INTRODUCTION
http://www.youtube.com/watch?v=qT
H_-yIwevE
POSTPARTAL NURSING
Developed by
D. Ann Currie, R.N. ,M.S.N.
2012
POSTPARTAL PERIOD
PHYSICAL CHANGES
PSYCHOSOCIAL CHANGES
NURSING CARE OF THE
POSTPARTAL CLIENT
HIGH-RISK POSTPARTAL CLIENTS
PHYSICAL CHANGES
DURING THE POSTPARTAL
PERIOD
REPRODUCTIVE SYSTEM
INVOLUTION-IS THE PROCESS
OF THE REDUCTION IN SIZE OF
THE UTERUS AFTER DELIVERY
TO PREPREGNANT SIZE
CAUSED BY UTERINE
CONTRACTIONS THAT
CONSTRICT AND OCCLUDE
BLOOD VESSELS AT THE
PLACENTA SITE
FACTORS THAT ENHANCE
INVOLUTION
UNCOMPLICATED LABOR &
DELIVERY
BREASTFEEDING
EARLY AMBULATION
COMPLETE EXPLUSION OF
PLACENTA AND MEMBRANES
FACTORS THAT IMPEDE
INVOLUTION
PROLONGED LABOR & DIFFICULT
DELIVERY
ANESTHESIA
GRAND MULTIPARITY
RETAINED PLACENTAL
FRAGMENTS OR MEMBRANES
FULL URINARY BLADDER
INFECTION
CONT.
OVERDISTENTION OF THE
UTERUS
USE OF OXYTOCIN DURING
LABOR
FUNDUS
TOP PORTION OF THE UTERUS
A PALPABLE INDICATOR OF
INVOLUTION
BOGGY UTERUSSOFT,RELAXED..CAN CAUSE
HEMORRHAGE
FUNDUS SHOULD BE FIRM
Assessing Fundus
FUNDUS
LOCATION
RIGHT AFTER DELIVERY THE
FUNDUS IS MIDWAY BETWEEN
SYMPHYSIS PUBIS AND
UMBILICUS
ONE HOUR AFTER DELIVERY THE
FUNDUS RAISES TO THE
UMBILICUS OR SLIGHTLY ABOVE1CM AND REMAINS THERE FOR 24
HRS.
FUNDUS
LOCATION- FUNDAL HEIGHT
DECREASES 1CM A DAY AFTER
THE FIRST 24 HR..
BY DAY 10 AFTER THE DELIVERY
THE FUNDUS CAN NO LONGER BE
FELT
FUNDUS SHOULD BE
MIDABDOMEN
DEVIATIONS ARE ABNORMAL AND
SHOULD BE CHECKED
Deviation of Fundus Location
LOCHIA
IS THE DISCHARGE OF BLOOD
AND DEBRIS FOLLOWING
DELIVERY
TYPES-RUBRA, SEROSA, AND
ALBA
SHOULD NOT CONTAIN LARGE
CLOTS
TOTAL VOLUME-240-270 ML.
DAILY VOLUME GRADUALLY
DECREASES
LOCHIA
AMOUNT MAY BE INCREASED BY
EXCERTION OR BREASTFEEDING
POOLING WHEN CLIENT IS
RECLINING CAN OCCUR
C/SECTION CLIENT MAY HAVE
LESS BUT SHOULD HAVE LOCHIA
UNEXPLAINED INCREASE IN
AMOUNT IS ABNORMAL
LOCHIA AMOUNTS
LOCHIA RUBRA
1-3 DAYS AFTER DELIVERY
DARK RED,BLOODY
FLESHY,MUSTY ODOR
CLOTS SMALLER THAN NICKEL
BLOOD,MUCUS, SHREDS OF
DECIDUA, EPITHELIAL CELLS
LOCHIA SEROSA
4-10 DAYS AFTER DELIVERY
PINK OR BROWNISH-WATERYODORLESS
SERUM,ERYTHROCYTES,SHREDS
OF DEGENERATING
DECIDUA,LEUKOCYTES,
CERVICAL MUCOUS,BACTERIA
LOCHIA ALBA
11-21 DAYS AFTER DELIVERY
MAY PERIST TO 6 WEEKS
YELLOW TO WHITE- MAY HAVE
STALE ODOR
LEUKOCYTES,DECIDUA
CELLS,EPITHELIAL CELLS,FAT,
CERVICAL MUCUS,
CHOLESTEROL, BACTERIA
LOCHIA
UNEXPLAINED INCREASE IN
AMOUNT OR REAPPEARANCE OF
LOCHIA RUBRA IS ABNORMAL..
