POST

PARTUM PERIOD

DEFINITIONS:
Post partum period (puerperium) start immediately after delivery and is completed when the reproductive tract has returned to nearly prepregnant state and family readjustment has occurred (usually defined as 6weeks). begins after the delivery of the placenta and ends at the beginning of the first menstrual cycle (usually 6-8weeks). There are so many anatomic and physiological adaptations that occur in this frame time.

PHYSIOLOGICAL CHANGES
Reproductive system Uterine involution Cervix involution Lochia Vagina Perineum Abdomen Breast

Endocrine system Cardiovascular system Respiratory system Renal and Urinary system Gastrointestinal system Musculoskeletal system Integumentary system

MATERNAL PSYCHOLOGICAL ADAPTATIONS

phase
Taking in ( 1 2 days postpartum )

characteristics
Mother passive, dependent, concerned with needs, verbalizes delivery experience Mother strives for independence; strong anxiety element; maximal stage of learning readiness; mood swings may occur Mother achieves interdependence; realisyic regarding regarding role transition; accepts baby as separate person; new norms established for self

Nursing Implications
Assist mother in meeting physical needs. Begin teaching to prepare for possible early discharge Provide positive reinforcement of parenting abilities

Taking hold ( 3 10 days postpartum )

Letting go ( 10 days upto 6weeks postpartum )

Assist mother in providing for her increased energy requirements; provide posite reinforcements she identifies her role with support system. Allow her to verbalize her new role

POSTPARTUM DEPRESSION/BLUES

Many mothers experience a let down feeling after birth, related to the magnitude of birth experience and doubts about the ability to cope effectively with the demands of child bearing. Typically it is mild and transient, beginning 2 to 3 days after delivery and resolving within 1 to 2 weeks. Rarely, relatively mild depression leads to POSTPARTUM PSYCHOSIS.

APPLICATION OF THE NURSING PROCESS TO A NORMAL CHILD BEARING POSTPARTAL CARE

ASSESSMENT
1. 2. 3. 4. 5. 6. 7. 8.

9.

Degree of homeostasis achieved Vital signs Fundus: height, consistency, and pollution Lochia; amount, color, consistency, odor Perineum: REEDA, comfort, hemorrhoids Bladder: distention and displacement Bowel: constipation Breasts/nipples: secretions, engorgement, nipple variations/conditions; color, support Psychological status

ANALYSIS AND NURSING DIAGNOSIS

Safe effective care environment a) High risk for infection b) Knowledge deficit Physiological integrity a) Effective breastfeeding b) Altered emotion Psychosocial integrity a) Altered sexuality pattern b) Anxiety Health promotion maintenance a) Altered family processes b) Altered parenting

PLANNING
IMPLEMENTATION EVALUATION

GOAL 1: CLIENT WILL ACHIEVE HOMEOSTASIS;

WILL BE KNOWLEDGEABLE ABOUT SELF-CARE

Implementation Review antepartum and intrapartum records of history.

a.

b.

Antepartal care, labor and delivery, and chronic conditions. Laboratory values: Hgb, HCT, VDRL, bloodtype, Rh factor, rubella titer

Immediate postdelivery care A. First hour after

1. 2. 3.

Provide quiet environment for the woman and family Monitor vital signs every 15minutes or less frequently. Evaluate fundal height and position.

1.

2. 

 

Inspect perineum for signs of bleeding, including hematoma formation. An ice pack on the perineum may promote comfort and help to reduce swelling of the tissue. Evaluate the amount of vaginal bleeding: Scant only blood on tissue when wiped, or less than 1 inch stain on the peripad within 1 hour. Small/light less than 4 inch stain on peripad within 1 hour Moderate less then 6 inch stain on peripad within 1 hour Heavy saturated peripad within 1 hour

Monitor ongoing postpartal progress by daily assessment.

Promote perineal healing and relief of perineal and hemorrhoidal discomfort. Treat afterbirth pains Odserve abdomen for muscle tone, diastasis recti abdominis,; measure degree of any diastasis; teach corrective exercise to client. Promote bladder and bowel function Teach self assessment and self care Document accurately

Evaluation client has stable vital signs, adequate intake and output; experiences no more than minimal pain and discomfort; perform self care.

GOAL 2: CLIENT WILL VERBALIZE AND DEMONSTRATE

KNOWLEDGE OF BREAST CHANGES, BREAST CARE, LACTATION, OR SUPPRESSION OF LACTATION

Implementation teach daily cleansing of breast; breastfeeding mother should wash nipples with clear warm water only to prevent the removal of the protective skin oil. Encourage air drying of nipples for 15 to 30 minutes after breastfeeding. Apply small amounts of breastmilk to nipple and aroela after nursing to promote healing/prevent soreness. Explain mechanism of lactation.

Help mother to infant to breast; demonstrate proper positioning; facilitate latch-on Teach lactating mother to relieve breast engorgement Apply warm packs before feeding for discomfort icepacks maybe used in between feedings for engorgement Promote comfort with use of of supportive nursing bra A mild analgesic may be used to promote comfort Observe breast for

a. b. c. d.

