MODULE 3
THE NEWBORN
POSTPARTUM ADAPTION
• TRANSITION TO EXTRAUTERINE LIFE
• NURSING ASSESSMENT OF THE
NEWBORN
• NEWBORN NEEDS AND CARE
• POSTPARTUM ASSESSMENT
• POSTPARTUM NEEDS AND CARE
MODULE 3 PART 1A
TRANSITION TO
EXTRAUTERINE LIFE
• RESPIRATORY
– FETAL LUNG DEVELOPMENT
– ALVEOLI
– SURFACTANT
– LECITHIN/SPHINGOMYELIN RATIO
– FETAL BREATHING MOVEMENTS
RESPIRATORY
PHYSICAL (MECHANICAL) EVENTS
– FLUID IN FETAL LUNGS ALMOST
COMPLETELY EXPANDS LUNGS; AIR
SPACES FILLED
– PRODUCTION OF FLUID SHARPLY
DECLINES 2-4 DAYS BEFORE LABOR
– THORACIC SQUEEZE
RESPIRATORY ADAPTION
• AFTER BIRTH CHEST WALL RECOILS,
CREATES NEGATIVE INTRATHORAIC
PRESSURE; AIR IS SUCKED BACK
INTO LUNG FIELDS, REPLACING FLUID
• AFTER FIRST INSPIRATION, NEWBORN
EXHALES, CREATING POSITIVE
INTRATHORACIC PRESSURE
MODULE 3 PART 1B
TRANSITION TO
EXTRAUTERINE LIFE
RESPIRATORY ADAPTION
• POSITIVE PRESSURE DISTRIBUTES
INSPIRED AIR THROUGHOUT ALVEOLI
• LUNGS CONTINUE TO EXPAND WITH
EACH BREATH
• REMAINING LUNG FLUID MOVES INTO
INTERSTITIAL TISSUE
CARDIOVASCULAR ADAPTION
• BEFORE BIRTH
– ARTERIALIZED BLOOD FROM PLACENTA
– INTO FETUS THROUGH UMBILICAL VEIN
AND PASSES RAPIDLY THROUGH LIVER
INTO INFERIOR VENA CAVA
– FLOWS THROUGH FORAMEN OVALE INTO
LEFT ATRIUM TO AORTA AND ARTERIES
OF HEAD WHY?
CARDIOVASCULAR ADAPTION
– PORTION BYPASSES LIVER THROUGH
DUCTUS VENOSUS
– VENOUS BLOOD FROM LOWER
EXTREMITIES AND HEAD PASSES
PREDOMINATELY INTO RIGHT ATRIUM,
RIGHT VENTRICLE AND THEN INTO
DESCENDING PULMONARY ARTERY AND
DUCTUS ARTERIOSUS
– THEREFORE, THE FORAMEN OVALE AND
DUCTUS ARTERIOSUS ACT AS BYPASS
CHANNELS
CARDIOVASCULAR ADAPTION
– THIS ALLOWS LARGE PART OF
COMBINED CARDIAC OUTPUT TO
RETURN TO PLACENTA WITHOUT
FLOWING THROUGH THE LUNGS
• AFTER BIRTH
– INFANT’S FIRST BREATH INFLATES
LUNGS—REDUCES PULMONARY
VASCULAR RESISITANCE TO
PULMONARY BLOOD FLOW
CARDIOVASCULAR ADAPTION
– DROP IN PULMONARY ARTERY
PRESSURE
– DECLINE IN RIGHT ATRIUM PRESSURE
– INCREASED PULMONARY BLOOD FLOW
RETURNED TO LEFT SIDE OF HEART
INCREASES PRESSURE IN LEFT ATRIUM
– THIS CHANGE CAUSES FUNCTIONAL
CLOSURE OF FORAMEN OVALE
CARDIOVASCULAR ADAPTION
– DUCTUS ARTERIOSUS CONSTRICTS AS A
RESULT OF ELEVATION OF SYSTEMIC
VASCULAR PRESSURE ABOVE
PULMONARY VASCULAR PRESSURE
WHICH INCREASES PULMONARY BLOOD
FLOW
– INCREASE IN BLOOD OXYGENATION
CONCENTRATION CAUSES MUSCULAR
WALLS OF DUCTUS ARTERIOSUS TO
CLOSE IN APRROX. 12 HOURS
CARDIOVASCULAR ADAPTION
• CAUSE OF CLOSURE OF DUCTUS VENOSUS
UNKNOWN
• CLOSURE ALLOWS BLOOD TO FLOW TO
THE LIVER
– THOUGHT TO BE DO TO:
• PRESSURE CHANGES AFTER CUTTING OF
CORD
• CARDIAC OUTPUT
• MECHANICAL PRESSURE CHANGES
Figure 3–11 Fetal circulation. Blood leaves the placenta and enters the fetus through the umbilical vein. After circulating through the
fetus, the blood returns to the placenta through the umbilical arteries. The ductus venosus, the foramen ovale, and the ductus
arteriosus allow the blood to bypass the fetal liver and lungs.
