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POSTPARTUM
Postpartum - also known as Puerperium last 6 weeks, following 6 weeks after Birth
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Physiological Maternal Changes During Postpartum - Lochial Flow - Moderate to Scant
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4th STAGE OF LABOR
- Monitor V/S uterine firmness, uterine position - midline of abdomen
- Every 15 mins x 4 for first hour, every 30 mins x 2 for second hour, hourly x2, then every 4-8 hr
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ASSESSING THE FUNDUS
- If Fundus becomes SOFT & BOGGY, HEMORRHAGE CAN OCCUR -> MASSAGE THE FUNDUS
- A Fundus RIGHT of the MIDLINE often FULL BLADDER
- Encourage to Void REEVALUATE AFTER VOIDING
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LOCHIA - MENSES --> Observe the amount Character & Color
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TYPES OF LOCHIA
- Lochia RUBRA - Bright RED color, Small CLOTS - nickle size, Last 1-3 days after delivery -> moderate amount ok
- Lochia SEROSA - Pinkish BROWN color, Lasts from 4-10 days after delivery
- Lochia ALBA - YELLOWISH WHITE CREAMY color, Last from 11 days - 6 weeks Postpartum
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ABNORMAL LOCHIA - Persistent Lochia Rubra > 3 days suggests retained Placental fragments
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UTERINE INVOLUTION - (Volume) Contraction of the Uterine
- Fundal Height - 1 FINGER BREATH (1-2 CM)
- After Delivery: Fundus at Midline, at level of Umbilicus - (FIRM) 1 hour after delivery
- By 10 days Postpartum Uterus should not be Palpated - UNPALPABALE (lies within the Pelvis)
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CERVICAL VAGINAL & PERINEAL CHANGES
- Promote measures to Soften Stools - DRINK LOTS OF FLUIDS & ENCOURAGE FIBER
- Educate Client for Proper Cleansing - Use Squeeze Bottle (PERI BOTTLE) after Voiding & Passing Stool; Cleanse from FRONT to BACK after each VOIDING & BOWEL MOVEMENT
- Promote Comfort Measures - ICE PACKS for first 24-48 hrs, SITZ BATHS after 24 hrs
- EPISIOTOMY - ice pack 1st day of Postpartum
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BREAST CHANGES - Secretion of Clustrum, a Thin yellowish secretion
- BREAST ENGORGEMENT - Both Breastfeeding Mom and None Breastfeeding can have a BREAST ENGORGEMENT
- Encourage WELL FITTING BRASSIERE - for NON-BREASTFEEDING to PREVENT ENGORGEMENT
- Breastfeeding --> release of OXYTOCIN --> let down Reflex & Uterine Contractions
- Teach Client storke Infants lips with Nipple--> Infant takes in part of ARREOLA & NIPPLE not just nipple tip
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BREASTFEEDING --> Teach to Prevent Mastitis
- Wash Hands before Handling the Breasts or Breastfeeding
- Wash Nipples with WARM WATER ONLY- do not use soap
- Expose Nipples to AIR to keep them DRY
- Change Breast Pads Frequently
- Baby should grasp Both Nipple & Areola
- Rls baby Grasp on Nipple b4 removing baby from the Breast
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CHANGES IN VITAL SIGNS - Insignificant Slight Transient Increase
- Elevation of Temperature (low grade) due to dehydration - ENCOURAGE FLUID INTAKE
- Low Grade 99.6 first due to DEHYDRATION - PUSH FLUIDS
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CHANGES IN GASTROINTESTINAL SYSTEM
CONSTIPATION - delayed 2-3 days after Birth --> ENCOURAGE AMBULATION, FIBER, FLUID ENCOURAGE STOOL SOFTENERS
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CHANGES IN MUSCULOSKELETAL SYSTEM
- Assess Clients Abdominal Wall --> usually resolves within 6 weeks
- Teach Client KEGAL EXERCISES - to STRENGTHEN PERINEAL MUSCLES --> PRIMARY PURPOSE IS TO STRETCH PERINEAL MUSCLES
- COMFORT LEVEL:
- AFTERPAINS common when BREASTFEEDING; Assess Location, Type & Quality (Abdomen/Cramps/8/10)
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IMMUNE SYSTEM - (RhoGAM) IM within 72 hrs of delivery to Suppress Antibody formation
BONDING & INTEGRATION --> Culture age & socioeconomic - BE SENSITIVE
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Psychosocial Adaptation & Maternal Adjustment
- TAKING-HOLD PHASE -->
- Begins 2nd & 3rd Postpartum; EVIDENCE HEALTHY ATTACHMENT SHE TALKS TO BABY EYE CTC/CUDDLES
- Eye Contact is GOOD EVIDENCE of Maternal Bonding
- LETTING-go-PHASE -->
- Begins to accept Neonate as Separate Individual
- Nx Interventions:Placing Infant SKIN TO SKIN --> Do you have any Concerns
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POSTPARTUM HEMORRHAGE
- Serious Complication of Childbirth that can Result in HYPOVOLEMIC SHOCK
- B/P Drop Systolic; SYSTOLIC of <90 or LESS report Immediately
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INVERSION OF THE UTERUS --> The Turning INSIDE OUT of the Uterus --> may be partial or Complete (Cervix/Vagina)
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RETAINED PLACENTA -
Monitor for Uterine Atony --> Excessive Bleeding or Clots larger than a quarter TOO LARGE ->PROBLEM
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LACERATIONS &/or HEMATOMAS
PAIN is most common symptom - ICE PACKS, SITZ BATH , LIDOCAINE
- Risk Factors:
- CPD - Cephalopelvic Disproportion
- Monitor S/S:
- Constant Oozing, slow tricle, or frank bright red blood flow from Vagina
- Visually or Manually Inspect the PERINEUM & RECTUM.
