POSTPARTUM PERIOD (Autosaved).pdf

CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna globular and be midline: perform...

CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna globular and be midline: perform fundal massage if bleeding increases. POSTPARTUM PERIOD D. Assess for bladder distention, especially during the first 24-48 hours Nursing Care Management and report to RN or PCP if client is distended. E. Perineal Area. 1. Observe episiotomy  Placental Delivery site for hematoma. 2. Apply aesthetic  Oxytocin (increases uterine sprays or ointment to decrease pain. 3. contractions, thereby minimizes Determine presence of hemorrhoids uterine bleeding: can be administered and provide relief measures. either student of IV or IM F. Lochia: record color, odor, and  Perineal Repair amount of discharge  Aftercare 1. Report any significant increase in amounts or foul odor of lochia to POSTPARTUM FUNDAL ASSESSMENT the charge nurse or the PCP 2. Change perineal pads frequently G. Abdomen and perineum 1. Initiate strengthening exercises for both abdominal wall and perineum (e.g, Isometric Kegel exercises for strengthening pelvic floor, leg raises) 2. Kegel exercise practice trying to stop the passing of gas or the flow of urine midstream, which replicates for the sensation of the pelvic muscles drawing upward and inward. POSTPARTUM CARE Goal: To provide comfort Goal: To initiate routine and relief of pain. postpartum data collection A. Episiotomy: use ice picks for first few hours followed by dry heat light or sitz A. General observations of mood, activity baths level, and feelings of wellness; routine B. Perineal care: use of “peri bottles” to vital sign collection. squirt over perineum (front to back) to B. Inspection of breasts: check for prevent contamination: avoid use of beginning engorgement and presence toilet tissue of cracks and nipples, any pain or C. Afterpain: use of an analgesics tenderness, and progress of (preferably 1 hour before feeding, breastfeeding especially for breastfeeding mothers) C. Check uterine fundus: determine D. Hemorrhoidal pain. height of fundus in relation to 1. Sitz baths, anesthetic ointments, umbilicus: should feel firm and rectal suppositories, tucks.  CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna 2. Encourage lying on side and 3. Assess breasts for engorgement, avoiding prolonged sitting nipple inversion, cracking, 3. Stool softeners or laxatives may inflammation, or pain and report to be indicated RN E. Breast engorgement: well-fitting bra to 4. If mother experience uterine provide support contractions during breastfeeding, administer analgesics before breastfeeding. Goal: To promote Goal: To prepare and plan for discharge. maternal-infant A. Determine if mother will need attachment and household help (especially important facilitate integration of if birth is twins) the newborn into the B. Assist the RN to teach the following family unit. the infant care skills: 1. Infant feeding. Always hold infant A. Use infant‟s name when talking about for feeding him or her a. Hold bottle so that air does not B. Encourage parents to provide as much get into nipple care as possible to the infant while still b. Method of cleaning bottles hospitalized and making formula. C. Accept parent‟s emotions and c. Positioning and feeding for encourage expression of feelings lactating mothers. D. Help parents understand sibling d. How to break the infant's behavior and to plan for the arrival of suction on the breast. the new family member e. Positioning for burping and bubbling. Goal: to establish 2. Diapering. successful infant feeding a. Frequent changing to prevent patterns diaper rash. b. Vaseline or Desitin ointment to A. Lactation suppression. prevent irritation. 1. Provide supportive bra, binder, or c. Keep diaper below the umbilical ice pack to decrease engorgement, cord. application of fresh cabbage 3. Bathing. leaves inside bra 2. Explain proper position for A. Use of a mild soap. feeding B. Kitchen sink is often a good 3. Formulas: ready-to-feed in place to bathe infant. disposable bottles often with C. Lotions can be applied; best disposable nipples advice is to avoid use of B. Lactating mothers (lactation powders. promotion) 1. Cleanse breast before infant nursing and afterwards 2. Air-dry nipples at least 15 minutes after breast feeding  CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna 4. Umbilical cord. Postpartum Care a. apply alcohol or wash with warm Assess and support... soap and water daily and after a. Breastfeeding (information and every diaper change, allow to dry support) b. stump usually falls off in 1 week b. Desires to use contraceptives to 10 days c. Adequate nutrition d. Immunizations, vitamins c. do not immerse abdomen during bathing until cord slump falls off Breastfeeding and breast care after delivery Goal: To prepare and plan for discharge. Breastfeeding  It provides numerous health benefits A. Determine if mother will need to both a mother and an infant · household help (especially  It remains the ideal nutritional source important if birth is twins). for infants through the first year of life B. Assist the RN to teach the  Prolactin- acts on the acinar cells of following infant care skills: mammary glands to stimulate the 5. Pacifiers. production of milk a. May be used to meet infant's sucking Colostrum need.  A thin, watery, yellow fluid composed b. Usually discontinued around 4 to 6 of protein, sugar, fat, water, minerals, months due to infant's lack of interest. vitamins, and maternal antibodies. 6. Sleeping.  