MODULE 3 PART 1C
TRANSITION TO
EXTRAUTERINE LIFE
CHEMICAL STIMULI
• CHEMICAL: FIRST BREATH (GASP).
CESSATION OF PLACENTAL BLOOD FLOW
STIMULATES MEDULLA TO TRIGGER
RESPIRATORY EFFORTS.
•
SURFACTANT REDUCES SURFACE
TENSION OF LUNG MUCOSA AND ALLOWS
EXHALATION WITHOUT LUNG COLLAPSE
THERMAL STIMULI
• THERMAL: SUDDEN CHILLING OF THE
MOIST INFANT STIMULATES THE SKIN
SENSORY RECEPTORS TO TRANSMIT
IMPULSES TO THE RESPIRATORY CENTER,
WHICH STIMULATES THE INITIATION OF
BREATHING.
•
EXCESSIVE COLD MAY RESULT IN COLD
STRESS
SENSORY STIMULI
• SENSORY:
– TACTILE, AUDITORY, AND VISUAL
STIMULI CAN HAVE AN EFFECT ON
RESPIRATION (DRYING OF INFANT, SKIN
TO SKIN CONTACT)
HEMATOPOIETIC SYSTEM
• AFTER BIRTH RBCS INCREASE, CELL SIZE
DECREASES
• HEMACRIT INCREASES 1-2 DAYS AFTER
BIRTH AS A RESULT OF:
– PLACENTAL TRANSFUSION
– LOW FLUID INTAKE
– DIMINISHED EXTRACELLULAR VOLUME
DECREASED % OF NEUTOPHILS
LEUKOCYTOSIS
MODULE 3 PART 1D
TRANSITION TO
EXTRAUTERINE LIFE
THERMOREGULATION
• NEONATE MUST BALANCE HEAT LOSS AND
HEAT GENERATION
– HEAT IS GENERATED BY METABOLISM OF
BROWN FAT
HEAT LOSS THROUGH:
– CONVECTION
– RADIATION
– CONDUCTION
– EVAPORATION
Figure 21–6 The distribution of brown adipose tissue (brown fat) in the newborn. Source: Adapted from Davis, V. (1980, November–December). Structure and
function of brown adipose tissue in the neonate. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 9, 364.
THERMOREGULATION
EXPLAIN WHY NEWBORNSNEWBORNS
HAVE DIFFICULTY WITH
THERMOREGULATION RELATED TO:
• SHIVERING
• SUBCUTANEOUS FAT
• BODY MASS AND WEIGHT
THERMOGENESIS
• HEAT PRODUCTION
– INCREASED BMR
– MUSCULAR ACTIVITY
– NONSHIVERING THERMOGENESIS (NST)
NEWBORNS CONSERVE HEAT WITH A
FLEXED POSTURE
THERMOREGULATION
• RELATE THE PROCESS OF
THERMOGENESIS IN THE NEWBORN
AND THE MAJOR MECHANISMS OF
HEAT LOSS TO THE CHALLENGE OF
MAINTAINING NEWBORN THERMAL
STABILITY.
