Title: The Postpartal Family: Adaptation and Nursing Assessment Needs and Care
1The Postpartal Family Adaptation and Nursing
AssessmentNeeds and Care
2Postpartum 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)
3Involution 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
4Postpartum 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
5Perineal 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
6Postpartum 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
7Postpartum Bowel Changes
- Bowels will be sluggish
- Episiotomy, lacerations, or hemorrhoids may delay
elimination
8Postpartum 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
9Postpartum 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
10Postpartum 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
11Postpartum 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
12Maternal Psychological Adjustment
13The mother has direct face-to-face and eye-to-eye
contact in the en face position.
14Postpartum Blues
- Transient periods of depression sometimes occurs
during the first few days postpartum - Mood swings
- Anger
- Weepiness
- Anorexia
- Difficulty sleeping
- Feeling let down
15Causes of Postpartum Blues
- Changing hormones
- Lack of supportive enviornment
16Cultural Influence in the Postpartum Period
- Non-Western cultures emphasize postpartum period
- Food and liquids after birth
- Hot-cold balance
- Role of grandmother
17Principles 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
18Postpartum Assessment
- B Breasts
- U Uterus
- B Bowel
- B Bladder
- L Lochia
- E Episiotomy/Lacerations
19Postpartum Assessment (continued)
- H Homans/Hemorrhoids
- E Emotions
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21Breast 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
22Abdominal Assessment
- Position of fundus related to umbilicus
- Position of fundus to midline
- Firmness
- Assess incision for bleeding, approximation, and
signs of infection
23Measuring 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
24The uterus becomes displaced and deviated to the
right when the bladder is full.
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26Assessment 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
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29Assessment 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
30Assessment of Psychological Adaptation and
Nutrition
- Adaptation to motherhood
- Fatigue
- Nutritional status
- Cesarean birth
- Return of bowel function
- Tolerance of dietary progression
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32Physical and Developmental Tasks
- Gain competence in caregiving
- Confidence is role as parent
- Return of all physical systems to prepregnant
state
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34The father experiences strong feelings of
attraction during engrossment.
35Factors 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
36The Postpartal Family Needs and Care
37Nursing Responsibilities for Client Teaching
- Assess educational needs
- Develop and implement a teaching plan
- Evaluate client learning
- Revise plan as needed
38Postpartal Teaching
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40Uterine Well-Being and Comfort Measures
- Assess uterus
- Assess lochia
- Afterpains
- Positioning
- Ambulation
- Analgesics
41Perineal Well-Being and Comfort Measures
- Assess perineum
- Perineal care
- Ice packs
- Surgigator
- Analgesics
42Comfort Measures
- Diaphoresis
- Suppression of lactation
- Well-fitting bra
- Cold compresses or cabbage leaves
- Anti-inflammatory medication
43Pharmacologic Interventions
44Emotional Stress Interventions
- Encourage mothers to tell birth stories
- Maternal role attainment
45Rest and Activity
- Provide opportunities for rest
- Encourage frequent rest periods
- Resumption of activity
- Avoid heavy lifting
- Avoid frequent stair climbing
- Avoid strenuous activity
46Postpartal Family Wellness
- Family-centered care
- Information
- Time for interaction
- Supportive environment
47Resumption of Sexual Activity
- Resume after episiotomy healed and lochia stopped
- Lubrication may be required
- Contraception
- Potential limiting factors
- Fatigue
- Demands of the infant
48Parent-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
49Parent-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
50Care of the Mother after Cesarean Birth
- Minimize complications
- Deep breathing and incentive spirometry
- Ambulation
- Pain management
- Rest
- Minimize gas pains
51Pharmacologic Management of Pain
52Needs after Discharge
- Increased need for rest and sleep
- Incisional care
- Assistance with household chores
- Infant and self-care
- Relief of pain and discomfort
53Parent-Infant Attachment
- Factors that hinder attachment
- Physical condition of the mother and the newborn
- Maternal reactions to stress
- Anesthesia
- Medications
- Newborn safety
54Nursing Care of the Adolescent
- Postpartum hygiene
- Contraceptive counseling
- Newborn care
- Include family in teaching
- Positive feedback
55Post-discharge Adolescent Needs
- Child care
- Transportation
- Financial support
- Nonjudgmental emotional support
- Education regarding newborn care and illness
- Education regarding self-care
56Care of the Mother who Relinquishes her Infant
- Active listening
- Provide nonjudgmental support
- Show concern and compassion
- Personalize care for the mother
57Early 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
58Early Discharge (continued)
- A scheduled postpartal and newborn well-baby
visit - Procedure for obtaining the birth certificate
- Newborn care
- Signs and symptoms of infant complications