44705507 Postpartal Care

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Manila Central UniversityCollege of Nursing

Midwiferyand


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POSTPARTAL


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OVERVIEW

A. ESSENTIAL CONCEPTS

B. GOALS OF POSTPARTAL CARE

C. FACTORS AFFECTING THEPOSTPARTAL EXPERIENCE

D.NURSING RESPONSIBILITIES

Postpartum period


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Postpartum period

ESSENTIALCONCEPTS


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ESSENTIAL CONCEPTSPOSTPARTUM CARE

Postpartum period

Refers to the medical and

nursing care given to a patientfrom the time of delivery untilher body returns to near its

nonpregnant state


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ESSENTIAL CONCEPTSPUERPERIUM

Is the 6-week period after delivery

Beginning w/ termination of labor

and ending w/ the return of thereproductive organs to nonpregnantstate

A physical and psychologicaladjustment to the process ofchildbearing

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ESSENTIAL CONCEPTS

INVOLUTIONProgressive changes

in the uterus afterdelivery

Leading to its return

to prepregnant stateand condition

Postpartum period


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ESSENTIAL CONCEPTS

POSTPARTAL PERIOD

Sometimes referred as the

fourth stage of pregnancy

Postpartum period


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ESSENTIAL CONCEPTS

One aspect of care thatcommonly suffers w/ the trend

toward earlier discharge issupport in breast-feeding

Postpartum period


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GOALS OF

POSTPARTAL

CARE


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GOALS OF

POSTPARTAL CAREPromote normal involution andreturn to the nonpregnant state

Postpartum period


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GOALS OF

POSTPARTAL CAREPrevent or minimize postpartumcomplications

Postpartum period


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GOALS OF

POSTPARTAL CAREPromote comfort and healing ofpelvic, perianal, and perinealtissues

Postpartum period


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GOALS OF

POSTPARTAL CAREAssist in restoration of normal bodyfunctions

Postpartum period


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GOALS OF

POSTPARTAL CAREIncrease understanding ofphysiologic and psychological

changes

Postpartum period


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GOALS OF

POSTPARTAL CAREFacilitate newborn care and self-care by the new mother

Postpartum period


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GOALS OF

POSTPARTAL CARE

Postpartum period

Promote newborns successfulintegration into the family unit


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GOALS OF

POSTPARTAL CARESupport parenting skills and parent-infant attachment

Postpartum period


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GOALS OF

POSTPARTAL CAREProvide effective dischargeplanning, including appropriate

referral for homes care follow-up

Postpartum period


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Postpartum period

Factors affecting

the postpartal

experience


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Factors affecting the

postpartal experience

Postpartum period

Nature of labor and delivery andbirth outcome


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postpartal experiencePreparation for labor and deliveryand for parenting

Postpartum period


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postpartal experienceAbruptness of the transition toparenthood

Familys individual and collectiveexperiences with childbearing andchildrearing

Family members role expectation

Postpartum period


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postpartal experienceSensitivity that increase the risk ofpostparum complications include:

Preeclampsia or eclampsiaDM

Cardiac problems uterine overdistension

Abruptio placenta or Placenta previaPrecipitous or prolonged labor, difficultdelivery, extended period of time spent instirrups

Postpartum period


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Postpartum period

NURSING

RESPONSIBILITIES


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NURSING

RESPONSIBILITIESProvide sensitive professional careto the new parents, which

includes:a.Accurate assessment of mothers

physiologic and psychological status

b. Anticipatory guidance and healthteaching as needed

Postpartum period


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NURSING

RESPONSIBILITIESFacilitate the familys bondingexperience

Postpartum period


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Physiological

changes ofPostpartumperiod


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POSTPARTAL

BIOPHYSICAL CHANGESA. REPRODUCTIVE SYSTEMB. ENDOCRINE SYSTEM

C. CARDIOVASCULAR SYSTEMD. RESPIRATORY SYSTEM

E. RENAL & URINARY SYSTEM

F. GASTROINTESTINALSYSTEMG. MUSCULOSKELETAL SYSTEM

H. INTEGUMENTARY SYSTEM

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REPRODUCTIVE

SYSTEM

CHANGES

Postpartum period

REPRODUCTIVESYSTEM CHANGES

UTERUSLOCHIA

CERVIX

VAGINA

PERINEUM

BREAST


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REPRODUCTIVE

SYSTEM

CHANGES:

