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Care of the Postpartum Client

Romamea Magdayao Ana Marie Lopez Rowena Jenniesa Labordo Hanna Mae Magtoles BSN2BSN2-C

Postpartum Physical Adaptations
(pg. 906-929) 906-

Uterine Involution Fundal position changes: ³Boggy´ Lochia: Rubra, Serosa, Alba Cervical changes Vaginal changes Perineal changes Recurrence of ovulation and menustration

Lactation Gastrointestinal System Urinary tract Vital signs Weight loss Postpartum chill Postpartal diaphoresis Afterpains or Afterbirth pains

Uterine Involution
The rapid reduction in size of the uterus and it¶s return to a condition similar to its preprepregnancy state. The uterus remains slightly larger than it was before the first pregnancy. Process is complete at 3 weeks except at the placental site (6 to 7 weeks) Subinvolution may be caused by an infection or retained placenta fragments.

Right after delivery: 1000 grams 1 week after :500 grams 2 weeks after : 300 grams 6 weeks after : 50 ± 60 grams

.Fundal Position Changes After birth :  1st day: one fingerbreadth below umbilicus  2nd day: two fingerbreadths below umbilicus  9th to 10th day: cannot be palpated abdominallyThe first postpartum day it is located 1 cm or fingerbreadth below the umbilicus.

Becomes ³boggy´ with uterine atony .Fundal Position Changes May be displaced to the left or right by a distended bladder.

³ Boggy Uterus ´ Massage the uterus Place infant on mother¶s breast Administer oxytocin  Check BP  Do not give if BP > 140/90 .

UTERINE CONTRACTIONS Prevent bleeding Afterpains ± uncomfortable cramps Common in multipara Oxytocin treated Breastfeeding mothers  2 ± 3 days .

NURSING MEASURES Explain the cause and purpose of afterpains Keep bladder empty Prone position to lessen discomfort Gentle massage Administer analgesics .

leukocytes and bacteria .VAGINAL DISCHARGE LOCHIA  Uterine discharge after delivery  Blood. epithelial cells. mucus.

. may be later in breastfeeding clients.COLOR AND PATTERN Rubra:  dark red in color  present the first 2-3 days 2postpartum  few small clots Serosa:  pinkish to brownish  4th to the 10th day Alba:  creamy or yellowish  persists for a week or two after serosa.


CERVICAL CHANGES Spongy. formless and bruised. flabby. Goes from dimple like to a lateral slit (fish mouth) . Original form is regained in a few hours The shape is permanently changed by the first childbearing.

VAGINAL CHANGES Edematous and bruised Small superficial lacerations may be present Laceration and episiotomy heals after 2 weeks Size and rugae return to pre pregnancy in 3 weeks By 6 weeks appears normal .

PERINEAL CHANGES edematous with some bruising Episiotomy edges should be approximated Ecchymosis may occur and delay healing Suture: 7 to 10 days Perineal muscle tone regained : 6th weeks .


PERINEAL CARE Flush with warm water Pat dry from front to back Change pad frequently Observe signs of infection Reduce hemorrhoids .

PERINEAL CARE ICE PACKS SITZ BATH  PROMOTE CIRCULATION  20 MINUTES PERINEAL LAMP     Promote vasodilation 25 to 40 watts light 12 -18 inches away 20 minutes 3x a day .

Recurrence of Ovulation and Menustration Variable Generally returns to non-nursing mothers nonbetween 7 and 9 weeks after birth The first cycle is non-ovulatory nonBreastfeeding clients may experience menstruation and ovulation based on the amount of time nursing«may occur from 2nd to 18th month .

the interplay of maternal hormones leads to the establishment of milk production. After birth. . the breasts develop in preparation for lactation as a result of both estrogen and progesterone.LACTATION During pregnancy.

iron and vitamins Bowels tend to be sluggish Episiotomy clients may delay bowel movement for fear of pain Cesarean birth clients may receive clear liquids and progress to a regular diet Stool softeners may be used .GASTROINTESTINAL May have a regular diet  High in protein.

incomplete emptying. At risk for over-distention. and decreased sensation of bladder filling. decreased sensitivity to fluid pressure. . swelling and bruising of tissue. Urinary output increases 1rst 24 hours post delivery (puerperal diuresis) diuresis) Urine specimens should be obtained as a catheterized specimen. and overbuildup of residual urine.URINARY TRACT increased bladder capacity.

3 weeks from delivery 2 Hemoconcentration in the first 3 to 7 days  Leukocytosis in the first 12 days  Elevated fibrinogen levels up to the third weeks  Physiologic bradycardia during the first 24 hours  Orthostatic hypotension in the first 24 hours .CARDIOVACULAR  Blood loss: NSD: 300 to 500 ml CS: 500 to 1000 ml reduction in blood volume  40% increase of maternal blood volume after delivery of the placenta  Return of cardiac output to pregnant state takes about 2.

INTEGUMENTARY  Disappearance of skin changes (6 weeks) except for striae and diastisis recti  Areolar hyperpigmentation may not disappear completely .

50Tachycardia should alert the nurse to blood loss/difficult birth. PIH. Pulse rate may decrease to 50-70. BP WNL. BP may indicate toxemia. birth. An occur. a decrease may occur.Vital Signs afebrile after the first 24 hours. .

