1.POSTPARTUM /PUERPERIUM

2. POSTPARTUM /PUERPERIUM Refers to the six-week period after delivery ofthe baby Principles: Promotehealing and involution of different partsof the body Provide emotional support Establish a successful lactation Prevent postpartum complications 3. Promote healing andinvolution of different partsof the body 4. Vascular changes The 30% - 50% increase in total cardiacvolume during pregnancy will be reabsorb intothe general circulation WBC count increases to 20,000 30,000/mm3 There is extensive activation of clotting factors,which encourages thromboembolization. All blood values are back to prenatal levels bythe 3rd and 4th week postpartum 5. Genital Changes Uterus Sealing of the placenta site Reduced to its approximate pregestational size Assessed by measuring the fundus byfingerbreadth In some women, causes afterpains Nursing Management: Never apply heat on abdomen Give analgesics as ordered Advise knee-chest position when perineum has healed 6. Lochia TYPE COLOR DURATION COMPOSITIONRubra Red 1-3 days Blood, fragments of decidua, and mucusSerosaPink3-10 daysBlood, mucus, and invading leukocytesAlbaWhite 10-14 days Largely mucus; Leukocyte 7. Genital Changes Characteristics of Lochia Pattern should not reverse It should approximate menstrual flow. However, itincreases with activity and decreases withbreastfeeding It should not have any offensive odor It should not contain large clots It should never be absent, regardless of themethod of delivery 8. Genital Changes Vagina Involutionfrom soft and with greater diameterthan normal until its approximate pregestationalstate takes the entire postpartal period Nursing Management: Encourage Kegel Exercise 9. Genital Changes Perineum Develops edema and generalized tenderness Labia majora and minora typically remainsoftened 10. Sexual Activity Maybe resumed by the 3rd or 4th weekpostpartum if bleeding has stopped andepisiorrhaphy has healed 11. Menstruation If not breastfeeding, return of menstrual flow isexpected within 8 weeks after delivery If breastfeeding, menstrual return is expectedin 3-4 months. In some women, nomenstruation occurs during the entire lactationperiod. 12. Urinary Changes There is marked diuresis within 12 hourspostpartum Common complaints are frequent urination insmall amounts and difficulty voiding Nursing management: Initiate voiding If measures fail, catheterization as ordered. 13. Gastrointestinal Changes There is delayed bowel evacuationpostpartally which maybe due to: Decreased muscle tone Lack of food and enema during labor Dehydration Perineal tenderness Almost immediately, the woman feels hungryand thirsty. She can eat unless she has theafter effects of general anesthesia. 14. Vital Signs Temperature may increase Bradycardia is common for the 6-8 dayspostpartum Orthostatic hypotension and dizziness iscommon 15. Weight There is an immediate weight loss of 10-12pounds 16. Provideemotionalsupport 17. The Psychological Phases duringthe Postpartum Taking In Phase Taking Hold Phase Letting Go Phase 18. Establish asuccessful lactation 19. Physiology of BreastmilkProduction Delivery of the placenta Anterior Pituitary Gland ProlactinAcinar Cells Production of Milk 20. Physiology of BreastmilkExcretion1.Crying of the baby / Thinking of thebaby2.Posterior Pituitary Gland3.Oxytocin4.Let-down reflex 21. Advantages of Breastfeeding For the mother: Economicalin terms of time, money, and effort More rapid involution Less incidence of cancer of the breast For the baby: Closer mother-infant relationship Contains antibodies Fewer incidence of GI diseases Always available at the right temperature 22. Health Teachings Hygiene: Wash breast daily Soap or alcohol should never be used Wash hands before and after feeding Insert clean OS squares or piece of cloth in thebrassiere to absorb moisture 23. Health Teachings Method: Stimulate the baby to open the mouth by