetting and sleep problems occur as coping
mechanism of regression
 May show hostility towards their parents of their
new sibling
 Parents should provide reassurance to their other
children = still loved and not been replaced
 Provide relaxed time for siblings to get to know the
infant
PREVENTION OF COMMON DISCOMFORTS
GOAL: To provide comfort and relief of pain.
EPISIOTOMY:
Cold or ice pack:
 Cold provides a vasoconstriction effect, thereby
reducing edema and discomfort.
 Provides an anesthetic effect, minimizing pain.
Dry-heat with peri-lamp:
 Dry heating can be done for 20 minutes with peri-
lamp positioned 20 inches away from the perineum.
 It may be done 3 times a day as ordered
 In the home, a 40 watt desk bulb ca be an effective
heath lamp
Moist Heat:
 Provide sitz bath twice a day or more
 The temperature of the water is maintained at 38° to
42°C
 Anesthetic sprays, ointments and analgesics for
relief of pain.
 Any needed oral medication should be administered
40 minutes before the infant’s feeding period
PERINEAL CARE FEEDING THE NB

 Use of “peri bottles” to squirt warm water over What is RA 7600?

perineum ( front to back ) to prevent contaminations
 Avoid use of toilet tissue
HEMORRHOIDAL PAIN
 Predisposing Factors:
- Bearing down during labor
- Pregnancy
- Constipation
Management
 Treat affected areas with cold packs after delivery
and leave in the same position no longer than 20
minutes and repeat every 4hours.
 Provide moist heat through a sitz baths with water
temperature at 38°C for a 20minute period
 Analgesic, rectal suppositories
 Encourage lying on side and avoidance of prolonged
sitting
 Stool softener or laxatives may be indicated
 Explain that are the condition corrects itself once the
increased blood supply and pressure of pregnancy
are diminished and regular bowel movements is
reestablished (usually by second or third day
postpartum)
 Avoid oily foods
 The rooming in the Breastfeeding Act of 1992
provides that infant born in hospitals, private
and government hospitals, be roomed-in with
their others to promote BF and ensure safe and
adequate nutrition to them.
To establish successful infant feeding patterns:
Non-Lactating Mother
- Provide supportive bra
- Explain proper position for feeding. Always hold the
bottle
- Never leave a bottle propped in the noenate’s
mouth
- Burp the neonate against the shoulder
Lactating Mothers
- Avoid the use of nipple creams, ointments or any
topical preparations.
- Teach mother to avoid using sunlamps or hair dryer
to dry nipples
- Assess breast for engorgement, nipple inversion,
cracking, inflammation or pain.
Types of Feeding Positions:

PRMOTE BONDING - Cross Cradle

- Cradle
 Encourage breastfeeding start early - Football
 Promote rooming-in - Side-lying
 Verbalize positive neonatal traits and similarities with the - Australian
mother’s/father’s feature
 Administer oxytocin drugs to promote uterine involution Teach Mother To:

WHEN TO RESUME SEXUAL INTERCOURSE?
 No prescribed time to resume sexual intercourse
Factors to consider in deciding when to resume sexual activity:
a. Maternal Comfort
- If the episiotomy wound is not yet healed, sexual
intercourse will be most uncomfortable, may cause
bleeding and may predispose to infection.
 Episiotomy wound will fully heal in 8 weeks, bleeding and
infection are less likely to occur once 14 PP days have
passed
1. Bring infant to level of breast; don’t lean over.
2. Turn infant completely on side with arms embracing
the breast on either side.
3. Bring infant in as close as possible with legs wrapped
around mothers waist and the tip of the nose
touching the breast
4. Bring infants lips to nipple; when infant opens the
mouth to the widest point, draw the infant the rest
of the way on to the nipple for him to latch on
5. Break the suction by placing a clean finger in the side
of the infants mouth before removing the infant
from the breast

