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Discuss physiologic and psychologic changes that occur in the postpartal period (puerperium).

See Ch 34.

Denise and Dan just had their first baby 10 minutes ago. What stage of labor and birth are they in?

Stage 4 (after the birth of the placenta to 1 to 4 hours after birth).

Denise and Dan are exhibiting beginning attachment behaviors. What will you observe?

Cuddling and holding the baby, talking to the baby, stroking movements, smiling, en face position, seeking out eye contact, making soothing noises, and asking questions about the baby are some examples.

How can you support the attachment process at this time?

Continue to provide opportunities for the parents to hold and interact with the baby. Complete any nursing activities while the baby is being held if at all possible, turn off the overhead lights to allow the baby to open its eyes, and encourage the parents in their activities.

The fundus should be where during postpartum?

at the level of the umbilicus.

The postpartum lochia should look and smell like what?

fleshy odor with blood and a small amount of mucus mixed in.

The postpartum perineum should appear and feel how?

edematous, painful to pressure, and perhaps displaying hemorrhoids.

The postpartum breasts should be what?

soft and secreting colostrum.

Uterine involution occurs as a result of what?

autolysis of protein material within the uterine wall.

Explain the physiologic mechanisms that cause postpartal chill

postpartal chill is usually experienced immediately after birth. It is thought to be related to the emptying of the uterus, the rapid cardiovascular changes that are occuring, and emotional responses to birth.

Explain the physiologic mechanisms that cause postpartal diaphoresis

it occurs on the day of birth or the first postpartum day. The body needs to shed extra fluid that has been retained during the pregnancy. The new mother may wake up in the night drenched with perspiration.

Explain the physiologic mechanisms that cause afterpains

a term used to refer to the rhythmic uterine contractions that continue to occur after birth. TZhe contractions are essential for involution to occur.

During the postpartal period, what psychologic adaptations does a new mother face?

enormous readjustment and readaptation to role, family, and self-image.

Describe postpartum blues

a feeling of depression and weepiness that many mothers experience in the first few days after birth.

Name and briefly describe the four stages of maternal role attainment.

see text, pg 1047-1048

Identify nine areas that should be examined during the initial postpartal physical assessment and then at least daily until the woman is discharged.

vital signs, breasts including nipples, fundus and abdomen, lochia, perineum (including the anus), elimination, lower extremities, nutritional status, activity level. Other areas that may be considered are discomfort level and sleep patterns.

Describe three observatoins you should make in assessing the breasts of a woman postpartally.

Note softness or firmness, filling, and engorgement. If breastfeeding, note nipple soreness, cracking of nipples, and areas of firmness. This is also a good time to determine whether the woman does breast self-exams and to provide teaching if she doesn't know how and desires to.

Why is it necessary to assess the fundus following childbirth?

To evaluate involution.

Why is the postpartal client asked to empty her bladder before you assess her fundus?

A full bladder may push the uterine fundus upward and to the maternal right side. The assessment will be inaccurate and palpating a full bladder will add to the mother's discomfort. Also, a woman with a full bladder is more likely to have heavier lochia.

Describe the correct procedure for evaluating descent of the postpartal fundus

Place the palm of your hand at the level of the umbilicus and cup it back toward the maternal spine. Feel for a rounded, firm object.

How is postpartal fundal height recorded?

Usually recorded as the number of fingerbreadths above of below the umbilicus.

A 21

year-old primapara gave birth 4 hours ago. Immediately following birth her fundus was midway between the symphysis and umbilicus. Where would you expect it to be now?-Up toward the umbilicus and in the midline.

A pt. reports that she got up to use the bathroom a short while ago and noticed a sudden increase in her lochia. From your check you know that her fundus is firm. How would you explain this occurrence to her?

As she lies on her back, lochia collects in the vagina. When she stands, the collected lochia is discharged. As long as the uterus is firm and in the midline and the flow is not more than moderate, she is fine.

In order to assess a postpartal woman's perineum, you would have her assume which position?

lateral Sims' position.

What observations about the condition of the postpartal client's anal area should be made during the assessment of the perineum?

Observe for hemorrhoids.

What information regarding the postpartal client's urinary elimination should you elicit during your physical assessment?

bladder distention, amount of urine being voided, any difficult or pain with voiding.

What information about your postpartal client's intestinal elimination should you elicit during your physical assessment and what are the teaching implications of your findings?

Whether she has had a bowel movement or not and what her normal bowel pattern is. Teaching could include the following: dietary needs for maintaining stool patterns, need for rest, exercise, and adequate fluids. You can assess what the mother finds helpful to stimulate bowel movements.

Why is it important to include an evaluation of your postpartal client's lower extremities as part of your postpartal assessment?

To assess for bruising, edema, tenderness, redness, muscle strain, and thrombophlebitis.

How is Homans' sign elicited?

by dorsiflexing the foot.

Discuss factors you should consider in completing a psychologic assessment postpartally.

Observe how the mother interacts with others: is she animated, does she smile, does she keep eye contact, is she able to ask for what she needs, is she hesitant or reticent with you or with specific family members? Remember that many of the characteristics just listed are culturally conditioned and therefore subjective, and careful follow-up is needed.

Identify two comfort measures for episiotomy/laceration

cold packs, sitz bath, sitting on a firm surface, spraying the area with warm water after urinating.

Identify two comfort measures for hemorrhoids

witch hazel packs, Tucks, patting when drying after urinating.

Identify two comfort measures for afterpains

warm packs, holding pillow against abdomen, lying on her stomach, analgesics.

Suppression of lactation in nonbreastfeeding mothers is generally accomplished by mechanical methods such as what?

Mother wears a firm bra and avoids any stimulation to the breasts. Engorgement occurs and then will slowly dissipate. It is uncomfortable for the mother.

What nursing assessments should you make for a patient the first time they get up following childbirth?

Assess her steadiness, dizziness, skin temperature and characteristics, skin color, BP, and pulse.

What teaching regarding perineal hygiene should you initiate after a woman gives birth?

The need for cleansing the vulva and perineum after voiding with a spray bottle of warm water or something similar, patting with toilet paper instead of wiping, patting from front to back to decrease incidence of UTI, and any measures to increase her comfort.

What precautions should you take to ensure the safety of a newly postpartal woman who wants to take a shower?

Make sure she knows how to operate the emergency call button in the shower, have her sit down on the shower chair, and stay in the room while she is in the shower. She is at most risk of fainting at this time.

Identify factors that influence a new mother's psychologic adjustment to childbirth and her newborn.

The desire for this child, her support system, methods of coping, resources, life desire, and knowledge base.

How can a nurse provide emotional support during the postpartal period?

By providing support, encouragement, and information as desired by the mother. Role modeling also is very helpful.

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