MODULE 3 PART 1E
TRANSITION TO
EXTRAUTERINE LIFE
HEPATIC ADAPTION
• IRON CONTENT STORED IN ______.
• CARBOHYDRATE METABOLISM—LOW
CARBOHYDRATE RESERVES
• MAIN SOURCE OF ENERGY IS _______.
• LIVER BEGINS TO CONJUGATE BILIRUBIN
• LACK OF INTESTINAL FLORA RESULTS IN ?
CONJUGATION OF BILIRUBIN
• UNCONJUGATED BILIRUBIN ATTACHES TO
GLUCURONIC ACID IN THE LIVER AND BECOMES
CONJUGATED
• THE CONJUGATED BILIRUBIN CAN NOW BE
EXCRETED BECAUSE IT HAS CHANGED FROM FAT
SOLUBLE TO LIVER SOLUBLE
• TOTAL BILIRUBIN IS BOTH THE CONJUGATED AND
UNCONJUGATED BILIRUBIN < 3MG/DL
CONJUGATION OF BILIRUBIN
• TYPES OF BILIRUBIN
– CONJUGATED
– UNCONJUGATED
– TOTAL
– UNCONJUGATED BILIRUBIN IS THE BREAKDOWN
PRODUCT DERIVED FROM Hgb and is not in
excretable form (FAT SOLUBLE)
• BILIRUBIN IS TRANSPORTED IN BLOOD VIA
ALBUMIN; BINDS WITH ALBUMIN FOR
EXCRETION
• BILIRUBIN IS TRANSFERRED INTO THE
HEPATOCYTES IN THE LIVER
PHYSIOLOGICAL JAUNDICE
• VERY COMMON IN NEWBORNS
• APPEARS AFTER FIRST 24 HRS OF LIFE
• ACCELERATED DESTRUCTION OF FETAL RBCs
– INCREASED AMOUNTS OF BILIRUBIN DELIVERED
TO LIVER
MAY BE CAUSED BY:
– INADEQUATE HEPATIC CIRCULATION
– DEFECTIVE UPTAKE OF BILIRUBIN FROM THE
PLASMA
– DEFECTIVE CONJUGATION OF BILIRUBIN
MODULE 3 PART 1F
TRANSITION TO
EXTRAUTERINE LIFE
GI ADAPTION
• GASTROINTESTINAL ADAPTION
– LACTOSE
– PROTEIN
– FAT
– SUFFICIENT ENZYMES EXCEPT AMYLASE
– CARDIAC SPHINCTER IMMATURE
• DIGESTION AND ABSORPTION
• ELIMINATION
– MECONIUM
– TRANSITIONAL STOOLS
FLUID AND ELECTROLYTE ADAPTION
URINARY ADAPTION
• OVER 90% OF NEWBORNS VOID WITHIN 24 HOURS
AFTER BIRTH
• IF NO VOIDING BY 48 HOURS:
– BLADDER ASSESSMENT
• PAIN
• RESTLESSNESS
• DISTENTION
FLUID AND ELECTROLYTE ADAPTION
• LESS ABLE TO CONCENTRATE URINE
• LIMITED TUBULAR REABSORPTION OF WATER
• LIMITED EXCRETION OF SOLUTES
• LIMITED DILUTIONAL CAPABILITIES
IMMUNOLOGIC ADAPTION
• PREGNANT WOMAN FORMS ANTIGENS IN
RESPONSE TO ILLNESS—ACTIVE
ACQUIRED IMMUNITY
• IgG—ONLY IMMUNOGLOGULIN THAT
PASSES THROUGH THE PLACENTA—
RESULTING IN PASSIVE ACQUIRED
IMMUNITY. TRANSFERRED PRIMARILY IN
THE THIRD TRIMESTER
IMMUNOLOGIC ADAPTION
• IgM—USUALLY NOT PASSIVELY
TRANSFERED
– ELEVATED LEVELS MAY INDICATE FETAL
ANTIGENIC ACTIVITY IN UTERO
• IgA—PASSIVE ACQUIRED IMMUNITY VIA
COLOSTRUM FUNCTIONS NOT FULLY
UNDERSTOOD (RESEARCH: RESP., GI,
EYES)
MODULE 3 PART 1G
TRANSITION TO
EXTRAUTERINE LIFE
PERIODS OF REACTIVITY AFTER
BIRTH
• FIRST PERIOD OF REACTIVITY