AFTERPAINS
CAUSED BY INERTMITTENT
UTERINE CONTRACTIONS
FOLLOWING DELIVERY
OCCUR IN ALL WOMEN
MORE PAINFUL IN MULTIPARIOUS
AND BREASTFEEDING WOMAN
ALSO IN WOMEN WHOSE UTERUS
WAS OVERDISTENDED
CERVIX
SOFT,IRREGULAR,AND
EDEMATOUS, MAYBE BRUISED
AND/OR SMALL LACERATIONS
CLOSES TO 2-3 CM AFTER
SEVERAL DAYS..FINGERTIP
AFTER 1 WEEK
MUST BE SLIGHTLY DILATED TO
ALLOW LOCHIA TO DRAIN
AFTER FIRST DELIVERY SHAPE IS
CHANGED
VAGINA
SMOOTH WALLS,EDEMATOUS
WITH MULTIPLE SMALL
LACERATIONS
PERINEAL DISCOMFORT/PAIN
SHOULD BE GONE BY 2 WEEKS
AFTER DELIVERY
LOW ESTROGEN LEVELS WILL TO
DECREASED LUBRICATION FOR 610 WEEKS
ABDOMINAL WALL
SOFT & FLABBY WITH
DECREASED MUSCLE TONE
STRIAE(STRETCH MARKS) WILL
FADE BUT STAY
DIASTISIS RECTI-SEPERATION OF
THE RECTUS MUSCLES OF THE
ABDOMEN-MAY IMPROVE IN THE
POSTPARTUM PERIOD
CARDIOVASCULAR SYSTEM
RETURNS TO PREPREGNANT
STATE WITHIN 2 WEEKS
THE ELIMINATION OF THE
INCREASED BLOOD VOLUME
DURING PREGNANCY IS DONE BY
DIURESIS
BLOOD PRESSURE SHOULD
REMAIN STABLE
CV SYSTEM -CONT.
BRADYCARDIA BEGINS SECOND
DAY-HR OF 50-70-CONT. FOR 6-10
DAYS
TACHYCARDIA-BLOOD LOSS,
TEMP.,OR OTHER PROBLEMS
WBC’S ELEVATED IN
POSTPARTUM PERIOD..LOOK FOR
INCREASE OF OVER 30% IN 6
HRS.
CV SYSTEM CONT.
DECREASED HGB IS RELATED TO
AMOUNT OF BLOOD LOSS
1ST 48 HRS POSTPARTUM ARE
THE GREATEST RISK OF
COMPLICATIONS FOR CLIENTS
WITH HEART DISEASE
RENAL SYSTEM
INCREASED BLADDER CAPACITY
AND DECREASED BLADDER TONE
LEAD TO DECREASED SENSATION
AND INCREASED RISK OF
URINARY RETENTION AND
INFECTION
POSTPATAL DIURESIS-2000-3000
ML.-ACCOUNTS FOR 5 LB WEIGHT
LOSS
A FULL BLADDER WILL DISPLACE
THE UTERUS
RENAL SYSTEM
FULL BLADDER CAN LEAD TO
UTERINE ATONY AND PP
HEMORRHAGE
FLUIDS ARE ALSO LOST
THROUGH
DIAPHORESIS..COMMONLY SEEN
AT NIGHT
GASTROINTESTINAL
SYSTEM
HUNGER AND THRIST ARE
COMMON FOLLOWING BIRTH OR
IN THE 1ST PP DAY.
CONSTIPATION-DECREASED
PERISTALSIS, USE OF NARCOTIC
ANALGESICS,DEHYDRATION,
DECREASED MOBILITY DURING
LABOR , AND FEAR OF PAIN
GI SYSTEM CONT.
