POSTPARTUM /PUERPERIUM
POSTPARTUM /PUERPERIUM   Refers to the six-week period after delivery of    the baby   Principles:     Promote  healing...
Promote healing andinvolution of different partsof the body
Vascular changes   The 30% - 50% increase in total cardiac    volume during pregnancy will be reabsorb into    the genera...
Genital Changes   Uterus     Sealing of the placenta site     Reduced to its approximate pregestational size     Asses...
Lochia   TYPE     COLOR   DURATION     COMPOSITI                                    ONRubra     Red       1-3 days     Blo...
Genital Changes   Characteristics of Lochia     Pattern should not reverse     It should approximate menstrual flow. Ho...
Genital Changes   Vagina     Involutionfrom soft and with greater diameter      than normal until its approximate preges...
Genital Changes   Perineum     Develops edema and generalized tenderness     Labia majora and minora typically remain  ...
Sexual Activity   Maybe resumed by the 3rd or 4th week    postpartum if bleeding has stopped and    episiorrhaphy has hea...
Menstruation   If not breastfeeding, return of menstrual flow is    expected within 8 weeks after delivery   If breastfe...
Urinary Changes   There is marked diuresis within 12 hours    postpartum   Common complaints are frequent urination in  ...
Gastrointestinal Changes   There is delayed bowel evacuation    postpartally which maybe due to:     Decreased   muscle ...
Vital Signs   Temperature may increase   Bradycardia is common for the 6-8 days    postpartum   Orthostatic hypotension...
Weight   There is an immediate weight loss of 10-12    pounds
Provideemotionalsupport
The Psychological Phases duringthe Postpartum   Taking – In Phase   Taking – Hold Phase   Letting – Go Phase
Establish     asuccessful lactation
Physiology of BreastmilkProduction   Delivery of the     placenta                           Anterior                      ...
Physiology of BreastmilkExcretion1.Crying of the baby / Thinking of the  baby2.Posterior Pituitary Gland3.Oxytocin4.Let-do...
Advantages of Breastfeeding   For the mother:     Economical  in terms of time, money, and effort     More rapid involu...
Health Teachings   Hygiene:     Wash   breast daily     Soap or alcohol should never be used     Wash hands before and...
Health Teachings   Method:     Stimulate   the baby to open the mouth by means of      rooting reflex     Infant should...
Associated Problems andManagement   Engorgement: tension of the breast during 3rd    to 4th days. It fades after the infa...
Associated Problems andManagement   Sore Nipples     Expose  nipple to air     If normal air-drying is not effective, e...
Associated Problems andManagement   Mastitis     Antibiotics                as ordered     Ice compress     Proper bre...
THE NEONATE-The first 28 daysafter delivery
Principles of Newborn Care   Establish and maintain a patent airway   Maintain appropriate body temperature   Immediate...
Establish and maintain a patentairway
Establish and maintain a patentairway•   Never stimulate crying unless secretions have    been drained out•   Position the...
Maintainappropriate bodytemperature
Maintain appropriate bodytemperature   Important as it may lead to cold stress   Heat loss in newborn occurs in 4 ways  ...
•       The newborn suffers large losses of body        heat (cold stress) because:    –     he is wet at birth    –     t...
Immediate assessment of thenewborn
•       APGAR scoring – a standardized evaluation        of the newborn’s condition/stability    –     Done 1 minute after...
SIGN       0          1           2HEART      Absent     <100/min    >100/minRATEMUSCLE     Limp,      Some        Well-fl...
   APGAR interpretation of    results:    0-3 (the baby is in serious     danger)    4-6 (condition is guarded)    7-1...
   Assessment of gestational age    Naegel’s Rule    Mc Donald’s Rule    Bartholomew’s Rule    UTZ
Proper identification of thenewborn
•   Must be done in the delivery room before    bringing the newborn to the nursery   Identification bands   Footprints
   NURSERY CARE
   Check the identification band   Take anthropometric measurements:     Length   = (Ave) 50cm / 20 inches             ...
   Take the temperature     At birth 37.2 degrees Celsius but will stabilize in 8      hrs.     (Before) rectal route i...
