Care of Mother, Child, and Adolescent (Well Clients) PDF

CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL CLIENTS) ST. PAUL UNIVERSITY – SURIGAO LECTURER: Ma’am Jobelle Teves COLLEGE OF NURSING (S.Y. 2022-2023) TRANSCRIBED BY: Charade P. Mosenabre TABLE OF CONTENTS...

CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL CLIENTS) ST. PAUL UNIVERSITY – SURIGAO LECTURER: Ma’am Jobelle Teves COLLEGE OF NURSING (S.Y. 2022-2023) TRANSCRIBED BY: Charade P. Mosenabre TABLE OF CONTENTS STAGES OF FETAL DEVELOPMENT I. ANTEPARTUM a. Stages Of Fetal Development* b. The Placenta c. The Decidua d. The Chorionic Villi* e. The Amniotic Membranes* f. Cardiovascular System g. Fetal Circulation h. Fetal Hemoglobin i. Respiratory System j. Nervous System k. Endocrine System* l. Digestive System m. Musculoskeletal System n. Reproductive System o. Urinary System p. Integumentary System q. Immune System II. INTRAPARTUM a. Components of Labor 1. Passage Types Of Pelves Found in Women 2. Passenger 3. Fetal Presentation and Position 4. Engagement 5. Station 6. Fetal Lie b. Types Of Fetal Presentation Cephalic Presentation Breech Presentation Transverse Presentation Shoulder Presentation c. Types Of Fetal Position d. Mechanism Of Labor (Cardinal Movements) e. Importance Of Determining Fetal Presentation and Position f. Powers Of Labor g. Uterine Contractions h. Cervical Changes i. Cervical Effacement and Dilation j. Psyche k. Theories Of Labor Onset l. Signs Of Labor III. POSTPARTUM ANTEPARTUM → Ejaculation – 15 to 200 million of sperm/milliliter of semen 90 seconds for the sperm to reach the cervix, 5 minutes to reach the fallopian tube → Ovum is capable of fertilization for 24-48 hours as long as 72 hours → successful fertilization occurs 28-48 hours to 72 hours MOSENABRE  2022 1  THE AMNIOTIC MEMBRANES The Umbilical Cord – 53cm in length; 2cm thick ORIGIN AND DEVELOPMENT OF ORGAN SYSTEM CARDIOVASCULAR SYSTEM → 16th day-network of blood vessels and single EMBRYONIC AND FETAL STRUCTURES heart tube THE PLACENTA → 24th day-the heart starts beating → Latin word for pancake → 6 to 7th week-septum divides the heart into → Growth parallels that of the fetus chambers → 15 to 20 centimeters in diameter; 2-3cm depth → 10th to 12th week - may be heard in a Doppler → 11th week-in doubt in ECG until 20th week → 28th week-sympathetic nervous system is complete (5 bits per minute on a FHT rhythm strip) FETAL CIRCULATION → as early as third week-fetal blood begins to exchange nutrients with the maternal circulation across chorionic villi → 110 to 160 bpm FHT - it's necessary to supply oxygen to cells, because blood cells are never fully saturated THE DECIDUA- ENDOMETRIUM AFTER BIRTH → 40%-70% - normal fetal oxygen saturation 1. Decidua Basalis - the portion where Trophoblast FETAL HEMOGLOBIN cells establish communication with maternal → Adult - two alpha and two beta chains blood vessels → Newborn - two alpha and two gamma chains at 2. Decidua Capsularis - stretches or encapsulates about six months after birth the surface of trophoblast → Adult HGB - 11 g/100ml 3. Decidua Vera - the remaining portion of the → Adult HCT - 45% uterine lining → Newborn HGB - 11.1 g/100ml THE CHORIONIC VILLI → Newborn HCT – 53% RESPIRATORY SYSTEM → at the third week of intrauterine life, the digestive and respiratory tracts exist as a single tube → By the end of 4th week, accept them begins to divide the esophagus from the trachea at the same time lung buds appear on the trachea → Until the 7th week of life, the diaphragm does not completely divide the thoracic cavity from the abdomen → The diaphragm becomes complete at the end of 7th week, if it fails to close (diaphragmatic hernia) MOSENABRE  2022 2  → Between 24th and 28th weeks alveoli ang 5. At 8th week, brain waves can be detected on an capillaries begin to form electroencephalogram (EEG) → Spontaneous respiratory practice movements 6. Meningocele develops due to lack of folic acid begin as early as three months gestation → Surfactant - our phospholipid substance, is formed and excreted by the alveolar cells at about 24th week o Two components: ▪ Lecithin ▪ Sphingomyelin → At 35 weeks there is a surge production of lecithin NERVOUS SYSTEM FUNCTIONS: 7. all the systems during pregnancy and at birth are o to detect changes and feel sensation vulnerable to damage from fetal anoxia o To