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41 Cards in this Set
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Puerperium |
period after delivery of placenta last 6 weeks |
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Nursing management: postpartum period assessment |
vitals temp- slight elevation during 1st 24 hours; normal afterwards pulse- during pregnancy cardiac output increases- immediately pp - relative bradycardia - 50-60 bpm; returns to prepreg level within 10 days respirations- 16-20 b/m blood pressure- within usual range pain- goal between 2-3 on scale |
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nursing management during post partum period |
postpartum adaptations post partum period puerperium: period after delivery of placenta lasting for 6 weeks maternal physiologic and psychological changes mother and family adjustment to new family member
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reproductive system adaptations |
uterus involution: contraction of muscle fibers; catabolism; regeneration of uterine epithelium lochia: rubra, serosa, alba afterpains cervix: closure; now appearing as jagged slit-like opening vagina: eventual thickening and return of rugae perineum |
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cardiovascular system adaptations |
blood volume and cardiac output hematocrit level pulse rate and bp coagulation factors rbc production |
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urinary system adaptations |
glomerular filtration rate voiding sensation: affected by: perineal lacerations generalized swelling and brusing of the perineum and tissues serroudning the urinary meatus hematomas decreased bladder tone due to regional anesthesia diminished sensation of bladder pressure due to swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor diuresis |
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gi system adaptations |
relief of pressure on organs bowel tone and peristalsis hunger and thirst |
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respiratory and endocrine adaptations |
respiratory system- resp rate and diaphragm position endocrine system- estrogen and progesterone levels, placental hormones, prolactin levels |
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postpartum discomforts |
afterbirth pains painful intermitten uterine contractions stronger and more frequent in the multiparous woman increased discomfort associated with breastfeeding and the admin of oxytocin perineal discomfort |
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maternal psychological adaptations |
reva rubins 3 phases taking-in phase- the time immediately after birth when the patient needs sleep, depends on others to meet her needs, n relives the events of the birth process taking-hold phase- 2nd phase of maternal adaptation, characterized by depended and independent maternal behavior letting-go phase- 3rd phase. occurring later in the postpartum period as the woman restablishes relationships with other people |
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nursing management: post prtum period: interventions |
preparing for discharge- criteria providing immunizations ensuring follow-up care telephone, outpatient, home visit - followup teaching about post partum blues |
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lacation |
secretion of milk by the breast result of interaction of progesterone, estrogen, prolactin, and oxytocin typically appearing 3 days after child birth -put baby on breast as soon as mother and babys conditions are stable; on delivery table if possible -stay with client each time she nurses until she feels secure or confident with baby and her feelings colostrum: 1-5 days pp rich in immunoglobulins, laxative effect |
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lactation cotd |
engorgement- process of swelling of the breast tissue due to an increase in blood and lymph supply as a precursor to lactation frequent emptying, warm showers and compresses before feeding, cold compressive between, if breast feeding tight supportive bra, ice, avoidance of breast stimulation |
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breast-feeding general principles |
baby to breast asap - baby-friendly colostrum; breast milk 2-3 days teaching and stay with new mom cracked nipples- expose nipples to air for 10 - 20 mins after feeding do not use soap, use lanolin ointment |
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management of breast engorgment |
breast-feed frequently apply warm packs before feeding application of warm compresses prior to feeding manual expression of milk warm water showers between feedings breast milk supression |
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ovulation and return of menstruation |
interplay of hormones; estrogen, progesterone, prolactin, oxytocin nonlactating women: return of mensturation 7-9 weeks after birth lacating woman- return depended on breast-feeding frequency and duration anywhere from 2-18 months |
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nursing management: postpartum period assessment |
breast - size, contour, engorgement uterus - height of fundus, firmness bladder- voiding, bladder emptying bowels- bowel sounds, distention lochia- amount, color, odor episiotomy and perineum- lacerations, hematoma extremities emotional status |
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bonding vs attachment |
bonding- close emotion attraction to a newborn by the parents that develops the first 30-60 mins after birth- unidirection from parent to infant attachement - development of a strong affection between an infant and significant other- mother, father, sibling, caretaker |
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typical assessments in postpartum period |
during first hours - every 15 mins during second hour - every 30 mins during first 24 hours - every 4 hours after 24hours: every hour |
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factors for increasing a womans risk for postpartum complications |