   Weight taking     5.5   – 6.5 lbs. (2.5 – 3.5 kg)   Feeding     Initial           feeding with an ounce of sterile ...
Nursery CarePhysical Assessment•   Vital Signs    o   Pulse - Apical pulse recommended                - 120-140 bpm, irreg...
•   Skin    –   Normally ruddy    –   Acrocyanosis during the first 24-48 hours of life    –   General mottling is common ...
   Head    Largest part of the body    Fontanelles are neither sunken nor     prematurely closed    Craniotabes presen...
CEPHALHEMATOMA
•   Eyes    –   Cry tearlessly during the first 2 months•   Nose    –   There should be no septal deviation•   Mouth    – ...
Cleft palate
Epstein pearls
Natal tooth
   Neck     Headrotate freely on the neck and flex forward     and back   Chest     Smaller or as large as the head   ...
   Abdomen    Liver, spleen, and kidneys may be     palpable at birth    Dome-shaped    Umbilical cord breaks free at ...
   Anogenital area     Inspect  anus to ensure presence and patency     Female genitalia: may have swollen labia and   ...
   Extremities     Hands  are clenched into fist     Note for polydactyly or unusual spacing of toes
   Cardiovascular System     As soon as breathing has been initiated,      oxygenation takes place in lungs     Increas...
   Gastrointestinal Tract    Meconium should be present within     24-48 hours after birth    Transitional stool presen...
   Urinary system     Urine is less concentrated     Female: strong stream voiding     Male: projected arc voiding   ...
   Senses     Sight:Can only see within 9 inches away from the      eyes on the first 6-8weeks     Hearing: As soon as ...
   Neuromuscular System    Blink reflex (always present)    Sucking reflex (disappears at 6 mos)    Swallowing reflex (al...
   Neuromuscular System      Rooting reflex (disappears by 6 weeks)
Neuromuscular SystemTonic neck reflex (disappears by 2-3 mos)
Neuromuscular SystemBabinski reflex (disappears at 3mos)
   Neuromuscular System       Moro reflex (disappears by 4-5 mos)
   Neuromuscular System     Palmar grasp reflex (disappears at 3 mos)
   Neuromuscular System              Plantar grasp reflex
Neuromuscular SystemStep/Walk-in place reflex (disappears by 3 mos)
   Neuromuscular SystemPlacing reflex
Discharge Instructions•   Bathing    –   Maybe given anytime but not within 30 minutes        after feeding    –   Sponge ...
•   Nutrition    –   Encourage breastfeeding           NUTRIENTS       HUMAN MILK     COW’S MILK           Proteins       ...
Discharge Instructions   Clothing the newborn     Rule   of thumb   Sleep pattern     Usually   sleeps 16-20 hours a day
Management for the CommonHealth Problems   Constipation     Encourage  breastfeeding     Add more fluids, carbohydrates...
Management for the CommonHealth Problems   Spitting up     Feed  in upright position     Position on right side after f...
   Miliaria   Starch bath   Seborrhic dermatitis   Apply mineral oil or petroleum jelly on scalp at    night before gi...
