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Postpartum Nursing

Postpartum Nursing. Postpartum or Puerperium. Period of 6 wks after delivery during which the reproductive system and the body returns to normal immediate--first 24 hrs early--first week late--2nd to 6th week. Dramatic Changes in every body system.

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Postpartum Nursing

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  1. Postpartum Nursing

  2. Postpartum or Puerperium Period of 6 wks after delivery during which the reproductive system and the body returns to normal immediate--first 24 hrs early--first week late--2nd to 6th week

  3. Dramatic Changes in every body system • While Changes are normal, in no other period of life is there such marked and rapid catabolism • Wt. Loss ot 15-17 lbs. Possibly more if breastfeeding.

  4. Uterus Breasts Perineum Vagina Elimination urinary bowels Endocrine Reproductive Cardiovascular Blood Changes Vital Signs Abd. musculature Sleeping and rest Psychological Changes in the following:

  5. Uterine Involution • Blood vessels contract, uterus shrinks • Involutes at 1cm/day 1cm=1fingerbreadth • Below the symphysis by 10-12 days • Process for involution=autolysis of protein • 1000gm at delivery, 60gm at 6 wks pp

  6. Autolysis • Outer decidua and autolysed protein excreted in lochia • Inner decidua forms new endometrium • Entire endometrium restored in 3 wk, except for placental site • Large bld vess. degenerate, replaced by smaller ones. • Cervix never returns to nulliparous state

  7. Nursing care r/t uterine changes • Palpate fundus at frequent intervals • q. 15” X 1hr • q. 1hr X 2 • q. 2hr X 2 • q. 4 hrs up to 24-48 hrs. post delivery • Massage if not firm • Deviation and above umb. may signal full bladder

  8. Lochia • Vaginal discharge after delivery,composed of leukocytes, epithelial cells, decidua, autolysed protein and bacteria. • Rubra--delivery to 3rd day • Serosa--days 4-10 • Alba--10--several weeks post delivery Assess color, amt, odor, clots

  9. Cramping or “Afterpains” • Primigravida--uterus tonically contracted unless clots or tissue remain in uterus. • Multipara--uterus contracts and relaxes at intervals causing “afterpains”. More severe when breasfeeding in both primiparas and multiparas.

  10. Breast Changes • Colostrum secreted from third tri. until lactation begins • Milk--lactation 3rd pp day • Engorgement from increased vascular and lymphatic circulation • Decreased/absent placental hormones cause prolactin to be secreted=lactation Check breasts for engorgement, nipple cracks, soreness

  11. Suppression of Lactation • Avoid breast stimulation • Ice • Tight bra • Do not pump or express milk • Homonal suppression (rarely)

  12. Perineal Changes • Episiotomy--subcuticular sutures • Pain for 24-48 hrs • ice for 24 hrs then heat (sitz baths) • Analgesics, systemic and topical • Sit properly • Keep clean--perineal care

  13. Evaluate Episiotomy or Perineal lac. for REEDA • Redness • Edema • Ecchymosis • Drainage • Approximation

  14. Vaginal Changes • rugae absent--return in 3 wks • edematous--venous congestion for 3 days • distention--decreases but never back to nulliparous state • lacerations • hymenal tags • labia flabby, improve but never back to nulliparous state

  15. Urinary Elimination • Bladder Changes • edema and hyperemia,extravasation • increased capacity, decreased sensitivity • overdistension with incomplete emptying • urethral trauma may cause dysuria Note, transient glycosuria, proteinuria, and keytonuria are normal in immediate pp. period.

  16. Problems with urinary elimination • Dysuria • IV fluids cause bladder fullness • regional anesthesia and decreased abdominal pressure=pt unaware of full bladder

  17. Nursing Care • Check bladder frequently post delivery • Full bladder can inhibit uterine contraction=bleeding Signs of full postpartum bladder=uterus high and displaced to side (usually R) • If no void in 4-6hrs, catheterize • Check amount of voiding (retention with overflow possible)

  18. Retention with overflow • When bladder is overdistended pt. will void small amouts without emptying bladder. • If catheterize for an overdistended bladder, remove only 1000cc and then clamp and consult MD • If unable to void after cathX2, Foley indicated

  19. Bowel Elimination Constipation r/t • decreased peristalisis • decreased intra abdominal pressure • hemorrhoidal discomfort • perineal discomfort Increase roughage and fluids, laxatives and suppositories--bowels normal by 1wk pp

  20. Endocrine Changes • Placental estrogen and progesterone removed • Prolactin increases, esp in breastfeeding women • Estrogen begins to increase to follicular levels at 3-4 wks p. Delivery • Menstruation returns--6 wks not breastfeeding, 2-18 mos breastfeeding

  21. Cardiovascular Changes • Blood volume goes rapidly from hypervolemia to hypovolemia • blood loss 400-500cc vaginal delivery 700-1000 cc Csection

  22. Blood Components • HCT (down 4pts for each pt blood lost) •  Leucocytes(15,000 to 30,000 mm3) •  Lymphocytes •  Fibrinogen--risk of thrombophlebitis •  ESR

  23. Vital Signs • BP first  then  • increases during uterine massage/pain • if PIH may stay elevated • orthostatic hypotension common • Temp first  then  • P--  • R-- 

  24. Other changes Postpartum Chill Shaking chill due to vasomotor instability Postpartum diaphoresis night sweats and increased odor

  25. Abdominal Musculature •  muscle tone--soft, weak, flabby • diastasis recti remains May do head and shoulder raises and lie on abdomen--ask MD about resumption of more vigourous activity (other muscles may be weak due to the exertion of delivery and lactic acidosis)

  26. Sleep and Rest Patterns • Sleep and rest patterns disrupted during thrird trimester and continue to be disrupted during pp period • excitement • anxiety • discomfort • baby feedings

  27. Psychological Changes The new mother must move from dependent to independent in a short time Reva Rubins three stages of the postpartum • Taking in • Taking hold • Letting go (taking over)

  28. Taking in phase • Focused on self (not infant) • dependent on others for help in care • needs assistance • decision making difficult • comfort-rest-food needs paramount • relives delivery experience May last for several hours or days

  29. Taking hold phase • Moving from dependence to independence •  energy level •  focus on infant • self care, focus on bowels, bladder, brfeed • responds to instruction, praise Lasts from 2days to 1wk

  30. Letting go phase • Giving up previous role • See self as separate from infant • Give up fantasy delivery and baby • Readjustment • Depression and grief work • from 1wk

  31. Postpartum blues • Reduction of progesterone, delayed prolactin release and changes in other placental hormones may trigger emotional instability • Body image changes and dependency needs may contribute • Overconcern re infant and self, and emotional lability are “normal” during the first 5-10 days after delivery

  32. Postpartum depression • Rejection of infant, or fears that she may harm infant call for immediate intervention. • Remind mom during postpartum teaching that these feelings sometimes occur and help is available

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