WK9 - Postpartum Care & Postpartum Complications PDF

Bachelor of Science in Nursing 2YA NCMA217 LEC: POSTPARTUM CARE Discussed by Prof. Jhal Espinosa POSTPARTUM CARE - Pagnailabas na si baby, biglang bababa yan hangga...

Bachelor of Science in Nursing 2YA NCMA217 LEC: POSTPARTUM CARE Discussed by Prof. Jhal Espinosa POSTPARTUM CARE - Pagnailabas na si baby, biglang bababa yan hanggang sa level - Refers to the medical and nursing care given to a woman ng umbilicus. Mag stay sya doon for about 2 days and after during the puerperium. Approximately 6 weeks after the that, every day it will go down by one finger breadth (1cm). delivery of the neonate beginning from the time that you have - Then after 10-14 days or 2 weeks, the uterus should not be terminated the labor. (hanggang sa mabalik ung mga palpable anymore. Because the uterus is already inside the reproductive organs sa non-pregnant state) pelvis. - This period constitutes a physical and psychological - Healing nun pinagiwanan ng placenta in the endometrium, that adjustment. will take approximately 6-7 weeks to permanently heal. - 4th trimester of pregnancy - Endometrium starts to regenerate – 6 weeks Principles - May pain si mami kapag na iinvolute kasi nag cocontract. Puerperium Discomfort. - Postpartum period 6 weeks - Analgesic drug e.g paracetamol to reduce the pain - Period of adjustment after the delivery of the baby when - Nursing care: continue breastfeeding, because as the baby the anatomic and physiologic changes of our body is sucks on the breast, more oxytocin is being produce. And being reverse to the normal non pregnant state. because of that the contraction will go into a normal Involution contraction and it will hassle the involution. - Uterus goes back to the prepregnant state (pagliit ni uterus) Post-partum care - Immediate care of the mother and neonate after delivery. Post-partum goals - Aim to help the mother in the healing of the process. - To provide emotional support. Post-partum Goals 1) Promote normal uterine involution and return to the nonpregnant state. 2) Promote comfort and healing of pelvis, perianal, and perineal tissues. 3) Prevent or minimize postpartum complications. 4) Assist in restoration of normal body functions The Lochia 5) Increase understanding of physiologic and psychological - Uterine flow consisting of blood, fragments of decidua, white adjustment and changes blood cells, mucus, and some bacteria 6) Facilitate newborn care and self-care by the new mother (baka - Last for 3 weeks after the baby is born. mamaya di pa marunong baka primi palang so kailangan e- - Kung normal spontaneous delivery si mami, the mother and assist talaga ng malala sizt) baby will stay in the hospital 1-3 days. Pero kapag cesarian, 5- 7) Promote the newborn’s successful integration into the family 7 days. unit - Rubra: the reason of being dark red color is it contains 8) Support parenting skills and parent newborn attachment epithelial cells, erythrocyte, decidua, odor – characteristic 9) Provide effective discharge planning human odor. (parang regla ung amoy). Makikita sya in 1st – 3rd day. Physiologic Changes of the Postpartum Period - Serosa: pinkish – contains serosanguinous discharge The uterus containing decidua, erythrocytes, leukocytes, cervical mucus - the sealing of the placenta site is accomplished by rapid and microorganism. May mga microorganism na sya kaya contraction of the uterus immediately after the delivery of the malakas na ung odor nya kaysa nun rubra. placenta. With time, thrombi form w/ in the uterine site and - Alba – albicans, nag eextend pa sya ng 6 weeks. It contains permanently seal the area leukocyte, decidua, epithelial cells and fats (kaya light color - Once na madetach ung placenta, ung attachment ng placenta sya). No odor or very slight odor. Slight bacteria. sa placenta site is exposed already. There are blood vessels - The mother and father should wait until the secretions or that is exposed in the area which can bleed. Then the uterus discharges of the lochia stop before doing sexual intercourse. will start to contract, and this contraction will pinch the blood And you must also consider the healing of episiotomy. 