initiate appropriate responses to change o To organize information for immediate use and ENDOCRINE SYSTEM store it for future use → as soon as endocrine organs mature in → Begin extremely just like circulatory system third intrauterine life, function begins and fourth weeks of intrauterine life → the fetal adrenal glands supply a precursor → A neural plate (a thickened portion of ectoderm) necessary for estrogen synthesis by the placenta is apparent by third week gestation o estrogen hormones help to increase the size of the uterus, allows blood to flow easily to the uterus and increase elasticity that handles baby’s growth in pregnancy → the fetal pancreas produces insulin needed by the fetus o maintaining tight glucose control throughout the last trimester can help enhance the baby’s final organ development → the thyroid and parathyroid glands play vital roles in fetal metabolic function and calcium balance 1. Spinal nerves have 31 pairs DIGESTIVE SYSTEM o 8 cervical pairs → at 4th week initially the solid tract hollows out to o 12 thoracic pairs become patent o 5 lumbar pairs → Later the endothelial cells of GI tract proliferate o 5 sacral pairs extensively occluding the lumen once more and o 1 very small coccygeal pair the tract must canalize again 2. All parts of the brain are not yet fully developed → atresia (blockage) or stenosis (narrowing) at birth, the growth proceeds during five to six years of life → cerebrum - largest part of the human brain → Cerebellum-include coordination, maintenance of posture and equilibrium → pons - act as respiratory center together with medulla to produce a normal breathing rhythm → Medulla oblongata-contains cardiac centers that regulate the heart rate 3. The eye and inner ear develop as projections of → vitalline membrane pushes the intestine into the the original neural tube base of the umbilical cord where it remains until 4. at 24th week, the ear is capable of responding 10 weeks sound; the eye exhibits a pupillary reaction (sight → When the abdominal cavity has grown large is present) enough to accommodate intestinal mass, MOSENABRE  2022 3  intestine must return to abdominal cavity and URINARY SYSTEM rotate 180 degrees, failure to do so would result → at 12 weeks gestation urine is formed and to omphalocele excreted into the amniotic fluid by 16 weeks at the rate of 500ML per day → oligohydramnios suggests that fetal kidneys are not secreting adequate urine → Patent urachus occur if the open lumen between urinary bladder and the umbilicus fails to close which can be discovered through a persistent drainage of a clear, acid- pH fluid from the umbilicus at birth INTEGUMENTARY SYSTEM → at 36 weeks subcutaneous fats begins to deposit → Skin is covered by lanugo that serves as insulation to preserve warmth in the utero → skin is also covered with vernix caseosa which is important for lubrication and for keeping the skin for soaking up in the utero → Meconium is a collection of cellular wastes, bile, IMMUNE SYSTEM fats, mucoproteins, mucopolysaccharides, and → at 20 weeks gestation IgG maternal antibodies portions of vernix caseosa accumulates in the cross the placenta to provide the fetus intestines as early as 16th week temporary passive immunity from diseases: → Sucking and swallowing reflexes are not mature o rubella until the fetus is about 32 weeks gestation or o Rubeola 1500 grams o Mumps → at 36 weeks the ability of GI tract to secrete o Hepatitis B enzymes for protein and carbohydrate digestion o Whooping cough becomes mature → Acquired passive IgG peaks at birth and then → The liver does not prevent recreational drugs or decreases over the next eight months as the alcohol ingested by the mother from entering infant builds up his own IgG, IgM, IgA stores fetal circulation although it is active throughout → because of the acquired passive antibody gestation but remains immature at the time of substantially declined by 2 months, birth immunizations are now given to infant → Hypoglycemia and hyperbilirubinemia are two common problems in the first 24 hours after INTRAPARTUM birth Components Of Labor o Passage MUSCULOSKELETAL SYSTEM o Passenger → at two weeks of fetal life, cartilage prototypes o Powers provide position and support o Psychological Outlook → at 12th week ossification begins and continues PASSAGE all throughout fetal life until