   GOD BLESS ON YOUR FINALS!   Aim to top your finals! Break a neck…                                            Sir cj
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
Postpartum slides finals for the students
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Postpartum slides finals for the students

  1. 1. POSTPARTUM /PUERPERIUM
  2. 2. POSTPARTUM /PUERPERIUM Refers to the six-week period after delivery of the baby Principles:  Promote healing and involution of different parts of the body  Provide emotional support  Establish a successful lactation  Prevent postpartum complications
  3. 3. Promote healing andinvolution of different partsof the body
  4. 4. Vascular changes The 30% - 50% increase in total cardiac volume during pregnancy will be reabsorb into the general circulation WBC count increases to 20,000 – 30,000/mm3 There is extensive activation of clotting factors, which encourages thromboembolization. All blood values are back to prenatal levels by the 3rd and 4th week postpartum
  5. 5. Genital Changes Uterus  Sealing of the placenta site  Reduced to its approximate pregestational size  Assessed by measuring the fundus by fingerbreadth  In some women, causes afterpains  Nursing Management:  Never apply heat on abdomen  Give analgesics as ordered  Advise knee-chest position when perineum has healed
  6. 6. Lochia TYPE COLOR DURATION COMPOSITI ONRubra Red 1-3 days Blood, fragments of decidua, and mucusSerosa Pink 3-10 days Blood, mucus, and invading leukocytesAlba White 10-14 days Largely mucus; Leukocyte
  7. 7. Genital Changes Characteristics of Lochia  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 should not contain large clots  It should never be absent, regardless of the method of delivery
  8. 8. Genital Changes Vagina  Involutionfrom soft and with greater diameter than normal until its approximate pregestational state takes the entire postpartal period  Nursing Management:  Encourage Kegel Exercise
  9. 9. Genital Changes Perineum  Develops edema and generalized tenderness  Labia majora and minora typically remain softened
  10. 10. Sexual Activity Maybe resumed by the 3rd or 4th week postpartum if bleeding has stopped and episiorrhaphy has healed
  11. 11. Menstruation If not breastfeeding, return of menstrual flow is expected within 8 weeks after delivery If breastfeeding, menstrual return is expected in 3-4 months. In some women, no menstruation occurs during the entire lactation period.
  12. 12. Urinary Changes There is marked diuresis within 12 hours postpartum Common complaints are frequent urination in small amounts and difficulty voiding Nursing management:  Initiate voiding  If measures fail, catheterization as ordered.
  13. 13. Gastrointestinal Changes There is delayed bowel evacuation postpartally which maybe due to:  Decreased muscle tone  Lack of food and enema during labor  Dehydration  Perineal tenderness Almost immediately, the woman feels hungry and thirsty. She can eat unless she has the after effects of general anesthesia.
  14. 14. Vital Signs Temperature may increase Bradycardia is common for the 6-8 days postpartum Orthostatic hypotension and dizziness is common
  15. 15. Weight There is an immediate weight loss of 10-12 pounds
  16. 16. Provideemotionalsupport
  17. 17. The Psychological Phases duringthe Postpartum Taking – In Phase Taking – Hold Phase Letting – Go Phase
  18. 18. Establish asuccessful lactation
  19. 19. Physiology of BreastmilkProduction Delivery of the placenta Anterior Pituitary Gland Prolactin Acinar Cells Production of Milk
  20. 20. Physiology of BreastmilkExcretion1.Crying of the baby / Thinking of the baby2.Posterior Pituitary Gland3.Oxytocin4.Let-down reflex
  21. 21. Advantages of Breastfeeding For the mother:  Economical in terms of time, money, and effort  More rapid involution  Less incidence of cancer of the breast For the baby:  Closer mother-infant relationship  Contains antibodies  Fewer incidence of GI diseases  Always available at the right temperature
  22. 22. Health Teachings Hygiene:  Wash breast daily  Soap or alcohol should never be used  Wash hands before and after feeding  Insert clean OS squares or piece of cloth in the brassiere to absorb moisture
  23. 23. Health Teachings Method:  Stimulate the baby to open the mouth by means of rooting reflex  Infant should grasp not only the nipple but also the areola  Infant should be introduced to breast gradually  Infant should be placed first on the breast he fed last in the previous feeding  Feed by demand  Advise the mother how to relax during feedings
