Chapter 17

Nursing Care of a Postpartal

Family
 Postpartal period (puerperium): 6-week period after
childbirth
Retrogressive maternal changes
 Involution of uterus and vagina
Progressive maternal changes
Production of milk for lactation, restoration of
normal menstrual cycle, beginning of a parenting
role
Psychological Changes of the Postpartal
Period #1
 Phases
 Taking in
 Taking hold
 Letting go
Psychological Changes of the Postpartal
Period #2
 Parental attachment/bonding
 En face position
 Engrossment
 Positive family relationships
 Rooming-in
 Sibling visitation
Psychological Changes of the Postpartal
Period #3

 Maternal concerns and feelings

Abandonment
Disappointment
Postpartal blues
Physiologic Changes of the Postpartal
Period #4
 Reproductive changes
 Uterus
 Lochia
 Cervix
 Vagina
 Perineum
Uterine Involution
Physiologic Changes of the Postpartal
Period #5
Physiologic Changes of the Postpartal Period #6

 Systemic changes
Hormonal
Urinary
Circulatory
Gastrointestinal
Integumentary
Physiologic Changes of the Postpartal
Period #7
 Retrogressive changes
 Exhaustion
 Weight loss
 Vital signs
Temperature
Pulse
Blood pressure
Physiologic Changes of the Postpartal
Period #8
Progressive changes
Lactation
Returnof menstrual flow
Beginning of parenting role
Assessing a Postpartal Woman and Family #1
Assessing a Postpartal Woman and Family #2

 First 24 hours
Health history
Family profile
Pregnancy history
Labor and birth history
Infant data
Postpartal course
Assessing a Postpartal Woman and Family #3

First
24 hours—(cont.)
Laboratory data
Physical assessment
General appearance
Hair
Face
Eyes
Assessing a Postpartal Woman and Family #4

First
24 hours—(cont.)
Reproductive system physical assessment
Breast
Uterus
Lochia
Perineum
Palpating the Uterus
Assessing a Postpartal Woman and Family #5
Nursing Diagnoses: The Postpartal Period

 Disturbed sleep pattern related to exhaustion from and

excitement of childbirth
 Risk for infection (uterine) related to presence of lochia
and denuded uterine surface
 Risk for fluid volume deficit related to uterine atony
 Pain related to perineal discomfort, uterine cramping
(afterpains), or muscular aches
Outcomes: The Postpartal Period

 Patientstates she is able to sleep and feels rested during

postpartal period.
 Patient’stemperature remains below 100.4°F; lochia is
present and without foul odor.
 Patient states degree of pain is tolerable; patient
demonstrates knowledge of measures for adequate pain
relief.
 Patient maintains vital signs within normal range; fundus is
firm to palpation; lochia discharge is small to moderate with
a minimum of clot formation.
Nursing Care During the Postpartal Period #1
 Relief of discomfort
 Afterpains
 Muscular aches
 Hot and cold therapy
 Perineal exercises
 Episiotomy care
Nursing Care During the Postpartal Period #2
Nursing Care During the Postpartal Period #3

 Perineal care
 Perineal self-care
 Rest
 Adequate fluid intake
 Urinary elimination
 Constipation/hemorrhoids
Nursing Care During the Postpartal Period #4

Assess peripheral circulation.

Prevent/alleviate breast engorgement.
Promote breast hygiene.
Promote uterine involution.
Nursing Care During the Postpartal Period #5

 Preparing for discharge

Group classes
Individual instruction
Discharge planning
Postpartal examination
Nursing Care During the Postpartal Period #6
Nursing Care During the Postpartal Period #7
Nursing Care During the Postpartal Period #8

 Woman and family with unique needs

Choosing not to keep child
Child remaining hospitalized
Adopting child