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Post Partum Period

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Post Partum Period

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  1. Post Partum Period Mary L. Dunlap MSN, APRN Fall 10

  2. Post Partum • Begins immediately after child birth through the 6th post partum week • Reproductive track returns to nonpregnant state • Adaptation to the maternal role and modification to the family system

  3. Safety for Mother and Infant • Prevent infant abductions • Check ID bands • Educate mother about safety measures

  4. Clinical Assessment • Review Antepartum and Intrapartum history • Receive report • Determine educational needs • Consider religious and cultural factors • Assess for language barriers

  5. Breast Uterus Bladder Bowel Lochia Episiotomy Legs Emotion Post Partum AssessmentBUBBLE-HE

  6. Vital signs Temperature Pulse Blood pressure Respirations Early Assessment

  7. Inspect for size, contour, asymmetry and engorgement Nipples check for cracks, redness, fissures Note if nipples are flat, inverted or erect Evaluate for mastitis Breast Assessment

  8. Supportive bra Correct position Correct latch-on technique Warm showers Expose to air Nursing Care Lactating Mother

  9. Avoid stimulation Wear support bra 24hrs Ice packs or cabbage leaves Mild analgesic for discomfort Nursing CareNon-Lactating Mother

  10. Location immediately after birth Descends 1 cm/day Consistency- firm/boggy Location Height- measured in fingerbreadths Assessment of Uterus

  11. Boggy fundus- massage until firm Medications- Pitocin, Methergine, Hemabate Teach new mom to massage her fundus Nursing care

  12. Afterpains Intermittent uterine contractions due to involution Primiparous-mild Multipara- more pronounced

  13. Patient in a prone position and place a small pillow under her abdomen Ambulation Medicate with a mild analgesic Nursing Interventions

  14. Spontaneous void 6-8 hrs Monitor output Postpartum Diuresis Bladder

  15. Encourage frequent voiding every 4-6 hours Monitor intake and output for 24 hrs Early ambulation Void within 4 hrs after birth Catheterize if unable to void Nursing care

  16. Bowel • Anatomy returns to normal location • Relaxin depresses bowel motility • Diminished intraabdominal pressure • Incontinence if sphincter lacerated • Spontaneous BM 2nd – 3rd post partum day

  17. Increase fiber in diet 6-8 glasses of water or juice Stool softener Laxative Sitz bath for discomfort Medications for hemorrhoids Nursing Care

  18. Lochia • Mixture of erythrocytes, epithelial cells, blood, fragments of decidua, mucus and bacteria • As involution proceeds it is the necrotic sloughed off decidua • 240-270 ml • Cesarean less • Present for 3-6 weeks

  19. Lochia • Rubra • Serosa • Alba • Documentation

  20. Educate mother on the stages of lochia Caution mother that an increase, foul odor or return to rubra lochia is not normal Instruct patient to change peri pad frequently Peri care after each void Nursing Care

  21. 1-2 inch incision in the muscular area between the vagina and the anus Assess REEDA Episiotomy care Episiotomy

  22. Peri care Ice packs Sitz baths Dry heat Topical medications Nursing Care

  23. Pain Assessment Determine source Document location, type and duration Interventions

  24. Homans’ sign Clinical assessment Assess for DVT

  25. Transient periods of depression during the first 1 to 2 weeks postpartum Tearfulness Sad feeling Confusion Insomnia Postpartum Blues

  26. Remind mom that the “Blues” are normal Encourage rest Utilize relaxation techniques Share her feelings with her partner If symptoms do not resolve and progress to depression medical treatment needs to be sought Nursing Care

  27. Maternal Physiological Adaptations

  28. Decrease in blood volume Elevated WBC Increased Fibrinogen Hematological System

  29. Hormonal Levels • Estrogen and Progesterone decrease • Anterior pituitary-prolactin for lactation • Expulsion of the placenta- placental lactogen, cortisol, growth hormone, and insulinase levels decrease • “Honeymoon phase”- insulin needs decrease

  30. Neurological System Maternal fatigue Transient neurological changes Headaches Carpel tunnel improvement

  31. GFR, Creatinine, and BUN return to prepregnant levels within 2-3 months Urinary glucose levels return to nonpregnant levels by 2nd PP wk Protienuria resolves by the 6th PP wk Natriuresis / Diuresis Renal

  32. Integumentary System • Darken pigmentation gradually fades • Hair regrowth returns to normal in 6-12 months • Striae( stretch marks) fade to silvery lines

  33. Cardiovascular System • Heart returns to normal position • Cardiac output elevated above prelabor levels up to 48 hrs. PP

  34. Immune System Rubella • Administer to nonimmune mothers • Safe for nursing mothers • Avoid pregnancy for 1 month • Flu-type symptoms may occur

  35. Rho (D) immune globulin Mother Rh negative, infant Rh positive Negative coombs’ test 300 mcg of RhoGam within 72 hrs after delivery Card issued to mother Immune System

  36. Involution of uterus Healing of placental site Vaginal changes Reproductive System

  37. Menstruation and Ovulation Nonlactactating mother • Menstruation returns in 6-8 wks • First cycle may be anovulatory Lactating mother • Delayed ovulation and menstruation

  38. Relaxation of pelvic joints, ligaments, and soft tissue Muscle fatigue and general body aches from labor and delivery of newborn Rectus abdominis diastasis Musculoskeletal System

  39. Multicultural Nursing Care Enhance Cultural Sensitivity Understand cultural influences on the post partum period Provide culturally appropriate care

  40. Gloves safety glasses Discourage breast feeding Avoid contact personal body fluid with infants mucous membranes HIV/AIDS

  41. Tubal ligation Cesarean birth Postpartal Surgical Patient

  42. Breast Feeding Optimal method of feeding infant Breast milk- Bacteriologically safe, fresh, readily available Box 15-3 pg.489 Breastfeeding benefits

  43. Lactogenesis- secretion of milk Milk ejection reflex- “let down” reflex Breastfeeding

  44. Cue signs- Box 15-4 pg. 492 Latch-on- Fig 15-8 pg 492 Assess for milk let down Breastfeeding

  45. Breastfeeding Positions Cradle hold Foot ball Side lying Fig 15-10 pg 494

  46. Incorrect latch-on Inverted nipples Breast engorgement Ineffective Breastfeeding

  47. Room temperature- 4 hrs Refrigerator- 5-7 days Deep freezer- 6-7 months Collection and Storage Breast Milk

  48. Formula Feeding Formula preparation Periodically check nipple integrity Bottle preparation

  49. Family and Infant Bonding Transitioning to parenthood Assuming the mothering role Parental bonding Factors that interrupt bonding

  50. Transitioning to parenthood Difficult and challenging Provide emotional support Accurate information Nursing goal create a supportive teaching environment