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Marababol, Maria Cyril Minguito, Velly Jane Miralles, Jeremiah John Montesclaros, Donita Pino, Irene Rivera, Nikki Sherylee Romanillos, Mhargie Ruiz, Maria Evangeline Tampus, Dan Patrick Tarucan, Neil Israel Verano, Britney Arlene Submitted to: Ms. Jean P. Bernal Clinical Instructor
GENERAL OBJECTIVE: After 1 hours and of varied teaching methodologies, the BSN 3 students will be able to gain basic knowledge, beginning skills, and a positive attitude on the concept of CARE OF POSTPARTUM PATIENTS. SPECIFIC OBJECTIVES Specifically, the BSN 3 students will be able to: 1. Identify the concepts of care of the postpartum women. o Efforts such as the Safe Motherhood Initiative and the World Health Organization (WHO) Making Pregnancy Safer Division and strategies to meet the United Nations Millennium Development Goals are supporting worldwide activities to reduce maternal and newborn mortality. Despite these efforts, hundreds of thousands of women and babies die or become disabled due to complications of pregnancy and childbirth every year. o Half of the maternal deaths occur within 24 hours of childbirth with postpartum hemorrhage (PPH) 5 minutes Lecture – discussion 1. Human Resources: • Time and effort of the group • Active participation of the class. Oral Recitation (question and answer) CONTENT TIME ALLOTMENT METHODOLOGY RESOURCES EVALUATION
being the leading direct cause of maternal death in most developing countries. Many of the cases of PPH result from problems during and immediately after the third stage of labor. o 75 percent of all neonatal deaths take place in the first week and 50 percent within 24 hours after birth. The postpartum/postnatal period, especially the early phase, is also the most neglected part of the pregnancy, delivery, and postpartum continuum of care. It stands to reason, therefore, that newborns may stand a better chance of surviving if they receive care during the period when they are at the greatest risk of dying. o Since the health and survival of the newborn are closely tied to that of the mother, it is important to integrate maternal and newborn health care into training programs, wherever possible. Although it is not feasible to integrated aspects of maternal
2. Material Resources: • er • • • • one Papers Chairs Pens Microph Comput
3. Book and Internet Resources: (See Bibliography)
training skilled birth attendants. including active management of the third stage of labor with care of the baby at birth. improving work environments of skilled providers. this set of materials links selected aspects.and newborn care. and supporting the development of improved access to care. immediate postnatal care of the woman and the baby. more women will have access to these interventions. ensuring the application of infection prevention principles. and counseling the woman/mother to care for herself and her newborn. . o Ongoing research in various settings continues to identify the best approaches for preventing and managing postpartum bleeding and its complications as well as caring for the newborn and woman in the immediate postpartum period. By developing national guidelines.
Anatomy of the Reproductive Organ 4. newborn. also known as the "baby blues. Identify the goal of treatment for postpartum women. o POSTPARTUM BLUES Postpartum blues." refers to the period of emotional highs and lows that commonly occur in those first days after birth. o (See Appendix A) 8 minutes Lecture – discussion 3. Define the following terms: 2 minutes o POSTPARTUM PERIOD Includes the six-week period after childbirth up to the mother's postpartum check-up with her health care provider o POSTPARTUM CARE -Postpartum care encompasses management of the mother. Lecture – discussion o Pain relief: If you delivered the baby normally through the birth canal. pain in the area between the rectum and vagina is common. and infant during the postpartal period. To relieve the pain and 3 minutes Lecture – discussion .2.
The anti-clotting effect means aspirin is best avoided in injuries that tend to bleed. you can sit in a warm bath. or put warm water on the area with a squirt bottle or sponge. Its anti- 7 minutes Lecture – discussion . For constipation try eating foods rich in fiber and drinking lots of liquids. 5. and is therefore useful to prevent heart attacks and strokes. it reduces the tendency of the blood to clot. Even at low doses.prevent infection. o ASPIRIN Aspirin is a pain reliever with antiinflammatory effects. o Constipation and hemorrhoids: It is common to be constipated or have discomfort from hemorrhoids after delivery. It is also important to wipe yourself from the front to back after a bowel movement to prevent infection. Elaborate drugs use for pain relief for postpartum. Ointments and sprays can be used to help reduce swelling in the area of the rectum. put cold packs on the area.
