The Postpartal Family: Adaptation and Nursing Assessment Needs and Care - PowerPoint PPT Presentation

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The Postpartal Family: Adaptation and Nursing Assessment Needs and Care

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The Postpartal Family: Adaptation and Nursing Assessment Needs and Care Postpartum Uterine Changes Uterine cells will atrophy Uterine debris in the uterus is ... – PowerPoint PPT presentation

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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
2
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)

3
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
4
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

5
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

6
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

7
Postpartum Bowel Changes
  • Bowels will be sluggish
  • Episiotomy, lacerations, or hemorrhoids may delay
    elimination

8
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

9
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

10
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

11
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

12
Maternal Psychological Adjustment
  • Taking In
  • Taking Hold

13
The mother has direct face-to-face and eye-to-eye
contact in the en face position.
14
Postpartum Blues
  • Transient periods of depression sometimes occurs
    during the first few days postpartum
  • Mood swings
  • Anger
  • Weepiness
  • Anorexia
  • Difficulty sleeping
  • Feeling let down

15
Causes of Postpartum Blues
  • Changing hormones
  • Lack of supportive enviornment

16
Cultural Influence in the Postpartum Period
  • Non-Western cultures emphasize postpartum period
  • Food and liquids after birth
  • Hot-cold balance
  • Role of grandmother

17
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

18
Postpartum Assessment
  • B Breasts
  • U Uterus
  • B Bowel
  • B Bladder
  • L Lochia
  • E Episiotomy/Lacerations

19
Postpartum Assessment (continued)
  • H Homans/Hemorrhoids
  • E Emotions

20
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21
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

22
Abdominal Assessment
  • Position of fundus related to umbilicus
  • Position of fundus to midline
  • Firmness
  • Assess incision for bleeding, approximation, and
    signs of infection

23
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
24
The uterus becomes displaced and deviated to the
right when the bladder is full.
25
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26
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

27
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28
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29
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

30
Assessment of Psychological Adaptation and
Nutrition
  • Adaptation to motherhood
  • Fatigue
  • Nutritional status
  • Cesarean birth
  • Return of bowel function
  • Tolerance of dietary progression

31
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32
Physical and Developmental Tasks
  • Gain competence in caregiving
  • Confidence is role as parent
  • Return of all physical systems to prepregnant
    state

33
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34
The father experiences strong feelings of
attraction during engrossment.
35
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

36
The Postpartal Family Needs and Care
37
Nursing Responsibilities for Client Teaching
  • Assess educational needs
  • Develop and implement a teaching plan
  • Evaluate client learning
  • Revise plan as needed

38
Postpartal Teaching
  • Mom topics
  • Baby topics

39
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40
Uterine Well-Being and Comfort Measures
  • Assess uterus
  • Assess lochia
  • Afterpains
  • Positioning
  • Ambulation
  • Analgesics

41
Perineal Well-Being and Comfort Measures
  • Assess perineum
  • Perineal care
  • Ice packs
  • Surgigator
  • Analgesics

42
Comfort Measures
  • Diaphoresis
  • Suppression of lactation
  • Well-fitting bra
  • Cold compresses or cabbage leaves
  • Anti-inflammatory medication

43
Pharmacologic Interventions
  • Rubella vaccine
  • RhoGAM

44
Emotional Stress Interventions
  • Encourage mothers to tell birth stories
  • Maternal role attainment

45
Rest and Activity
  • Provide opportunities for rest
  • Encourage frequent rest periods
  • Resumption of activity
  • Avoid heavy lifting
  • Avoid frequent stair climbing
  • Avoid strenuous activity

46
Postpartal Family Wellness
  • Family-centered care
  • Information
  • Time for interaction
  • Supportive environment

47
Resumption of Sexual Activity
  • Resume after episiotomy healed and lochia stopped
  • Lubrication may be required
  • Contraception
  • Potential limiting factors
  • Fatigue
  • Demands of the infant

48
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

49
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

50
Care of the Mother after Cesarean Birth
  • Minimize complications
  • Deep breathing and incentive spirometry
  • Ambulation
  • Pain management
  • Rest
  • Minimize gas pains

51
Pharmacologic Management of Pain
  • Epidural analgesia
  • PCA

52
Needs after Discharge
  • Increased need for rest and sleep
  • Incisional care
  • Assistance with household chores
  • Infant and self-care
  • Relief of pain and discomfort

53
Parent-Infant Attachment
  • Factors that hinder attachment
  • Physical condition of the mother and the newborn
  • Maternal reactions to stress
  • Anesthesia
  • Medications
  • Newborn safety

54
Nursing Care of the Adolescent
  • Postpartum hygiene
  • Contraceptive counseling
  • Newborn care
  • Include family in teaching
  • Positive feedback

55
Post-discharge Adolescent Needs
  • Child care
  • Transportation
  • Financial support
  • Nonjudgmental emotional support
  • Education regarding newborn care and illness
  • Education regarding self-care

56
Care of the Mother who Relinquishes her Infant
  • Active listening
  • Provide nonjudgmental support
  • Show concern and compassion
  • Personalize care for the mother

57
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

58
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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