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post partum nc

nursing care during the post partum period

QuestionAnswer
puerperium refers to the post partum period. describe: variable. first 6 weeks, begins with delivery of placenta, ends with resumption of menses. Body ungergoes rapid physiological adaptations while adujsting to new role
Incvolution is the process taht results i rapid healing and a return to the pre-pregnant state. name three processes during involution: contraction, catabolism, regeneration
Post partum assessment for NSVD or CS includes: VS, Breasts, Bladder, Lochia, Perineum, Lower Extremities, Other systems
Normal VS include Temp may be elevated for 24hrs, BP stable, bradycardic pulse expected, resp rate is normal,
Assessment of breasts should reveal: firm, tender (engorgement), bind mother if not breast feeding, reassure mother who is breast feeding
Assessing the uterus location, fundus is the top of uterus, should be firm,contracted following involution; fundus is midline +/- 1-2 cm above or below the umbilicus for first 12 hours. descends 1 cm daily, assess by palpation, bed is flat
Bladder distention May urinate frequently. Bladder tone is usually restored in 3 months Know s/s of urinary tract infection.
Bowels Assess for active bowel sounds, abdominal distention, signs of constipation. Usually first bowel movement is in the 2nd-3rd day. Encourage adequate fluid intake, progressive exercise and dietary fiber to facilitate soft stools.
Lochia post delivery uterine discharge. Characterized by its appearance and contents. Assessed in conjunction with fundal check, noting: Color. Amount. Odor. Presence of clots.
3 types of Lochia Lochia rubra: Blood content; bright red colored for the for 1-3 days. Lochia serosa: Pink to brown discharge day 4 – 10 days. Lochia alba:  Slightly yellow to white discharge which lasts from 11days to 3 weeks.
measuring Lochia Heavy is saturating a pad every 1 hours. Moderate is less than a 4 - 6 inch stain on the pad. Light is less than a 1 - 4 inch stain. Scant is less than a 1 inch stain. Excessive is saturation of a peripad pad within 15 minutes.
notify the physician about: Foul smelling, bright red discharge. Clots are passed which are larger than the size of your fist. Pad is saturated in less than one hour.
REEDA- Acronym for checking epesiotomy Redness. Edema. Ecchymosis. Discharge. Approximation.
while assessing the perineum for the epesiotomy pt, have the pt in what position? Assess the perineum by having the mother lay on her side in Sims position and flex her upper leg. Observe the episiotomy and also note the number and size of hemorrhoids.
what are comfort measures for epesiotomy care? Ice pack. Topical medications: Dermoplast. Epifoam. Tucks pads. Sitz bath.  Dry heat, heat lamp. Oral analgesics.
what are expected findings in the cardiovascular system of post partum pts? Blood volume. Cardiac Output. Blood clotting factors are higher the postpartum patient is at increased risk for clot formation. Chills thought to be related to the sudden release of pressure on the pelvic nerve can develop.
what might be found in the post partum neurological system? Reversal of maternal adaptations to pregnancy and those resulting from trauma during labor and childbirth. Pregnancy-induced neurological discomforts abate after birth. Postpartum headaches may be caused by various conditions.
Endocrine changes: Placental hormones decrease. Ovulation resumes: Breastfeeding delays ovulation. Endocrine glands return to normal.
musculoskeletal system Abdominal muscle tone returns to normal. Feet may be permanently enlarged. Exercise per provider’s guidance.
Integumentary: Chloasma (mask of pregnancy) disappears. Striae fade. Hyperpigmentation of the skin fade after delivery but fade. Fine hair seen during pregnancy usually disappears after giving birth.
Immune system (Rho Gam): Given to a Rh- mother who has a Rh+ infant. Given w/in 72 hrs.Rubella Immunization (German Measles):Given to the susceptible mom to Prevent infection during subsequent pregnancies.Must consent and be counseled to avoid pregnancy 28 days
Cesaerian Delivery: Normal postpartum assessment along with postoperative assessment. In addition, assess the following Pain: Level. PCA. Opioids and / or other medications. Respirations: Incentive spirometer use. Ambulate according to protocols. Abdomen: Auscultate bowel sounds; Keep NPO until return. Observe dressing. Be gentle doing assessment of fundus.
I/O's for C-section include IV fluids. Monitor foley drainage. Dietary changes according to protocol. Simethecone for decreasing flatulence.I/
Post Partum psychosocial adaptations Important to assess the woman’s ability to meet her own needs and those of her infant. Parent-newborn relationship assessments are vital.
what are Ruben's Pscyhological changes in puerperium Phase 1: Taking In. Phase 2: Taking Hold. Phase 3: Letting Go.
Assessing Mother's psychosocial status Self-Concept. Body Image. Sexuality.
what are physical and emotional skills that a mother must be taught during the post partum period? Kegel Exercise to strengthen pubococcygeal muscles. Emotional Needs: parenting is a learned role. Mother must be taught: Take care of herself. Use good hand washing. Breast care. Incision/episiotomy care. REST.
what are post partum danger signs Passive reactions, either verbal or nonverbal. Hostile reactions. Disappointment over the sex of the baby. Lack of eye contact. Non-supportive interaction between parents.
What is post partum blues? Mild depression. Affects 70% of mothers. Self-limiting. Does not affect the mothers ability to care for the infant.
how are roles in the family reorganized after the birth of an infant? Mother: Primary caregiver to the infant. Loss of freedom. Must be sensitive to concerns. Father: Must involve from birth to develop a bond. Eager to help, but lack confidence. Must be included in teaching.
how do siblings adapt? Depends on developmental level. Toddler: Infant is competition. May have sleep problems. Regression. Preschooler: look more than touch. School age: easily adapt. All need attention and reassurance. Sibling classes may help.
common post partum meds? Most common: Pitocin. Methergine. Usually administered IV. See Christensen & Kockrow, page 855-856 for list of commonly used drugs in the postpartum period.
what are the criteria for discharge teaching? No complications. Normal assessments. Immunizations given if needed. Discharge teaching given. Demonstration of readiness to take care of self and baby is evident. Support person is available.
planning begins at the confirmation of pregnancy so that what can be taught? Uterine Massage. Lochia norms. Involution. Care of abdominal incisions. Breast care. Bowel and urinary functions. Nutrition.
what else may be taught? Rest and sleep. Exercise. Sexual activity. Follow-up appointments. Medications. Emotional responses. Infant care and feeding. Family adjustments. Resources.
what are reportable signs for her? Fever, erythema, edema,pain in either breast that is not relieved by support or analgesics.abdominal tenderness. Feeling of pelvic fullness or pressure. perineal pain.Frequency, urgency or burning on urination.Abnormal change in character of lochia...
Created by: redhawk101