b. Perineal Swelling HOW DO YOU CARE FOR THE BREASTS OF LACTATING

- Some mothers wait for 6weeks, after the check-up, before MOTHER?
they resume sexual activity
c. Personal desire to have sex a. Start early
 If a vaginal delivery, BF may be done as early as
INITIATION TO CONTRACEPTION 30 min after birth
 BD on the DR table is done primarily to
 Counseling is crucial for successful PP
stimulate bonding
 Provide the method that the client wants
 If a CS, 4 hours after delivery
 Take into considerations their physical, mental,
social, emotional, economic, and spiritual welfare.
 b. Empty the breasts with each feeding time. This - Advise the client against drinking carbonated
stimulates milk production: beverages
200-300mL per day by Day 4 - Suggest using new straw when drinking
600 mL per day by about 6 weeks - Rectal suppositories may be used to increase
c. Allow the NB to nurse in short. Frequent periods: peristalsis and stimulate flatus passage
2-3 minutes during the 1st day
Increasing gradually to 10 minutes on each breast in SUMMARY
later days
Routine assessments are usually done every 4 to 6 hours
d. Demand feeding
unless risk factors exist:
e. Advise other to wera well-fitted bra.
BF does not cause the breast to sag. It is the absence Vital signs – Report temperature above 38 degree C ( 100.4
of breast support that causes sagging of the breasts degree F) or normal heart respiratory rates
f. Manage from pain engorgement:
Compress: Warm = Lactating Fundus - evaluate firmness, height and location
Cold = non-lactating
Lochia- observe for character color, amount, odor and
Breast massage, breast pumping if lactating
presence of clots.
Analgesics as ordered
g. Wash hands before handling breasts Extremities - observe for signs of thrombophlebitis, ability to
h. Daily wash at bath time. Express to air ambulate and homan’s sign
i. Do not use soap, alcohol, antiseptic agents as they
tend to dry the nipples and predispose the to cracks Emotional – evaluate family interaction, support and any
and infection signs of depression state.
j. Use bra lined with clean gauze to absorb moisture;
don’t use plastic lined bra. Attachment – observe for interest in newborn, eye contact,
touch contact and ability to respond to infant cries.
EVALUATING BREASTFEEDING
Breasts – check for engorgement nipple tenderness, and
1. How do you know that an infant is getting enough breast feeding
breast milk?
2. Heat infant swallow and make “ka” or “ah” sounds. Bowel – determine passage of flatus, bowel sounds and
3. See smooth nutritive sucking. Smooth series of defecation
sucking and swallowing with occasional rest periods.
Pain – determine location character, severity, use of relief
Not the short, choppy sucks that occur when the
measures and need for analgesics
baby is falling asleep.
4. Breast gets softer during the feeding Perineum – observe for hematoma edema and episiotomy;
5. Breast-feeding 8-12 times per day; more milk is note hemorrhoids and degree of discomfort if any.
produced with frequent-breast feeding
6. Infant has atleast 2-6 wet diapers per day for 1st 2 Bladder - observe fullness, output, burning and pain.
days after birth; 6-9 diapers per day by the 5th day.
7. Infant has at least 3 bowel movements daily during
the 1st month and often more.
8. Infant is gaining weight and is satisfied after feeding.

NURSING CARE FOR CESAREAN DELIERY PP

 Monitor RR regularly and notfy if less that 12 per

minute
 Auscultate bowel sounds
 Inspect surgical wound for redness, edema,
tenderness, bleeding or discharge
 MIO
 Splint the abdomen during coughing
 Use anti embolism stockings or instruct the client to
dangle her feet before getting out of bed.
 Encourage progressive increase in activity and assist
the client with ambulation when needed
 Remove foley catheter and dressing at about 24
hours
 Shift to regular diet when bowel sounds are audible
 Allow client to shower by 1st post-operative day
 Encorage early and frequent ambulation
 Prevent abdominal distention as much as possible: