Davis Advantage for Maternal-Child Nursing Care (Ch 11)

Davis Advantage for Maternal-Child Nursing Care, Third Edition. Chapter 11 Caring for the Postpartal Woman and Her Family Copyright ©2022 F.A. Davis Company  Postpartum...

Davis Advantage for Maternal-Child Nursing Care, Third Edition. Chapter 11 Caring for the Postpartal Woman and Her Family Copyright ©2022 F.A. Davis Company  Postpartum  Postpartum- 6-week period after childbirth. The first 4 hours postpartum is also known as the 4th stage of labor  Hemorrhage and infection most common complication  Think psychosocial piece- bonding, adjustment, PPD  Big patient education focus  Insurance – cannot force less than 48 hours Vaginal 96 hours C/S Copyright ©2022 F.A. Davis Company  Ensuring Safety for the Mother and Infant  Security protection for patients, mother/baby units, and visitors  JCAHO – mandatory security system  Misidentification of newborns while in the hospital Check identification bracelets  Protecting the infant from abduction Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Early Maternal Assessment  Vital Signs Temperature: below 100.4F (38C) Pulse: decrease common (50-70) Blood pressure: compared to first trimester Respirations: normal range of 12-20 Pain: “fifth vital sign” ‒ Should not be high level pain (should be up to abt 4/10 max) See p. 372 table 11-1 WBC – should be around 13-14k due to stress of delivery  Medications Can now have Ibuprofen, Aleve, now that baby is out Copyright ©2022 F.A. Davis Company  Concise Postpartum Assessment Guide to Facilitate Nursing Care  BUBBLE-HE Breasts Uterus Bladder Bowel Lochia Episiotomy (perineum) Homan’s sign Emotions Copyright ©2022 F.A. Davis Company  Review of common terms  Fundal Check- checking the location and consistency of the fundus in the abdominal cavity (umbilicus is the landmark)  Uterine Atony- decreased tone of the uterine muscle. The primary cause of postpartum hemorrhage (Boggy vs firm)  Involution-the process by which the uterus returns to a pre-pregnant size, shape, and location and the placental site healing  Sub-involution-term used when uterus does not return to its pre-pregnant size or shape Still staying above the umbilicus after delivery Copyright ©2022 F.A. Davis Company  Uterus  Fundal check is essential  Umbilicus is the baseline marker Placement of the fundus  Firm or boggy  Midline or to either side Copyright ©2022 F.A. Davis Company  Bladder – Risk for retention  Significant fluid movement & diuresis must occur  IV fluids  Increase urine output  Numbness from delivery  Poor tone  Pain  Decreased urge to void  Encourage fluids and frequent voiding  Edema is still common Should still not be at face or hands Copyright ©2022 F.A. Davis Company  Bowel  Constipation is common  Baby’s head has been compressing  Poor intake before/during labor  Fear, pain, lacerations  Decrease urgency  Encourage ambulation, fiber, fluids  Stool softeners for everyone Copyright ©2022 F.A. Davis Company  Sitz bath Copyright ©2022 F.A. Davis Company  Maternal Physiological Adaptations and Continued Assessment of the Patient  Hematological Body can compensate for 500 – 1000 ml of blood Decrease in Hgb and increase in HCT (why) ‒ HCT goes up because higher concentration from diuresis ‒ Don’t want it greater than 10% ‒ Pt. Education: increase hydration and iron-rich foods Increase in WBC – Normal in during first days  Metabolic systems No more placenta, fetus, hormones will cause a decrease in glucose needs. GDM will go away. T2DM and T1DM will need less insulin or none Copyright ©2022 F.A. Davis Company ‒ Hypoglycemia high chance, hyperglycemia low  Maternal Physiological Adaptations and Continued Assessment of the Patient (continued)  Neurological system Assess and define headaches Pre-eclampsia still active/potential Spinal/Epidural headaches: front of head, gets better lying down (pre-e h/a does not relieve with position changes) ‒ Check the BP ‒ Check for visual disturbances ‒ Check for epigastric pain  Renal system, fluids, and electrolytes Already discussed, diuresis expected  Respiratory system Should really have no issues and should go down to normal with no desats Problems arise from a complication (tachypnea and elevated HR) Copyright ©2022 F.A. Davis Company  Maternal Physiological Adaptations and Continued Assessment of the Patient (continued)  Cardiovascular system Increase CO (fluids) Highest time for a cardiac compromise due to the speed of change after birth  Rhogam Needs to be given only if infant is positive Have up to 72 hrs. to give  Ovulation Does return, can get pregnant, need contraception thoughts, breastfeeding is not a reliable contraception method Copyright ©2022 F.A. Davis Company  Maternal Physiological Adaptations and Continued Assessment of the Patient (continued) Gastrointestinal system Constipation C/S – N&V (1-2 hrs), clear to solid progression intake ‒ Longer than 1-2 indicates an ileus SVD – will be hungry – feed them!  