21 days vessels, so that it will stop bleeding. And because of that or maximum of 6 wks. pinching effect, there will be thrombi formation, and this will - 6 weeks after birth the woman will menstruate, that is for non- permanently seal the openings left by the placenta. So, the lactating mothers. While for lactating mothers, it will take uterus will no longer bleed, and we won’t have any problem approximately 24 weeks or 6 months for menstruation to with hemorrhage. return. - The uterus contracts firmly after delivery of the newborn and - Kapag hindi agad bumalik ang mens ng mother pero hindi reducing the size of the uterus. The uterine contraction allows nagla lactate its normal lalo nap ag regular yung mother but in it to involute para sya ay magreturn sa normal size. nursing care kailangan kapag ganun is mag family planning J.A.K.E 1 of 7  NCMA217 LEC: WEEK 9 – POSTPARTUM CARE (MAM ESPINOSA) sya kase baka hindi nya alam na hindi sya nagme mens but The Abdomen nago ovulate na pala sya tendency na pwede sya ulit mabuntis. - It remains soft, and flabby for some time after delivery Lochia Duration Color Amount - Striae remain but lightens to silvery white Moderate in - Assessment of the rectus abdominis muscle. Rubra 1-3 days Red - During the pregnancy, the muscle separated from each other amount Pinkish to brown 4- and that is normal. Decreased in - It can take several months to heal the muscles and move close Serosa 3-10 days 6th day pinkish amount to each other. 7-9 day brownish th 10-21 days Minimal in - Diastasis recti – the abdominal muscles getting stubborn. ayaw Alba Cream white nyang bumalik sa kanyang original form. Ayaw nya mag dikit (up to 6wks) amount uli. (Aki: kaya wag ng pilitin ibalik ung dati. Kasi kahit anong effort mo kung ayaw nya bumalik. Edi wag. HAHA jk leng The Cervix nemen. Elay: wag na balikan ang past wag marupok owkieee - It becomes thicker and firm. Childbirth results in a permanent emzz) so, nagiging weak ung core ng body, it leads to back change in the cervical os from round to elongated pain. And ung belly nya name-maintain nya ung laki ng belly. - Complete cervical involution may take approximately 3-4 months. (cervical involution – going to go back to non- - S&S – there is indentation in between, and the color becomes pregnant state but it will not take the same form during the bluish to purplish. Nursing care is to recommend that the client performs exercises. (light – moderate exercises for abdominal) time na hindi pa sya nabubuntis) The Breast - Ung hindi pa nabubuntis ung babae, bilog pa ung butas ng - During the 1st week after delivery, as the colostrum is cervix nya, pero after delivery of the baby, it will shrink, up to changing to mature milk, your breast will become full. 1cm but the shape is elongated. It has experience tremendous trauma because of the passing baby. - This normal postpartum fullness usually lessens w/ in 3 to 5 - Cesarian – may changes din sya pero hindi lng sya masyadong days, if feeding or pumping does not adequately remove all the milk your body produces, engorgement may develop. elongated. Kasi may mga nag ta-trial labor before cesarian - Prolactin – hormone responsible in stimulating milk section. production. This are being stimulated by rapid rack of the estrogen and progesterone level. - Breastfeeding mother – ung posterior pituitary gland ay mag sesecrete din ng oxytocin hormone para maka initiate ng let down reflex or milk ejection reflex. - She should regularly breast feed the baby, so that there will be The Vagina increasing amount of prolactin and oxytocin production para - It is smooth and swollen, tuloy tuloy ung production ng breastmilk. w/ poor tone after - Colostrum is present kailangan ni baby na makuha yan delivery - Breast engorgement – may occur in nursing and non-nursing - Rugae re-appear by 3-4 mothers. Specifically, in 2nd or 3rd day because of vasodilation. weeks Ipabreastfeed nya lng si baby or minsan apply warm compress - Hindi na bumabalik sa para ma alleviate ng pain. original na itsura kasi there will be scar formation bcz of the episiotomy. - There is a surgical procedure to repair a vagina sa mga gusto pang mother na maayos yung part. The Perineum - It appears edematous and bruised after delivery - Episiotomy or laceration may be present. - There will be pain. - Nursing care: position her sims position. Nakadapa na Systematic Changes of the Postpartum Period nakagilid, put a pillow under the flex leg so that lalabas ung The Renal/Urinary System isang paa, mas mababa ung extend ng paa, so magkakaroon ng - Overdistention of the bladder is common due to increased gap or space in between the legs, so there will be more space bladder capacity, swelling, bruising