adulthood → refers to the route of a fetus must travel from the → carpals, tarsals, and sternal bones does not uterus through the cervix and vagina to the ossify until birth is coming up external perineum spent → as early as 11 weeks can be seen to move on an o a woman's pelvis is of adequate size and ultrasound although quickening occurs at almost contour 20 weeks gestation REPRODUCTIVE SYSTEM → at about 6th week of life gonads form (ovary or testis) → as early as eight weeks the gender of the fetus can be ascertained by chromosomal analysis → If testes is formed, testosterone is secreted and in the absence of testosterone secretion female organs will form → The testes is formed in the abdominal cavity and do not ascend until 34th to 38th week MOSENABRE  2022 4 TYPES OF PELVES FOUND IN WOMEN o complete flexion (good attitude) o Gynecoid o Spinal column is bowed forward o platypelloid o Head flexed forward o android o Chin touches the sternum o anthropoid o Arms are flexed and folded on the chest o The thighs are flexed onto the abdomen o Calves are pressed against the posterior aspect of the thigh b. sinciput - moderate flexion (military attitude) o the chin is not touching the chest but in alerts position o does not usually interfere labor c. Brow - partial extension o in partial extension, the brow of the head is presented to the birth canal d. Face - poor flexion, complete extension o The back is arched and the neck is PASSENGER extended → the passenger is the fetus o May occur if there is less than the → The body part of the fetus that has the widest normal amount of amniotic fluid diameter is the head, so this is the part least present (oligohydramnios), which likely to be able to pass the pelvic ring does not allow a fetus adequate movement STRUCTURES AND DIAMETERS OF THE FETAL SKULL 1. Molding - is a change of shape of the fetal skull produced by the force uterine contractions 2. ENGAGEMENT pressing the vertex of the head against the - refers to the settling of the presenting part of not- yet-dilated cervix the fetus far enough into the pelvis to be at - it lasts a day or two soon after birth the level of ischial spine - caput succedaneum, a swelling of the scalp - in a primipara, non-engagement of the head of a newborn due to pressure from uterus or at the beginning of the labor indicates a vaginal wall in vertex delivery possible complication - In multiparas, engagement may not be FETAL PRESENTATION AND POSITION present at the beginning of the labor 1. ATTITUDE 3. STATION - describes the degree of flexion a fetus - refers to the relationship of the presenting assumes during labor or the relation of the part of a fetus to the level of the ischial fetal parts to each other spines a. vertex MOSENABRE  2022 5  4. FETAL LIE - they relationship between the long (cephalocaudal) axis of the fetal body and the long axis of a woman's body - whether the fetus is lying in a horizontal 3. SHOULDER PRESENTATION (transverse) or a vertical (longitudinal) a fetus lies horizontally in the pelvis so position that the longest fetal axis is perpendicular to that of the mother the presenting part is usually one of the shoulders (acromion process), an iliac crest, a hand, or an elbow TYPES OF FETAL PRESENTATION → denotes the body part that will first contact the cervix or be born first o cephalic presentation o Breech presentation TYPES OF FETAL POSITION o Shoulder presentation → the relationship of the presenting part to a 1. CEPHALIC PRESENTATION specific quadrant of a woman's pelvis Most frequent type of presentation, → the maternal pelvis is divided into 4 occurring as often as 95% of the time quadrants according to the mother's right the fetal head is the body part that will and left: first contact the cervix ▪ right occiput posterior (ROP) four types of cephalic presentation ▪ left occipital posterior (LOP) (vertex, brow, face, and mentum) ▪ Right occiput anterior (ROA) 2. BREECH PRESENTATION ▪ left occiput anterior (LOA) o O – occiput/back of the head either the buttock or feet are the first o M – mentum/chin body parts that will contact the cervix o Sa – sacrum occur in approximately 3% of births and o A – acromion process are affected by fetal attitude → Position is indicated by abbreviations three types of breach presentation o the first letter defines whether the (complete, frank, and footling) landmark