Aspirin decreases the tendency of the blood to clot for many days after a single dose. so it's unlikely to cause . o ACETAMINOPHEN Is a non-aspirin pain reliever. Aspirin can irritate the stomach. It is quite well-tolerated by the stomach. up to 4 times daily. Aspirin should be avoided by persons with active ulcers. Aspirin can easily cause poisoning if doses are doubled. Beyond two tablets (650 mg). little further relief of pain occurs. The pills should be taken with food (if possible) to prevent stomach upset. Do not take higher doses without the advice of your physician.inflammatory effects make it useful for tendonitis. The most wellknown brand is Bayer. and by those on anticoagulants (blood thinners). Usual dose: Two tablets (650 mg) every 4 hours. There's a limit to the amount of pain relief you can get with aspirin.
It does not cause ulcers or irritate the stomach. It has no anticoagulant effect. Acetaminophen has NO anti-inflammatory activity. burns. Beyond 1000 mg (two extra-strength tablets). it's important not to exceed the recommended dose. There's a limit to the amount of pain relief you can get with acetaminophen. Acetaminophen can be used for the pain of insect stings. Identify the appropriate diet for postpartum mothers o The basic postpartum diet is a simple but healthy and wholesome one. as well as bruises. abrasions.nausea or abdominal pain. 6. and sprains. The most well-known brand of acetaminophen is Tylenol. no further relief of pain occurs. Because acetaminophen is poisonous in large doses. Usual dose: 2 tabs (650 mg) every 4 hours. It can best be summed up by the following 10 minutes Lecture – discussion . up to four times daily.
and seeds. preferably organic. • Eat foods that supply your body with antioxidants (mainly fresh fruits and vegetables). nuts. foods – whole grains. • Eat whole. • Avoid refined sugars and flour. o Eat Foods that Supply Your Body with Essential Fatty Acids Fatty acids are the final . fresh vegetables and fruits. such as ground flaxseeds. • Eat a source of nutrient -laden fiber. like fresh salmon. for example. and seeds. during pregnancy and postpartum. nuts.guidelines: • Eat foods that supply your body with essential fatty acids. unprocessed meats. • Eat slowly and chew your food thoroughly.
the immune system. Fatty acids were once viewed as nothing more than a source of stored calories. Once a baby reaches about six months of age. Diseases related to inflammation. arachidonic acid (AA) and docosahexaenoic acid (DHA). the developing fetus requires large amounts of two specific fatty acids. hormone imbalances. o Omega-3 Fatty Acids When you are pregnant. and the heart can often be partially or completely resolved if essential fatty acid levels are balanced through dietary changes or supplementation. behavioral problems.breakdown product of fats in the diet – the part of the fats you eat that is either stored or used in the cells for energy. but modern research has shown that the quality of fatty acids in the body has profound effects on human health. to build brain and nerve cell membranes. his or her body will be able to make .
when those . More than half of the nerve connections in baby's brain form during the first year of life. then through breast milk.DHA and AA from other fatty acids. These fats are also needed for proper brain and nervous system function in people of all ages. The fats you eat are transformed into hormone-like messenger molecules called prostaglandins. but are needed more than ever during gestation and in your baby's infancy. Ideally. mother's milk supplies DHA and AA to her baby through nursing for at least a year. and how the balance of essential fats in your diet dictates the balance of prostaglandins in your body. and the integrity of these connections is dependent upon the fatty acid supply from the mother. these fats must be supplied in exact form by the mother's body – first through the placenta. but while still in utero and in the first six months of life.