• PERIOD OF INACTIVITY
• SECOND PERIOD OF REACTIVITY
NEUROLOGIC &SENSORY PERCEPTION
FUNCTION
• FACTORS AFFECTING NEONATE’S
ORGANIZATION AND QUALITY OF MOTOR
ACTIVITY
– SLEEP-WAKE STATES
– ENVIRONMENTAL STIMULI
– CHEMICAL IMBALANCE
– HYDRATION STATUS
– RECOVERY FROM STRESS OF BIRTH
BEHAVIORAL STATES OF NEWBORN
• HABITUATION
• ORIENTATION
• SELF QUIETING ABILITY
• AUDITORY
• OLFACTORY
• TASTING, TACTILE
BEHAVIOR STATES OF NEWBORN
• SLEEP STATES
– DEEP OR QUIET
– ACTIVE REM
• ALERT STATES
– DROWSY, SEMIDOZING
– WIDE AWAKE (QUIET ALERT)
– ACTIVE AWAKE (ACTIVE ALERT)
– CRYING
MODULE 3 PART 2A
NEWBORN ASSESSMENT
NEWBORN ASSESSMENT
• GESTATIONAL AGE ASSESSMENT
– EXTERNAL PHYSICAL CHARACTERISITICS
– NEUROLOGIC/NEUROMUSCULAR
DEVELOPMENT
THIS WILL BE PERFORMED IN CLINICAL
Figure 22–12 Classification of newborns based on maturity and intrauterine growth. Sources: Adapted from Lubchenco, L. O.,
Hansman, C., & Boyd, E., (1966). Intrauterine growth in length and head circumference as estimated from live births at gestational
ages from 26 to 42 weeks. Pediatrics, 37, 403–408; Battaglia, F. C., & Lubchenco, L. O. (1967). A practical classification of newborn
infants by weight and gestational age. Journal of Pediatrics, 71, 159.
PHYSICAL ASSESSMENT
• DATA FROM OTHER SOURCES CAN
INFLUENCE ASSESSMENT FINDINGS:
– MATERNAL PRENATAL HISTORY
– BIRTHING HISTORY
– MATERNAL ANALGESIA/ANESTHESIA
– TREATMENT GIVEN IMMEDIATELY AFTER
BIRTH
– GESTATIONAL AGE ASSESSMENT
PHYSICAL ASSESSMENT
• WEIGHT, LENGTH, CHEST, HEAD,
ABDOMINAL MEASUREMENTS
• VITAL SIGNS
– TEMPERATURE, PULSE, RESPIRATION,
BLOOD PRESSURE, PULSE OX
WHAT ARE THE AVERAGE
MEASUREMENTS FOR THE NEWBORN?
PHYSICAL ASSESSMENT
• HANDS OFF ASSESSMENT: OBSERVATION
– NAME SIX AREAS YOU COULD OBSERVE
WITH THE NEWBORN (HANDS OFF
ASSESSMENT)
PHYSICAL ASSESSMENT
• HEAD
– PROPORTIONALLY LARGER THAN BODY
– SHAPE, SIZE, APPEARANCE
– MOLDING
– FONTANELLES
– DEVIATIONS
Figure 22–24 Cephalhematoma is a collection of blood between the surface of a cranial bone and the periosteal membrane. This is a
cephalhematoma over the left parietal bone. Source: Potter, E. L., & Craig, J. M. (1975). Pathology of the fetus and infant (3rd ed.).
Chicago: Year Book Medical Publishers. Reproduced with permission.
Figure 22–25 Caput succedaneum is a collection of fluid (serum) under the scalp. Source: Photo courtesy of Mead Johnson
Laboratories, Evansville, IN.
