NCM 101 Lecture Notes FINALS Handout 8 _____________________ THE POSTPARTUM PERIOD:

Begins with the delivery of the pl !ent nd ends when ll of the "odily syste#s ret$rn to their pre%pregn nt st te The period of invol$tion ppro&i# tely en!o#p sses ' wee(s

MUST )*O+S:
The v gin re ppe r. re# ins s#ooth w lled for ,%- wee(s "efore r$g e st rt to The first #enstr$ l !y!le postp rt$# is $s$ lly A*O/U0ATOR1 Menses # y res$#e in -%' wee(s if the #other is not "re stfeeding 0evels of H23 nd HP0 re l#ost negligi"le "y 4- ho$rs

Puerperium 5th stage of labor, 1st 6 weeks post-partum Characterize by involution Involution - return to the normal stage of reproductive organ after pregnancy Return to Normal Healing: Physiologic Changes and Systemic Changes Cardiovascular System o plasma volume o sudden in blood volume o elevated !C"s up to #$, $$$ mm# o hyperfibrinogenemia o orthostatic hypertension can be possible o early ambulation prevents thrombos formation steps in ambulation %lat &emifowlers %owlers with dangling alk with assist Genital Tract o Fundus goes down 1 finger breadth a day 1$th day non palpable behind the symphysis pubis Subinvolution delayed healing of uterus containing 'uarters or clots of blood may lead to puerperal sepsis anagement : ()C o !"ter Pains *fter birth pains +ultiparous breastfeeding most common to develop ,osition - prone Cold compress +efenamic acid o #ochia Components !lood (ecidua !C +icroorganisms # types 1

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Ms. April Anne D. B l non

NCM 101 Lecture Notes FINALS Handout 8 _____________________

Rubra 1 # days, musty, moderate amount Serosa . 1$th day, pink or brown !lba 1$ /1th day, cr0me white, amount

$rinary Tract o $rinary Fre%uency due to urinary retention with overflow o &ysuria (amage to the bladder 1rine collection for culture and sensitivity &timulate navel to urinate ,alpate bladder 2istening to 3unning water ,ull pubic hair - stimulate cremasteric refle4 Colon o Constipation (ue to 5,6 !earing down may cause pain Perenium o ,ain relieved by sim"s position o Cold compress 1st /. hours if there is pain at episiorraphy followed by warm compress ' (TI(N!# S$PP(RT )* Ta+ing phase 1st # days dependent phase passive, can"t make decision tells about childbirth e4perience focus on7 8ygiene ,* Ta+ing Hold . 9th day dependent to independent phase active, decides actively focus7 care of newborn health teaching 7 %amily planning -* #etting Go :nterdependent phase 3edefines goals, new roles as parents +ay e4tend till the child grows Post Partum .lues .th 5th days overwhelming feeling of depression, inability of sleep and lack of appetite 5$ ;$< incidence rate cause by sudden hormaonal change progesterone suddenly decreases allow crying7 therapeutic may lead to postpartum psychosis= depression

POSTPARTUM BLUES ONSET 1-10 days after birth S!MPTOMS Sadness, crying spells INCI ENCE 70 of all births THERAP! Support and empathy
2

POSTPARTUM EPRESSION 1-12 months after birth Anxiety, feeling of loss, sadness 10 of all births !ounseling and drug therapy

POSTPRTUM PS!CHOSIS Within the first month after birth Delusions and hallucinations, signs of harming infant and self 1-2 of all births "sychotherapy and drug therapy

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Ms. April Anne D. B l non

NCM 101 Lecture Notes FINALS Handout 8 _____________________

ETIOLO"! #ormonal changes, stress #x of pre$ious depression, hormonal responses and changes, lac% of social support systems 'efer to counseling "ossible acti$ation of pre$ious mental illness, hormonal changes, family history of bipolar disorders 'efer to counseling and safeguard mother from in(ury to self and to the ne)born

