Nursing Care During the Fourth Trimester

1
Chapter 21

• Nursing Care During theFourth Trimester

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Nursing Care of the Postpartum Woman

• Nurse provides care that focuses on transition to
  parenting
• Womans physiologic recovery
• Psychologic well-being
• Ability to care for herself and her new baby
• Needs of other family members include strategies
  in plan of care to assist family in adjusting to
  baby

3
Transfer from Recovery Area

• In traditional setting woman is moved to
  postpartum room after recovery
• In LDRP setting woman and infant remain together
  in room where birth occurred
• Postanesthesia recovery
• Regardless of obstetric status, no woman should
  be discharged from recovery area until completely
  recovered from anesthesia
• Transfer from recovery area

4
DischargeBefore 24 Hoursand After 48 Hours

• Terms for decreasing length of stay of mothers
  and newborns after low risk birth
• Early postpartum discharge
• Shortened hospital stay
• 1-day maternity stay
• Laws relating to discharge
• Newborns and mothers Health Protection Act of
  1996
• Advantages and disadvantages to early postpartum
  discharge

5
DischargeBefore 24 Hoursand After 48
Hourscontd

• Criteria for early discharge
• Woman recovered and able to care for self and
  baby
• Provider and nurse are still responsible if the
  woman is discharged before her condition is
  stable

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Nursing Care ManagementPhysical Needs

• Couplet or mother-baby care
• Infant security
• Prevention of infection
• Prevention of excessive bleeding
• Maintenance of uterine tone
• Prevention of bladder distention

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Nursing Care ManagementPhysical Needscontd

• Promotion of comfort
• Nonpharmacologic interventions
• Pharmacologic interventions
• Promotion of comfort
• Promotion of rest
• Promotion of ambulation
• Promotion of exercise

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Nursing Care ManagementPhysical Needscontd

• Promotion of nutrition
• Promotion of normal bladder function
• Promotion of normal bowel function
• Promotion of lactation
• Suppression of lactation

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Planning Future Pregnancies

• Rubella vaccination
• If woman is not immune, vaccination is
  recommended
• Must use contraception for 1 month
• Rh Isoimmunization
• Rh immune globulin should be given within 72
  hours for R-negative women who deliver an
  Rh-positive infant

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Nursing Care ManagementPsychosocial Needs

• Impact of birth experience
• Maternal self-image
• Adaptation to parenthood and parent-infant
  interactions
• Family structure and functioning
• Impact of cultural diversity

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Discharge Teaching

• Self-management and signs of complications
• Sexual activity/contraception
• Prescribed medications
• Routine mother and baby checkups
• Dealing with activities of daily living at home
• Dealing with visitors

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Discharge Teachingcontd

• Follow-up after discharge
• Home visits
• Telephone follow-up
• Warm lines
• Support groups
• Referral to community resources

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Key Points

• Postpartum care modeled on concept of health
• Cultural beliefs and practices affect patients
  response to puerperium
• Nursing plan of care includes
• Assessment to detect deviations from normal
• Comfort measures to relieve discomfort or pain
• Safety measures to prevent injury or infection

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Key Pointscontd

• Teaching/counseling to promote womans feelings
  of competence in self- and baby care
• Common nursing interventions include
• Evaluating and treating boggy uterus and the full
  urinary bladder
• Pharmacologic and nonpharmacologic relief of pain
  and discomfort associated with episiotomy or
  lacerations
• Measures to promote or suppress lactation

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Key Pointscontd

• Meeting psychosocial needs of new mothers
  involves planning care that considers composition
  and functioning of entire family
• Early postpartum discharge will continue to be
  trend as result of
• Consumer demand
• Medical necessity
• Discharge criteria for low risk childbirth
• Cost-containment measures

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Key Pointscontd

• Effective means to prevent crisis and facilitate
  physiologic and psychologic adjustments in
  combination include
• Early discharge classes
• Telephone follow-up
• Home visits
• Warm lines
• Support groups