MODULE 3 PART 2B
NEWBORN ASSESSMENT
PHYSICAL ASSESSMENT
• SKIN
– COLOR, TEXTURE, TURGOR
DEVIATIONS
– TELANGIECTATIC NEVI (STORK BITES)
– MONGOLIAN SPOTS
– ACROCYANOSIS
– HARLEQUIN SIGN
– JAUNDICE
– ERYTHEMA TOXICUM
– MILIA
– MOTTLING
PHYSICAL ASSESSMENT
• EYES
– TEARLESS CRYING
– PERPHERAL VISION
– CAN FIXATE ON NEAR OBJECTS
– BLINKS IN RESPONSE TO BRIGHT
LIGHT
– PUPILLARY REFLEX PRESENT?
PHYSICAL ASSESSMENT
• NOSE
– APPEARANCE
– MIDLINE
– PATENT NARES
• EARS
– PLACEMENT
– SOFT, PLIABLE, READY RECOIL
– DEVIATIONS
MODULE 3 PART 2C
NEWBORN ASSESSMENT
PHYSICAL ASSESSMENT
• NECK
– APPEARANCE—SHORT WITH SKIN FOLDS
– CLAVICLE
– INSPECTION
– REFLEXES—TONIC NECK, MORO
• CHEST
– APPEARANCE, SIZE, SHAPE
– CIRCUMFERENCE
– EXPANSION, RETRACTION
– DEVIATIONS
PHYSICAL ASSESSMENT
• MOUTH
– SYMMETRY OF MOVEMENT
– REFLEXES—GAG, SWALLOWING,
SUCKING
– HARD/SOFT PALATE
– EPSTEIN’S PEARLS
– TONGUE—PROPORTION, COLOR,
MOVEMENT, PLACEMENT
DEVIATIONS
PHYSICAL ASSESSMENT
• HEART
– LOCATION
– PMI
– RATE, RHYTHM
– FUNCTIONAL MURMURS
• ABDOMEN
– APPEARANCE, SIZE, SHAPE
– DIASTASIS RECTI, BOWEL SOUNDS
– UMBILICAL CORD
• BREASTS
– DISTANCE BETWEEN NIPPLES, SHAPE
– DEVIATIONS
PHYSICAL ASSESSMENT
• BLADDER
• FEMORAL PULSES
• INGUINAL AREA
• BLADDER
• GENITALS
– MALE—PENIS, SCROTUM, TESTES,
MEATUS
– FEMALE—MONS, CLITORIS, LABIA
MAJORA, MINORA, DISCHARGE
– DEVIATIONS
PHYSICAL ASSESSMENT
• BUTTOCKS, ANUS
– SYMMETRY
– ANUS PATENT
– GLUTEAL FOLDS
• EXTREMITIES, TRUNK
– RANGE OF MOTION, FLEXION,
EXTENSION
– DEVIATIONS
PHYSICAL ASSESSMENT
• EXTREMITIES
– ARMS/LEGS: EQUAL IN LENGTH,
SPONTANEOUS JOINT MOVEMENT,
FLEXED WHEN QUIET, SYMMETRICAL
MOVEMENT
– HANDS/FEET: CORRECT # OF FINGERS,
TOES, PALMAR, PLANTAR CREASES
MODULE 3 PART 2D
NEWBORN ASSESSMENT
PHYSICAL ASSESSMENT
• HIPS
– ABDUCT TO MORE THAN 60 DEGREES
– EQUAL KNEE HEIGHT
– BARLOW, ORTOLANI MANEUVER
• SPINE
– C-SHAPED
– FLAT, STRAIGHT
– CORRECT # OF VERTEBRAE
– TRUNCAL INCURVATION
– DEVIATIONS
Figure 22–34 A, Congenitally dislocated right hip in a young infant as seen on gross inspection. B, Barlow’s (dislocation)
maneuver. Baby’s thigh is grasped and adducted with gentle downward pressure. Dislocation is palpable as femoral head slips out of
acetabulum. C, Ortolani’s maneuver puts downward pressure on the hip and then inward rotation. If the hip is dislocated, this
maneuver forces the femoral head over the acetabular rim with a noticeable “clunk.”