Convenient rule of thumb is a 2 point drop in hematocrit equals a blood loss of 500 mL.Blood Values Blood values should return to the prepregnant state by the end of the postpartum period. . Leukocytosis with white blood cell (WBC) counts up to 30.000 per mL may occur early postpartum.

placenta and amniotic fluid. Normally return to pre-pregnant preweight by 6 weeks postpartum.Weight Loss An initial weight loss of 10 to 12 lbs occurs as a result of the birth of the infant. . Puerperal diuresis accounts for loss of an additional 5 lbs during the early postpartum period.

Chills and fever late in the postpartum period may indicate sepsis. .  Warm blankets usually relieve this tremor or chill. a normal occurrence as the body rids itself of waste products. Diaphoretic episodes may occur at night.Postpartum Chill and Postpartal Diaphoresis Most clients experience a shaking chill or tremor after delivery.

AMBULATION NSD : 4 ± 8 hours ANESTHESIA : 8 hours ADVANTAGES:  Prevent constipation  Prevent circulatory problems. urinary problems  Promote recovery  Hasten drainage of lochia .

pelvic floor and abdomen .EXERCISE Purpose  Prevent complications  Psychological well being  Strengthen muscles of back.

EXERCISE POSTPARTUM EXERCISE      Abdominal breathing Kegel exercise: tighten perineal muscle Arm Raising Leg Raising SitSit-ups .

REST AND SLEEP At least 8 hours Avoid heavy lifting Light housekeeping: 2 weeks Normal activities: 4 ± 6 weeks .


Discharge  Primiparas : 2 to 3 days Multipara: 1 to 2 days CS: 3 to 4 days  Discharge IE is done before leaving  Follow up: 4 to 6 weeks after delivery .

Postpartum Psychological Adaptations .

Postpartum Psychological Adaptations Postpartum blues Development of Parent-Infant Parentattachment Initial attachment Behavior FatherFather-Infant Interactions Cultural Influences .

RUBIN¶S POSTPARTUM PHASE TAKINGTAKING-IN PHASE  1st 2.3 days postpartum  Need for sleep and rest  Dependence on other TAKINGTAKING-HOLD PHASE  Transition phase  3rd day to 2 weeks postpartum  Control body function .

TAKINGTAKING-HOLD PHASE  Ability to assume the mother role LETTINGLETTING-GO PHASE  Realize that the infant is a separate individual and not a part of herself  Feeling of loss  Adjustment phase .

Manifested by mood swings.2 weeks after birth. and a feeling of letdown.Postpartum blues Transient period of depression : 1 . anger. anorexia. weepiness. difficulty sleeping. CAUSE: Hormonal changes and psychological adjustments .

Postpartum blues Resolve naturally in 2 to 3 weeks with support and reassurance. . the client should be evaluated for postpartum depression. If symptoms persist.

Development of Parent-Infant Parentattachment Level of trust Level of self-esteem selfCapacity for enjoying herself Interest in and adequacy of knowledge about childbearing and childrearing Client¶s prevailing mood or usual feeling tone Reactions to the present pregnancy .

delight in each others company when synchronous) . expectancy. be understanding not condescending Reciprocity is an interactional cycle that occurs simultaneously between mother and infant.Initial attachment Behavior Progression of touching activities En face position dominates Relies heavily on senses of sight. (mutual cueing behaviors. hearing in getting to know the baby Some negative feelings may occur. touch.

.FatherFather-Infant Interactions Primary role has been supporting role Engrossment (the characteristic sense of absorption. preoccupation. and interest in the infant demonstrated by fathers during early contact with the newborn.

Cultural Influences Postpartum care my be affected by cultural beliefs: No shower. ³hot´ and ³cold´ foods Do not make generalizations Extended family may play an important role in care . no breastfeeding for the first three days.

even pigmentation. midline and at/or below umbilicus. Pulse 50 -90. full. no clots. respirations 16-24. temp 981698100.4 Breasts: Smooth. may be tender on palpation Lochia: rubra. engorged Abdomen: soft. fundus firm. rubra to . scant to moderate. filling. soft.Postpartum Assessment Vital signs: BP should remain consistent with baseline BP during pregnancy.

Postpartum Assessment Perineum: Slight edema. bonding. swelling or drainage. normal bowel movement by the 2nd to 3rd day post delivery Psychological adaptation: cultural assessment. hemorrhoids (none or small) Lower extremities: No pain with palpation. episiotomy without redness. negative Homan¶s sign Elimination: voiding 4-6 hrs. no 4bladder distention noted. attachment behaviors . no bruising. holding en face.

Postpartum Assessment .

Postpartum Psychosis. Pelvic Cellulitis Perineal Wound Infection Cesarean Wound Infection Urinary Tract Infection (UTI) Mastitis Thromboembolitic Disease: Superficial Leg Vein Disease. Septic Pelvic Thrombophlebitis Postpartum Psychiatric Disorder: ³baby blues´. Deep Vein Thrombosis.Dysfunctions of the Postpartum Period Postpartal Uterine Infection: Endometritis. Postpartum Major Mood Disorder .

pharmacologic (bromocriptine) . avoiding nipple stimulation.Two methods of milk suppression a. ice packs) b. mechanical (tight bras.