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Normal Postpartum


Chapter 21 What common changes in vital signs occur in the postpartum period? 8 Cardiovascular System Changes How does the body rid itself of excess Plasma volume? – PowerPoint PPT presentation

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Title: Normal Postpartum

Normal Postpartum
Chapter 21
Normal Puerperium
  • It is the period of recovery that occurs from
    childbirth and extends for 6 weeks after delivery
  • What is involution?

Postpartal Physical Adaptations
Reproductive System Changes
The Uterus
  • What are the three ways that the uterus

Contraction of the Uterus
  • Muscle fibers become shorter controlling the
    bleeding by compressing and sealing off blood
  • Acting as the living ligature

Protein Material Catabolism
  • Release of a proteolytic enzyme into the
    endometrium and myometrium.
  • This enzyme breaks down the protein material in
    the hypertrophied cells causing the uterine
    muscle cells to decrease in size
  • The uterus gradually decreases in size as the
    cells grow smaller

Regeneration of the Endometrium
  • the placenta site heals in about 6 weeks with the
    other part healing in 3 weeks.
  • Heals by exfoliation rather than by forming scar
  • The endometrium grows from the margins of the
    placental site and from the fundi of the
    endometrial glands left in the basal layer of the
    placental site

Critical Thinking
Why does the uterus heal by Exfoliation and
not by primary intention?
Uterine Changes
  • Placement and size
  • Where is the normal placement of the uterus
    immediately after birth, 12 hours later?
  • What is the size of the uterus?

What nursing intervention should the nurse
encourage PRIOR to assessing the fundus?
Uterine Changes
  • What is the normal tone of the uterus?
  • What is the technique used to assess the uterus?

Uterine Involution
  • What is the PRIORITY intervention when the uterus
    is found to be boggy?
  • Why is it important not to over-stimulate the

  • What interventions must the nurse include if the
    uterus is found deviated from midline?

Short Answers
  • The nurse is going to assess the uterus. The 3
    main assessments include
  • 1.
  • 2.
  • 3.
  • The normal height of a first day postpartum woman
    is ________________. It should decrease
    _____fingerbreadth per _______.
  • The tone should be __________. If found boggy,
    the nurse would ___________ the uterus.

  • What are the three types of lochia?
  • What is a normal amount?
  • What question is important to ask
  • the woman when assessing amount?
  • What is normal odor of Lochia?

Characteristics of Lochia
  • Should not be excessive in amount
  • Should never have an offensive odor
  • Should not contain large pieces of tissue
  • Should not be absent during the first 3 weeks
  • Should proceed from rubra -- serosa -- alba

Match the Lochia
  • A. Pinkish serum with mucus and debris usually
    occurs on day 3 - 10.
  • B. Creamy yellowish brownish. Occurs after day
  • C. Dark Red and consists mainly of blood.
    Occurs day 1 - 3.
  • Lochia rubra
  • Lochia serosa
  • Lochia alba

Fill in the Blank
  • Lochia should never be ______________ in amount.
  • Lochia should never have an ______________odor.
  • Lochia should not contain __________ _________
    of tissue
  • Lochia should not be _____________ during the
    first ________ weeks
  • Lochia should proceed from _________ to _________
    to ___________.

  • Remains soft and flabby, appears bruised and may
    have some lacerations
  • No longer does the external os have the
    pre-pregnant appearance -- now appears as a
    jagged slit not a circle.

  • May be edematous and bruised.
  • Rugae begin to appear when ovarian function
  • May teach the mom to do Kegels exercises to
    increase the blood flow to the area and aid in

  • Assess
  • the episiotomy the same as with any incision.
  • R redness
  • E edema or swelling
  • E ecchymosis or bruising
  • D drainage
  • A approximated
  • How should the nurse assess
  • the perineum?

What are measures to teach the mom in caring for
the perineum?
Comfort Measures
  • Relief of Perineal Discomfort
  • Ice packs
  • Topical agents
  • Perineal care
  • Sitz bath
  • Relief of hemorrhoidal discomfort may include
  • Sitz baths
  • Topical anesthetic ointments
  • Witch hazel pads

Ovulation and Menstruation
  • When does Menstruation generally return?
  • Return is prolonged for the breastfeeding mom
    because of alterations in the gonadotropin-releasi
    ng hormone production.

Ovulation and Menstruation
  • Nurses need to teach moms that breastfeeding is
    NOT a reliable means of contraception.
  • WHY

  • Allow the mother to assess her own breasts --
    similar to doing a self-breast exam
  • ask if feels any nodules, lumps
  • ask if nipples are sore, reddened, blisters,
  • Assess nipples for everted, flat, inverted
  • Teach to care for breasts according to whether
    they are breastfeeding or bottle feeding.