is pointing (R or L) o middle letter denotes fetal landmark (O, M, Sa, A) MOSENABRE  2022 6  o the last letter indicates whether the call ma ineffective dilation of cervix or landmark points anteriorly, posteriorly, irregular/weak uterine contractions) or transversely → Early rupture of the membranes may occur increasing the possibility of infection, fetal anoxia, meconium staining and respiratory distress → If labor is threatening and unsatisfactory, it can interfere with maternal-child bonding FOUR METHODS TO DETERMINE FETAL POSITION 1. combined abdominal inspection or palpation called Leopold’s Maneuver 2. vaginal examination 3. auscultation of fetal heart tones 4. ultrasound Exercise: 1. Celeste’s obstetrician asks you which fetal position and presentation are ideal. Your best answer would be: a. Right occipitoanterior with full flexion b. left transverse anterior in moderate MECHANISM OF LABOR (CARDINAL flexion MOVEMENTS) c. right occipitoposterior with no flexion d. left sacroanterior with full flexion → passage of fetus through the birth canal POWERS OF LABOR involves several different position changes to keep the smallest diameter of the head → the force supplied by the fundus of the uterus, always presenting to the smallest diameter implemented by uterine contractions, a natural of the pelvis process that causes cervical dilation and o descent expulsion of fetus from the uterus o Flexion UTERINE CONTRACTIONS o Internal rotation → Origin - begin at a pacemaker point located in o Extension the uterine myometrial near one of the o External rotation uterotubal junctions sweeping down over the o Expulsion uterus as a wave → Phase - it has three phases: o increment - when the intensity of contraction increases o acme - when the contraction is at its strongest o decrement - when the intensity of contraction decreases → Contour changes o physiologic retraction ring o pathologic retraction ring (Bandl’s ring) IMPORTANCE OF DETERMINING FETAL PRESENTATION AND POSITION → Cervical changes → other than vertex presentation could put a o effacement - is shortening and thinning fetus at risk (ineffective descent of the fetus of the cervical canal (gradual) 0-100% MOSENABRE  2022 7  o dilatation - refers to the enlargement or falls - this increase in uring widening of the cervical canal wide production can lead to a weight loss enough (approximately 10cm) to permit between 1-3 lbs passage of a fetus 4. Braxton Hicks contractions o painless, erratic uterine contractions PSYCHOLOGICAL OUTLOOK that occur toward the end of → refers to the psychological state or feelings that pregnancy, they ready the cervix for a woman brings into labor labor, but cervical dilation does not → women without adequate support can have an occur with them experience so frightening and stressful they can 5. Ripening of the cervix develop a post-traumatic stress syndrome o an internal sign seen only on pelvic → Encourage women share the experience after examination labor, debriefing time o Godell’s sign - upon palpation the THEORIES OF LABOR ON SET consistency of the cervix is similar to → normally begins when a fetus is sufficiently an earlobe matured to cope up with extrauterine life B. SIGNS OF TRUE LABOR 1. Uterine contractions → in some instances, labor begins before a fetus is o Productive uterine contractions mature (preterm birth) and in others, labor is signal that labor has begun delayed until the fetus and placenta have both 2. Show passed beyond the optimal point of birth (post o mucus term birth) o cervical capillaries seep blood as a → Uterine muscles stretching results in release of result of pressure exerted by the prostaglandins fetus, this blood is mixed with → pressure on the cervix stimulates the release of mucus, takes on a pink tinge and is oxytocin from the anterior pituitary gland referred to as show or bloody show → oxytocin stimulation works together with 3. Rupture of membranes prostaglandins to initiate contractions o sudden gush or scanty, slowing → increasing estrogen in relation to progesterone seeping of Clear fluid from the is interpreted as progesterone withdrawal vagina → placental age triggers contractions at a set point o amniotic fluid continues to be → rising fetal cortisol levels reduces progesterone produced until delivery of the formation and increases prostaglandin formation