Nursing Care of the Mother in Postpartum

The Postpartum Period

u   from delivery of infant to 6 weeks

u   rapid physical and emotional changes

u   potentially dangerous period

Nursing is Challenging

u   demonstrate knowledge of postpartum changes

u   conduct thorough assessments

u   initiate appropriate interventions

u   prevent problems by client teaching

The Focus of Nursing Care

u   Maintaining physiologic  stability

u   Promoting comfort

u   facilitating return to normal activity levels

u   support the establishment of sound relations within family

Client teaching

u   self

u   infant

Assessment

u   first hour following delivery q 15 minutes

u   abnormal findings - more frequent monitoring

u   once stable q 4 hours until discharge

Preparation for the Assessment

u   review of client record

u   explain procedures

u   provide privacy

u   wear gloves

u   practice universal precautions

Assessment  for Physiologic Stability

u   Compare vitals signs with baseline

u   Monitor uterine activity

u   Determining amount and type of Lochia

u   Perineum

u   Breasts

u   Bowel elimination

Assessment - Vital Signs

u   Temperature

u   Pulse

u   Respiratory Rate

u   Blood Pressure

Temperature

u   slight elevation not abnormal in first 24 hours

u   due to exertion of labor and dehydration

u   temperature greater than 100 beyond 24 hours may indicate infection

u   accompanying foul smelling lochia - infection

Pulse

u   slight bradycardia- decrease workload of heart - okay

u   mild tachycardia - blood loss, pain, excitement , physical exertion- okay

u   Persistent tachycardia - abnormal - excessive blood loss, or hemorrhage

u   significant changes report immediately

Respiratory Rate

u   no abnormal breath sounds should be present

u   slightly elevated with exertion, excitement or pain

u   tachypnea, abnormal breath sounds, breathlessness, chest pain , anxiety due to dyspnea - indicate - pulmonary edema or pulmonary emboli

u   report abnormal findings immediately

Blood Pressure

u   should remain near normal levels

u   slight elevation - exertion, excitement or oxytocic medications

u   consistent or sudden elevation with headache , visual disturbances - PIH

u   orthostatic hypotension - changes in intraabdominal pressure

Uterine contraction

u   using palpation

u   Involution - centimeters below umbilicus

u   soft - difficult to feel - boggy

u   medications - oxytocin, ergotrate, methergine, carbopost

Lochia

u   immediately after delivery

u   1-2 hours - flow moderate - 1- 2 hours saturated in an hour

u   clots bigger than nickel size abnormal

Perineum

u   tenderness, erythema, edema , ecchymosis - normal

u   hematoma - painful to touch

u   ice applications

Additional Assessments

u   Bubble HE

u   comfort level

u   urinary output

u   breasts

u   bowel elimination

u   relationship with newborn

Nursing Diagnosis

u   see box 13.2

u   risk for infection

u   risk for injury

u   pain

u   knowledge deficit

Implementation

u   Promoting comfort

u   medication - Tylenol , ibuprofen

u   Perineal pain

   sitz bath

   ice packs

   sprays

   tucks

Self Care Ability

u   assess mothers ability to care for self and baby

   identify potential problems

   client teaching

u   assist with grooming and sitz bath

Nutrition and Fluid volume

u   provide nutritious meals

u   bowel sounds before feeding surgical patient

u   encourage fluid and fiber

u   increased intake if breastfeeding

u   adapt meals

Infection Prevention

u   universal precautions

u   frequent handwashing

u   perineal cleansing

u   clean after each defecation and urination

Activity Promotion

u   exhausted but euphoric

u   vertigo - orthostatic hypotension

u   good footwear

u   simple muscle toning exercises

Promoting Urinary elimination

u   void spontaneously 4-6 after delivery

u   difficult - warm water , running water, sitz bath

u   catheterize

Promoting Bowel Elimination

u   high fiber diet

u   stool softeners

u   well balanced meal

u   encourage fluids

u   avoid codeine - make constipated

Postpartum Warning Signs

u     Excessive bleeding

u     Vaginal odor

u     Abdo cramping

u     Fever > 100

u     Severe leg cramps

u     Sore sutures

u     No BM 1 week

u     Sore reddened area breast

u     Depression

Emotional Well-being

u   look for unusual comments

u   verbalize concerns about

   care of infant

   labor experience

   postpartum changes

u   fears whatever troubling her

u   provide reassurance

Care of Newborn

u   instruction regarding care

u   excellent opportunity

u   start ASAP

u   gain confidence

Care after Cesarean Section

u   modifications

u   dressing

u   Pain

u   infection

u   movement

u   diet

Client Discharge

u   see client teaching box