Post-Partum Care Nurses can be effective in making a smooth transition for the new family.

The Puerperium The interval from the birth of the baby until the reproductive tract returns to its prepregnant condition. Usually time for this is 4 to 6 weeks. Involution is the term referring to the return of the uterus to its pre-pregnant state.

Normal Body Changes

Reproductive System has the most significant changes. The Uterus Involution Lochial flow and return of menses Cervix/vagina The breasts Breast-feeding mothers Non-breast feeding mothers

Other Body changes

Vital signs Cardiovascular changes Urinary effects G-I effects Muscular changes Integumentary effects

Post-Partum Blues

Causes Hormonal changes New responsibilities Signs and symptoms Sudden crying or tearfulness for no reason Nursing Care Reassurance and information Post-Partum Psychosis

Nursing Care and Assessment Mental observations Alertness Bonding

Mood changes Vital signs Temperature Blood pressure Pulse rates

Head to Toe Assessment (Cont)

Condition of breasts Lactating mothers Non-breast feeding Mothers Abdomen Fundal location and tone Bladder distention Bowel sounds/distention Perineum Effectsbruising, swelling, hematomas Episiotomy Lochia

Head-to-toe assessment

Extremities IV sites Edema Homans sign Teaching needs Self-care Infant care Discharge information

AssessmentBubble

BBreasts UUterus BBladder BBowel LLochia EEpistomy/Extremities

Phases of the Post-partum Period

Taking in phase Still have significant physical needs that must be met Not receptive to teaching at this time Taking hold phase

Eager to assume care for infant and self Ready to receive health teaching and info Maternal Love

Instinctive? Develops gradually over time Things that may hinder Single parenting Financial concerns Disappointment Jealousy Abnormalities

Teaching Points

Breasts care Good support bra Use only water Lubrication and air dry Prevention of cracks or fissures Lochial flow Normal pattern should not reverse Should not have an offensive odor Should not contain large clots

Teaching Points (Contd)

Perineal Care Cleanse after each elimination Wipe from front to back Change peri pads often Good handwashing Episiotomy care Bladder care Increase fluids Heed the urge and void frequently Avoid a distended bladder

Teaching points (contd)

Bowel care Increase fluids, fiber and activity Stool softeners Rest and activity

No heavy lifting Rest when infant sleeps Exercises according to MDs recommendations

Emotional Care Single, unwed mothers Unwanted child Infant with illness or anomalies Sorrowing mothers

Complications of the Puerperium

Bleeding complications one of leading causes of mortality/morbidity Normal blood loss is 250350 mls with delivery More than 500 mls in 24 hours is excessive Greatest danger is within the first 24 hours

Bleeding Complications Uterine Atony Acreta Retained placental fragments Cervical lacerations Complicationsinfections

Endometritis Mastitis Cystitis

Others Complications

Thrombophlebitis Pulmonary Embolus DIC