Colostrum secretion Engorgement Nipple inversion or crackling Inflammation and/or pain

Instruct mother to safely remove infant from breast; squeeze infants cheeks, place finger in infants mouth Promote comfort for nonlactating client with use of supportive bra, ice packs; do not express milk or pump breasts give medication if prescribed. Teach to avoid handling the breast since this stimulates more milk production Lactation suppression such as bromocriptine mesylate may be given to bottle feeding mothers to suppress milk production and breast engorgement

Explain advantages and dis-advantages of breast-feeding and bottle-feeding a. Bottle feeding

Advantages  Prepared to be as much like breastmilk as possible  Can tell how much the baby is taking  Father can enhance bonding during feeding  Easier to satisfy large babies

Disadvantages  Some babies become colicky  Decreased transfer of immune bodies from the mother  Chance of error in preparation of powder and liquid preparation  Less expensive, prepared formulas that need refregiration nust be warmed  Prepared formulas may be quite expensive

Breast feeding
advantages Considered to be the best food for neonate Involution occurs more rapidly Readily available No preparation needed, no cost Babies receives immune factors from the breastmilk help prevents against diseases  Have fewer allergies  Nursing mothers may experienced such sense of closeness to her baby, fulfillment and motherliness     

Contraindication to breastfeeding Mother is high risk for AIDS Mother who has active tuberculosis until she has received appropriate medication and is judged noncontagious A woman with established cardiac disease or renal disease Mentally disturbed mothers Those with herpes in breast Undergoing chemotherapy Newborn with galactosemia

Evaluation Lactating client demonstrates correct care of the breasts, wears a supportive bra; feeds newborn comfortably, knows how to express milk; nonnursing measures to suppress lactation, identify advantages and disadvantages of breastfeeding and bottlefeeding.

GOAL 3: CLIENT WILL VERBALIZE KNOWLEDGE OF

NUTRIENTS TO MEET OWN NEEDS AND SUPPLY CALORIES/NUTRIENTS FOR LACTATION

Implementation Encourage nutrient snacks and increase fluids Teach lactating mothers to increase amounts of protein at about 20 grams more, calcium, iron, phosphorous and vitamins Advice increase intake of iron rich food for mothers with low hemoglobin or history of hemorrhage, fresh fruits and vegetables with high fiber will help reestablish normal bowel habbits.

Lactating mothers should add between 500-900 additional calories daily for milk production. Teach to avoid medication that are transmitted by way of the breast milk

Evaluation Client verbalizes understanding of dietary recommendations; select food from the basic food groups to meet postpartal and lactation needs

GOAL 4: PARENTS WILL CONTINUE TO ATTACH AND

BOND WITH THE NEWBORN

Implementation Encourage physical closeness between the newborn and parents; teach them to see eye to eye contact and an en face position Encourage physical examination: exploration with fingertips/palms, touching and stroking Compare newborns likeness to and differences from other family members Explain how normal newborn appears Encourage addressing newborn by name

Allow parents to verbalize their feelings, concerns, and question about newborn. Stay with parents during initial feeding and care activity as needed Identify newborn behavioral cues and responses Teach newborn care Provide positive reinforcement of parenting abilities

Evaluation
Parents will experience bonding/attachment behaviors; make positive statements about the newborn

GOAL 5: CLIENT WILL BE KNOWLEDGEABLE

ABOUT REST AND EXERCISE IN THE IMMEDIATE POSTPARTAL PERIOD

Implementation

Encourage early ambulation to prevent thrombophlebitis and constipation Restrict dangling of feet for a long time with sitting position on side of the bed Encourage frequent rest periods during the day with minimal interruptions

    

Teach post partum exercises to strengthen muscle of the back, pelvic floor, abdomen: kegels or pelvic floor exercises increase vaginal tone Advise client to see the physician before resuming strenous activities Exercises for the immediate postpartum period:
Toe stretch Pelvic floor exercise Exercises for later recovery period Buttocks exercises Twist

Evaluation client takes several rest periods during the day; performs postpartum exercises correctly

GOAL 6: CLIENT WILL DISCUSS CONFLICTS

ABOUT ROLE CHANGES

Implementation Explain that conflicts are common  Interdependence vs. dependence  Love vs. resentment to newborn  Idealized vs. role conflict  Self fulfillment vs. motherhood  Love for significant others vs. motherhood

 

Provide maternal psychological adaptation Listen to mother and help her interpret events of labor and delivery Clarify any misconceptions about the birth experience Encourage rooming in with the newborn Obtain information for evaluating the future parent child relationship Act as role model in assisting the maternal asks

Evaluation Client discusses conflicts about maternal role; ask questions; shares feelings and concerns about caring for the baby and incorporating newborn into the family.

GOAL 7: PARENTS WILL VERBALIZE

UNDERSTANDING ABOUT HOME CARE OF MOTHER AND NEWBORN

Implementation Provide discharge planning and teaching information about  Normal physiologic changes  Expected weight loss  Lochia  Changes in the abdominal wall  Perineal healing: episiotomy sutures absorb in three weeks  Diaphoresis common in the first 2-3weeks (night sweats)

Maintaining lactation  Return of menses and ovulation Teach maternal self care needs; proceed slowly with activities Instruct to report any of the following  Increased temperature  Increased lochia or reverse in trend in lochia characteristics  Signs of bladder infection  Pain in calf  Signs of episiotomy or breasts infection Discuss and demonstrate newborn care Provide opportunity for client to care for newborn in hospital


Review feeding technique Discuss concerns and questions about newborn care, behavior and basic needs Discuss family planning Discuss sexual adjustment; encourage open communication among partners

Evaluation parents describe and demonstrate skills for maternal self care, newborn; describe plans to set aside separate and special times for newborns siblings have appointment for follow up care.

- end

Good morning!!!