membranes after the birth of a fetus → fetal membrane production of prostaglandins o early rupture of the membranes can stimulates contractions be advantageous as it can cause the SIGNS OF LABOR fetal head to settle snugly into the A. PRELIMINARY SIGNS OF LABOR pelvis 1. Lightening o if labor has not spontaneously o descent of the fetal presenting part occurred by 24 hours after into pelvis that occurs approximately membrane rupture, labor will be 10 to 14 days before labor begins induced to help reduce intra uterine o a woman may experience shooting infection and prolapse of the leg pains from the increased umbilical cord pressure on her sciatic nerve, FALSE LABOR TRUE LABOR increased amount of vaginal CONTRACTIONS CONTRACTIONS discharge, and urinary frequency → begin and remain → begin irregularly from pressure on her bladder irregular but become 2. Increase in level of activity → felt first regular and o It is related to an increase in abdominal E and predictable epinephrine release initiated by a remain confined → felt first in lower decrease in progesterone produced to the abdomen back and sweep by the placenta and groin around to the o additional epinephrine prepares a → often disappear abdomen in a woman's body for the work of Labor with ambulation wave ahead and sleep → continue no 3. Slight loss of weight → do not increase in matter what the o body fluid is more easily excreted from the body as progesterone level duration, MOSENABRE  2022 8  frequency or woman's level of NURSING CARE intensity activity 1. Transfer to delivery room for 8 to 9 CM → do not achieve → increase in dilation for multigravidas and full dilation cervical dilation duration, for primiparas frequency, and 2. Monitor vital signs and fetal heart rate intensity 3. prepare perineal area → achieve cervical 4. encourage pushing with contractions dilation (0 to 10 5. initiate breast feeding “Unang Yakap” centimeters) C. THIRD STAGE (PLACENTAL STAGE) - begins with the birth of the infant and ends with the Exercise: delivery of the placenta Celeste Bailey did not recognise for over an hour that 1. Placental Separation – occurs she was in labor. A sign of true labor is: automatically as the uterus resumes a. Sudden increased energy from contractions epinephrine The following signs indicate that the placenta b. Nagging but constant pain in the has loosened and is ready to deliver: lower back o lengthening of the umbilical cord c. urinary urgency from increased o sudden gush of blood (normal blood bladder pressure loss is 300-500ml) d. show or release of cervical mucus o change in the shape of the uterus plug TYPES OF PLACENTAL SEPARATION 1) Schultz (shiny, fetal side) STAGES OF LABOR 2) Duncan (dirty, maternal A. FIRST STAGE - beginning with true labor side→raw and red) contractions and ending when the cervix is fully 2. Placental Expulsion – after separation, the dilated placenta is delivered either by the natural a. Latent or preparatory phase bearing-down effort of the mother or by o contractions are mild and short gentle pressure on the ctracted uterine o lasting 20 to 40 seconds fundus by the physician or nurse-midwife o cervix dilate from 0-3cm (Crede’s maneuver) o lasts 6hrs. in nullipara, and 4.5hrs in multipara NURSING CARE b. Active phase - assess for uterine contraction o rapid cervical dilatations from 4 to 7 - monitor vital signs centimeters - administer 10 units oxytocin IM with BP o contractions are stronger precaution and infuse oxytocin as ordered o lasting 40 to 60 seconds every three - send cord blood to laboratory if mother is to five minutes O-positive or Rh-negative o lasts 3 hours in nullipara and 2 hours DANGER SIGNS OF LABOR AND DELIVERY in multipara c. Transition phase o Maximum dilation of 8-10cm A. MATERNAL o intensity of contractions at their a. High or low blood pressure peak that lasts 60-90 seconds every → Normally rises slightly in the second two to three minutes (pelvic) stage of Labor because of her pushing off NURSING CARE → 140 / 90mmHg (the basic criteria for 1. monitor vital signs and fetal heart rate PIH) and falling blood pressure every 15 minutes maybe the first sign of intra uterine 2. bed rest for ruptured membrane hemorrhage 3. empty the bladder as ordered 4. teach breathing techniques 5. maintain safety B. SECOND STAGE - from full dilatation and cervical effacement to birth of