Musculoskeletal system Lots of aches and pains Joints loose Do not resume strenuous exercise No abdominal strain Copyright ©2022 F.A. Davis Company  Developing Cultural Sensitivity  Knowledge of various dimensions of care  Holistic approach that expands knowledge, changes attitude, and enhances clinical skills  Conduct cultural assessments  Expand knowledge of culturally influenced beliefs  Clinical implications of culturally appropriate care Copyright ©2022 F.A. Davis Company  Patient education  Activity and rest  Nourishment  Elimination  Perineal care  Teaching about perineal care Copyright ©2022 F.A. Davis Company  Care of the Postpartal Surgical Patient  Care of the patient after cesarean birth Same care as any patient with abdominal surgery Add BUBBLE-HE  Recovery from anesthesia  Abdominal distention – gas N & V  Urinary system 4 – 6 hrs. after PP should see urine Remove catheter abt 12-16 hrs/ PP Copyright ©2022 F.A. Davis Company  Terms associated with the Breasts  Primary Engorgement This occurs in all woman at approximately the 3rd day postpartum (may be earlier in multiparas) regardless of feeding status of the mother (breast vs. bottle) Occurs in response to the release of oxytocin which stimulate the mammary glands to begin milk production  Colostrum Thin, yellowish sticky “first” milk a mother produces which is high in antibodies and nutrients  Lactation Term used interchangeably with breastfeeding. To produce milk from mammary glands or to suckle (nurse) one’s young. Copyright ©2022 F.A. Davis Company  Educating Parents to Make Informed Infant Nourishment Choices  Discussion/education prenatally  Highly recommended but it is their choice Be reasonable with demands Encourage to stick with it – not easy Pacifiers/bottles - controversy  All about supply and demand The more a baby breastfeeds the more milk is produced  Benefits – see box 11-2, p. 387  Contraindications – see p.387 Copyright ©2022 F.A. Davis Company  Breast Crawl Copyright ©2022 F.A. Davis Company  The golden hour Copyright ©2022 F.A. Davis Company  The physiology of lactation  Lactogenesis – prolactin and oxytocin  Three stages of milk production 1. Late prenatal – milk was starting to form 2. Colostrum - After delivery of placenta - nutrient dense, yellow, thicker, sticky 3. Mature milk – 1-3 days  Let-down reflex – tingling Anxiety/pain barrier Copyright ©2022 F.A. Davis Company  Breastfeeding success  Partnering with an IBCLC and other community resources  Rooming in so mom can respond  Care of the breasts during lactation Clean with warm water – no soap Breast creams – a no-no Use colostrum or coconut oil  Latch Pain, blisters sign of poor latch Copyright ©2022 F.A. Davis Company  Home health RN  If qualify get her an appointment  Checks on baby and mom Baby – weight check, jaundice, environment Mom – Emotions (PPD), breastfeeding, bonding Copyright ©2022 F.A. Davis Company  Cues of successful breastfeeding  Infant weight – no greater than 7% loss  Infant sucking and swallowing  Infant satisfaction  Breasts are less full after feeding  See more on p. 390 Copyright ©2022 F.A. Davis Company  Additional breastfeeding info  Positions Whatever mom likes best, G1 try different ones Baby’s head must be midline  Safety during breastfeeding Do not sleep with infant Side lying the toughest to stay awake  Breast shells for flat, inverted, soreness  Donor breast milk  Tobacco, alcohol, meds and Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Help moms relieve engorgement Copyright ©2022 F.A. Davis Company  Breasts complications  Clogged milk duct – palpable nodule  Abnormal engorgement  Cracked nipples  Mastitis Engorgement and/or clogged milk duct leading causes for mastitis Copyright ©2022 F.A. Davis Company  Clogged milk duct  Will present as a hard nodule  Warm compress will loosen  Message the area  Pump, hand express, feed, make the milk flow Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Visual Cues of mastitis Copyright ©2022 F.A. Davis Company  Promoting Family and Infant Bonding  Attachment refers to the tie that exists between the parent and infant  Bonding begins at the moment the pregnancy is confirmed and continues through the birth experience, during the postpartal period, and throughout the early years of the child’s life Copyright ©2022 F.A. Davis Company  Promoting Family and Infant Bonding (continued)  Facilitating the transition to parenthood Let mom and support do infant care  Assumption of the maternal role  Assessing for maternal-infant attachment  Assumption of the paternal role  Factors that may interrupt the bonding process  Helping older siblings adjust to the Copyright ©2022 F.A. Davis Company  Emotional and Physiological Adjustments During the Puerperium  Emotional events Maternity blues/baby blues/postpartum blues Postpartum depression Postpartum psychosis  Physiological responses to emotional events Tiredness and fatigue Copyright ©2022 F.A. Davis Company  Same concepts apply Copyright ©2022 F.A. Davis Company  Community Resources for the New Family  Support groups Share experiences and challenges  Home visits Maternal and baby assessments  Telephone follow-up Call approximately 2 to 3 days after discharge  Outpatient clinics An option for facilities that do not offer home visits Copyright ©2022 F.A. Davis Company