means ofrooting reflex Infant should grasp not only the nipple but also theareola Infant should be introduced to breast gradually Infant should be placed first on the breast he fedlast in the previous feeding Feed by demand Advise the mother how to relax during feedings 24. Associated Problems andManagement Engorgement: tension of the breast during 3rdto 4th days. It fades after the infant beginssucking Advise use of firm-fitting brassiere for goodsupport Cold compress / warm compress depending if themother will breastfeed or not 25. Associated Problems andManagement Sore Nipples Exposenipple to air If normal air-drying is not effective, exposure to a20-watt bulb placed 12-18inches away 26. Associated Problems andManagement Mastitis Antibioticsas ordered Ice compress Proper breast support Discontinue breastfeeding in affected breast 27. THE NEONATE-The first 28 daysafter delivery 28. Principles of Newborn Care Establish and maintain a patent airway Maintain appropriate body temperature Immediate assessment of the newborn Proper identification of the newborn Nursery care 29. Establish and maintain a patentairway 30. Establish and maintain a patentairway Never stimulate crying unless secretions havebeen drained out Position the head lower than the rest of thebody except if there are signs of increased ICP Suction the baby properly Turn the head to one side Suction gently but quickly Suction the mouth first before the nose Test the patency of airway 31. Maintainappropriate bodytemperature 32. Maintain appropriate bodytemperature Important as it may lead to cold stress Heat loss in newborn occurs in 4 ways Conduction Convection Evaporation Radiation 33. The newborn suffers large losses of bodyheat (cold stress) because: he is wet at birth the delivery room is cold he does not have enoughsubcutaneous fats/adipose tissues shivering mechanism is notfunctioning thermoregulatory center isunderdeveloped 34. Immediate assessment of thenewborn 35. APGAR scoring a standardized evaluationof the newborns condition/stability Done 1 minute afterbirth then 5 minutes after 36. SIGN 01 2HEARTAbsent 100/minRATEMUSCLE Limp,SomeWell-flexedTONE flaccidflexion ofextremitiesextremitiesRESPIRAT Absent Weak cryGood,ORY strong cryEFFORTREFLEX No Grimace,Sneeze;IRRITABILI response weak crygood,TYstrong cry 37. APGAR interpretation ofresults:0-3 (the baby is in serious danger)4-6 (condition is guarded)7-10 (baby is in the best possible health) 38. Assessment of gestational ageNaegels RuleMc Donalds RuleBartholomews RuleUTZ 39. Proper identification of thenewborn 40. Must be done in the delivery room beforebringing the newborn to the nursery Identification bands Footprints 41. NURSERY CARE 42. Check the identification band Take anthropometric measurements: Length = (Ave) 50cm / 20 inches= (Normal range) 47.5 53.75 cm / 19-21 in- Head circumference = 33-35 cm- Chest circumference = 31-33 cm- Abdominal circumference = 31-33cm 43. Take the temperature At birth 37.2 degrees Celsius but will stabilize in 8hrs. (Before) rectal route is preferred Give initial oil bath Dress the umbilical cord Credes prophylaxis Vitamin K administration 44. Weight taking 5.5 6.5 lbs. (2.5 3.5 kg) Feeding Initial feeding with an ounce of sterile water Subsequent feedings given by demand 45. Nursery CarePhysical Assessment Vital Signso Pulse - Apical pulse recommended- 120-140 bpm, irregularo Respirations largely abdominal- Gentle, quiet, rapid but shalow- 30-60cpmo Blood pressure not routinely measured unlessCoartation of the Aorta is suspected 46. Skin Normally ruddy Acrocyanosis during the first 24-48 hours of life General mottling is common Physiologic Jaundice from 2-7 days of life Harlequin sign is normal first few days of life Mongolian spots normal but disappear by school age Lanugo disappears within 2 weeks Desquamation normal within 24 hours of life Milia disappear by 2-4weeks Deviation