the infant MOSENABRE  2022 9  b. Abnormal Pulse PARTOGRAPH → Normally pregnant women have a pulse rate of 70 to 80bpm and increases slightly during second stage of Labor because of exertion involved → maternal PR>100 during normal labor should be reported for it may be another indication of hemorrhage c. Inadequate or prolonged contractions → Less frequent, less intense, or shorter duration, may indicate uterine exhaustion-inertia → uterine contractions lasting longer than 70secs should be reported d. Pathologic retraction ring → It is important to observe the contours of a woman abdomen periodically during labor because extreme uterine stress may lead to uterine rupture POST PARTUM e. Abnormal lower abdominal contour - is the period that occurs shortly after birth → A full bladder may be injured by the o physiological or body changes pressure of a fetal head and may not o psychological changes allow the fetal head to descend PHYSIOLOGIC CHANGES OF POST PARTAL PERIOD → women need to try to void about every A. REPRODUCTIVE SYSTEM CHANGES two hours during labor involution is the process whereby the f. Increasing apprehension reproductive organs return to their non pregnant → Needs to be investigated for physical state reasons, because it can be a sign of I. The uterus oxygen deprivation or internal ▪ Immediately after birth it weighs hemorrhage about 1000 grams ▪ at the end of the first week it B. FETAL reduces to 500 grams a. High or low fetal heart rate (FHR) ▪ when involution is complete ( 6 → normal FHR-100 to 160bpm and is weeks) it weighs 50 grams assessed only between contractions ▪ breast feeding mother can allow b. Meconium staining uterus to contract more quickly, → a green color in the amniotic fluid however not sufficient to protect reveals that the fetus had lost rectal against postpartum hemorrhage sphincter control indicating hypoxia ▪ uterine involution may be → it may be normal in a breech delayed by multiple births, presentation because of the pressure on hydramnios, exhaustion from the buttocks prolonged labor, excessive c. Hyperactivity analgesia → Frantic motion is a common reaction to ▪ soon after birth if the uterine will the need for oxygen or the fetus may be relax, uterine atony, indicates experiencing hypoxia danger for it causes bleeding → 10 movements of any kind in an hour or ▪ afterpains may develop less is normal following an increasing strength d. Oxygen saturation of uterine contractions → normal O2 sat- 40% to 70% II. Lochia ▪ The uterine flow, consisting of blood, fragments of decidua, white blood cells, mucus, and some bacteria Type of Color post composition lochia partal day MOSENABRE  2022 10 lochia rubra Red 1-3 blood, ▪ Blood volume returns to its normal fragments prepregnancy level by the first or of decidua, second week after birth and mucus ▪ usual blood loss with vaginal birth is Lochia Pink 3 to 10 Blood, 300 to 500ML; cesarian birth is 500 serosa mucus and to 1000ML invading d. The gastrointestinal system leukocytes ▪ Digestion and absorption begin to lochia Alba White 10 to 14 largely be active again soon after birth (may last mucus, unless she had a cesarean birth six weeks) leukocyte ▪ bowel evacuation may be difficult count is because of the pain of episiotomy high sutures or hemorrhoids III.the cervix Diastasis Recti – separation of the ▪ The internal os closes as before rectus abdominis as the abdomen but after a vaginal birth the expands external os remains slightly open and appears slitlike or stellate (starshaped), which is previously round IV. the vagina ▪ is soft, with few rugae, and its diameter is considerably greater than normal ▪ kegel’s exercise increases the strength and tone of vagina more rapidly V. the perineum ▪ Because of great pressure experienced during birth, a chemosis is developed from ruptured capillaries e. The integumentary system B. SYSTEMIC CHANGES ▪ striae gravidarum is still present a. The hormonal system ▪ chloasma and linea negra will be ▪ pregnancy hormones begin to barely visible in six weeks time decrease as soon as the ▪ diastasis recti is still present and placenta is no longer present could be relieved by sit-ups ▪ hCG and hPL are negligible by C. PROGRESSIVE CHANGES 24 hours; progestin and estrone 1. Lactation by one week; FSH for about 12 o continues to excrete colostrum for the days first two postpartum