Postpartum period

uterus


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REPRODUCTIVE SYSTEM

CHANGESUterus

Contracts firmly

Reducing its size by over ;remains this size for 2 days, then

decreases in size (involution)Descends one finger breadth perday

Postpartum period


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REPRODUCTIVE SYSTEM

CHANGESUterus

@ 10 to 14 days postpartumcannot be palpated abdominally

Returns to nonpregnant state by

4 to 6 weeks postpartum

Postpartum period


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REPRODUCTIVE SYSTEM

CHANGESUterus

Site of placental attachmentrequire - 6 to 7 weeks to heal

Endometrial regeneration require

6 weeks

Postpartum period


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REPRODUCTIVE

SYSTEM

CHANGES:

Postpartum period

lochia


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REPRODUCTIVE SYSTEM

CHANGESLochia

Discharge from uterus during thefirst 3 weeks ff. delivery

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Postpartum period

Color Days Components

Lochia

rubra

Dark red 1-3 Blood & cellular

debris from

decidua

Lochiaserosa Pinkishbrown 3-10 Mostly serumSome blood

Tissue debris

Lochia

alba

Yellowish

white

10-14 Leukocytes w/

decidua

Epithelial cells

Mucus


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REPRODUCTIVE

SYSTEM

CHANGES:

Postpartum period

cervix


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REPRODUCTIVE SYSTEM

CHANGESCervixBecomes thicker and firmer

By end of first postpartal weekdilated1 cm

Complete cervical involution

3 to 4 monthsCervical os

From round to elongated

Postpartum period


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REPRODUCTIVE

SYSTEM

CHANGES:

Postpartum period

vagina


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REPRODUCTIVE SYSTEM

CHANGESVaginaSmooth and swollen

w/ poor tone after delivery

Rugae

Appear 3 to 4 weeks postpartum

Estrogen index

Return in 6 to 10 weeks

Postpartum period


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REPRODUCTIVE

SYSTEM

CHANGES:

Postpartum period

perineum


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REPRODUCTIVE SYSTEM

CHANGESPerineumAppear edematous & bruised after

deliveryEpisiotomy or laceration may bepresent

Postpartum period


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REPRODUCTIVE

SYSTEM

CHANGES:

Postpartum period

abdomen


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REPRODUCTIVE SYSTEM

CHANGESAbdomenRemain soft and flabby

Striae remainBut take a silvery-white appearance

Postpartum period


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REPRODUCTIVE SYSTEM

CHANGESAbdomenDiastasis recti

Separation of abdominal recti muscleMay occur w/ poor muscle tone

Postpartum period


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REPRODUCTIVE

SYSTEM

CHANGES:

Postpartum period

breast


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REPRODUCTIVE SYSTEM

CHANGESBreastRapid drop in estrogen &

progesterone levels w/ increase insecretion of prolactin after delivery

Postpartum period


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REPRODUCTIVE SYSTEM

CHANGES

Postpartum period

Breast

Colostrum

Present @ time of delivery

Breast milk

Produced by 3rd or 4th postpartumday


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REPRODUCTIVE SYSTEM

CHANGESBreastBecoming larger & firmer

As lactation is established (primaryengorgement

w/ congestion subsiding in 1 or 2

days

Postpartum period


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REPRODUCTIVE SYSTEM

CHANGES

Postpartum period

Breast

Prolactinstimulates alveolar

cells to produce milk


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REPRODUCTIVE SYSTEM

CHANGESBreastSucking newborns

Causes oxytocinrelease &contractility of myoepithelial cells tostimulate milk flow (let-down

reflex)