from normal: Pallor , Gray color 47. HeadLargest part of the bodyFontanelles are neither sunken nor prematurely closedCraniotabes presentCaput succedaneum or Cephalhematoma may be present 48. CEPHALHEMATOMA 49. Eyes Cry tearlessly during the first 2 months Nose There should be no septal deviation Mouth Should open evenly when crying Palate should be intact Epsteins pearls may be present Natal teeth may be seen 50. Cleft palate 51. Epstein pearls 52. Natal tooth 53. Neck Headrotate freely on the neck and flex forward and back Chest Smaller or as large as the head Breast may be engorged Witchs milk may be present 54. AbdomenLiver, spleen, and kidneys may be palpable at birthDome-shapedUmbilical cord breaks free at 6th 10th day after birth 55. Anogenital area Inspectanus to ensure presence and patency Female genitalia: may have swollen labia andpseudomenstruation Male genitalia: Scrotum may be edematous Testes should be present Cremasteric reflex should beelicited 56. Extremities Handsare clenched into fist Note for polydactyly or unusual spacing of toes 57. Cardiovascular System As soon as breathing has been initiated,oxygenation takes place in lungs Increased pressure on the left side ofthe heart results in: Closure of the foramen ovale Change of Ductus arteriosus intoLigamentum arteriosum Ductus venosus becomesLigamentum venosum- Blood volume: Ave = 300ml or 80- 58. Gastrointestinal TractMeconium should be present within 24-48 hours after birthTransitional stool present on the 2nd 10th day of lifeMilk stool (Breastfed / Bottlefed)Deviation from normal: Clay- colored, blood-flecked, black tarry stool 59. Urinary system Urine is less concentrated Female: strong stream voiding Male: projected arc voiding Autoimmune system Have difficulty forming antibodies until 2 months Passive natural immunity 60. Senses Sight:Can only see within 9 inches away from theeyes on the first 6-8weeks Hearing: As soon as amniotic fluid has beenabsorbed Taste and Smell: As soon as mucus and fluidhave been cleared Touch: Most develop of all senses 61. Neuromuscular SystemBlink reflex (always present)Sucking reflex (disappears at 6 mos)Swallowing reflex (always present)Extrusion reflex (disappears by 4 months) 62. Neuromuscular SystemRooting reflex (disappears by 6 weeks) 63. Neuromuscular SystemTonic neck reflex (disappears by 2-3 mos) 64. Neuromuscular SystemBabinski reflex (disappears at 3mos) 65. Neuromuscular System Moro reflex (disappears by 4-5 mos) 66. Neuromuscular System Palmar grasp reflex (disappears at 3 mos) 67. Neuromuscular SystemPlantar grasp reflex 68. Neuromuscular SystemStep/Walk-in place reflex (disappears by 3 mos) 69. Neuromuscular SystemPlacing reflex 70. Discharge Instructions Bathing Maybe given anytime but not within 30 minutesafter feeding Sponge baths are done until cord falls off Cord care Always maintain the cord dry Dub 70% alcohol once or twice a day If it remains moist for a week, advise to see thedoctor 71. Nutrition Encourage breastfeeding NUTRIENTS HUMAN MILK COWS MILK Proteins8% 20% Fats50%50% Carbohydrates 42%30% MineralsLesser Greater Should feed by demand Should be burp at least twice during feeding 72. Discharge Instructions Clothing the newborn Rule of thumb Sleep pattern Usually sleeps 16-20 hours a day 73. Management for the CommonHealth Problems Constipation Encouragebreastfeeding Add more fluids, carbohydrates, sugar Colic Feed by demand Burp at least twice during feeding May need to change formula as per doctors order 74. Management for the CommonHealth Problems Spitting up Feedin upright position Position on right side after feeding Burp more frequently Diaper rash Exposeto air Careful washing and rinsing 75. Miliaria Starch bath Seborrhic dermatitis Apply mineral oil or petroleum jelly on scalp atnight before giving shampoo in the morning 76. GOD BLESS ON YOUR FINALS! Aim to top your finals! Break a neckSir cj