infection operative procedure- forceps, cesarean, vacuum history of diabetes, including gestation-onset diabetes prolonged labor -24 hrs plus use of indewelling urinary cath anemia- hemoglobin <10.5 mg/dl multiple vaginal exams during labor prolonged rupture of membranes <24 hrs manual extraction of placenta compromised immune system -hiv pos |
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risk factors postpartum hemmorage |
precipitous labor less then 3 hrs uterine atony placenta previa or abruption placenta labor induction or augmentation operative procedures - vacuum extraction, forceps, cesarean. retained placental fragments prolonged 3rd stage of labor - more then 30 mins multiparity, mor ethen 3 births closely spaced uterine overdistention - large infant, twins, hydraminos |
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post partum danger signs |
fever more then 100.4 , 38c foul-smelling lochia or unexpected change or ammount large blood clots or bleeding that saturates a peripad in an hour severe headaches or blurred vision visual changes, such as blurred vision or spots or headaches calf pain with dorsiflexion of the foot swelling, redness, or discharge at episiotomy, epidural, or abdnominal sites |
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pp danger signs contd... |
dysuria, burning, or incomplete emptying of the bladder sob or difficulty breathing without exertion depression or extreme mood swings |
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vital signs assessment |
temp - slight elevation during 1st 24 hours; normal afterwards pulse - 40-80 bmp; puerperal bradycardia resp- 16-20 b/m blood pressure - within usual range pain - goat between -0-2 on pain scale |
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emotional status assessment: postpartum period |
interaction with family level of independence energy levels eye contact with infant posture and comfort level with infant sleep and rest patterns be alert for mood swings, irritability, or crying episodes |
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nursing management: bonding and attachment |
transition to parenthood- stages, factors affecting attachement: parents bg, infant, care practices critical attributes of attachment : proximity, reciprocity, commitment positive and negative attachement behaviors |
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factors affecting attachment |
parents bg infant temperament and health at birth care practices separation immediately after birth policies discouraging exploreing infant intensive care environment staff indifferences or lack of support for parents |
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teaching topics for postpartum period |
pain and discomfort immunizations nutrition activity and exercise lactation discharge teaching sexuality and contraception follow-up |
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nursing management in postpartum period- nursing interventions |
providing optimal cultural care promoting comfort - cold and heat ap, topical preps, analgesics assisting with elimination- promote voiding, promoting bowel elimination |
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nursing management in post part : nursing interventions contd |
promoting activity, rest, and exercise- early ambulation, rest periods, exercise program; kegels assisting with self-care measures ensuring safety counseling about sexuality and contraception |
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ensuring safety during ambulation |
promoting nutrition- general recommendations, needs fore the breast-feeding woman supporting choice of newborn feeding method - assistance with breast-feeding, bottle feeding |
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teaching about postpartum blues |
transient emotional disturbances characterized by anxiety, irritability, insomnia, crying, loss of app, sadness symptoms usually begin 2-4 days after child birth and resolve by day 8 blues typically resolve with restorative sleep postpartum depression and psychosis are more serious and require professional referral |
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preparing for discharge |
criteria provide immunizations ensuring follow-up care - telephone, outpatient, home visit |
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breast |
is client breast/bottle feeding check nipples- blisters, bleeding, redness wearing bra? good latch, proper positioning of baby on breast. client perform self breast exams? if bottle feeding - does she know NOT to express milk, ice packs, cabage leaves, analgesics, supportive bra?
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uterus |
nontender? where is fundus? fundus firm or boggy? location is noted from the umbilicus. is it centered or deviated to the right? |
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bowel |
passing gas? burping or pass gas? bowel sounds present in all 4 quadrants? hypoactive or hyperactive? last bm? does she need something to help move bowels? cesarean or vaginal birth? |
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bladder |
last time voided? bladder distending? foley? swelling in perineal area which could impede ability to void? |
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lochia |
vaginal bleeding after childbirth. usually noted as heavy, moderate to scant, not color. rubra- first 3 days. then serosa to alba. |
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episiotomy/laceration incision- cesarean |
check for redness, edema, approximation, swelling. note if client is using sitz bath or ice. have the client roll on side- sims to evaluate assess lacerations/eppis. any hemmoroids |
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homans sign |
any pain in the back of clients legs when dorsiflexed indicative of blood clot swelling in calves or legs clonus bilaterally? |
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edema/ emotions |
edema on hands/face. feet must take off socks and look. edema - is it pitting? fingerprint on skin left? emotions- tearful? AAO? bonding with newborn? touching, holding, making eye contact with newborn? |
