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Adaptation: Breast
_______: secretion of milk by breast.
_______: Protein fill precursor to milk, antibody rich.
Develop breast milk in ____ days.
- Lactation: secretion of milk by breast.
- Colostrum: protein fill precursor to milk, antibody rich.
- Breast milk: 4 - 5 days.
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Breastfeeding hormones
_____ levels increase at term with a decrease in ____ and _____ levels.
______ and _____ levels decrease after the placenta is delivered.
- Prolactin levels increase at term with a decrease in estrogen and progesterone.
- Estrogen and Progesterone levels decrease after the placenta is delivered.
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Breastfeeding hormones
______ is released from anterior pituitary gland and initiates milk production.
_____ is released from posterior pituitary gland to promote let down.
Infant sucking at each feeding stimulates ____ and ____ release.
- Prolactin is released from anterior pituitary gland and initiates milk production.
- Oxytocin is released from posterior pituitary gland to promote let down.
- Infant sucking at each feeding stimulates prolactin and oxytocin release.
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Breast/Nipples
Normal:
Abnormal:
Filling, full and engorged breasts are generally seen after ____ days PP.
- Normal: Soft, filling, full, engorged.
- Abnormal: Redness, tenderness, heat, edema, cracking (strong sucking/latching wrong)
Filling, full and engoreged breast are generally seen after 3,4, or 5 days post partum.
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Breastfeeding Education
Benefits Mother?
- Reduces PPH (Postpartum Hemorrhage)
- Weight loss
- Reduces cancers and risk of osteoporosis
- Enhances bonding
- May delay the return of menstruation BUT SHOULD NOT BE USED AS A FORM OF CONTRACEPTION.
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Breastfeeding Education
Benefits Newborn?
- Brain development
- Immunological
- Decreases SIDS risk
- Gain weight faster
- Protection against Diabetes, allergies
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Breast Care
- Wash with warm water
- Use Colostrum or lanolin for cracks/blister
- Feed q 2-3 hours
- Ensure proper latch
- Engorgement (heat and cold, breast massage, milk expression, breast pump, anti inflammatory meds)
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Nursing interventions to support/assist the breastfeeding mother
- Assist the mother to begin breastfeeding within the 1st hour after birth (GOLDEN HOUR)
- Teach the mother to recognize and respond to early infant feeding cues (sucking hand, looking around, tongue out)
- Inform the mother about BF community support resources and refer to a lactation consultant. (Natural part of life)
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Breastfeeding contraindications
- Infant with classic galactosemia (Inability to digest galactose; sugar found in milk)
- Mother with:
- Active untreated tuberculosis
- Human T-cell lymphotrophic virus
- Radioactive isotopes
- Antimetabolites or chemotherapeutic agents
- Certain medications or active drug use
- Herpes lesion on breast
- HIV positive
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Adaptations: uterus
_____: uterus returns to normal size and location.
Process?
- Involution: uterus returns to normal size and location.
- Process:
- Contraction of muscle fibers
- Catabolism to reduce enlarged cells
- Regeneration of uterine epithelium in lower layer after upper layers have sloughed
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Adaptations: Uterus
weight after birth:
weight at 1 week:
weight at 6 weeks:
- Weight after birth:1000g (2.2 lb)
- weight after 1 week: 500 g (1lb)
- weight after 6 weeks: 60 g (2 oz)
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Fundal assessment
A _______ can impede the involution process
Be sure your patient has _____ when you check fundal height.
A full bladder can impede the involution process. ( Fundus shifted up/to the side can cause uterine atony)
Be sure your patient has voided when you check fundal height.
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Adaptations: afterpains
Caused by hormone ______ resulting in uterus contracting for involution.
More acute in multiparous...why?
- Caused by hormone Oxytocin resulting in uterus contracting for involution.
- More acute in multiparous...because of older weaker muscles.
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Adaptation: Bowel
- Decreased bowel tone and peristalsis
- BM may not return for 2-3 days
- Psychological: may not want to push due to fear of pain.
- Constipation
- Return of appetite (long strenuous activity/need for nourishment)
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Nursing: Bowel
Assess for:
- Bowel sounds
- Flatus (want them passing gas)
- Pain
- Distention
- NPO post c/s until bowel sounds return
- Colace
- Ambulate!!!
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Adaptation: Bladder
Normal:
NSVD:
C/S:
Postpartum diuresis:
Abnormal:
- Normal
- NSVD: voiding after 4-6 hours
- C/S: patent catheter on day 1, voiding on day 2
- Postpartum diuresis: 12 hrs to 1 week
- (all fluid starts coming out)
- Abnormal:
- Dysuria (painful urination)
- Urinary retention
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Causes of impeded urination
- Decreased sensation r/t anesthesia (epidural)
- Perineal laceration- psychological
- Swelling and bruising of perineum and urinary meatus - unable to void r/t trauma Hematomas
- Decrease bladder tone
- Swelling and bruising of bladder
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Urine retention
Major cause of uterine atony (excessive bleeding)
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Nursing care for bladder
- Assist the patient to bathroom
- Peribottle
- Possible catheterization
- Teach about kegel exercises
- Monitor for UTI
- Assess urine output
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Adaptations: Lochia
______: vaginal discharge that occurs after birth. consists of ____, _____, and _____.
3 stages:
Lochia _____: deep red, ___ days
Lochia _____: brownish/pink, ___ days
Lochia _____: creamy white, up to __ weeks
- Lochia: vaginal discharge that occurs after birth. Consist of blood, fibrinous products, decidual cells.
