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Title:

Normal Postpartum

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... perineal tenderness, hemorrhoids and episiotomy; FEAR Teach: increase fluids, fiber, and activity, Stool softeners, anesthetic sprays, ... – PowerPoint PPT presentation

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Title: Normal Postpartum


1
Normal Postpartum
  • Revised Spring 2011

2
Normal Puerperium
  • It is the period of recovery
  • It is a complex state of the childbearing
    experience
  • It is a period of INVOLUTION

3
  • The responses of the mother to the birth of her
    infant are influenced by many factors such as

4
The Uterus Involution
  • The uterus needs to return to its pre-
  • pregnant state. This occurs by

Contraction of the Uterus
Autolysis / Catabolism
Regeneration of the Endometrium
5
Assessments
6
Breasts
  • Process of lactation
  • Suckling
  • Hypothalamus stimulated
  • Anterior pituitary
  • Posterior pituitary
  • Suppression of lactation
  • Decrease stimulation
  • Wear a tight fitting bra or binder
  • Do not express milk from the breasets
  • Take shower with back to warm water
  • Ice packs

7
Assessment of the Uterus
  • Tone -- should be firm. Assess by supporting
    lower portion with one hand and palpate fundus
    with other. If found boggy, then massage. Do not
    overmassage. Causes relaxation and more
    bleeding.

8
Assessing for Hemorrhage r/t Uterine Atony
  • Normal for loss of up to 500 cc during vaginal
    delivery and 1000 cc in cesarean delivery.
    Main assessment is for excessive bleeding.
    Fundus should be firm, midline, and small amt.
    lochia rubra, no large clots.
  • May be treated with Methergine. Be sure you
    assess the B/P prior to giving--hold the dose if
    elevated gt140 / 90

9
Lochia
  • Assess Amount
  • When did you last change
  • your pad
  • Assess Odor
  • Fleshy, not foul smelling Lochia

10
Cervix
  • 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.

11
Vagina
  • May be edematous and bruised.
  • Rugae begin to appear when ovarian function
    returns.
  • May teach the mom to do Kegels exercises to
    increase the blood flow to the area and aid in
    healing

12
Perineum
  • May have tears, lacerations, or an episiotomy
  • Assessing May need to turn patient into the Sims
    position to visualize.

13
Endocrine
  • Resumption of ovulation
  • Lactation
  • Weight loss

14
Cardiovascular
  • Plasma volume body rids itself of excess by
    diuresis (may have 3000ml/day) and diaphoresis
  • Blood volume
  • Increase for 24-48 hrs after delivery
  • Increase blood back to heart when blood from
    placenta unit returns to central circulation
  • Extravascular interstitial fluid is moved into
    the vascular system/intravascular
  • Increased cardiac output mainly r/t increased
    stroke volume

15
Oxygentation
  • Vital Signs
  • Temperature -- may see a SLIGHT 100. rise in
    temperature because of dehydration and exertion
    of labor in first 24 hrs
  • Pulse -- Bradycardia is common for 6 - 8 days
    postpartally. RT vagal response to increased
    sympathetic nervous system stimulation during
    labor and increase in stroke volume.
  • Respirations begin to fall to normal pre-birth
    range.
  • B/P -- should remain steady. Not elevated or
    decreased

16
Labs to Remember!
  • Pregnancy
  • Postpartum
  • 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
  • WBC leukocytosis is common with values of
    20,000 30,000 RT increassed neutrophils
  • RBC return to normal
  • Hgb. normal to see a drop of about 1 gram
  • Hct normal to see a drop of about 4 points and
    then a rise RT gt loss of plasma than RBC death

17
Assessment for Thromboembolism
  • Plasma fibrinogen (coagulation) increases
  • Plasminogen (lysis of clots) does not rise
  • Hypercoagulable state
  • assess for homans sign

18
Bowel
  • Bowel sounds
  • Passing flatus
  • Bowel movement
  • Address risks of constipation
  • What are some of the causes?
  • Discuss concerns

19
Bladder
  • Diuresis
  • Overdistention
  • Causes
  • Signs and Symptoms
  • Signs of UTI

20
Musculoskeletal
  • Aches and pains
  • Decreased levels of Relaxin
  • Abdominal Wall

21
Integumentary
  • Melasma (Mask of Pregnancy)
  • Linea Nigra
  • Striae gravidarum (stretch marks)
  • Hair loss

22
Neurological
  • Decreased sensation
  • Headaches
  • Frontal
  • Postpunctural
  • Accompanied by blurred vision, photophobia
  • Pain

23
Rest
  • Sleep
  • Exercise

24
Safety
  • Pain
  • Perineal
  • Afterbirth
  • Breast engorgement
  • Gas distention

25
Decision Making
  • During your shift assessment of the postpartum
    moms peri pad, you find it saturated with lochia
    rubra.
  • What would be your nursing interventions now?

26
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.

27
Postpartum Phases by Rubin
  • Taking - in
  • Occurs during day 1 - 3 following delivery.
  • Main nursing is to listen and help the mother
    interpret events of the delivery to make them
    more meaningful and clarify any misconceptions
  • Taking - Hold
  • Occurs during day 3 to about 2 weeks postpartum
  • Best time for teaching!
  • Letting Go Phase
  • occurs after about 2 weeks

28
Attachment
  • Bond that endures over time. Contact should
    occur as early as possible and as frequently as
    possible.
  • Allow time for attachment to occur with all
    members of the family

29
Claiming
  • 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
30
The Steps in Attachment are
1. 2.
3.

4.
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