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Post Partum Period

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Post Partum Period Mary L. Dunlap MSN, APRN Fall 10 Retained placental fragments- check placenta after delivery- if lobes are missing the uterus will need to be ... – PowerPoint PPT presentation

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Title: Post Partum Period


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

6
Early Assessment
  • Vital signs
  • Temperature
  • Pulse
  • Blood pressure
  • Respirations

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

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

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

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

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

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

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

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

15
Nursing care
  • 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

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

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
Nursing Care
  • 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

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

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

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

24
Assess for DVT
  • Homans sign
  • Clinical assessment

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

26
Nursing Care
  • 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

27
Maternal Physiological Adaptations
28
Hematological System
  • Decrease in blood volume
  • Elevated WBC
  • Increased Fibrinogen

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
Renal
  • 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

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
Immune System
  • 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

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

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

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

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

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

41
Postpartal Surgical Patient
  • Tubal ligation
  • Cesarean birth

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

43
Breastfeeding
  • Lactogenesis- secretion of milk
  • Milk ejection reflex- let down reflex

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

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

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

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

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

51
Assuming the mothering role
  • Rubins three phases
  • Taking in
  • Taking hold
  • Letting-go
  • Table 15-6 pg. 499

52
Bonding
  • Bonding process helps to lay the foundation for
    nurturing care
  • Touch- skin to skin
  • Eye contact
  • Breastfeeding

53
Discharge Planning and Teaching
  • Self Care

54
Discharge Teaching
  • Fundus and Lochia
  • Episiotomy care
  • Incision care
  • Signs of infection- box 15-5 pg 505
  • Elimination

55
Discharge Teaching
  • Nutrition
  • Exercise
  • Pain management
  • Sexual activity
  • Contraception

56
Community Resources
  • Support groups
  • Home visits
  • Telephone follow-up
  • Outpatient Clinics

57
Postpartum Complications
58
Postpartum Hemorrhage
  • Blood loss of more than 500 ml of blood after a
    vaginal birth
  • 1000 ml of blood after cesarean section
  • Any amount of bleeding that places mother in
    hemodynamic jeopardy

59
Postpartum Hemorrhage
  • LARRY- common causes of early PPH
  • Laceration
  • Atony
  • Retained placental tissue
  • Ruptured uterus
  • You pulled to hard on the cord

60
Postpartum Hemorrhage
  • 4 Ts- factors associated with PPH
  • Tone
  • Trauma
  • Tissue
  • Thrombin

61
Postpartum HemorrhageTone/Atony
  • Altered muscle tone due to overdistention
  • Prolonged or rapid labor
  • Infection
  • Anesthesia
  • Box 16-1 pg 513

62
Postpartum HemorrhageTrauma
  • Cervical lacerations
  • Vaginal lacerations
  • Hematomas of vulva, vagina or peritoneal areas
  • Box 16-2 pg 514

63
Postpartum HemorrhageTissue
  • Retained placental fragments
  • Uterine inversion
  • Subinvolution

64
Postpartum HemorrhageThrombin
  • Disorders of the clotting mechanism
  • This should be suspected when bleeding persists
    without an identifiable cause

65
Management of PPH
  • Frequent VS
  • Fundal massage
  • Administer medications- Box 16-1
  • Monitor blood loss for amount
  • Maintain IV
  • Type cross match
  • Empty bladder

66
Hematoma
  • Localized collection of blood in connective or
    soft tissue under the skin
  • Risk factors
  • Signs and symptoms
  • Management

67
Postpartum Infections
  • A fever of 100.4 or higher after the first 24 hrs
    for 2 successive days of the first 10 PP days
  • Fever of 102.2 or greater within first 24 hrs-
    sever pelvic sepsis Group A or B streptococcus

68
Postpartum Infections
  • Endometritis- Table 16-2 pg 521
  • Wound infection- Table 16-3 pg. 523
  • UTI- Table 16-4 pg. 524
  • Mastitis- Table 16-5 pg 525
  • Septic Pelvic Thrombophlebitis-Table 16-6 pg 526

69
Endometritis
  • Involves the endometrium, decidua and adjacent
    myometrium of the uterus
  • Lower abdominal tenderness or pain
  • Temperature
  • Foul-smelling lochia

70
Nursing Care
  • Administer broad spectrum antibiotic
  • Provide analgesia
  • Provide emotional support

71
Wound Infection
  • Sites- Cesarean incision, episiotomy and genital
    tract laceration
  • Drainage
  • Edema
  • Tenderness
  • Separation of wound edges

72
Nursing Care
  • Aseptic wound management
  • Frequent perineal pad changes
  • Good hand washing
  • Administer antibiotics
  • Analgesics

73
Urinary Tract Infection
  • Burning and pain on urination
  • Lower abdominal pain
  • Low grade fever
  • Flank pain
  • Protienuria, hematuria, bacteriuria, nitrates and
    WBC

74
Nursing Care
  • Frequent emptying of bladder
  • Increase fluid intake
  • Antibiotics
  • Analgesics

75
Mastitis
  • Infection of the breast (one sided)
  • Seen 2-3 weeks after delivery
  • Caused by staphylococcus aureus
  • Infected nipple fissure - to ductal system
    involvement- edema obstructs milk flow in a lobe-
    mastitis

76
Mastitis Symptoms
  • Flu like symptoms
  • Tender, hot, red area on one breast
  • Breast distention with milk

77
Nursing Management
  • Empty the breast by increasing the frequency of
    nursing or pumping
  • Antibiodics
  • Analgesics

78
Postpartum Infection Education
  • Continue antibiotics
  • Monitor temperature and notify provider if temp
    greater then 100.4
  • Watch for signs and symptoms of a recurrence
  • Practice good hand washing

79
Thrombophlebitis and Thrombosis
  • Thrombosis (blood Clot) can cause inflammation of
    the blood vessel (thrombophlebitis) which can
    cause thromboembolism (obstruction of blood
    vessel)

80
Assessment Superfical
  • Tenderness and pain in extremity
  • Warm and pinkish red color over thrombus area
  • Palpable- feels bumpy and hard
  • Increased pain when ambulating

81
Nursing Care
  • NSAIDs for pain
  • Bed rest elevate affected leg
  • Warm compresses
  • Elastic stockings

82
Assessment Deep Vein
  • Located from foot to pelvis- can dislodge and
    cause PE
  • Calf swelling
  • Warmth
  • Tenderness
  • Pedal edema
  • Diminished peripheral pulses

83
Nursing Care
  • Bed rest
  • Elevate effected leg
  • Continuous moist heat
  • TED hose both legs
  • Analgesics PRN
  • Anticoagulation therapy

84
Pulmonary Embolism
  • Abrupt onset chest pain, dyspnea, diaphoresis,
    syncope, anxiety
  • ABC response
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