Postpartum period


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REPRODUCTIVE SYSTEM

CHANGESBreastAverage amount of milk produced

(24 hrs) increase over time:First week: 6 to 10 oz

1 to 4 weeks: 20 oz

After 4 weeks: 30 oz

Postpartum period

1 oz = 34 ml

204 to 340 ml680 ml1020 ml


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Postpartum period

ENDOCRINE

SYSTEMCHANGES


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ENDOCRINE SYSTEM

CHANGESEstrogen & Progesterone level

Decrease rapidly after delivery

Postpartum period


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ENDOCRINE SYSTEM

CHANGESOvulation & return of menstruationinfluenced by:

Lactating45% resume menstruation by 12 weeks

80% have one or more anovulatory cyclesbefore the first ovulation

Postpartum period


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ENDOCRINE SYSTEM

CHANGESOvulation & return of menstruationinfluenced by:

Nonlactating40% resume menstruation by 6 weeks afterdelivery

65% by 12 weeks & 90% by 24 weeks

50% ovulate during first cycle

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ENDOCRINE SYSTEM

CHANGESEstrogen & Progesterone level

Rapid drop ff. delivery of placenta

Responsible for ana. & physio.changes in puerperium

Postpartum period


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ENDOCRINE SYSTEM

CHANGESRequirements for rest andsleep increase significantly

Postpartum period


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Postpartum period

CARDIOVASCULAR

SYSTEM CHANGES


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CARDIOVASCULAR

SYSTEM CHANGESTransient bradycardia40 to 70 bpm

Occurs 24 to 48 hrs after delivery

May persist for first 6 to 8 days

Postpartum period


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CARDIOVASCULAR

SYSTEM CHANGESBlood volumeDecreases to nonpregnant levels by

2 weeks after delivery

Postpartum period


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CARDIOVASCULAR

SYSTEM CHANGESHematocrit levelRises by 3rdto 7thpostpartum day

Postpartum period


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CARDIOVASCULAR

SYSTEM CHANGES

Postpartum period

Leukocytosis level

20,00 to 25,000 WBC/mL

Continues for several days afterdelivery to prevent infection


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CARDIOVASCULAR

SYSTEM CHANGESBlood pressureRemains stable

Pulse

Returns to nonpregnant rate by 3

months postpartum

Postpartum period


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Postpartum period

RESPIRATORY

SYSTEMCHANGES


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RESPIRATORY SYSTEM

CHANGESPulmonary functions return tononpregnant status by 6 months

after delivery

Postpartum period


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Postpartum period

RENAL &URINARY

SYSTEM

CHANGES

&


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RENAL & URINARY

SYSTEM CHANGESOverdistension of bladderCommon due to:

Bladder capacity

Swelling

Bruising of tissues around the urethra

Diminished sensation to increasedpressure

Postpartum period

RENAL & URINARY


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RENAL & URINARY

SYSTEM CHANGESFull bladderDisplaces the uterus

Can cause postpartum hemorrhage

Bladder distension

Can lead to urinary retentionDecrease rapidly after delivery

Postpartum period

RENAL & URINARY


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RENAL & URINARY

SYSTEM CHANGESAdequate bladder emptyingGenerally resumes 5 to 7 days after

tissue swelling and bruising resolve

Postpartum period

RENAL & URINARY


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RENAL & URINARY

SYSTEM CHANGESGlomerular filtration rateRemains elevated for 7 days after

delivery

Postpartum period

RENAL & URINARY


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RENAL & URINARY

SYSTEM CHANGESDilated ureters & renal pelvisElevated to their nonpregnant state 6

to 10 weeks after delivery

Postpartum period

RENAL & URINARY


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RENAL & URINARY

SYSTEM CHANGESPuerperal diaphoresis & diuresisOccur w/in first 24 hrs after delivery