- 3 stages:
- Lochia rubra: deep red, 3-4 days
- Lochia serosa: brownish/pink, 3-10 days
- Lochia Alba: creamy white, up to 6 weeks
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Lochia
Normal:
Abnormal:
- Normal:
- scant to moderate
- Few clots (good clots= nickle size)
- No odor
- Abnormal:
- Large flow
- Large clots (bad clots = quarter size/larger)
- Foul odor
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Lochia: amount
Saturation of pad in _____ minutes is indicative of hemorrhage.
women with ______ generally have less lochia due to manual extraction of uterine debris.
Saturation of pad in <15 minutes is indicative of hemorrhage.
Women with C sections generally have less lochia due to manual extraction of uterine debris.
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Adaptations
______: closes but never regains prepregnant state
Vagina:
Edematous and lax post delivery (swollen, ice pack) Returns to prepregnant size ____ Epithelium restored _______ (use lubricant) Instruct patient to use water soluble lubricant for coital discomfort.
Cervical: closes but never regains prepregnant state (easier future deliveries)
- Vagina:
- Edematous and lax post delivery (swollen, ice pack)
- Returns to prepregnant size 6-8 weeks
- Epithelium restored 6-8 weeks (use lubricant)
- Instruct patient to use water soluble lubricant for coital discomfort.
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Adaptations
______: edematous and bruised.
Lacerations:
1st degree ____________
2nd degree ____________
3rd degree ____________
4th degree _____________
- Perineum: edematous and bruised
- Lacerations:
- 1st degree involves skin and superficial structures
- 2nd degree involves through perineal muscle
- 3rd degree extends through anal sphincter muscle
- 4th degree continues through anterior rectal wall
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Episiotomy
Incision made into _____ during 2nd stage of labor. Midline vs mediolateral up to 6 months to heal
- Incision made into perineum during 2nd stage of labor.
- Midline vs mediolateral
- up to 6 months to heal (easiest to assess by having patient roll on her side)
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Episiotomy/perineum evaluation
Normal
Abnormals
Normal: slight edema or bruising, nor discharge from wound (differentiate between wound and vaginal discharge)
Abnormal: Excessive pain (infection), REEDA (Redness, Edema, Ecchymosis, discharge, approxiamtion), Gaping wound, Hemorrhoids
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Perineum Education
- Medications (tylenol, percocet)
- Perineal care (keep it clean)
- Handwashing (before and after changing pads)
- Healing time (6-8 weeks, varies)
- Sutures
- Bathing (showers, no baths to prevent infection)
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Perineal interventions
Ice packs (reduce swelling) Warm water Witch hazel pads (hemorrhoids) Anesthetic sprays (numbs area) Benzocain
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Homan's/DVT
EBP does not support performing Homan's sign. Research has demonstrated performing a Homan's sign may actually break a clot loose.
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Adaptations: Emotions/psychological
Normal
Abnormal
- Normal: Excited, Euphoric, exhausted, tearful, worried about baby, en face position (face to face)
- Abnormal: Not caring for the baby (may vary regarding culture) Mood swings, irritability
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Psychological adaptation
_____: psychological response in ___ mothers.
Usually resolves without intervention ____ days.
causes:
Hormonal shifts
Lack of support
Insecurity
_______: must be ruled out if symptoms continue
- Postpartum blues: psychological response in 70% of mothers.
- Usually resolves without intervention 10 - 14 days.
- Postpartum depression must be ruled out if symptoms continue past 10 - 14 days.
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_______: formation of relationship b/w parent and newborn through physical and emotional interactions.
Attachment
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Rubin's maternal role framework
_______: Mother dependent on other to meet needs. Recounts labor experience. Baby is now separate from her.
________: Dependent/independent. Concerned w/ her health and baby. Takes over w/ her own care.
_________: woman reestablishes relationships w/ others. More confidence in motherhood role.
Taking in phase: mother dependent on other to meet needs. Recounts labor experience. Baby is now separate from her. (24 - 48 hours)
Taking hold phase: dependent/independent. Concerned w/ her health and baby. Takes over w/ her own care. (2nd - 3rd day - several weeks)
Letting go phase: woman reestablishes relationships w/ others. More confidence in motherhood role. (Down the road, 4 months)
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Partner's psychological adaptation
Transition to fatherhood
Stages:
1.
2.
3.
_______: watching two people fall in love.
- Stages
- 1. Expectations
- 2. Reality
- 3. Transition to mastery
Engrossment: watching two people fall in love.
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Nursing management
Promote optimum comfort:
Promote bonding:
Common medications:
- Promote optimum comfort: analgesics, position, ambulate
- Promote bonding: skin to skin
- common medications: colace, immunizations
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Common injections in postpartum
- Influenza vaccine (flushot)
- TDAP (Tentanus-diphtheria toxoid)
- Rhogam or Rhophylac: given for RH negative mother and RH positive baby.
- Rubella vaccine: given postpartum
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