HEMORRHOIDS-BECAUSE OF
PRESSURE OF PUSHING DURING
2ND STAGE OF LABOR.
Assessment for Hemorrhoids
ENDOCRINE SYSTEM
ESTROGEN AND PROGESTERONE
LEVELS DROP RAPIDLY AFTER
DELIVERY OF THE PLACENTA
MENSTRUATION USUALLY
RESUMES 7-9 WEEKS FOR
NONLACTATING WOMEN- 90% BY
12 WEEKS-1ST CYCLE IS USUALLY
ANOVULATORY
ENDOCRINE CONT.
OVULATION AND MENSTRUATION
RETURN TIME IS PROLONGED
WITH LACTATING WOMENDEPENDS WHETHER SHE IS
SUPPLEMENTING WITH
FORMULA-VARY 2 TO 18 MONTHS
PLACENTAL HORMONES WHICH
CAUSES INSULIN RESISTANCE
WILL DECREASE BY 3-4 DAYS
AFTER DELIVERY
ENDOCRINE CONT.
LACTATION
COLOSTRUM/MILK
PROLACTIN
OXYTOCIN
PSYCHOLOGICAL CHANGES
IN THE POSTPARTAL PERIOD
PHASES OF MATERNAL
ADJUSTMENT
PHASES OF PATERNAL
ADJUSTMENT
BONDING
POSTPARTUM BLUES
PHASES OF MATERNAL
ADJUSTMENT
TAKING-IN/DEPENDENT PHASETAKING-HOLD/DEPENDENTINDEPENDENT PHASELETTING-GO/INTERDEPENDENT
PHASEDEVELOPMENTAL TASKMATERNAL ROLE ATTAINMENT
1ST DICUSSED BY R.RUBIN
TAKING-IN
DEPENDENT PHASE
1ST 1-3 DAYS..CAN BE SHORTEN
PREOCCUPIED WITH OWN NEEDS
PASSIVE AND DEPENDENT
TOUCHES AND EXPLORES INFANT
NEEDS TO DISCUSS LABOR &
DELIVERY EXPERIENCE
TAKING IN FOOD ,H2O,REST, AND
CARE
TAKING-HOLD
DEPENEDENT-INDEPENDENT
PHASE
3-10DAYS POSTPARTUM
OBESSED WITH BODY FUNCTIONS
RAPID MOOD SWINGS
ANTICIPATE GUIDANCE MOST
EFFECTIVE NOW…GOOD TIME TO
TEACH
INTERESTED IN LEARNING CARE OF
BABY
LETTING-GO
INTERDEPENDENT PHASE
10 DAYS TO 6 WEEKS
POSTPARTUM
MOTHERING FUNCTIONS
ESTABLISHED
SEES INFANT AS A UNIQUE
PERSON
REESTABLISHES RELATIONSHIP
WITH HUSBAND
PATERNAL ROLE
EXPECTATIONS
REALITY
TRANSITION TO MASTERY
EXPECTATIONS
1ST STAGE
THE FATHER HAS
PRECONCEPTIONS ABOUT WHAT
LIFE WILL BE LIKE AFTER THE
BABY COMES HOME
MAY NOT BE REALISTIC
REALITY
2ND STAGE
FATHER REALIZES THAT
EXPECTATIONS ARE NOT
ALWAYS BASED ON FACT
COMMON FEELINGSSADNESS,AMBIVALENCE
JEALOUSLY
FRUSTATION
REALITY
OVERWHLMING DESIRE TO BE
MORE INVOLVED
SOME ARE PLEASANTLY
SURPRISED AT EASE AND FUN OF
PARENTING
TRANSITION TO MASTERY
3RD STAGE
FATHER MAKES CONSCIOUS
DECISION TO TAKE CONTROL
AND BECOME MORE ACTIVELY
INVOLVED WITH INFANT
BONDING
FINGERTIPS,PALMS AND THEN
ENFOLING OF INFANT
EN FACE POSITION
MOTHER USES A SOFT HIGHPITCHED TONE OF VOICE
NURSE SHOULD ASSIST BOTH
MOM AND DAD WITH BONDINGTIME/ISSUES
Face to Face with Eye Contact
POSTPARTUM BLUES
A MATERNAL ADJUSTMENT
REACTION
TRANSIENT DEPRESSION
USUALLY OCCURS BETWEEN
2ND-3RD PP DAY AND/OR WITHIN
THE 1ST 2 WEEKS PP
RELATED TO HORMONAL
CHANGES,FATIGUE, AND STRESS
ALL WOMEN EXPERIENCE IT
PP BLUES CONT.