First 3 or 4 days after birth, colostrum production continues. a. Usually sleeps through the  It is easy to digest and capable of night at around 2 to 3 providing adequate nutrition for a months of age. newborn b. Encourage mother to sleep while infant is sleeping, to 10 day- mature breastmilk is produced avoid sleep deprivation. Let-down reflex · 7. Illness. a. Common behavior changes are  When the infant sucks at the breast, irritability, crying, loss of appetite, and oxytocin is released, causing the fever. collecting sinuses of the mammary b. Explain how to take an infant's glands to contract, forcing milk temperature. forward through the nipples  It may also triggered by the sound of 8. Taking the infant outside. the infant crying or by thinking about the newborn a. Dress infant as you would dress yourself. Advantages. b. Traveling: use a car seat. 9. Explain importance of follow-up well-baby  It may serve as a protective function in check-up visits with health care provider. preventing breast cancer  CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna  The release of the oxytocin (posterior TABLE 19.3 LATCH BREASTFEEDING pituitary gland) aids un uterine CHARTING SYSTEM involution  It can have an empowering effect 0 1 2 because it is a skill only a woman can L: Latch Too Repeated Grasps breast; master sleepy attempts; tongue down;  It reduces the cost of feeding and or necessaryto lips flanged; preparation time reluctan hold nipple rhythmic t; no in sucking  It provides an excellent opportunity to latch mouth;stim enhance the mother-baby relationship achieve ulate to  It contains IgA that keeps the infant d suck protected from virus and bacteria A: Audible None A few Spontaneous and being absorbed from the GIT · swallowin swallows intermittent  Increase the effectiveness of g with under 24 hr old; antibodies It contains ideal electrolyte stimulation spontaneous and frequent over 24 and mineral composition for infant hr old growth T: Type Inverted Flat Everted (after  It contains linoleic acid, an essential ofnipple stimulation) fatty acid for skin integrity, less Na, K, C: Engorg Filling; Soft, nontender Ca, P than do formulas Comfort ed; reddened/s  It prevents excessive weight gain (breast/ni cracked mallblisters pple) , or Breastfeeding and breast care after bleedin bruises;mil delivery g, d/moderate  Educating all pregnant women about large discomfort the benefits and management of blisters, or breastfeeding bruises;  Helping women initiate breastfeeding severe within half an hour after birth discomf  Assisting mothers to breastfeed and ort maintain lactation even if they should H: Hold Full Minimal No assist from be separated from their infant (positioni assist assist (staff staff; mother  Nor giving newborns food or drink ng) (staff placespillo able to holds ws for position/hold other than breast milk unless infant support, baby by herself medically indicated, so they are at 1060 hungry to breastfeed breast at breast)  Supporting rooming-in (such as elevates allowing mothers and in- fants to head of remain together) 24 hours a day bed);  Encouraging breastfeeding un demand teachone side,  Fostering the establishment of mother breastfeeding support groups and doesother; referring mothers to them on discharge mother from the birthing center or hospital takes overfeedin g  CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna  Provide information regarding techniques for burping the breastfed baby  Support for a mother who is breastfeeding multiple infants  Prevent or relieve engorgement  Promote healing of sore nipples  Anticipate potential problems and suggest methods for resolving them  Provide information for a mother who works outside the home  Provide information on weaning IMMEDIATE NEWBORN CARE Learning Objectives  Provide immediate care of the newborn Differences in the sucking mechanism. (A)  Perform thorough assessment of the Breastfeeding. actual postpartum client and her (1) Lips of the infant clamp in a C shape. The newborn cheek muscles contract.(2) The tongue thrusts Goals forward to grasp the nipple and areola. (3)  To establish, maintain, and support Thenipple is brought against the hard palate as respirations the tongue pulls backward,bringing the areola  To provide warmth and prevent into the mouth. (4) The gums compress the hypothermia To ensure safety, prevent areola,squeezing milk into the back of the injury and infection throat. (B) Formula feeding. Thelarge rubber  To identify actual or potential nipple of a bottle strikes the soft palate and problems that may require immediate interfereswith the action of the tongue. The attention tongue moves forward against thegums to control the overflow of milk into the Newborn priorities in First Days of Life esophagus  Initiation and maintenance of Breastfeeding and breast care after respirations „ delivery  Establishment of extrauterine circulation  Provide information regarding  Control of body temperature lactation and proper positioning  Intake of adequate nourishment techniques  Establishment of waste elimination  Promote adequate sucking  Prevention of infection  Provide immediate support if problem  Establishment of an infant-parent arise relationship  CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna  Developmental care, or care that balances physiologic needs and stimulation for best development Immediate care of the newborn A- airway B-body temperature C- Check the newborn (Apgar score) D-determined identification (identification band, footprints, fingerprints, crib card, bead bracelet, birth certificate) Immediate care of the newborn A. Head Circumference Range: 22-37 cm (125-145 in) Approximately 2 cm luger than chest circumference Perform initial assessment (APGAR Score) B. Chest Circumference Average: 32 cm It is taken twice: Initially @ 1 min. and @ 5 (12.5m) Range. 33-35 cm (12-14 in) min. after birth C. Body Length-Height Average 50 cm (20) Special consideratrìon: Range 48-62 cm (18-22)  1st 1 min- to determine general condition of baby Growth 25 cm (1) per month for first  Next 5 mins. - to determine baby's D. Abdominal Circumference capabilities to adjust extrauterine  Next 15 mins. Dependent on the 5 Average: 32cm (12.5inch) mins. Ranger: 31 to 33  CALAMBA DOCTORS’ COLLEGE Virborough Subdivision, Parian, Calamba City, Laguna