Nursing Care of the Post-partum Family

requirements of involution

- Contraction of the uterine muscle after birth and the delivery of the placenta - Catabolic changes within the uterine muscle - Regeneration of the uterine epithelial lining, which can take 2-3 weeks - Healing of the placental site, which takes about 6-7 weeks

BUBBLE- HE : Emotional State

- Get a sense of the mother's general attitude about birth and being a mother - Have an understanding of the mother's relationship with her significant other can also give insight - Assess the mother's perception of her skill level in caring for her newborn - (is her pain being addressed? Is she getting enough rest? Is she eating well?) - Assess for risks of depression, may use tools such as the Edinburgh Postnatal Depression Scale (EPDS)

physiological change of the cervix

- after birth, it's spongy, flabby, formless, may appear bruised - external os changes from dimple-like of the nullipara changes to lateral slit of the mulitpara

BUBBLE - HE

- breast - uterus - bladder -bowel - lochia -episiotomy - Homan's sign - emotional state

taking in

1st period after delivery when the new mother is focused on her own need for food, rest, and fluids, and can be dependent on others

The new father shares his concern regarding how the baby will bond with him. He states, "I read in the baby book that feeding time is the best time to bond with your baby. My wife is breastfeeding our baby, so how can I bond with our son?" What other ways of connecting and strengthening the father's relationship with his son can the nurse teach the father?

Changing the baby's diaper, holding and talking to this son, bathing the baby

the nurse is observing a new mother with her newborn. Which of the following are interventions that allow a new mother to acquaint herself with her newborn?

Holds the newborn in her arms and states, "He has his daddy's nose.", holds the newborn so that she has direct face-to-face and eye-to-eye contact, unwraps the newborn and explores the baby's extremities with her fingertips

attachment

Progressive, reciprocal process that is facilitated by positive feedback - Parents provide food, warmth, and safety for the infant; infant reciprocates by making eye contact, tracking the parents' faces, and grasping a parent's finger

REEDA

Redness, Erythemia, Edema, Drainage, Approximation

The nurse is assessing a breastfeeding mother with engorged breasts. Which intervention should the nurse teach the breastfeeding mother?

Teaching how to express her breasts in a warm shower

maternal hypervolemia

acts to protect the mother form excessive blood loss - typically occurs immediately after birth because the maternal circulation has an increase in blood volume and no longer travels through the placenta

acculturation

adapt to a new cultural norms

vital signs during postpartum period

afebrile (no fever) - initial temp may be up to 110.4F as result of exertion and dehydration - transient rise in BP which then returns normal after a few days - pulse: 50-70 beats/min during first 6-10 days which may be related to cardiac strain and increased stroke vol.

letting go

allows the woman to let go of her former self

BUBBLE- HE : Bladder and bowel

amount and timing of first void; mothers should void within 6 hours after birth

The nurse is doing a postpartum assessment on a client who delivered 8 hours ago. On completing the fundal assessment, the nurse notes the fundus is situated on the client's left abdomen. Which of the following actions is appropriate?

ask the client to empty her bladder

uterine atony

boggy uterus

engrossment

characteristic sense of absorption, preoccupation, and interest in the infant demonstrated by fathers during early contact with their infants

assimilation

completely changes their cultural idenity to become part of the majority culture

ethnocentrism

conviction that the values and beliefs of one's own cultural group are the best ones or the only acceptable ones

lochia alba

creamy or yellowish discharge (white); composed primarily of WBCs, bacteria, cervical mucus; present for a week or two

lochia rubra

dark red in color, fleshy but not foul order; small or stringy clots are common (large clots are accompanied by excessive bleeding) - present for first 2-3 days postpartal

postpartum period (pueperium)

first 6 weeks after birth during which physiologic changes that occurred during pregnancy begin to return to normal

intrauterine infection

foul-smelling lochia or vaginal discharge, subinvolution (slow descent), fever, trachycardia

physiological change of the fundus

immediately after birth it can be felt midway between the maternal symphysis pubis and the umbilicus

assessment of bowel function

includes auscultation of the abdomen for bowel sounds, inspect abdominal incisions according to REEDA

physiological change of the vagina

initially may be edematous and have small lacerations

maternal touch

intially mother may hold their newborn en face and explore extremities using finger tipping

physiological change of the uterus

involution

can increase the intensity of afterpain

mulitparity, breastfeeding, multiple gestation, conditions that cause overdistention of the uterus

A client is complaining of painful contractions, or afterpains, on her second postpartum day. The nurse knows that which condition could increase the severity of afterpains?

multiparity

taking on

not a period of postpartum psychological adaptation

BUBBLE- HE : Breast

palpation for tenderness and softeness, fullness, or firmness - assess for engorgment (firm, full, warm, tender, leak colostrum or milk) - inspect nipples for cracks or fissues; erected or flat? inverted or everted?

BUBBLE- HE : Uterus

palpation of the uterine fundus - assess boggy or soft fundus and massage until it firms - deviation to the right or left and above the umbilicus is indicative of bladder distention

lochia serosa

pinkish color; follows from about 3rd to 10th day

"baby blues"

postpartum transient depressive condition that can affect 50-80% of mothers after birth; characterized by mood swings, weepiness, anorexia, insomnia, irritability, feeling "let down" - evaluate if longer than 2 weeks - doesn't interfere with mother's ability to care for herself or newborn - self-limiting confition

involution

rapid reduction in the size of the uterus and its return to a condition similar to its non-pregnant state; prevented by a full bladder and places the mother at risk for excessive bleeding

bonding

refers to that initial attraction felt by parents for their newborn during the first 30-60 minutes after birth - Unidirectional form parent to child - Enhanced through parental/infant touch and interaction

BUBBLE- HE : Homan's sign

screening tool for deep vein thrombophlybitis (DVT) performed by sharply dorsiflexing the foot; the resulting pain is considered (+) sign and should be investigated further

diastasis recti abdominis

separation of the rectus abdominis muscles which may occur with pregnancy

physiogical change of the perineum

soft tissue in and around it may appear edematous with some bruising

The nurse is assessing her client and asks her how she is feeling. In response to the nurse's question, the postpartum client indicates that she is fine. She then begins talking to the baby, checking the diaper, and asking infant care questions. The nurse determines that the client is in which postpartum phase of psychological adaptation?

taking hold

The nurse observes several interactions between a mother and her newborn daughter. Which maternal behaviors should the nurse identify as evidence of mother-infant attachment?

talks and coos to her daughter, cuddles her daughter close to her

taking hold

the mother becomes more independent, taking more responsibility for her self-care; since she is starting to feel more comfortable taking care of herself, her focus will start to shift to her newborn, exhibiting interest in how to properly care for her newborn

fundus

top portion of the uterus and is situated in the midline of the abdomen

lochia

vaginal discharge that occurs after birth consisting of RBCs, decidua material, and bacteria

average blood loss

vaginal: 200 to 500mL C-section: 1000mL or more

Four hours after a vaginal delivery, the nurse is assisting a primparous client, who had an epidural anesthesia, to the bathroom to void. The client says that she feels dizzy when sitting up on the side of the bed. The nurse explains that is most likely caused by which of the following?

↓ blood volume in the vascular system