- Apply Ice Packs to Small Vulvar Hematoma's & encourage Sitz Bath - DO NOT RUB
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THROMPOPHLEBITIS
- PT/INR if clientis on Warfarin (Coumadin)
- Platelet count, PT & PTT if Client is on Heparin
Monitor for S/S Thromphlebitis -->Assess lower extremities --> CHECK DORSIFLEXION; ABNORMAL TO FIND CALF PAIN IF DORSIFLEX
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PUERPERAL INFECTIONS --> After Birth
- If any Discomfort & Tenderness in Abdomen Suspect Infection
- Monitor for S/S of Endometritis, Wound Infection, Mastitis - ASSESS FOR DISCOMFORT/PAIN in ABDOMEN
- NX INTERVENTION:
- Encourage use of Ice Packs/ or MOIST WARM PACKS especially on affected Side->PAINFUL AREA
- Encourage client completely empty Breasts at each Feeding to prevent Milk Stasis -> CAUSES CLOGGED MILK DUCT
- Instruct Client to Report of REDNESS & fever / WARM PAIN IN THE BREASTS.
- Most Effective to Prevent Engorgement Feed Baby Every 2-3 hrs
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URINARY TRACT INFECTIONS (UTI) -> Signs of Cystitis --> Blood Tinged & Painful Urination
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POSTPARTUM DEPRESSION
10-15% of New Mothers; assess for suicidal thoughts, delusion, flat affect
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NORMAL NEWBORN - Neonate 4 dramatic changes to adapt outside Uterus
- Respiration - suction mouth then nose
- Circulation -
- Temperature Regulation
- Nourishment
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GESTATIONAL AGE ASSESSMENT
- Weight: 2500 - 4000 grams (51/2 - 10 lbs) same time daily
- Length: 45 -55cm (18 - 22 inches) top of head to heel
- Head Circumference: 32-36.8 (12.6 - 14.5 inches) at level of Infant's eyebrows
- Chest Circumference: 30-33 cm (12-13 inches) at the nipple line
- Normal HR: 100-160 <100 call MD
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PHYSICAL EXAM
- Respirations-> 30-60 bpm
- HR--> 100-160 bpm
- B/P-->60-89 mm Hg systolic 40-50 mmHg diastolic
- Temperature--> 97.4 -98.9 axillary
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NORMAL SKIN DEVIATIONS
- Milia - white spots on the chin nose forehead
- Mongolian Spots - present on dark skinned infants
- Telangiectatic Nevi (Stork Bites) flat pink or red marks
- Nevus Flammeus (Port Wine stain) - capillary angioma
- Erythema Toxicum (Neonatorum) - pink rash
- EPSTEINS PEARLS - SMALL WHITE CYST
- Physical Exam:
- Mouth - Epstein Pearls --> Symmetrical Lip Movement
- Abdomen -
Umbilical Cord 2 ateries 1 vein- Anogenital: Male/Female -
Must Void/Stool within 24 hrs
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REFLEXES
- Sucking - Place finger in Baby's mouth
- Moro - Suddenly lowering the body & assessing Bilateral Arm Extension & leg Flexion
- Rooting - Baby's Head will turn
- Palmar - Holding Baby's Palm
- Stepping -
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SENSES -
- Vision -
- Hearing -
- Touch -
- Taste -
- Smell -
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CIRCUMCISION CARE -
Nursing Action --> AFTER CIRCUMCISION CARE CHECK SWELLING /BLEEDING
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PRETERM INFANT
S/S: Respiratory Distress --> NOTIFY MD IMMEDIATELY
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POST TERM INFANT
Peeling Cracked, --> QUESY'S IN A SOLES of the FEET
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HYPERBILIRUBINEMIA
- Physiologic Jaundice - AFTER 24 HRS of AGE
- Pathologic Jaundice - BEFORE 24 HRS of age or is PERSISTENT AFTER DAY 7, BILIRUBIN > 13 mg//DL
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SETTING UP PHOTOTHERAPY
- Maintain Eye Mask over Newborn's Eyes -
- COVER INFANTS EYE FOR PHOTOTHERAPY
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CONGENITAL ANOMALIES
- CLEFT LIP/PALATE -Opening of the Palate
- PKU - Phenylkenonuria - to prevent mental retardation
- GALACTOSEMIA - Inability -> LACTOSE INTO GALACTOSE INTO GLUCOSE
- HYDROCEPHALUS -
- RN measures head Circumference for HYDROCEPHALUS
- increase size of Head most characteristics of hydrocephalus
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