days, on the third b. the urinary system day her breasts become full and feel ▪ during pregnancy, as much as tense and tender as milk forms within 2000 to 3000ML of excess fluid breast ducts accumulates in the body→1500 o primary engorgement is the feeling of to 3000ML per day during 2nd tension in the breasts on the 3rd to 4th to 5th day after birth day ▪ assess a woman bladder from 2. Return of menstrual flow overdistention frequently soon o the production of placental estrogen and after birth to prevent permanent progesterone ends up on the delivery of damage the placenta ▪ increased size of uterus (hydro o if a woman is breastfeeding, her nephrosis) that occurs during menstrual flow may not return for three pregnancy remains present for to four months (lactation amenorrhea); if about four weeks after birth she is not breastfeeding her menstrual c. the circulatory system flow returns 6 to 10 weeks after birth 3. Psychological post partal changes MOSENABRE  2022 11  o the postpartum period is a time of o Lactation amenorrhea transition, during which a couple gives o Calendar up concepts such as “childless” or o Ovulation method “parents of 1” o Symptothermal o nurses can help couples acknowledge o Postovulation the extent of the change, so that they → Barrier Methods can gain closure on their previous o cervical cap lifestyle o sponge D. TAKING-IN PHASE o diaphgram - woman is largely passive for two to three days o female condom period o male condom - A woman develops dependence partly resulting → Hormonal methods from physical discomfort or extreme exhaustion, o transdermal patch she is encouraged to rest in this phase to regain o vaginal ring strength o IUD - Encouraging her to talk about the birth helps her o COC integrate it into her life experiences o depo-provera E. TAKING HOLD PHASE o Intradermal Implants - begin to initiate action → Surgical Methods - giving birth without anesthesia may reach this o Female sterilization face in a matter of hours after birth o Male Sterilization - express a little to strong interest of caring for the baby PSYCHOLOGICAL AND PHYSIOLOGIC CHANGES F. LETTING GO PHASE OF PREGNANCY - a woman finally really finds her new role A. Social Influences - gives up fantasized image of her child and o health care settings view pregnancy as a accepts the real one time of health - requires readjustment of relationships and is o nurses can help by informing women extended during the child's growing years about their new health care options and continuing to work with other health care POSTPARTUM COMPLICATIONS providers to demedicalize childbirth PHYSIOLOGICAL B. Cultural Influences A. uterine ateny o a woman's cultural background may B. lacerations strongly influence how active a role she C. retained placental fragments wants to take in her pregnancy D. uterine inversion o nurses must respect person's belief, but E. subinvolution encourage a woman to also respect that F. perineal hematoma physiologically these types of action G. pueperal infection could not affect a fetus H. endometritis C. Family Influences I. thrombophlebitis o the family in which a woman was raised a. femoral can be influential to her beliefs about b. pelvic pregnancy c. pulmonary embolus o becoming a mother is a second J. mastitis adjustment above and beyond being K. urinary retention pregnant L. urinary tract infection D. Individual Influences M. post partal PIH o acceptance can be easy for mothers if N. reproductive tract displacement she has a support group (child's father, O. separation of the symphysis pubis loved ones) PSYCHOLOGICAL o women who do not have a support A. post partal blues group often look to health care providers B. post partal depression during pregnancy to fill the role of an C. postpartal psychosis attentive listener NATURAL FAMILY PLANNING/PERIODIC PSYCHOLOGICAL TASKS OF PREGNANCY ABSTINENCE METHOD First Trimester → Natural Family Planning Task: Accepting the pregnancy o Abstinence MOSENABRE  2022 12  o Woman and partner both spend time APGAR recovering from shock of learning about (Appearance, Pulse, Grimace, Activity, the pregnancy. A common reaction is Respiratory) ambivalence of feeling both pleased and Score not pleased about the pregnancy. Sign to 0 1 2 Second Trimester Assess Task: Accepting the baby Heart rate Absent Slow >100 o Woman and partner move through (