The postpartum period, or puerperium lasts from delivery of the placenta to 6 weeks afterward, immediate postpartum consists of the first 24 hours after delivery.The early postpartum period lasts from the second day after delivery to the end of the first week
The postpartum period also known as the fourth trimester, continues until 6 weeks postpartum period
There are so many physiological and psychological changes during this period the nurse must response to. that is based on the assessments
Physicians, midwives, nurses, social workers, lactation consultants and others must ensure that client s receive the services they need
Nurses should plan the care and implement that as well as evaluate and follow- up the care. The nurse may need to be prepared to care for both the mother and infant
The hospitals and the family-centered maternity care must care the nursing mother and the family. The mother adjust to multiple physical, cognitive and psychological changes
Health education for preparing a mother for this period is important
Clinical assessment
Vital signs
Nurse must assess vital signs, funds, and lochia every 15 minutes for the first hour, every 30 minutes for the second hour, third and fourth hour and then every 8 hours thereafter
Close monitoring assists in identifying potential complications such as hemorrhage, and infection considering the client who received anesthesia
Blood Pressure
B/P usually changes in this period within first six hours, the B/P should stabilize to or remain consistent with the client s baseline before delivery. B/P may be lowered due to the effects of analgesia or anesthesia
Signs of orthostatic hypotension may include dizziness or faintness immediately after sitting or standing
Hemorrhage in the postpartum may be difficult to identify because the B/P may be within normal limits
Blood volume increases 30% during pregnancy therefore time needed to return to pregnancy volumes
B/P elevation may be related to oxytocin administration or excessive use of medications
Hypertension may be the result of (PIH), anxiety or essential hypertension
Pulse
Due to stress of childbirth, pulse may be increased immediately after birth. A heart rate greater than 100 bpm may indicate pain, fever, anxiety, dehydration, infection or hypovolemia
The postpartum period, or puerperium lasts from delivery of the placenta to 6 weeks afterward, immediate postpartum consists of the first 24 hours after delivery. The early postpartum period lasts from the second day after delivery to the end of the first week. The postpartum period also known as the fourth trimester, continues until 6 weeks postpartum period. There are so many physiological and psychological changes during this period the nurse must response to. that is based on the assessments. Physicians, midwives, nurses, social workers, lactation consultants and others must ensure that client s receive the services they need. Nurses should plan the care and implement that as well as evaluate and follow- up the care. The nurse may need to be prepared to care for both the mother and infant. The hospitals and the family-centered maternity care must care the nursing mother and the family
The postpartum period, or puerperium lasts from delivery of the placenta to 6 weeks afterward, immediate postpartum consists of the first 24 hours after delivery. The early postpartum period lasts from the second day after delivery to the end of the first week. The postpartum period also known as the fourth trimester, continues until 6 weeks postpartum period. There are so many physiological and psychological changes during this period the nurse must response to. that is based on the assessments. Physicians, midwives, nurses, social workers, lactation consultants and others must ensure that client s receive the services they need. Nurses should plan the care and implement that as well as evaluate and follow- up the care. The nurse may need to be prepared to care for both the mother and infant. The hospitals and the family-centered maternity care must care the nursing mother and the family
The mother adjust to multiple physical, cognitive and psychological changes. Health education for preparing a mother for this period is important. Clinical assessment Vital signs Nurse must assess vital signs, funds, and lochia every 15 minutes for the first hour, every 30 minutes for the second hour, third and fourth hour and then every 8 hours thereafter.
Close monitoring assists in identifying potential complications such as hemorrhage, and infection considering the client who received anesthesia. Blood Pressure B/P usually changes in this period within first six hours, the B/P should stabilize to or remain consistent with the client s baseline before delivery. B/P may be lowered due to the effects of analgesia or anesthesia. Signs of orthostatic hypotension may include dizziness or faintness immediately after sitting or standing. Hemorrhage in the postpartum may be difficult to identify because the B/P may be within normal limits.
Blood volume increases 30% during pregnancy therefore time needed to return to pregnancy volumes. B/P elevation may be related to oxytocin administration or excessive use of medications. Hypertension may be the result of (PIH), anxiety or essential hypertension. Pulse Due to stress of childbirth, pulse may be increased immediately after birth. A heart rate greater than 100 bpm may indicate pain, fever, anxiety, dehydration, infection or hypovolemia.
