Postpartum

Nursing Diagnosis: risk for impaired parenting reIated to inadequate

bonding behavior after chiIdbirth.
Outcome evaluation: parents hold and comfort their infant appropriately and
voice positive characteristic of child.
To asses that bonding is occurring, listen to what parent say about their newborn
in the immediate postpartal period. Do they make positive statement such as,
"'m glad he's a boy or "she's cute or negative ones such as, " really hoped it
would be a girl or "she looks like a circus clown with no hair? first impression
may not be a lasting ones. However, negative comments need to be identified,
so that extra discussion about things such as what it feels like to have four boys,
or not to have the prettiest in the nursery can take place. Although brief hospital
stays are advantageous in many ways, if such discussion does not occur, a
family may be discharged from the health care agency with their needs unmet. At
home, away from the health care personnel who are attuned to how
disappointment can interfere with parent-child interaction, parents may have
great difficulty adjusting to and relating to this new child.
Nursing Diagnosis: Disturb sIeep pattern reIated to exhaustion from and
excitement of chiIdbirth.
Outcome Evaluation: Client state she is able sleep and feels rested during
pospartal period.
After birth, a woman is paradox. She is excited. She has a baby and she
wants to hold and be with this new person in her life. She wants to talk to her
support person about the experience, their child and their future. At the same
time, she is exhausted that she falls asleep easily.
Allow the woman to have time with her expanded family in the birthing
room immediately after the baby's birth so she can then enjoy sound rest.
Promote rest in the earIy postpartaI period.
few woman are prepared for the degree of fatigue they experienced after child
birth. Try to do all procedures swiftly yet gently, to allow as much time for sleep
as possible. f a woman has discomfort from hemorrhoids, perineal stitches, or
after pains, be sure she has pain relief so she can rest comfortably or sleep.
Urge her not to fall a sleep in a narrow hospital bed with her infant. Sharing bed
is controversial even in a large bed. A newborn in a narrow bed be easily fall and
injured.
Some woman experience shaking chills immediately or within a half hour
after birth. This is caused in part by pressure changes in the abdomen that occur
with reduction in the bulk of the uterus and temperature readjustment in response
o the diaphoresis of labor. t also may result from the exhilaration the woman is
feeling, combined with exhaustion. n any event, shaking chills at this point are
common, so that she will not attribute them to a developing cold or infection.
Cover her with a warm blanket , offer her a warm drink, and assure her the
occurrence is normal. These actions are usually enough to make the chill
transient and allow the woman to fall into a sound, much needed about an hour.
Although a woman may choose any position to sleep, she may enjoy
being able to sleep on stomach, something she wasn't able to do during
pregnancy.
Promote Rest throughout the Puerperium
The importance of rest throughout the entire puerperium cannot be
stressed enough. As long as a woman is in the health care facility, reserve naps.
nclude suggestions for getting adequate rest while at home in discharge
instructions, because rest may prove difficult.
Many women do not realize how long it will take to fully return to their
previous level of functioning. When families were closely knit and neighborhoods
were smaller, a new mother had someone in her family or close neighborhood to
look after the baby while she napped.
A woman without support has many demands for her new role---being a
mother instead of a daughter; a mother as well as a wife, a mother of three, not
two. f she overcomes by sleep hunger, her judgement and sense of balance can
be bluured. Although it is not the only contributing factor, extreme fatigue is
associated with the development of postpartal depression (Corwin & Arbour,
2007).
Nursing Diagnosis: Risk for bathing/hygiene seIf-care deficit reIated to
exhaustion from chiIdbirth.
Outcome Evaluation: Client takes daily responsibility for own hygiene. Client
appears clean, dressed, and well groomed.
After childbirth, women often report that their hospital or birthing center
room is being kept too warm; to prove it, they point out how heavily they are
perspiring.
You can assure a woman that sweating is a normal postpartal event that
helps to bring her body back to its pre-pregnant state. f she has profuse
diaphoresis, particularly at night, she usually prefers to wear a hospital gown
rather than one of her own.
A daily is refreshing. Be certain to accompany a woman for a shower on
her first postpartal day, because she often is more fatigued than she realizes.
Standing under warm water may also make her dizzy and she may need help to
walk safely back to bed.
Formerly, women were not allowed to take tub baths after birth, for fear
that bacteria from the water would enter the vagina and cause infection. There
appears to be little evidence that this is a real danger, however, so if a woman
wants to bathe instead of shower, she may do so.
Nursing Diagnosis: ImbaIanced nutrition, Iess than body requirements,
reIated to Iack of knowIedge about postpartaI needs.
Outcome Evaluation: Client ingests a 2200- to 2700- kcal diet and drinks 6-8
glasses of fluid daily.
Postpartal menu and planning should include a diet of between 2200 and
2300 calories daily. Foods should be high in protein and in the vitamins and
minerals needed for good tissue repair. A woman who is breastfeeding needs an
additional 500 calories and an additional 500 ml of fluid each day to encourage
the production of high-quality breast milk.
Teach woman to continue to eat a nutritious diet after she returns home.
This can be a problem, because some women become so fatigued during their
first weeks at home that they feel unable to prepare adequate meals. Neglecting
to eat properly leads to more fatigue and ultimately to an even less nutritious diet.
f a woman has any prenatal vitamins or supplementary iron preparations
left over from pregnancy, she should, as a rule, continue to take them until her
supply is used. f she needs further supplements, her physician will prescribe
them for her, either on discharge or when she returns for her postpartum check-
up (Lipscomb & Novy, 2007).
Promote Adequate FIuid Intake
The rapid diuresis and diaphoresis that occur during the second to fifth
postpartal days ordinarily result in a weight loss of 5 lb in addition to the
approximately 12 lb lost at childbirth.
Women often feel thirsty during this period of rapid fluid loss and want
additional fluid. t seems a paradox that while the body is riding itself of unwanted
fluid, it should also demand fluid. Part of the need for fluid sterns from the
increased amount of nitrogen being released by catabolized uterine cells. A
woman needs to increase her fluid intake to rid her body of these wastes.
You may need to encourage some woman to drink adequate fluid during
the first few postpartum days because they are restricting fluid in the hope of
preventing their breasts from becoming engorged some woman to drink
adequate fluid during the first few postpartum days because they are restricting
fluid in the hope in preventing their breast from becoming engorged other
mothers are beginning diets that they hope will bring their bodies more quickly
back to their non pregnant slim state. However fluid restriction does little to other
breast engorgement and overall this is not a good building and readjusting for
which a woman needs both ample nourishment and adequate fluid intake
encourage her to drink at least three to four 8-oz of glasses of fluid each day (six
to eight glasses if breastfeeding
Nursing Diagnosis: Risk of impaired urinary eIimination or constipation
reIated to Ioss of boweI sensation after chiIdbirth.