NURSIN" ROLE

&ffering compassion and understanding

Postpartal Complications Hemorrhage bleeding within /. hours postpartum 'arly Pospartal Hemorrhage )* $terine !tony boggy fundus profuse bleeding interventions o massage the uterus o cold compress o modified trendelenburg o fast drip :> o breastfeeding to release o4ytocin ,* #aceration well contracted uterus with profuse bleeding assess perenium for laceration degrees o" laceration o 1st degree vaginal skin and mucus membrane o /nd degree 1st degree ? muscles o #rd degree /nd degree ? e4ternal sphincter of rectum o .th degree #rd degree ? mucus membrane of rectum -* Hematoma bluish discoloration of sub@ tissues of vagina or perenium candidates o delivery of very large babies o pudendal block o e4cessive manipulation due to e4cessive :A intervention o cold compress 1$ /$ min then allow #$ minutes rest period for /. h /* &IC 0 disseminated intravascular coagulation Consumption of pregnancy BothertermC %ailure to coagulate !leeding in the eyes, ears, nose 6ozing blood &een in cases with o *bruptio placenta o &till birth = :1%( anagement o !lood transfusion of cryoprecipitate or fresh frozen plasma o hysterectomy #ate Postpartum Hemorrhage Retained placental "ragments *

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Ms. April Anne D. B l non

NCM 101 Lecture Notes FINALS Handout 8 _____________________

manual e4traction of fragments is done uterine massage &1C e2cept "or cases o" o Placenta !creta umusual attachment of the placenta to the myometrium o Placenta Increta deeper attachment of placemat to the myometrium o Placenta Percreta invasion of placenta to the perimetrium Candidates of these disorders are Drand multiparous ,ost C& *ll these re'uires hysterectomy In"ection Sources o Andogenous from normal flora of the body o A4ogenous from the health care team +ost common *naerobic &treptococci anagement o &upportive care o %luid intake o E&! if there is fever= cold compress ? paracetamol may also be given o *nalgesics Diven on time to achieve ma4imum effect o Culture and sensitivity Perenial In"ection &ame s= s4 with infection / # stitches are dislodges with purulent drainage E4 resuturing 'ndometritis :nflammation of the endometrium Den s=s4 of infection ? abdominal tenderness anagement o 8igh fowler"s facilitates drainage ) localize infection o *dminister o4ytocin

ANATOMIC AN PH!SIOLO"IC A APTATION OF THE NE# BORN FETUS NE#BORN RESPIRATOR! 5l$id filled Air filled S!STEM High press$re 0ow press$re
syste# ! $ses the "lood to "e sh$nted fro# the l$ngs tho$gh the d$!t$s rterios$s to the rest of the "ody syste# en!o$r ges "lood flow thro$gh the l$ngs for g s e&!h nge In!re sed 64 !ontent of the "lood in the l$ngs !ontri"$tes to the !losing of the d$!t$s rterios$s 0$ngs Press$re in the left tri$# is gre ter th n the right. This ! $ses the for #en ov le to !lose

SITE OF "AS E$CHAN"E CIRCULATION THROU"H THE HEART

Pl !ent Press$re in the right tri$# is gre ter in the left En!o$r ges "lood flow thro$gh the for #en ov le

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NCM 101 Lecture Notes FINALS Handout 8 _____________________

HEPATIC AN PORTAL CIRCULATION
D$!t$s venos$s "yp ssed M tern l liver perfor#s filtering f$n!tions Body te#per t$re # int ined "y # tern l "ody te#per t$re nd the w r#th of the intr $terine environ#ent D$!t$s venos$s !loses nd "e!o#es lig #ent hep ti! nd port l !ir!$l tion "egins 5i&ed post$re Brown f t% whi!h is spe!i li7ed for# of he t prod$!ing tiss$e fo$nd only in fet$ses nd in new"orns

THERMORE"ULATION

ASSESSME*T O5 THE HEAD:

Breg# : 8DIAMO*D SHAPED 8!loses t 94%9: #onths of ge 0 #"d : "egins to !lose t "o$t 4 #onths of B$lging font nels # y indi! te in!re sed I2P S$n(en font nels # y indi! te ;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;; res$lts fro# press$re of the presenting p rt g inst the !ervi& whi!h del ys veno$s ret$rn res$lting to !!$#$l tion of fl$ids within the s! lp < dis ppe rs witho$t tre t#ent in ,%- d ys = 5or!eps delivery nd too #$!h press$re g inst the pelvis # y le d to r$pt$re of sever l ! pill ries of the perioste$# of the fet l s($ll res$lting to !!$#$l tion of "lood "etween the s($ll "one nd the perioste$# res$lting to this finding: ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;< resolves within ,%' wee(s fter "irth witho$t tre t#ent =

ge

ASSESSME*T O5 THE EARS:

The level of the top p rt of the e r sho$ld "e in line with the o$ter ! nt$s of the eye 2hildren with E rs "elow this line re (nown to h ve down>s syndro#e

ASSESSME*T O5 THE E1ES

Tr$e eye !olor "egins to show Te rs ppe r fter ,%- #onths t ,%- #onths fter "irth

ASSESSME*T O5 THE MOUTH

Rooting? s$!(ing? nd e&tr$sion refle& sho$ld "e present t "irth *ew "orn " "ies h ve s! nty s liv "e! $se of i## t$re s liv ry gl nds

;;;;;;;;;;;;;;;;;;;;;;;;; Teeth fo$nd in new"orns. Sho$ld "e $prooted to prevent spir tion ,

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NCM 101 Lecture Notes FINALS Handout 8 _____________________

;;;;;;;;;;;;;;;;;;;;;;;;; S# ll white !ysts seen t the p l te whi!h re !!$#$l tion of epitheli l !ells. These dis ppe r within 4 wee(s

ASSESSME*T O5 THE 2HEST

2hest retr !tions8 RDS B$lging of the !hest8 pne$#othor &

ASSESSME*T O5 THE BREAST:

;;;;;;;;;;;;;;;;;;;;;;;;% Is thin w tery fl$id se!reted "y the new"orn>s nipple whi!h dis ppe rs within the first wee( of life. It is ! $sed "y the infl$en!e of # tern l hor#ones.

ASSESSME*T O5 THE S)I*:

;;;;;;;;;;;;;;;;;;;;;;;;;: irreg$l r dis!olor tion of the s(in res$lting fro# v so!onstri!tion? l !( of f t nd hypo&i *ew"orns do not swe t "e! $se of i## t$re swe t gl nds. Swe ting will "egin fter #onth ;;;;;;;;;;;;;;;;;;;;;;;;;: white !heese li(e s$"st n!es in s(in !re ses whi!h re !!$#$l tion of old !$t neo$s !ells nd se!retions of the se" !eo$s gl nds while in the $tero. Se" !eo$s gl nds f$n!tion intr $tero "e! $se of@ in response to hor#ones of the #other. ;;;;;;;;;;;;;;;;;;;;;;;;;: !logged nd distended se" !eo$s gl nds seen on the new"orn>s f !e? p rti!$l rly on the nose. These dis ppe r witho$t tre t#ent within 4%- wee(s fter "irth when the gl nds # t$re nd dr in ;;;;;;;;;;;;;;;;;;;;;;;;;: fine downy h irs fo$nd on the inf nt>s sho$lders? " !(? !hee(? forehe d? nd $pper r# ;;;;;;;;;;;;;;;;;;;;;;;;;: "l$ish dis!olor tion of the lower " !( nd "$tto!(s seen #ostly in !hildren of Asi n nd Afri! n n!estry ;;;;;;;;;;;;;;;;;;;;;;;;;: h r#less r sh fo$nd in # ny new"orns? res$lts fro# re !tion to !lothes nd sheets. S$"sides in 4 wee(s witho$t tre t#ent ;;;;;;;;;;;;;;;;;;;;;;;;;: "l$ish dis!olor tion of the s(in ;;;;;;;;;;;;;;;;;;;;;;;;;: "l$ish dis!olor tion of the h nds poor peripher l !ir!$l tion nd feet d$e to

;;;;;;;;;;;;;;;;;;;;;;;;;: t$rning p le of the $pper h lf of the "ody while the lower portion develops deep red !olor when the inf nt is p$t on side lying

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Ms. April Anne D. B l non