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puerperium v2

puerperium v2

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Published by: Ritamaria on Mar 11, 2010
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09/21/2010

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PUERPERIUM

RACHEL P. FUENTES, RN Ateneo de Davao University

PUERPERIUM
 PUERPERIUM/POSTPARTUM
 6-week period after delivery

 INVOLUTION
 return of reproductive organs to their prepregnancy state

PRINCIPLES OF POSTPARTUM CARE
A. Promote healing & return to normal of the different parts of the body
1. Vascular changes
a. The 30-50% ↑ in bld vol is reabsorbed into general circulation w/in 5-10 mins b. ↑ WBC c. Risk for thrombo-embolism
Early ambulation – after 4-8° postpartum

d. 3 – 4 wks postpartum – all bld values return to normal

PRINCIPLES OF POSTPARTUM CARE
2. Genital changes a. Uterine involution – measured by fingerbreaths (=1cm) b. Knee-chest position – for return of uterus in its normal anteflexed position c. Afterpains – strong uterine contractions felt Nsg mgt: analgesic

PRINCIPLES OF POSTPARTUM CARE
d. Lochia – uterine discharge consisting of bld, decidua, WBC, mucus 1. Rubra – 1st 3 days; red, mod in amt 2. Serosa – next 4-9 days; pink or brownish & ↓ amt 3. Alba – from 10th day up to 3-6 wks; colorless, minimal amt

PRINCIPLES OF POSTPARTUM CARE
e. Pain in perineal region

Relieved by:
1. 2. 3. 4. Sim’s position Perineal heat lamp Warm Sitz bath BID Topical or oral analgesics

PRINCIPLES OF POSTPARTUM CARE
f. Sexual activity – 3-4 wks postpartum if bleeding has stopped & episiorrhaphy has healed. g. Menstruation
1. Breastfeeding – 3-4 mons 2. Not breastfeeding – w/in 8 wks

f. Postpartum check-up – 6th wk

PRINCIPLES OF POSTPARTUM CARE
3. Urinary changes
a. Diuresis – w/in 12° b. Frequent urination in small amts

3. GI changes – delayed bowel evacuation due to:
α . ↓ muscle tone b. Lack of food + enema during labor c. Dehydration d. Fear of pain from perineal tenderness

PRINCIPLES OF POSTPARTUM CARE
5. VS
a. b. c. T° may ↑ Bradycardia – common for 6-8 days postpartum RR – no change 10-12 lbs immediate wt loss Further wt loss – next days

5. Weight

PRINCIPLES OF POSTPARTUM CARE
 Provide emotional support
 Taking In Phase

1st 1-2 days. Mother is passive & dependent on others; keeps on verbalizing about recent delivery.
 Taking Hold Phase

After she has rested and recovered from stress of delivery, the new mother begins to initiate & take axn, has energy for the infant. Lasts 2 days to several weeks.
 Letting Go Phase

Family relationships are adjusted to accommodate the infant. Give up the fantasy child and gets to know the real child.

PRINCIPLES OF POSTPARTUM CARE
 Prevent postpartum complications

PRINCIPLES OF POSTPARTUM CARE
 Establish successful lactation
↓ Estrogen & progesterone Stimulate anterior pituitary gland to produce prolactin Acts on acinar cells to produce foremilk Stored in collecting tubules

When infant sucks

Posterior pituitary gland is stimulated to produce oxytocin Cause contraction of collecting tubules Milk ejected forward Let-down reflex

 Advantages of breastfeeding
 For the mother
 Economical  Rapid involution  Less incidence of breast Ca

 For the baby
 Bonding  Contains antibodies  Less incidence of GI dses  Always available  Right temperature

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