POSTPARTAL NURSING

Developed by

D. Ann Currie, R.N. ,M.S.N.

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 UTERUS-SOFT,RELAXED..CAN CAUSE HEMORRHAGE

FUNDUS SHOULD BE FIRM

Assessing Fundus

FUNDUSLOCATION

RIGHT AFTER DELIVERY THE FUNDUS IS MIDWAY BETWEEN SYMPHYSIS PUBIS AND UMBILICUS

ONE HOUR AFTER DELIVERY THE FUNDUS RAISES TO THE UMBILICUS OR SLIGHTLY ABOVE-1CM AND REMAINS THERE FOR 24 HRS.

FUNDUSLOCATION- 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-WATERY-ODORLESS

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

CERVIXSOFT,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 6-10 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 SYSTEMINCREASED 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 WOMEN-DEPENDS 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 PHASE-

TAKING-HOLD/DEPENDENT-INDEPENDENT PHASE-

LETTING-GO/INTERDEPENDENT PHASE-

DEVELOPMENTAL TASK- MATERNAL ROLE ATTAINMENT

1ST DICUSSED BY R.RUBIN

TAKING-INDEPENDENT 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-HOLDDEPENEDENT-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-GOINTERDEPENDENT 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 FEELINGS-SADNESS,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 HIGH-PITCHED TONE OF VOICE

NURSE SHOULD ASSIST BOTH MOM AND DAD WITH BONDING-TIME/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 LET-DOWN,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 ASSESSMENT-BUBBLE-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 CARENUTRITION

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 1:8-NONIMMUNE

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

DEEP VEIN THROMBOSIS