Post Partum Care (Puerperium) : Iril I. Panes, RN, MAN
Post Partum Care (Puerperium) : Iril I. Panes, RN, MAN
Post Partum Care (Puerperium) : Iril I. Panes, RN, MAN
(PUERPERIUM)
Iril I. Panes, RN, MAN
DEFINITIONS
A. Puerperium/Postpartum refers to the
six-week period after delivery of the baby
B. Involution the return of the
reproductive organs to their pre- pregnant
state
2. Genital changes
a. Uterine involution is assessed by
measuring the fundus by fingerbreadths
(= 1 cm). On PPD 1 fundus is one
fingerbreadth below the umbilicus; on PPD
2, 2 fingerbreadths below umbilicus and
so forth until on the 10th day postpartum,
it can no longer be palpated because it is
already behind the symphysis pubis
Characteristics:
Pattern should not reverse
It should approximate menstrual flow (However, it
increases with activity and decreases with
breastfeeding)
It should not have any offensive odor. It has the same
fleshy odor as menstrual blood. Otherwise, it means
either poor hygiene or infection
It should not contain large clots
It should never be absent, regardless of method of
delivery. Lochia has the same pattern and amount,
whether CS or normal vaginal delivery.
3. Urinary changes
a. There is marked diuresis within 12 hours postpartum to
eliminate excess tissue fluid accumulation during
pregnancy.
b. Some newly delivered mothers may complain of frequent
urination in small amounts; explain that it is due to urinary
retention with overflow. Others, on the other hand, may
have difficulty voiding because of decreased abdominal
pressure or trauma to the trigone of the bladder. Voiding
maybe initiated by pouring warm and cold water alternately
over the vulva, encouraging patient to go to the comfort
room and let her listen to the sound of running water. If
these measures fail, catheterization, done gently and
aseptically, is the last resort on doctors order. (If there is
resistance to the catheter when it reaches the internal
sphincter, ask patient to breathe through the mouth while
rotating the catheter before moving it inward again.)
5. Vital Signs
a. Temperature may increase because of
the dehydrating effects of labor.
Implication: Any increase in body
temperature during the first 24 hours
postpartum is not necessarily a sign of
postpartum infection.
b. Bradycardia ( = heart rate of 50-70 per
minute) is common for 6- 8 days
postpartum
c. There is no change in respiratory rate.
B. Psychological Phases
Provide emotional support the
psychological phases during the
postpartum period are:
1.Taking-in phase first 1-2 days
postpartum when mother is passive and
relies on others to care for her and her
newborn. She keeps on verbalizing her
feelings regarding the recent delivery for
her to be able to integrate the experience
into herself.
3. Letting go Phase
The mother is now ready for her new role as a
parent
2. Management:
a. Massage first nursing action
b. Ice compress
c. Oxytocin administration
d. Emptying the bladder
e. Bimanual compression to explore retained
placental fragments
f. Hysterectomy last resort
B. Lacerations
C. Hypofibrinoginemia a clotting defect
2. Treatment:
a. Ice compress during the first 24 hours
b. Oral analgesic, as ordered
c. Site is incised and bleeding vessel is
ligated
2. Infection
a. Sources:
Endogenous (primary) sources bacteria
in the normal flora become virulent when
tissues are traumatized and general
resistance is lowered
Exogenous sources pathogens
introduced from external sources.
Organism most frequently responsible for
postpartum
Types of infection
A. Infection of the perineum
Specific symptoms:
Pain, heat and feeling of pressure in the
perineum
Inflammation of the suture line, with 1 or 2
stitches sloughed off
With or without elevated temperature
Specific management:
Doctor removes sutures to drain area and resutures
Hot Sitz bath or warm compress
B. Endometritis inflammation/infection of
the lining of the uterus
Management:
Oxytocin
Fowlers position to drain out lochia and
prevent pooling of infected discharge
Implications of physiology of
breastmilk production
a. Regardless of the mothers physical
condition, method of delivery or breast
size, condition, milk will be produced.
b. Lactation does not occur during
pregnancy because estrogen and
progesterone are present and therefore,
inhibit prolactin production
Implications of physiology of
breastmilk production
f. If emergency delivery when the uterus
does not contract, put the infant to the
breast.
During initial contact in emergency delivery,
determine whether the woman in labor is a primi
or a multi, the EDC and also assess the stage of
labor. And if not sterile equipment is available to
cut the cord, wrap the baby and the placenta
together; never cut the cord unless sterile
equipments are available
Advantages of breastfeeding
a. For mother:
Economical in terms of time, money and
effort
More rapid involution
Less incidence of cancer of the breast,
according to some studies
Advantages of breastfeeding
b. For the baby:
Closer mother-infant relationship
Contains antibodies that protect against
common illnesses
Less incidence of gastrointestinal
diseases
Always available at the right temperature
Health Teachings
a. Hygiene
Wash breasts daily at bath or shower time
Soap or alcohol should never be used on
the breasts as they tend to dry and crack
the nipples and cause sore nipples
Wash hands before and after every
feeding
Insert clean OS squares or piece of cloth
in the brassiere to absorb moisture when
there is considerable breast discharge
Health Teachings
b. Method as suggested by the La
Leche League
Side-lying position with a pillow under the
mothers head while holding the bulk of
breast tissues way from the infants nose
Stimulate the baby to open his mouth to
grasp the nipples by means of the rooting
reflex
Infant should grasp not only the nipple but
also the areola for effective sucking
motion
. Engorgement
feeling of tension in the breasts during the
third postpartum day, sometimes
accompanied by an increase in
temperature (milk fever). The breasts
become full, feel tense and hot, with
throbbing pain. It lasts for about 24 hours
and is due to increased lymphatic and
venous circulation.
Management
Advise use of firm-fitting brassiere for good support. It
will not only decrease the discomfort from breast
engorgement but also prevents contamination of the
nipples and the areolae.
Cold compress is applied if mother does not intend to
breastfeed; warm compress is applied if she will
breastfeed
Breast pump is not used if mother is not going to
breastfeed, since either will only stimulate milk
production.
Sore nipples
Management:
Expose nipples to air by leaving bra unsnapped
for 10 to 15 minutes after a feeding
When normal air drying is not effective,
exposure to a 20-watt bulb place 12-18 inches
away will cause vasodilatation, increase
circulation and promote healing
Do not use plastic liners that are found in some
nursing bras because they prevent air from
circulating around the breasts
d. Nutrition
lactating mothers should take 3000
calories daily and should have larger
amounts of proteins (=96 gms per day),
calcium, iron, Vitamins A, B, and C. Nonbreastfeeding women can have the same
requirements as in pregnancy
ANY QUESTIONS?
Critical Thinking:
Christine gave birth to her baby at 8am. Your
assessment findings at 8pm are as follows:
BP: 120/80
PR: 70
RR: 16
T: 37.8C
You found that the uterine fundus is 1cm above
the umbilicus and right of midline. Christine says
she has been perspiring a lot.
Questions:
1. What is probably causing Christines
slightly elevated temperature? (5 pts)
2. What could be the implication of the data
fundus 1cm above the umbilicus and
right of midline for the mother? What will
be your nursing interventions? (15 pts)