Outcome evaIuation: Client voids more than 30mL/hr without urinary retention,
beginning 1hr after birth and has a bowel movement by postpartum day 4. No
urinary incontinence is noted.

Promote Urinary EIimination: Because the diuresis of the postpartal period
begins almost immediately after birth, a woman's bladder begins filling almost
immediately .A full bladder puts pressure on the uterus and causes difficulty with
uterine contraction. An overall tended bladder may also damage bladder
function. Women who have had epidural anesthesia are particularly pron to
developing urinary retention.
Encourage a woman to walk to the bathroom and void at the end of the first hour
after birth, to help prevent bladder distention. Some women have too much
perineal edema to be able to void this early .A woman with an episiotomy may be
reluctant to void because she knows that acid urine against her suture will sting.
However , many women have enough residual effect of epidural or pudendal
anesthesia at this time that voiding is painless .Assist by providing privacy (but
remain in close proximately in case a woman becomes dizzy if this is her first
time out of bed ),running water at the sink or offering the woman a drink of water.
Pouring warm tap water over the vulva, if consistent with the agency's policy for
perineal care, also may help.
f the woman still has not been able to void by 4 to 8hrs after birth, and
bladder distention is present. She will need to be catheterized. Because the
perineum is edematous after birth, the vulva in a postpartum woman appears out
of proportion .This makes it difficult to locate the urethra for urinary
catheterization. Be certain that, during catheterization, you do not invade the
vagina by mistake thereby carry contamination to the denuded uterus.
Occasionally, because of poor tone, the bladder retains large amount s of
residual urine after voiding .This uterine harbors bacteria, which can cause
bladder infection.
To detect whether urinary retention is occurring, be certain to measure the first
voiding after birth, whether the bladder is emptying also may be judged by
measuring fundal height and position or by palpating or percussing bladder
prominence in the lower abdomen. f a woman a woman is voiding 100ml at a
time or has a displaced uterus or palpable bladder, her physician or nurse-
midwife may order catheterization for residual urine after a voiding. As a rule, if
the residual is more than 150ml, the catheter is left in place for 12 to 24hrs to
give the bladder time to regain its normal tone, and to begin function efficiently.
Fortunately for most women who must have been catheterized, the procedure
needs to be done only once after birth .Usually, after another6-8hrs had passed
and the bladder has filled again, some of the perineal edema is subsided, the
bladder has achieved better tone, and the woman is able to void by herself if
helped to the bathroom.
Because catheterization can lead to urinary infection, it should not be used
indiscriminately in the postpartal period. On the other hand, it should be done
before the woman's bladder is injured of the uterus is displaced and
unconstructed, resulting in bleeding.
Some woman report urinary incontinence during the tone and sensation. Kegel
exercises are helpful to strengthen perineal muscles and eliminate incontinence
in the future.
Prevent Constipation: mTo prevent constipation, many woman are prescribed
a stool softer such as docusate sodium, beginning with the first day after birth. f
a woman has not moved her bowels by the third postpartum day, a mild laxative
or cathartic may be prescribed .There is a danger in giving cathartics before the
third day, because the resulting increase in intestinal activity could cause uterine
irritation and lead to insufficient contraction.
Early ambulation, a good diet with adequate roughage and an adequate fluid
intake all aid in preventing the problem of constipation

Prevent DeveIopment of Hemorrhoids: The pressure of the fetal head on the
rectal veins during birth tends to aggravate of produce hemorrhoids.Gentle
manual replacement of hemorrhoidal tissues may also give relief, assuming sims
position several times a day aids in a good venous return to rectal area and also
reduces discomfort. ncreased fluid and the administration of a stool softener
prevent the development of hardened stool, which can irritate hemorrhoids.

Nursing Diagnosis: risk of ineffective peripheraI tissue perfusion reIated to
immobiIity and increase estrogen IeveI.

POST.SURGERY pain