Process of Lactation
  • Sucking of infant stimulates the nerves beneath
    skin of the areola to transmit messages to the
  • Hypothalamus sends messages to the pituitary
  • Anterior pituitary -- stimulates Prolactin to be
    released which is the ultimate stimulation for
    milk production
  • Posterior pituitary -- releases Oxytocin which
    stimulates the contraction of the cells around
    the alveoli in the mammary glands. This causes
    milk to be propelled through the duct system to
    the infant. This is the LET-DOWN reflex. Felt
    as a tingling sensation

Breastfeeding Care
  • No soap on the nipples, wash in water
  • wear supportive bra
  • Breastfeeding tips
  • Most important is the latch-on Teach measures
    to assist with the infant getting the nipple and
    areola in the mouth
  • Teach different positions to hold the baby
  • No timing
  • Relax to allow for let-down
  • express colostrum on the nipples after feeding
  • remember drops of colostrum are the same as
    ounces of milk -- if wetting 6 - 10 diapers /
    day, then must be getting enough to eat

Suppression of Lactation
  • Key is to teach the mother measures to decrease
    stimulation of the breasts
  • Wear a tight-fitting bra or binder
  • Do not express milk from the breasts
  • Take shower with back to the warm water
  • Ice packs

Fill in the Blank
  • The Anterior pituitary stimulates the release of
    ___________________ which is responsible for
    _________ _____________________.
  • The posterior pituitary gland releases
    ___________ which is responsible for the
    ______-__________ reflex.

Short Answers
  • What are four important interventions to teach a
    mom who is bottle feeding to decrease stimulation
    of the breasts.
  • 1.
  • 2.
  • 3.
  • 4.

Cardiovascular System
Cardiovascular System Changes
  • How does the body rid itself of excess Plasma
  • Blood Volume
  • Increase for about 24-48 hours after delivery
  • Increase in blood flow back to the heart when
    blood from the placenta unit returns to central
  • Extravascular interstitial fluid is moved into
    the vascular system / intravascular
  • Leads to increased cardiac output mainly RT
    increase stroke volume.

Blood Values
  • Post Partum
  • WBC leukocytosis is common with values of
    25,000 30,000 RT increased neutrophils
  • RBC return to normal
  • Hgb. normal to see a drop of about 1 gram
  • Hct normal to see a drop of about 2- 4 points
    and then a rise RT gt loss of plasma than RBC
  • Platelets drop and gradually rise
  • Pregnancy
  • WBC elevated slightly to about 12,000
  • RBC increase slightly to about 10 milion.
  • Hemoglobin stays about normal at 12 g. Below
    10 g anemia
  • Hemotocrit lowers 33-39 RT hemodilution. If
    drops below 32- 35 anemia

  • Assess for Thromboembolism
  • During pregnancy, plasma fibrinogen (coagulation)
    increases, Mothers body has the ability to form
    clots and prevent excessive bleeding.
  • Plasminogen (lysis of clots) does not rise
  • Hypercoagulable state and the woman is at a
    greater risk for thrombus formation.
  • assess for homans sign

Vital Signs
  • Temperature
  • A slight elevation of up to 100.40 may occur
    related to dehydration and increase basal body
    metabolism from exertion of labor and delivery.
  • After 24 hours, the temperature should be normal
  • A temperature greater than 100.40 suggests
  • Blood Pressure
  • Should remain stable
  • Hypovolemia can indicate postpartum hemorrhage
  • Hypervolemia could indicate preeclampsia

Vital Signs
  • Pulse
  • Bradycardia of 50 70 bpm is Normal
  • Tachcardia is not considered a normal occurrence
    and may indicate excessive blood loss
  • Respirations
  • Should remain stable and within normal range

Critical Thinking
  • The womans vital signs are
  • T.100.8, P- 56, R 16, B/P 110/65.
  • How would the nurse interpret these findings?
    What interventions are indicated?

Gastrointestinal Tract
  • The most common GI problem during postpartum is
    constipation EXPLAIN.
  • What teaching is important to assist in
    decreasing constipation?

Urinary System
  • What is the most common problem associated with
    the urinary system?
  • Why be concerned?

Critical Thinking
  • A primigravida delivered 2 hours ago. The woman
    states she would like to go to the bathroom.
    What should the nurse do?
  • The woman is unable to void. What should the
    nurse do next?

  • Who is more likely to experience afterbirth
    pains? Explain.
  • Relief of after pains
  • Positioning (prone position)
  • Analgesia administered an hour before
  • Encourage early ambulation - monitor for
    dizziness and weakness

Rest and Activity
  • Most common problem is Sleep -- the excitement
    and exhilaration experienced by birth my make it
    difficult to sleep. They are tired and need
    rest. Allow for times of uninterrupted sleep.
  • Exercises -- have the patient to ask her own
    doctor for specific exercises. Usually walking
    is safe. May eventually do postpartum exercises.
    Just need to allow the body to return to its
    pre-pregnant state before straining it.