Respiratory rate
Epidural narcotics include fentanyl and morphine, both of which have the potential to depress the respiratory rate less than 12 breaths per minute
Temperature
A temperature greater than 100.4F ? (38 C °) may indicate dehydration or increased temperature. Later on may indicate infection
Physical Examination
Breasts
Breasts are enlarged, soft, warm and contain only a small amount of colostrums, milk. Nipples should be intact without redness, tenderness, crakes or blisters
Mothers may experience breast engorgement (enlargement and filling of the breast with milk)two-four days after delivery
Breasts still tender, uncomfortable until the milk either released through infant sucking, manual expression, or pumping
Uterus
The uterus begins the process of involution or reduction in size. It generally takes 6 weeks for complete physiologic involution. The involution will be delayed when there is hemorrhage, infection or retained placental parts
By the end of the 3 weeks, the endometrial lining and site of the placental attachment should have return to a nonpregnant state
Immediately after delivery the funds can be located midline at the level of or one to two fingerbreadths below the umbilicus
Fundal massage provides the opportunity to maintain contraction of the uterine blood vessels
A fundus that remains boggy (fundus may be felt soft) mat be related to an overdistended uterus or fibroids. It is a warning sign of uterine atony and potential postpartal hemorrhage
Assessment of uterine pain
Abdominal cramping or after pains are caused by uterine tonic contractions, which are the efforts of the uterus to expel blood clots and placental fragments. The contractions are enhanced with oxytocin
Bladder
In the immediate postpartum period the bladder is congested, edematous and hypotonic from the effects of labor unless a urinary tract infection present, these effects should resolve within 24 hours of delivery
The diuresis results from the decreasing production of aldosterone hormone
The renal pelvis and uterus, stretched and dilated during pregnancy, return to normal by the end of 4 weeks postpartum
Risk factors for any problems include: episiotomy, perineal edema or tenderness, long labor, assisted vaginal delivery, lacerations, previous catheterization and anesthesia
Nursing responsibilities
Teaching the mother to empty the bladder after delivery.
Assist the client to the bath room to protect against falls.
Monitor for orthostatic hypotension and faintness.
. The nurse should note complaints of urinary frequency, dysuria and retention.
Notify if the woman has not voided 6-8 hours after delivery.
. Observe the bladder distension.
. The nurse may need to perform a straight catheterization when the client can not urinate.
Bowel and gastrointestinal system
Mother appetite will return to normal after delivery and become hungry 1-2 hours after delivery.
If there is no anesthesia problems, diet habits with regular food may be resumed.
Client may need a diet high in protein and iron if she has experienced heavy blood loss. Adequate dietary protein and iron facilitate tissue healing and restore iron levels.
The most problems of this period is the constipation, the nurse should assess the client s abdomen for nondistension, softness and bowel sounds.
Constipation may be due to increase in progesterone at the end of pregnancy.
For woman who has episiotomy, fear of tearing the stitches may lead to constipation.
Teach mother to reduce her fear that those stitches are deep.
In severe constipation, administer an analgesic and a stool softener to facilitate bowel movement.
Lochia
The usual uterus discharge of blood, mucus, and tissue after childbirth is called lochia, it contains erythrocytes, epithelial cells, and bacteria.
It is assessed according to it s amount, color, and change with activity and time.
Episiotomy
It is the surgical incision made to enlarged the vaginal opening for delivery of the baby s head. Depending on client s preference, situation, and judgment.
It may be incised midline down the center of the perineum. Without episiotomy the perineum may suffer from lacerations during childbirth.
To assess the episiotomy client lies on her side, flexing her upper leg toward her hip by using a good light source to visualize the incision and repair.
Care of the vulva includes applying ice packs to the perineum to assist in constricting blood vessels, minimize the risk of hematoma and decrease muscle irritability and spasm.
Teaching about hygiene including washing daily, cleaning after voiding and bowel movement, dry it well, change the pad. Teaching about perineal exercise.