of tissues around the for the perineal area. - Nursing consideration: engorge breast, kaya it’s kind of urethra and diminished sensation to increased pressure difficult to position the mother in sims, kasi madadaganan ni - parang kakulangan ng pakiramdam sa bladder {alam mo pakiramdam ng namanhid ka ng ilang minute kase di ka mami. Kaya dapat mag pa breast milk muna si mami bago sya crinushback awts ganurn}, kahit puno na yung bladder nya mag sims position. hindi pa din umiihi that could cause urinary retention kase - After 24 hrs u can give ice pack for the edema hindi pa nga ene excrete J.A.K.E 2 of 7  NCMA217 LEC: WEEK 9 – POSTPARTUM CARE (MAM ESPINOSA) - The glomerular filtration rates remain elevated for about 5-7 - WBC mag eelevate. Normal: 2500-1100. Pero sa bagong days postpartum panganak 25,000. Kumbaga nagready lang ung katawan ni - Dilated ureters and renal pelvis return to their nonpregnant mami, just in case there’s an infection. state within 6-10 weeks after the delivery The Gastrointestinal System - Diuresis occurs within the 2nd to the 5th day after delivery. - Digestion and absorption begin to be active again soon after - Gumigilid si uterus. That can soften or make uterus baggy and birth unless a woman has had a cesarean birth. Almost that can lead to bleeding. Hindi sya makacontract dahil wala immediately, the woman feels hungry and thirsty, and she can sya sa position nya. eat without difficulty from nausea or vomiting during this time. - If the bladder is always distended, that can lead to urinary - Gastrointestinal motility and tone. Peristaltic movement will retention then it can lead to urinary tract infection. return to non-pregnant state in 2 weeks. So, because of that, it - Adequate bladder emptying resumes 5-7days. is expected, that the patient will experience constipation. - Kapag ung babae umiihi ng madalas pero trickles lng, may - Dahil magkakaroon sya ng constipation, decrease muscle tone, problema yon. Dapat ang normal, unang ihi ni mami 100-150 perineal discomfort, the mami will refuse to defecate. Pag ml. pinipigil nya mag move ng bowel that can lead to constipation - May also complain of dysuria – because of the damage in the - Mag kakaproblema tau kapag na constipate si mami kasi hindi trigone in the bladder. sya allowed to exsert effort to move the bowel. Hindi sya mag - Normal delivery – we catheterize the woman before delivery, pass out ng hard stool kasi it will damage the episiotomy. so that we can release the urine in bladder, so mag shishrink - The client may return to pre-pregnant weight in 6 to 8 weeks. ung bladder and it will facilitate the passage of the descent of - Normally, Magkakaroon si mami ng hemorrhoid because of the fetus. the pressure of the descent of the fetus. - Catheterization is a dependent nursing function. (orange). One - Nursing intervention: we cannot allow the patient to remain time big time ang pag gamit sa orange, while the yellow kase constipated kasi madadamage natin ung episiotomy. So, we it uses for C-section. need to increase fiber intake such as vegetables and increase - Nursing intervention: to encourage urination, offer a bed pan fluid intake both water and citrus juice (fresh). Citrus juice and u can alternately pour warm and cold water. That can will have vitamin C and it will aid in the healing process in stimulate micturition. Also, kung ready to ambulate na sya at episiotomy. hindi nahihilo (make sure there’s no orthostatic hypotension) - kapag ginawa mo na lahat ng effort pero wala nangyari, we Samahan nyo sa CR, and mag run kau ng water, ng patak need to notify the physician. (kaya hanap ka nlng ng iba kung patak lng, and this sound will also stimulate the mother to void. ayaw nya tanggapin lahat ng effort mo HAHAHA) and seek (make sure u do not flash the toilet while naka upo si mami an order for stool softener or laxative. kasi ung splash ng water from the toilet, that can have The Integumentary System microorganism which can go to the perineal area and infect the - Profuse puerperal diaphoresis is evident on the first 24 hours episiotomy) postpartum (sobrang pagpapawis) nursing intervention: - Kapag wala tlg taung makuhang urine output, we need to punasan at patuyuin, palitan ng dami para comfortable sya. notify the physician right away. - Melanin decreases gradually, causing a decrease in The Circulatory System hyperpigmentation - The usual blood loss w/ a vaginal birth is 300 to 500 mL. - Visible