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Title: The Postpartal Family: Adaptation and Nursing Assessment Needs and Care


1
The Postpartal Family Adaptation and Nursing
AssessmentNeeds and Care
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Postpartum Uterine Changes
  • Uterine cells will atrophy
  • Uterine debris in the uterus is discharged
    through lochia
  • Lochia rubra is red (first 2-3 days)
  • Lochia serosa is pink (day 3 to day 10)
  • Lochia alba is white (continues until the cervix
    is closed)

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Involution of the uterus. Immediately after
delivery of the placenta, the top of the fundus
is in the midline and approximately two thirds to
three-fourths of the way between the symphysis
pubis and the umbilicus
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Postpartum Cervical and Vaginal Changes
  • Cervix is spongy, flabby, and may appeared
    bruised
  • External os may have lacerations and is irregular
    and closes slowly
  • Shape of the external os changes to a lateral
    slit
  • Vagina may be edematous, bruised with small
    superficial lacerations
  • Size decreases and rugae reappear within 3-4
    weeks
  • Returns to prepregnant state by 6 weeks

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Perineal Changes and Return of Menstruation
  • Perineum may be edematous, with bruising
  • Lacerations or an episiotomy may be present
  • Menstruation generally returns between 6 and 10
    weeks (nonbreastfeeding

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Postpartum Abdominal and Breast Changes
  • Loose and flabby but will respond to exercise
  • Uterine ligaments will gradually return to their
    prepregnant state
  • Diastasis recti abdominis
  • Striae will take on different colors based on the
    mothers skin color
  • Breasts are ready for lactation

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Postpartum Bowel Changes
  • Bowels will be sluggish
  • Episiotomy, lacerations, or hemorrhoids may delay
    elimination

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Postpartum Bladder Changes
  • Increased bladder capacity
  • Swelling and bruising of tissues around the
    urethra
  • Decrease in sensitivity to fluid pressure
  • Decrease in sensation of bladder filling
  • Urinary output is greater due to puerperal
    diuresis
  • Increased chance of infection due to dilated
    ureters and renal pelves

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Postpartum Changes in Vital Signs
  • Temperature may be elevated to 38C for up to 24
    hours after birth
  • Temperature may be increased for 24 hours after
    the milk comes in
  • BP rises early and then returns to normal
  • Bradycardia occurs during first 6-10 days

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Postpartum Changes in Lab Values
  • Nonpathologic leukocytosis occurs in the early
    postpartum period
  • Blood loss averages 200-500 mL (vaginal),
    700-1000 mL (cesarean)
  • Plasma levels reach the prepregnant state by 4-6
    weeks postpartum
  • Platelet levels will return to normal by the 6th
    week
  • Diuresis
  • Cardiac output returns to normal by 6-12 weeks

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Postpartum Weight Changes
  • Initial weight loss of 10-12 lbs
  • Postpartum diuresis causes a loss of 5 lbs
  • Return to their prepregnant weight by the 6th to
    8th week

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Maternal Psychological Adjustment
  • Taking In
  • Taking Hold

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The mother has direct face-to-face and eye-to-eye
contact in the en face position.
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Postpartum Blues
  • Transient periods of depression sometimes occurs
    during the first few days postpartum
  • Mood swings
  • Anger
  • Weepiness
  • Anorexia
  • Difficulty sleeping
  • Feeling let down

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Causes of Postpartum Blues
  • Changing hormones
  • Lack of supportive environment

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Post Partum Depression
  • It is common to experience maternity blues that
    may last for a few hours or days after birth.
    Postpartum depression should be considered when
    symptoms of depression last longer than 2 weeks.
  • 10-20 of women suffer from serious postpartum
    depression

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Cultural Influence in the Postpartum Period
  • Non-Western cultures emphasize postpartum period
  • Food and liquids after birth
  • Hot-cold balance
  • Role of grandmother

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Principles of Conducting a Postpartum Assessment
  • Selecting the time that will provide the most
    accurate data
  • Providing an explanation of the purpose of the
    assessment
  • Ensuring that the woman is relaxed before
    starting
  • Recording and reporting the results clearly
  • Body fluid precautions

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Postpartum Assessment
  • B Breasts
  • U Uterus
  • B Bowel
  • B Bladder
  • L Lochia
  • E Episiotomy/Lacerations

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Postpartum Assessment (continued)
  • H Homans/Hemorrhoids
  • E Emotions

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Breast Assessment
  • Size and shape
  • Abnormalities, reddened areas, or engorgement
  • Presence of breast fullness due to milk presence
  • Assess nipples for cracks, fissures, soreness, or
    inversion

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Abdominal Assessment
  • Position of fundus related to umbilicus
  • Position of fundus to midline
  • Firmness
  • Assess incision for bleeding, approximation, and
    signs of infection

