-
Puerperium
First six weeks after birth of infant
-
What’s the fourth trimester of pregnancy
Puerperium
-
Neonate?
Newborn up till 28 day
-
Bonding?
- Rapid process of attachment for the parent and child.
- Takes place during the first 30-60 minutes after birth.
-
Attachment
Long term process that establishes enduring bond between parent and child.
-
Claiming process
Parents identified likenesses and differences
-
Engrossment
Parents interest and preoccupation in the new born
-
Factors affecting adaptation of the parents
- Fatigue
- Previous experience with newborn
- Expectations of newborn
- Knowledge of and confidence in providing care
- Temperament of newborn *
- Temperament of parents
- Age of parents
- Support systems
-
Involution
Return of uterus to prepregnancy size and condition
-
Lochia
Vaginal discharge after child birth
-
It takes _____ for the vagina to regain pre-pregnancy contour
6 weeks
-
Let down reflex
Neurohormonal reflex that causes milk to be expressed
-
Prolactin
Responsible for milk production.
-
Oxytocin
Responsible for milk “let down” or ejection from breast.
-
____ is not a reliable method of birth control
Breastfeeding
-
Most non breast feeding mothers will resume me striating within _____
3 months
-
Colostrum
Yellowish fluid rich in antibodies and high in protein first two or three days after birth.
-
Engorgement occurs by day _____
Three or four
-
Vasocongestion of breast tissue during milk production causes
Distention, swelling, and tenderness
-
Lactation ceases within ______ if breast feeding stopped or never begun
One week
-
To suppress lactation and promote comfort, mothers should
Wear a well fitting bra continuously for several days.
-
Mothers can ____ following recovery from analgesia
Eat and drink
-
Breast feeding mothers should consume _____ than usual pre preg diet
500 more calories
-
Causes difficulty with BM
- Decreased peristalsis
- Diarrhea
- Lack of food during labor
- Dehydration
- Perineal trauma
- Hemorrhoids
- Anticipation of discomfort
- Pain medications
-
Blood loss for vagina birth is ___
500 ml
-
Blood loss for c section is ____
1000ml
-
Increased levels of clotting factors and fibers protect against ______ but can lead to ____
Postpartum hemorrhage
Thrombus formation.
-
Moms with varicose veins, c sections, or Hx of thrombophlebitis are at increased risk for
Thrombus formation
-
Mothers may have problems with _____ and ______ of bladder
-
Full bladder displaces the uterus
Up and to the side
-
Uterine atony
When uterus remains flaccid and the client passed large clots although the fundus has been massaged every 15 minutes
-
How often should the nurse massage the fundus after birth ?
Every 15 minutes.
Helps keep it tight and slows bleeding.
-
What to do with uterine atony
Massage the fundus and have someone call the MD
-
May have permanent ____ in shoe size
Increase
-
Takes ___ for abdominal muscles to return to pre-pregnant state
6 weeks
-
In relation to the skin, changes that occur after pregnancy
- Melanocyte- stimulating hormone declines
- Hyperpigmentation lightens*
- Most of the skins elasticity returns
- Striae (stretch marks) May still be visible
- Fine hair usually disappears
-
Maternal discomfort can be caused from
- Fatigue
- After pains
- Muscles ache
- Episiotomy
- Abd incision pain
- Breast enforcement
-
Mothers with headaches should be assessed for
Pregnancy- induced hypertension
-
Immediately after giving birth mothers will lose ____lbs
- 13
- Infant, placenta, amniotic fluids, and blood loss.
-
Within six weeks of giving birth mothers will lose ____lbs
8-9
Resulting from dieresis, diaphoresis, and involution.
-
It takes _____ for moms to return to prepregnancy weight
6mo
-
Taking in phase
- Occurs within the first 24 hrs after birth.
- Mom needs food, drink, and sleep.
-
Taking hold phase
- Mother becomes more independent and takes an interest and responsibility for her own care.
- Focus shifts to the care of the infant
-
Letting go phase
Move past the role of expecting and moves forward as a family unit.
-
Postpartum blues
Emotional lability and crying for no apparent reason
Can last 2 weeks
-
Unplanned C section
Taking in phase may last longer
Help mom understand the birth and incorporate the experience into her reality
-
Postpartum depression
- Mild, moderate, or severe
- Cares for infant but Is unable to feel the love
- Irritability, guilt, shame, unworthiness, sense of self loss.
Symptoms persists beyond first few weeks after birth.
-
Postpartum psychosis
Paranoid, grandiose or bizarre delusion, mood swings, confused thinking, grossly disorganized behavior that represent dramatic change from previous functioning.
Obsessive concerns about the infant health
-
Infants with problems
May be harder to bond with
-
Newborns and mothers health protection act of 1996
- Requires health plans to allow 48-hour stay after vaginal birth and 96 hour stay after c-section birth.
- May offer home care follow up
- Teach pt to report any fever or bright red discharge
-
Nursing process for a postpartum pt
- BUBBLE
- Breast
- Uterus
- Bladder
- Bowels
- Lochia
- Episiotomy, lacerations, and c section
-
When examining the breast note
Size, shape, abnormalities and reddened areas
Palpate for softness, firmness, engorgement, warmth, tenderness
Check nipples for cracks, fissures, soreness, and inversion.