CHARACTERIZED BY MOOD
SWINGS,ANGER, TEARFULNESS,
FEELINGS OF LETDOWN,ANOREXIA, AND SLEEING
PROBLEMS
USUALLY RESOLVES
SPONTANEOUSLY
IF CONT. OR WOMAN HAS
DEEPENING DEPRESSION MAY
HAVE PP DEPRESSION
POSTPARTAL NURSING
EVALUATE PRENATAL AND
INTRANATAL HISTORY FOR RISK
FACTORS
POSTPARTUM ASSESSMENTBUBBLE-HEB-AND PREECLAMPSIA
SCREENING
VITAL SIGNS
PP NURSING-CONT.
PREVENTING PP HEMORRHAGE
ASSESS FOR RISK FACTORS
ASSESS FUNDUS & LOCHIA
MASSAGE FUNDUS AS NEEDED
KEEP BLADDER EMPTY
ADMINSTER MEDICATIONS IF
NEEDED-PITOCIN,METHERGINE
ERGOTRATE
CONT.
PUT BABY TO BREAST EARLY AND
FREQUENTLY
`MONITOR VS
COMFORT
ICE TO PERINEUM 20 MINUTES
ON/1O-2O MINUTES OFF-1ST 24
HRS
SITZ BATHS-COOL OR WARM TID
AFTER 12-24 HRS…MGSO4
CRYSTRALS
PERICARE- AFTER USING
BATHROOM OR PRN
APPLY TOPICAL ANALGESICS-
COMFORT
TEACH CLIENT TO TIGHTEN
BUTTOCKS THE SITTING…LAY ON
SIDE
ADMINSTER ANALGESICS
KEGAL’S
H2O,FIBER,& STOOL
SOFTNERS,AMBULATE
Kegal’s Exercise
ELIMINATION
BOWEL
URINARY
INFANT CARE
SUCCESSFUL FEEDING
BATHING
SAFETY
ADL’S
POSITIONS
FOLLOW UP VISITS
SELF CARE
NUTRITION
REST
COMFORT
DISCOMFORTS
ACTIVITIES
F/U
WARNING SIGNS
CONTRACEPTION
RHOGAM
ASSESS RH NEG WOMAN
NEG INDIRECT COOMBS
RH POS BABY WITH NEG DIRECT
COOMBS
NO ALLERGIES TO GLOBULIN
PREPARATIONS
ADMINSTER 300UG IM WITHIN 72
HRS
RUBELLA VACCINE
RUBELLA TITER LESS THAN 1:8NONIMMUNE
NO ALLERGY TO NEOMYCIN
ADMINISTER O.5 ML SC PRIOR TO
DISCHARGE
CLIENT SHOULD NOT GET
PREGNANT FOR 3-4 MONTHS
NOT WITH RHOGAM
PP WARNING SGNS
BRIGHT RED BLEEDING MORE
THAN 1 PAD/HOUR OR PASSING
LARGE CLOTs
TEMPERATURE GREATER THAN
100.4 F AFTER 1ST 24 HRS.
CHILLS
EXCESSIVE PAIN ANYWHERE
REDDENED AREAS ON BREAST
PP WARNING SIGNS
REDDENED OR GAPING
EPISIOTOMY
FOUL SMELLING LOCHIA
INABLE TO VOID..BURNING..ETC
CALF PAIN,
TENDERNESS,REDNESS,
SWELLING
FLU-LIKE S/S.
Mastisis
QUESTIONS
THANK YOU
http://www.youtube.com/watch?v=EE
qj2BdVerg