Postpartum period


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Postpartum period

GASTROINTESTINAL

SYSTEM CHANGES

GASTROINTESTINAL


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GASTROINTESTINAL

SYSTEM CHANGESHunger and thirstCommon after delivery

Postpartum period

GASTROINTESTINAL


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GASTROINTESTINAL

SYSTEM CHANGESGI motility & toneReturn to nonpregnant state w/in

2 weeks after delivery

Postpartum period

GASTROINTESTINAL


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GASTROINTESTINAL

SYSTEM CHANGESConstipationCommonly occurs during the early

postpartum period

Postpartum period

GASTROINTESTINAL


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GASTROINTESTINAL

SYSTEM CHANGESPrepregnant weightReturns in 6 to 8 weeks

If weight gain was in N range

Postpartum period

GASTROINTESTINAL


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GASTROINTESTINAL

SYSTEM CHANGESHemorrhoidsCommon problem in early postpartal

period

Due to pressure on the pelvic floorand straining during labor

Postpartum period


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Postpartum period

MUSCKULOSKELETAL

SYSTEM CHANGES

MUSCULOSKELETAL


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MUSCULOSKELETAL

SYSTEM CHANGESAmbulate 4 to 8 hrs afterdelivery

Early ambulation ( ENCOURAGED) toavoid:

Complications

Promote involution

Improve emotional outlookPostpartum period

MUSCULOSKELETAL


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MUSCULOSKELETAL

SYSTEM CHANGESPelvic articulationRelaxation and increased mobility

Occurs 6 to 8 weeks after delivery

Postpartum period


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Postpartum period

INTEGUMENTARY

SYSTEM CHANGES

INTEGUMENTARY SYSTEM


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CHANGESMelaninDecrease gradually after delivery

Causing decrease inhyperpigmentation

Postpartum period



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CHANGESVisible vascular changesDisappear as estrogen levels

decrease

Postpartum period


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STU Y WELL


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Psychological

changes ofPostpartum

period

POSTPARTAL


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POSTPARTALPSYCHOSOCIAL ADAPTATION

A.ESSENTIAL CONCEPTS

B.TAKING-IN PERIOD

C.TAKING-HOLD PERIOD

D.LETTING-GO PERIOD

E. POSTPARTUM DEPRESSION

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ESSENTIAL CONCEPTS

Estrogen & Progesterone level


Postpartum period


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ESSENTIAL CONCEPTS



Postpartum period


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ESSENTIAL CONCEPTS



Postpartum period

TAKING IN PERIOD


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TAKING-IN PERIOD



Postpartum period

TAKING IN PERIOD


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TAKING-IN PERIOD



Postpartum period

TAKING IN PERIOD


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TAKING-IN PERIOD



Postpartum period

TAKING IN PERIOD


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TAKING-IN PERIOD



Postpartum period

TAKING HOLD PERIOD


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TAKING-HOLD PERIOD



Postpartum period

TAKING HOLD PERIOD


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TAKING-HOLD PERIOD



Postpartum period

TAKING HOLD PERIOD


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TAKING-HOLD PERIOD



Postpartum period

LETTING GO PERIOD


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LETTING-GO PERIOD



Postpartum period

LETTING GO PERIOD


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LETTING-GO PERIOD



Postpartum period

LETTING GO PERIOD


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LETTING-GO PERIOD



Postpartum period

POSTPARTUM


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DEPRESSION



Postpartum period

POSTPARTUM


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DEPRESSION



Postpartum period

POSTPARTUM


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DEPRESSION



Postpartum period


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NursingManagement

of Normal

PPP

Nursing Management of


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g gNormal PPP

Assessment

Nursing diagnoses

Planning and Implementation

Evaluation

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Postpartum period

ASSESSMENT


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Postpartum period

NURSING

DIAGNOSES


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PLANNINGIMPLEMENTATION

AND

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Postpartum period

EVALUATION


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References

References

eferen es

referen e

References


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Maternal & Child Health Nursing5thedition, 2004

Adele Pillitteri

References

References


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ReferencesEssentials of Maternity Nursing

The nurse and the child bearing

family 2nd edition, 1987

Irene M. Bobak

Margaret Duncan

Jensen

* very understandable

References


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ReferencesMyles Textbook for Midwives

11thedition, 1989

V. Ruth BennettLinda K. Brown

References


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References Williams Obstetrics 19th edition,

1993

F. Gary Cunning

Paul C. McDonald

Norman F. Gant

Kenneth J. Leveno

Lary G. Guilstrap III


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STU Y WELL

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44705507 Postpartal Care

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