The omega-3 fat docosahexaenoic acid.4°F during first 24 h after delivery considered normal.systems are undergoing fastest period of growth. Encourage fluids. your emotional and physical well-being will most likely be compromised in the postpartum period and beyond.48°F. is the most important structural and cognitive (brain-function-related) fat for your brain and for your baby's brain. their 7. or DHA. The placenta draws DHA from the mother's body like a vacuum cleaner. o Vital signs Nursing Considerations Temp of 100. If you do not keep replenishing your supply. check 15 minutes Lecture – discussion . Formulate a nursing care plan for postpartum women. If temp is above 100. and the milk ducts continue to drain her stores for as long as her baby nurses.
. The patient should rise slowly from lying or sitting to prevent "blackouts" or falls. Decreased pulse rate (as low as 50) is considered normal during first postpartal week.the following infection: for possible Lacerations Sutures Breasts lochia (foul odor of lochia may indicate infection) urine Pulse elevation may be first sign of hemorrhage. Decreased BP and/or narrowed pulse pressure are signs of shock. Assess BP every hour if patient has been preeclamptic. Orthostatic hypotension is common during the early postpartal period.
or anesthesia may predispose to pneumonia (women . Prolonged bed rest. o Head Nursing consideration Assess for headache resulting from anesthesia or elevated B Visual light flashes may indicate preeclampsia o Lungs Nursing consideration Check for adventitious sounds. vomiting. labor.o Intake and output Nursing consideration Accurate I&O for at least 12 h (urinary retention may occur).
Assess for infection painful. (warm. .who have had spinal or epidural anesthesia may have difficulty coughing or clearing the lower airway until anesthesia wears off). Breast milk appears by about 72 hours. Breast engorgement occurs on the 3rd or 4th postpartal day and should resolve spontaneously within 36 h. Assess for irritation of nipples. Bra should be worn by all women during the postpartal period. Chest pain and dyspnea are common symptoms of pulmonary embolism. o Breasts Nursing consideration Colostrum appears within first 12 hours. reddened area).
Assess daily for BM. Should be firm and at umbilicus immediately after delivery.o Abdomen Nursing consideration Assess fundus.) Increase fiber and fluid intake to prevent constipation. then fall 1 cm (1 fingerbreadth) each day for next 10 days. (Patient may be taught to massage fundus. (Analgesics and other aspects of labor and delivery make constipation very common. massage top of fundus with fingers held together. . assess first for bladder fullness.) Auscultate to assess peristalsis. If fundus is boggy. If fundus is boggy and bladder is empty. and have patient void if indicated.
Assess lochia.Encourage early ambulation. Assess for hemorrhoids. edema. Occasional passage of clots in the absence of heavy flow may be . Patients who report or are observed to have heavy bleeding should be placed on pad count. or redness. A continuous flow of bright red lochia or the passage of large and/or frequent clots is abnormal and indicates hemorrhage. o Perineum Nursing consideration Assess episiotomy for bleeding. Assess for hematoma (purplish mass may be seen at introitus of vagina) if patient complains of severe perineal pain or a feeling of fullness in the vagina.
4-10 days Lochia alba: Whitish yellowish. o Lower Extremities Nursing considerations Assess veins for redness and extreme warmth (signs of phlebitis). Lochia should progress as follows: Lochia rubra: Dark red. Pain indicates positive Homans’ or . 2 —3 days Lochia serosa: Paler. up to 3 wks Lochia should be odorless.normal. brownish pink. Assess for pain while dorsiflexing foot.
Watch for signs of parent-infant bonding: Parents hold baby so that mutual gazing can occur ("enface" position). Parents stroke baby. Parents talk to baby. Ambulation and/or early leg exercises help prevent venous stasis and clot formation. Parents make positive statements about baby.sign. which is sign of thrombophlebitis. Mild "let-down feeling" is usually considered normal. . o Psyche Nursing considerations Assess mood.