*** if mastitis is diagnosed, pt can still breast feed as long as there aren’t abscesses****
-
When assess uterus
- Palpate fundus
- Note size, consistency, and placement.
- Fundus should be around the umbilicus for the first 12hrs after birth.
- Should be firm and midline
- Should decrease one finger breadth per day (1cm) *****
- After pains
- Breast feeding stimulated the release of oxytocin which stimulates uterine contractions. = involution 👌🏻
-
If uterus is boggy, soft, and above umbilicus, nurse should
- Massage the fundus or encourage breast feeding
- If those don’t work md may prescribe pitocin
-
If boggy uterus with fundus above the inimical snd divisors to the side assess
Fullness of bladder and distention
-
I and o is kept for ____hr after birth
24
-
Inspect anus for ____ when checking episiotomy
Hemorrhoids
-
Lochia:
- Vaginal discharge after birth
- Changes from rubra (red) to serosa (pink) to alba (white)
-
Assess______ with lochia
Color, amount, Pedro and presence of clots.
-
For the first three days lochia is
Rubra with small pieces of mucus
-
On 4th day after birth,lochia
- Decreases
- Color is pink or brown
-
After 10 days, Lochia
Discharge becomes yellowish white (alba)
-
It is _____ for lochia to increase with animation of increases activity
Common
-
To assess episiotomy
- Mom in sims position
- Redness=inflammation
- Ecchymosis= bruising
- Edema= swelling
- Possible discharge
- Approximation of suture line
- Pain of labia
-
Temp increases to ___ for ____ after birth
-
After 24 hrs and elevated temp may indicate ___\ after birth
Infection
-
Pulse may decrease to _____ after ____
Elevation may indicate pain, anxiety, or HEMORRHAGE
-
Increased BP after birth may indicate
PIH
-
Decreased BP after birth may indicate
Excessive bleeding
-
S/s of thrombophlebitis
- Redness, heat, edema, and tenderness
- Homans signs: pain with dorsal flexion of foot.
-
Bonding and attachment is
- The way mothers hold, examine, and speak to infant.
- Important signs: cradling, gazing at infant, speaking pleasantly
-
Assess parenting capability by
Observing feedings, dispersing, bathing and consoling skills
-
Assess self care by
- Showering, perineal care, checking the fundus, breast care, and rest.
- Encourage mom to bathe, toilet, and feed herself independently.
***** assist moms with first time getting out of bed after brith******
-
Rh Immune Globulin
Given with 72 hrs to prevent sensitization or Rh
(Neg mom, positive baby)
-
Rubella immunization
Recommended for all women who have not had rubella or have 1:8 titer in postpartum period.
- Should be given before discharge.
- Breast feeding allowed
- Shouldn’t get pregnant for three months.
-
What to assess with c sections
- Incision:redness, heat, pain, edema, and suture line approximation.
- *may produce less lochia and clots.
- Assess RR and breath sounds
- Assess effort of changing position, cough and deep breathing, incentive spirometer.
- Assess abd and bs, I AND O, pain.
-
Uterine atony
- Hemorrhage is a stead food of blood.
- Uterus boggy or soft.
-
Retained placental fragments
Prevents uterus from contracting effectively and bleeding continues.
-
Laceration of the birth canal
May occur in the perineum, vagina, cervix, or around urethral meatus.
-
Hematoma
Bleeding into tissue with no external laceration.
-
Late hemorrhage occurs
1-2 weeks after birth
-
First sign of late hemorrhage
Tachycardia from hypovolemic shock.
-
Predisposing factors for late hemorrhage
Low playlets, Hx of bleeding, Hx of alcohol abuse, herbal and homeopathic remedies, ASA or NSAIDS, obesity or poor nutrition.
-
Medical management of hemorrhage
- Oxytocin/pitocin
- Possible D&C or evacuation of hematoma
- Md palpates uterus to make sure it’s contracting
- Thorough exam of birth canal for laceration or hematoma
-
Puerperal infection
- Occurs between birth and 6 weeks postpartum
- Fever of 100.4 on two separate occasion within 24hr.
- Includes wound infection, metritis, mastitis, and UTI
-
Med/surg management of infection
- Removal of suture to allow drainage
- C&S to ID organism.
- Hot showers for comfort and blood flow for pts with mastitis. Still allows to breast feed until abscess ruptures
- Metritis=iv antibiotics
- Mastitis= early antibiotic therapy to prevent abscess
-
Risk factors for thrombophlebitis
35+, c section, prolonged time in stirrups, obesity, smoking, Hx of varicosities or venous thromboses.
-
How to prevent thrombophlebitis
- Frequent early ambulation to increase venous return
- Avoid prolonged standing or sitting
- Do not cross legs
-
Med surg management of thrombophlebitis
- Analgesics, antibiotics,
- iv heparin if DVT is present for 5-7 days followed by anticoagulant for 6 weeks or more.
- Rest, elevation of affected leg, local application of heat, TED, Doppler for affected extremity.
-
DIC
Disseminated intravascular coagulation
Abnormal stimulation of clotting
Causes clots then causes bleeding.
-
DIC may result from
Missed abortions, abruptio placentae, amniotic fluid embolism, sever preeclampsia, hemorrhage and a dead fetus.
|
|