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Measuring the descent of the fundus for the woman
having a vaginal birth. The fundus is located two
fingerbreadths below the umbilicus. Always
support the bottom of uterus during any
assessment of fundus
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The uterus becomes displaced and deviated to the
right when the bladder is full.
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Assessment of Lochia and Perineum
  • Assess lochia for amount, color, and odor
  • Presence of any clots
  • Wound is assessed for approximation, redness,
    edema, ecchymosis, and discharge
  • Presence of hemorrhoids
  • Level of comfort/discomfort
  • Efficacy of any comfort measures

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Assessment of Extremities, Bowel, and Bladder
  • Homans sign
  • Assess calf for redness and warmth
  • Adequacy of urinary elimination
  • Bladder distention and pain during urination
  • Intestinal elimination
  • Maternal concerns regarding bowel movements

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Assessment of Psychological Adaptation and
Nutrition
  • Adaptation to motherhood
  • Fatigue
  • Nutritional status
  • Cesarean birth
  • Return of bowel function
  • Tolerance of dietary progression

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Physical and Developmental Tasks
  • Gain competence in caregiving
  • Confidence is role as parent
  • Return of all physical systems to prepregnant
    state

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The father experiences strong feelings of
attraction during engrossment.
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Factors that Influence Parent-Infant Attachment
  • Family of origin
  • Relationships
  • Stability of the home environment
  • Communication patterns
  • The degree of nurturing the parents received as
    children

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The Postpartal Family Needs and Care
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Nursing Responsibilities for Client Teaching
  • Assess educational needs
  • Develop and implement a teaching plan
  • Evaluate client learning
  • Revise plan as needed

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Postpartal Teaching
  • Mom topics
  • Baby topics

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Uterine Well-Being and Comfort Measures
  • Assess uterus
  • Assess lochia
  • Afterpains
  • Positioning
  • Ambulation
  • Analgesics

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Perineal Well-Being and Comfort Measures
  • Assess perineum
  • Perineal care
  • Ice packs
  • Surgigator
  • Analgesics

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Comfort Measures
  • Diaphoresis
  • Suppression of lactation
  • Well-fitting bra
  • Cold compresses or cabbage leaves
  • Anti-inflammatory medication

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Pharmacologic Interventions
  • Rubella vaccine
  • RhoGAM

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Emotional Stress Interventions
  • Encourage mothers to tell birth stories
  • Maternal role attainment

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Rest and Activity
  • Provide opportunities for rest
  • Encourage frequent rest periods
  • Resumption of activity
  • Avoid heavy lifting
  • Avoid frequent stair climbing
  • Avoid strenuous activity

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Postpartal Family Wellness
  • Family-centered care
  • Information
  • Time for interaction
  • Supportive environment

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Resumption of Sexual Activity
  • Resume after episiotomy healed and lochia stopped
  • Lubrication may be required
  • Contraception
  • Potential limiting factors
  • Fatigue
  • Demands of the infant

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Parent-Infant Attachment
  • Incorporate family goals in care plan
  • Postpone eye prophylaxis for 1 hour after
    delivery
  • Provide private time for the family to become
    acquainted
  • Encourage skin-to-skin contact
  • Encourage mother to tell her birth story

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Parent-Infant Attachment
  • Encourage involvement of the sibling
  • Prepare parents for potential problems with
    adjustment
  • Initiate and support measures to minimize fatigue
  • Help parents identify, understand, and accept
    feelings

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Care of the Mother after Cesarean Birth
  • Minimize complications
  • Deep breathing and incentive spirometry
  • Ambulation
  • Pain management
  • Rest
  • Minimize gas pains

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Pharmacologic Management of Pain
  • Epidural analgesia
  • PCA

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Needs after Discharge
  • Increased need for rest and sleep
  • Incisional care
  • Assistance with household chores
  • Infant and self-care
  • Relief of pain and discomfort

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Parent-Infant Attachment
  • Factors that hinder attachment
  • Physical condition of the mother and the newborn
  • Maternal reactions to stress
  • Anesthesia
  • Medications
  • Newborn safety

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Nursing Care of the Adolescent
  • Postpartum hygiene
  • Contraceptive counseling
  • Newborn care
  • Include family in teaching
  • Positive feedback

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Post-discharge Adolescent Needs
  • Child care
  • Transportation
  • Financial support
  • Nonjudgmental emotional support
  • Education regarding newborn care and illness
  • Education regarding self-care

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Care of the Mother who Relinquishes her Infant
  • Active listening
  • Provide nonjudgmental support
  • Show concern and compassion
  • Personalize care for the mother

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Early Discharge
  • Signs of possible complications
  • Rest and activity
  • Resumption of sexual activity
  • Referral numbers for questions
  • Contact information about local agencies or
    support groups
  • Bottle or breastfeeding information

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Early Discharge (continued)
  • A scheduled postpartal and newborn well-baby
    visit
  • Procedure for obtaining the birth certificate
  • Newborn care
  • Signs and symptoms of infant complications
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