IMPLEMENTATION: INDEPENDENT: Vital signs. o DIAGNOSIS: Risk for uterine infection related to lochia and episiotomy. Parents give baby cherished name. PLANNING: Major patient goals include verbalize understanding of risk factors. RATIONALE: Alterations from . achieve timely wound healing. fundal height and status of episiotomy were monitored. identify interventions and demonstrate techniques to prevent risk of infection. amount. lochia (character. and continue to be free from any symptoms of infection during postpartum. odor and presence of clots).
Prevents . Antiseptic feminine wash or clean warm water may be used. retained fragments or sub involution of the uterus. Emphasized early ambulation and beginning postpartal exercise with resumption of normal activities as tolerated. Proper perineal care hygiene were reinforced. Circulation of blood is promoted through regular movements thus it helps in the healing process. RATIONALE: Mothers who had NSVD are allowed to ambulate 4 – 8 hours after childbirth. and RATIONALE: Appropriate self care of the perineum in postpartum patients reduces the risk of bacterial invasion.normal maybe signs of infection.
Protein is needed for tissue repair and regeneration. and urinary problems.constipation. RATIONALE: This promotes healing by reducing basal metabolic rate and allowing oxygen and nutrients to be . meat products. and a sense of wellbeing. nuts. circulatory problems. Promote rapid recovery. RATIONALE: Vitamin C is known to prevent infection. Encourage to eat foods that are rich in protein and vitamin C. Hastens drainage of lochia. Citrus fruits are rich in vitamin C. and legumes are rich in sources of which. Enough rest and sleep was also advised. Improve GI and urinary function.
healing.utilized for tissue growth. lochial discharge has no foul odor. EVALUATION: Expected patient outcomes: No redness or anomalous discharge is present at episiotomy line. temperature is not greater . and regeneration. RATIONALE: Antibiotics are used to treat and prevent infections caused by susceptible pathogens in skin structure infections. DEPENDENT: Intake of antibacterial medication such as amoxicillin and cephalexin as per doctor’s order and advise.
Implementation: .than 40⁰c. achieve timely wound healing. Identify interventions and demonstrate techniques to prevent risk of infection. Goals: Client states degree of pain is tolerable Demonstrates knowledge of measures for adequate pain relief. or episiotomy discomfort. o Nursing Diagnosis: Acute Pain related to after pains. Include verbalize understanding of risk factors. Continue to be free from any symptoms of infection during postpartum.
Position the woman in a prone position. Rationale: The prone position applies pressure to the uterus and thus stimulates contractions. with a small pillow under her lower abdomen. Provide sitz bath as ordered. the after pains cease. severity. Assess the location. or infection. When the uterus maintains a constant contraction. and duration of the patient’s pain. Rationale: Excessive perineal / vaginal pain may indicate hematoma formation / lacerations. Rationale: The warmth of the water in the sitz bath provides .
Administer ordered. reduce o Nursing Diagnosis: Risk for impaired urinary elimination or constipation related to loss of bladder and bowel sensation after .comfort. decreases pain. and promotes circulation to the tissues. imaging. Encourage use of relaxation techniques. Rationale: This will client’s discomfort. Rationale: To distract attention and reduce tension. Provide information about the cause of after pains. analgesics as Rationale: For pain relief. This promotes healing and reduces the incidence of infection. such as focused breathing.
then heat as ordered. Patients usually find it easier to void on the commode. Rationale: To help prevent bladder distention. Monitor the position of the . Implementation: Ambulate the patient to the bathroom to void as soon as possible after delivery. Goals: Patient will maintain normal bowel and bladder function during the postpartum period. Apply ice to the perineum during the first 24 hours. Rationale: Minimizing edema will prevent urinary retention caused by obstruction.child birth.