Resumption of Activities
  • New mother should gradually increase activities
    and ambulation after birth
  • She should avoid heavy lifting, excessive stair
    climbing, strenuous activity
  • Resume light housekeeping by second week at home
  • Delay returning to work until after 6-week
    postpartum examination

  • Recommend exercise to provide health benefits to
    new mother
  • Nurse should encourage client to begin simple
    exercises while on nursing unit
  • Inform her that increased lochia and pain may
    necessitate a change in her activity

  • Perineal pain -- caused from trauma during
    delivery, episiotomy, hemorrhoids. Provide
    comfort measures such as sitz baths, Tucks,
    Sprays / Foams, oral analgesics.
  • Afterbirth pain -- more common in multigravidas
    and breastfeeding moms. Treat with mild
    analgesics (NSAIDS, Acetamenaphen),heating pad,
    lie on abdomen, discontinue use of oxytocins,
  • Breast engorgement -- warm or cold packs,
    increase feedings, decrease stimulation. Bind
  • Gas distention -- no ice, increase warm / hot
    fluids, increase walking, rocking chair,
    antiflatus drugs.

Decision Making
  • During shift assessment of the post partum moms
    peri pad, the nurse found it saturated with
    lochia rubra.
  • What would be the priority nursing
  • intervention?

The Nutrition Need
  • Most moms are hungry and eager to eat. Start off
    slowly to avoid nausea and vomiting.
  • Diet should include
  • High in Protein, vitamin C, and fiber
  • Increase in fluids
  • Lactating moms need about 700 extra calories for
    milk production
  • Prenatal vitamins and iron supplements are often
    continued in the postpartum period.

Psychological Adjustment
  • The responses of the mother to the birth of her
    infant are influenced by many factors such as
  • Her parents own birth -- parenting and
  • Cultural background -- only by understanding and
    respecting the values and beliefs of each woman
    can the nurse plan and meet the patients needs
  • Readiness for parenthood -- emotional maturity,
    pregnancy planned or unplanned, financial
    status, job status
  • Freedom from discomfort -- physical condition
  • Health of her newborn -- physical condition,
    prematurity, congenital defects
  • Opportunities for parent- infant interactions

Postpartum Blues
  • Transient period of depression
  • Occurs first few days after delivery
  • Mother may experience tearfulness, anorexia,
    difficulty sleeping, feeling of letdown
  • Usually resolves in 10 to 14 days

The Process of Becoming Acquainted
  • Initial attraction felt by parents
  • Contact should occur as early as possible and as
    frequently as possible.
  • Allow time for attachment to occur with all
    members of the family

  • Bond that endures over time
  • Occurs through mutually satisfying experiences
  • Reciprocity - Mutually gratifying interaction
    among mother, infant, father

Attachment Process
  • The Claiming Process
  • Includes the identification
  • Of the babys specific
  • Features, relating them
  • To other family members

Those long toes are
just like his Dads
The Steps in Attachment are
1. 2.


Postpartum Phases by Rubin
  • Taking - in
  • Occurs during day 1 - 3 following delivery.
  • Marked by a period of being dependent and passive
  • Mothers primary needs are her own -- food
  • and sleep
  • Mother is talkative about her labor and delivery
  • Main nursing is to listen and help the mother
    interpret events of the delivery to make them
    more meaningful and clarify and misconceptions

Postpartum Phases by Rubin
  • Taking - Hold
  • Occurs during day 3 to about 2 weeks postpartum
  • Ready to deal with the present
  • More in control . Begins to take
  • hold of the task of mothering
  • It is the best time for teaching!

  • Tailoring teaching to individual Learning Styles
  • Demonstrations
  • Group Classes
  • Videotapes

Postpartum Phases by Rubin
  • Letting Go Phase
  • occurs after about 2 weeks
  • Mother may feel a deep loss over the separation
    of the baby from part of her body and may grieve
    over this loss.
  • Common for Postpartum Blues to occur during this

Father-Infant Interaction
  • Engrossment
  • Sense of absorption
  • Preoccupation - Interest in infant

  • Preparation for discharge should begin when
    expectant mother enters birthing unit
  • Mother needs to be aware of signs of postpartum
    complications and should be aware of her
    self-care needs
  • Nurses should begin first by assessing knowledge
    and expectations of new mother and family
  • Nurse should be available to answer questions and
    provide support to parents

Discharge Printed Information
  • Nurse should review with new mother any
    information she has received regarding postpartum
    exercises, prevent of fatigue, sitz bath and
    perineal care, etc. - nurse should spend time
    with parent to determine if they have any
    last-minute questions before discharge
  • Printed information about local agencies and
    support groups should be given to new family

The End