vascular changes of pregnancy disappear as estrogen - With cesarean birth, it’s up to 500 to 1000mL. levels decrease. - A 4-point decrease in hematocrit (proportion of RBC to - 1st 24 hours she will experience profuse diaphoresis. circulating plasma) and a 1-g decrease in hemoglobin value - During the pregnancy, she was able to incur a lot of occur w/ each 250mL of blood lost. pigmentation. And now, she has delivered the baby, the - Para malaman natin na 500 ml ung lumalabas na blood, use melanin pigment that cause of all hyperpigmentation will regular size of kidney basin because that can accommodate gradually decrease and this will start the hyperpigmentation 500 ml of blood. Cesarian – silver kidney basin. lighten up. - Women usually continue to have the same high level of - During pregnancy, the woman experiences vascular changes, plasma fibrinogen during the 1st the postpartal week. Because nag increase sya kasi gusto ng katawan ng maraming blood it is protecting the woman from hemorrhage. (Plasma vessels for more blood supply for the baby. So, this will lead fibrinogen – nag cacause sya ng blood clotting) but because of to the presence of varicose veins. (malalaking ugat). clotting effect, the woman is prone to thrombus formation. The Immune System Babara sa blood vessels. - A slight increase in maternal body temperature may occur - Plasma level 1000 ml without apparent cause following childbirth - Once u found out the patient has thrombus formation, DO - It is normal for 1st 24 hours postpartum, for the mother to NOT MASSAGE kasi if u massage, gagalaw ung thrombus experience slight hyperthermia up to 37.9 C. so, we give TSB formation and this will travel in the blood vessels. Dumadaan (tepid sponge bath), nag lalagyan tayo ng towel sa noo. ung blood vessels sa mga main organs. And if the thrombus - But if the mother experiences hyperthermia in the next 48 formation travels to the main organs, babara yon doon at hours or 2nd and 3rd day postpartum, temperature increase 38 C magkakaproblem. and above then that can be sign of having an infection. So, u - The client will experience an elevated pulse during labor and need to notify the physician. delivery. It will decrease in about an hour after delivery. The Respiratory System - Hematocrit drops during the 3-4days, but it will stabilize by 2 - Pulmonary functions return to nonpregnant status by 6 months months postpartum. after delivery. J.A.K.E 3 of 7  NCMA217 LEC: WEEK 9 – POSTPARTUM CARE (MAM ESPINOSA) - When the baby is out, there is no longer a pressure in the - The first 3 postpartum voiding should be measured and diaphragm, so it is allowed to expand properly, and it will go should be at least 150 cc. back to nonpregnant state. - If there is burning sensation during urination, then that is Musculoskeletal System reportable matter to the doctor that may indicate infection - Most women ambulate 4-8 hrs after delivery, early ambulation or urinary retention. is encouraged to avoid complications, promote uterine B – bowel movement? involution, and improve emotional outlook - Ask ur patient when was the last time she move her bowel. - Relaxation and increased mobility of pelvic articulation occur Kasi expected natin that she will be constipated. So, if 6-8 weeks after delivery. she’s not able to move her bowel by the 2nd postpartum - Encourage mother to do early ambulation pero u need to check day, we are going to perform all our independent nursing the orthostatic hypotension. So, the nurse assists the mami in intervention such as we will increase fluid intake and give the first ambulation. (pa upuin muna, then iharap nyo sa side her high fiber diet. ng bed, pagalawin ung paa. After a few mins, wala nangyayari - Pero kapag wala pa rin, we need to seek to physician to or hindi na nahihilo si mami, make her stand the bed side.) give the mother a mild laxative. - Teach the significant other do not let the mother to lock the L – Lochia: amount, odor, color, clots door. Kase once na mag collapse si mother hindi mo agad - Vaginal discharge. We must check the peripad that she is maagapan and possible na pwede tumama head nya kung saan. using. We need to see if there are clots. That could be sign Endocrine System of impending bleeding or hemorrhage. - Prolactin levels will remain elevated if the woman continue to - Make sure ung number of postpartum days nya ay tama sa breastfeed kulay ng lochia. - If not breastfeeding, prolactin level