Encourage the patient to walk. Administer stool softeners or laxatives. Encourage a high – fiber diet. Rationale: Patients often need medication to help keep stools soft and to stimulate peristalsis. as ordered. Develop a discharge plan for postpartum women. Rationale: Walking stimulates intestinal peristalsis. Rationale: A fundus that is raised and displaced to the right suggests a full bladder. Encourage the consume fluids. . 8. patient to 10 minutes Lecture – discussion Rationale: Inadequate fluid intake predisposes the patient to harder stool formation. Rationale: Fiber provides bulk in the intestine and promotes normal bowel function.fundus.
o (See Appendix A) APPENDIX A ANATOMICAL STRUCTURES (INTERNAL & EXTERNAL) Figure 1: External .
Figure 2: Internal .
encourage patient to follow the given schedules especially on the immunization of the newborn. ask the patient questions to know that she really understand. remind the patient medication schedules. encourage patient and the family to attend mass every Sunday and to pray together everyday. Spiritual Attend mass every Sunday and do not forget to pray everyday. Treatment Follow the schedule administration. C. signs and symptoms of note for redness. take enough hours of sleep each day at about 8hours/day. encourage the patient to ask questions to things which she did not understand. she and her significant others will be able to: A. Implementation Medication Comply the entire medication regimen correctly and completely. Evaluation Evaluate the patient’s understanding of all the treatment regimens and planned actions. to ensure instruct patient to follow schedules for visits. Diet Eat nutritious and rich in fiber foods for early recovery and avoid the risk of constipation. B. . discuss with the patient the basic food groups and the right food to eat. practice relaxation for early recovery from labor. encourage enough sleeping periods rest and NURSING ORDER Asses for continuity of pain felt on the traumatized area of the perineum.APPENDIX B DISCHARGE PLAN PATIENT’S OUTCOME CRITERIA As soon as the patient is discharged from the hospital. Exercise Patient should techniques. instruct patient to comply all the immunizations needed for the newborn. Out patient referral Comply schedules for check up. D. swelling and tenderness on the perineal area. of the Plan for the schedules of immunization for the newborn. encourage patient to watch out and remember all take home medications ordered by the doctor. Assess for inadequate rest and sleep pattern periods. Assessment Asses for infection. perform pain destruction method. for medication Health teaching Perform measures that help promote healthy lifestyle. Planning Plan for consultation recuperation.
Volume 1. Murr. Klossner. 23-25 First Lock Yang Road. Introductory Maternity & Pediatric Nursing. Marilynn E. Canada: Aspen Publishing Company. Nancy. Davis Company. 2007. . Maternal & Child Health Nursing: Care of Childbearing & Childrearing Family. Jayne. Nurse’s Pocket Guide. Lippincott Williams & Wilkins. 2008. 11th edition. Maternal – Newborn Nursing. 5th edition.A. N. 2008.. Adele. Mary Ellen L..al. 2007. 11th edition. Alice C. Moorhouse.BIBLIOGRAPHY BOOKS: Doenges. Alice C. Fundamentals of Maternal and Child Nursing Care. Marilynn E. Mary Frances. Jurong Pillitteri. Nurse’s Pocket Guide. 2006. Lippincott Williams & Wilkins. Philadelphia Doenges. Singapore: Pearson Education South Asia Pte Ltd. Hatfield. Moorhouse. Pennsylvania: F.A. Davis Company.. 2007. Mary Frances. London. Marcia L.. 1989. Murr. Volume 1. Philadelphia Duell. et.. Pennsylvania: F. Toronto.
motherhood-cafe.com/postpartum-blues.htm http://www.html http://www.htm http://pregnancy.com/postpartum-care-diseasesindex-taj-pharmaceuticals.html: http://nursingcrib.com/postpartum-period.html .motherhood-cafe.tajpharma.nih.com/nursing-care-plan/risk-for-uterine-infection-rt-lochia-and-episiotomy/ http://www.nlm.com/firstaid/painmeds.utahmountainbiking.com/recovery/postpartum-diet/35973.com/p/articles/mi_gGENH/is_20050229/ai_2699003628/ http://www.familyeducation.INTERNET RESOURCES: http://www.gov/medlineplus/postpartumcare.html http://findarticles.
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