NEUROLOGICAL ASSESSMENT
• GENERAL PHYSICAL CHARACTERISTICS
• OBSERVABLE BEHAVIORS:
– STATE OF ALERTNESS, CRY
– RESTING POSTURE
– QUALITY OF MUSCLE TONE, MOTOR
ACTIVITY
PHYSICAL ASSESSMENT
•
NEUROMUSCULAR
– SYMMETRICAL MOVEMENT
– HEAD LAG
•
REFLEXES
–
–
–
IMMATURITY/DAMAGE TO THE CNS IS
CHARACTERIZED BY A VARIETY OF
CHANGES IN REFLEXES
PROTECTIVE
FEEDING
MODULE 3 PART 2E
NEWBORN ASSESSMENT
PHYSICAL ASSESSMENT








MORO
BABINSKI
ROOTING
SUCKING
PRONE CRAWL
TONIC NECK
STEPPING
BLINKING, YAWNING, COUGHING,
SNEEZING, DRAWING AWAY FROM PAIN
NEUROLOGICAL ASSESSMENT
ABNORMAL FINDINGS INCLUDING
FLACCIDITY, TREMORS, FEEDING
DIFFICULTIES, AND ASYMMETRY OF
MOVEMENTS MAY INDICATE
NEUROLOGICAL DAMAGE AND NEED
FURTHER EVALUATION. WHAT MAY
BE THE POSSIBLE CAUSES MAY BE
RELATED TO THE ABOVE FINDINGS?
MODULE 3 PART 3
ADMISSION PRODEDURES,
NEEDS AND CARE
ADMISSION PROCEDURES
• WHY DO WE PERFORM A PHYSICAL &
GESTATIONAL ASSESSMENT WITHIN TWO
HOURS OF BIRTH?
• STABLE VITAL SIGNS
• CLEAR AIRWAY
• NEUTRAL THERMAL ENVIRONMENT
• PROPHYLACTIC VITAMIN K
Figure 23–3 Injection sites. The middle third of the vastus lateralis muscle is the preferred site for intramuscular injection in the newborn. The middle third of
the rectus femoris is an alternate site, but its proximity to major vessels and the sciatic nerve requires caution in using this site for injection.
ADMISSION PROCEDURES
• PROPHYLACTIC EYE TREATMENT
• ASSESSMENT OF NEONATAL
DISTRESS
• FIRST FEEDING
• PARENT NEWBORN ATTACHMENT
NURSING CARE OF NEWBORN
• MAINTENANCE OF
CARDIOPULMONARY FUNCTION
• THERMOREGULATION
• ADEQUATE HYDRATION
• SKIN INTEGRITY
• SAFETY PROMOTION—PREVENTION
OF COMPLICATIONS
• CIRCUMCISION
NURSING CARE OF THE NEWBORN
• PARENT TEACHING
– EXPECTED INFANT BEHAVIORS
– GROWTH AND DEVELOPMENT
PARAMETERS
– SAFETY ISSUES
– NEWBORN SCREENING/IMMUNIZATIONS
– NEWBORN CARE
– NEWBORN FEEDING
NURSING CARE OF THE NEWBORN
• ENHANCING PARENT-INFANT
ATTACHMENT
• PARENT TEACHING
– PHYSICAL CHARACTEISTICS OF
NEWBORN
– BONDING PROCESS
– SLEEP/WAKE CYCLES
– COMFORTING TECHNIQUES
MODULE 3 PART 4 NEWBORN
NUTRITION
NUTRITIONAL NEEDS OF NEWBORN
•
•
•
•
•
•
•
CALORIES
PROTEIN
FAT
CARBOHYDRATES
VITAMINS, MINERALS
FLUID REQUIREMENTS
WEIGHT GAIN
BREAST FEEDING
• ADVANTAGES
– IMMUNOLOGIC
– NUTRITIONAL
– PSYCHOSOCIAL