will return to normal levels E – episiotomy location, stiches, edema, and redness. by 3 weeks postpartum - Inspect – u position her in dorsal recumbent position. And - Without breastfeeding, ovulation may return as soon as 45 u need to provide privacy. And use a penlight. days. However, ovulation may be delayed by as much as 6 - Check also for rectal area, kung may hemorrhoids. months if the mother is exclusively breastfeeding every 2-3 - Check also for episiotomy, for proper wound healing, hours. (Lactation amenorrhea) walang signs of infection or inflammation. And make sure - More than 3 months, pwede wala pa syang menstruation pero to touch the sides of labia majora, if it is warm to touch baka nag oovulate na si mami kasi after 3 months, the baby then that is a problem. sleeps longer. Kaya humahaba na ung interval ng H – Homan’s sign – positive? breastfeeding then baka magkaroon na sya ng ovulation. That - Papahigain si mami and itataas ung isang paa. Tas ung is why we encourage her that she needs to use another family paa i-dorsiflex then ung isang kamay mo, pipindutin or planning on the 3rd month. ipepress ung cuff area ng paa. If there is pain and redness, - The LAM not guaranteed in 6 months that is positive hooman’s sign. So, there is possible thrombus formation. Postpartum Maternal Assessment - Do not massage, kase pwede sya mag travel and mapunta B.U.B.B.L.E. – H.E. maternal assessment sa mga major organs. B – breast side, shape, and engorgement E – emotional status and bonding. - Palpation BUBBLE HER Sa ibang book may R sa dulo – Respiratory - If may nodule, make sure to assess that by breastfeeding. changes. Make sure that she empties the breast then if there’s still a BUBBLE SHE – meron namang S – skin integumentary nodule, u need to notify the physician. system. - Pero kapag nawala ung nodule, most probably curdle milk. DVT and Homan’s Sign - So, we need to palpate the breast kasi minsan sumasabay A positive homan’s sign is indicative of DVT ung breast cancer sa postpartum period. The patients. leg is positioned at a 90-degree angle (either - Nursing intervention: instruct the mother to clean her while in supine or sitting) breast every day. (she can soak it with warm water) she Dorsiflexion of the foot reveals pain in the calf if positive just needs to wash it with warm water. Kailangan linisin Other signs of DVT: Redness, Sudden sharp pain, Warmth in lagi kasi ung drips ng breastmilk contains glucose at yun the leg ay makaka irritate sa skin ni mami, it can lead to irritation and break of skin that can cause infection. U – uterus: firm or boggy? - Palpate the uterus, u must ensure that the uterus is firmed, contracted and globular. And it is following the proper uterine involution pattern. B – bladder: tender or distended? - As checking the height of the fundus. - We have to talk to the mother about proper perineal care, explain that she should wipe from front to back. Because the back near the anus is considered contaminated. - Distention – it needs to be emptied so that it will not be dispelled the position of the uterus. J.A.K.E 4 of 7  NCMA217 LEC: WEEK 9 – POSTPARTUM CARE (MAM ESPINOSA) Postpartum Complications Postpartum hemorrhage Predisposing Factors Management Uterine atony - Over distention of - Vigorous fundal (exhaustion of the uterus (na-over massage muscle) stretch) - Bimanual uterine - Most - Multiple pregnancy compression common - Caesarean section - Ice compress Management cause of post- - Chorioamnionitis - Modified partum (infection of a Trendelenburg Hematoma – purplish discoloration - Remove hematoma hemorrhage chorion) - Fast drip of IV of the subcutaneous tissue of the - Cold compress wherein the - Macrosomia (large fluids vagina or perineum uterus fail to for gestational age) - Oxytocin - There is blood underneath contract and - Rapid or prolonged administration Disseminated Intravascular - Blood transfusion becomes labor - Let the newborn Coagulation (DIC) - Hysterectomy more relaxed - Deep inhalation suck the nipple - Hypofibriginemia – failure to and boggier anesthesia of the mother coagulate - Hysterectomy - Predisposing factors – abruptio o Uterine atony – lumambot ung uterus, it refuses to contract placenta, amniotic fluid embolism because of exhaustion of muscle. and still birth o Magpaalam muna kay mami bago mo sya i-fundal massage. Wag ung biglaan. (ung bigla ka nya iniwan na wala syang Uterine inversion - Repositioned vaginally snasabi