– CONVENIENCE
• DISADVANTAGES
– MEDICAL CONTRAINDICATIONS
– MATERNAL MEDICATIONS
– CONTAMINANTS IN BREAST MILK
BREAST FEEDING
– EXCLUSION OF FATHER
– DIFFICULT TO MAINTAIN WITH MOTHER
WORKING OUTSIDE THE HOME
• COMPOSITION OF BREAST MILK
– COLOSTRUM
– TRANSITIONAL MILK
– MATUREMILK
– FOREMILK
– HINDMILK
FORMULA FEEDING
• ADVANTAGES
– PARENTS CAN SHARE FEEDING
– EASIER FOR MOTHER WHO WORKS
OUTSIDE THE HOME
• DISADVANTAGES
– FORMULAS PREPARATION
– EXPENSE
– ALLERGIC REACTIONS TO FORMULA
– LACK OF IMMUNOLOGIC PROPERTIES
MODULE 3 PART 5
POSTPARTUM ADAPTION
POSTPARTUM PHYSICAL
ADAPTIONS
•
•
•
•
•
•
•
INVOLUTION OF THE UTERUS
CHANGES IN FUNDAL POSITION
LOCHIA
CERVICAL AND VAGINAL CHANGES
PERINEAL CHANGES
ABDOMEN
GASTROINTESTINAL
POSTPARTUM PHYSICAL
ADAPTIONS
•
•
•
•
•
•
URINARY TRACT
VITAL SIGNS
BLOOD VALUES
WEIGHT LOSS
POSTPARTAL DIAPHORESIS
“AFTERPAINS”
POSTPARTUM PSYCHOLOGIC
ADAPTIONS
• MATERNAL ROLE
– TAKING IN PERIOD
– TAKING HOLD PERIOD
– BINDS IN PERIOD
• MATERNAL ROLE ATTAINMENT
– ANTICIPATORY STAGE
– FORMAL STAGE, INFORMAL STAGE
– PERSONAL STAGE
DEVELOPMENT OF PARENT INFANT
ATTACHMENT
POSTPARTUM PSYCHOLOGIC
ADAPTION
• INITIAL BEHAVIOR
– TOUCHING
– EN FACE POSITION
– SENSE OF SMELL
– CONNECTEDNESS
• ACQUAINTANCE PHASE
• PHASE OF MUTUAL REGULATION
• RECIPROCITY
POSTPARTUM PSYCHOLOGIC
ADAPTION
• POSTPARTUM “ BLUES’’
• POSTPARTUM DEPRESSION
• POSTPARTUM PSYCHOSIS
CULTURAL INFLUENCE IN POSTPARTUM
PERIOD
• NON-WESTERN CULTURES
EMPHASIZE POSTPARTUM PERIOD
•
•
•
•
FOOD AND LIQUIDS AFTER BIRTH
HOT-COLD BALANCE
ROLE OF GRANDMOTHER
ROLE OF FATHER
MODULE 3 PART 6
POST PARTUM ASSESSMENT
POSTPARTUM ASSESSMENT
•
•
•
•
•
•
•
•
VITALS SIGNS, BREATH SOUNDS
B
U
B
B
L
E
H
POSTPARTUM ASSESSMENT
• CULTURAL ASSESSMENT
• PSYCHOLOGIC ADAPTION
• ATTACHMENT ASSESSMENT
• EDUCATION AND TEACHING
POSTPARTUM NURSING CARE
• PROMOTION OF PHYSICAL WELL
BEING
– UTERINE STATUS
– VS
– CARDIOVASCULAR STATUS
– ELIMINATION PATTERNS
– NUTRITIONAL STATUS
– SLEEP/REST
– COMFORT PROMOTION
POSTPARTUM NURSING CARE
• EDUCATIONAL NEEDS
• PARENT INFANT ATTACHMENT
• RUBELLA IMMUNITY
• PREVENT DEVELOPMENT OF
ANTIGENS
• TREAT ANEMIA
POSTPARTUM NURSING CARE
• COMFORT MEASURES
– PERINEAL DISCOMFORT
– AFTERPAINS
– IMMOBILITY
– DIAPHORESIS
– SUPPRESION OF LACTATION
– PROMOTION OF REST