  24. 24. Associated Problems andManagement Engorgement: tension of the breast during 3rd to 4th days. It fades after the infant begins sucking  Advise use of firm-fitting brassiere for good support  Cold compress / warm compress depending if the mother will breastfeed or not
  25. 25. Associated Problems andManagement Sore Nipples  Expose nipple to air  If normal air-drying is not effective, exposure to a 20-watt bulb placed 12-18inches away
  26. 26. Associated Problems andManagement Mastitis  Antibiotics as ordered  Ice compress  Proper breast support  Discontinue breastfeeding in affected breast
  27. 27. THE NEONATE-The first 28 daysafter delivery
  28. 28. Principles of Newborn Care Establish and maintain a patent airway Maintain appropriate body temperature Immediate assessment of the newborn Proper identification of the newborn Nursery care
  29. 29. Establish and maintain a patentairway
  30. 30. Establish and maintain a patentairway• Never stimulate crying unless secretions have been drained out• Position the head lower than the rest of the body except if there are signs of increased ICP• Suction the baby properly – Turn the head to one side – Suction gently but quickly – Suction the mouth first before the nose – Test the patency of airway
  31. 31. Maintainappropriate bodytemperature
  32. 32. Maintain appropriate bodytemperature Important as it may lead to cold stress Heat loss in newborn occurs in 4 ways  Conduction  Convection  Evaporation  Radiation
  33. 33. • The newborn suffers large losses of body heat (cold stress) because: – he is wet at birth – the delivery room is cold – he does not have enough subcutaneous fats/adipose tissues – shivering mechanism is not functioning – thermoregulatory center is underdeveloped
  34. 34. Immediate assessment of thenewborn
  35. 35. • APGAR scoring – a standardized evaluation of the newborn’s condition/stability – Done 1 minute afterbirth then 5 minutes after
  36. 36. SIGN 0 1 2HEART Absent <100/min >100/minRATEMUSCLE Limp, Some Well-flexedTONE flaccid flexion of extremities extremitiesRESPIRAT Absent Weak cry Good,ORY strong cryEFFORTREFLEX No Grimace, Sneeze;IRRITABILI response weak cry good,TY strong cry
  37. 37.  APGAR interpretation of results: 0-3 (the baby is in serious danger) 4-6 (condition is guarded) 7-10 (baby is in the best possible health)
  38. 38.  Assessment of gestational age Naegel’s Rule Mc Donald’s Rule Bartholomew’s Rule UTZ
  39. 39. Proper identification of thenewborn
  40. 40. • Must be done in the delivery room before bringing the newborn to the nursery Identification bands Footprints
  41. 41.  NURSERY CARE
  42. 42.  Check the identification band Take anthropometric measurements:  Length = (Ave) 50cm / 20 inches = (Normal range) 47.5 – 53.75 cm / 19-21 ½ in - Head circumference = 33-35 cm - Chest circumference = 31-33 cm - Abdominal circumference = 31-33cm
  43. 43.  Take the temperature  At birth 37.2 degrees Celsius but will stabilize in 8 hrs.  (Before) rectal route is preferred Give initial oil bath Dress the umbilical cord Crede’s prophylaxis Vitamin K administration
  44. 44.  Weight taking  5.5 – 6.5 lbs. (2.5 – 3.5 kg) Feeding  Initial feeding with an ounce of sterile water  Subsequent feedings given by demand
  45. 45. Nursery CarePhysical Assessment• Vital Signs o Pulse - Apical pulse recommended - 120-140 bpm, irregular o Respirations – largely abdominal - Gentle, quiet, rapid but shalow - 30-60cpm o Blood pressure – not routinely measured unless Coartation of the Aorta is suspected
  46. 46. • Skin – Normally ruddy – Acrocyanosis during the first 24-48 hours of life – General mottling is common – Physiologic Jaundice from 2-7 days of life – Harlequin sign is normal first few days of life – Mongolian spots normal but disappear by school age – Lanugo disappears within 2 weeks – Desquamation normal within 24 hours of life – Milia disappear by 2-4weeks – Deviation from normal: Pallor , Gray color
  47. 47.  Head Largest part of the body Fontanelles are neither sunken nor prematurely closed Craniotabes present Caput succedaneum or Cephalhematoma may be present
  48. 48. CEPHALHEMATOMA
  49. 49. • Eyes – Cry tearlessly during the first 2 months• Nose – There should be no septal deviation• Mouth – Should open evenly when crying – Palate should be intact – Epstein’s pearls may be present – Natal teeth may be seen
  50. 50. Cleft palate
  51. 51. Epstein pearls
  52. 52. Natal tooth
  53. 53.  Neck  Headrotate freely on the neck and flex forward and back Chest  Smaller or as large as the head  Breast may be engorged  Witch’s milk may be present
  54. 54.  Abdomen Liver, spleen, and kidneys may be palpable at birth Dome-shaped Umbilical cord breaks free at 6th – 10th day after birth
  55. 55.  Anogenital area  Inspect anus to ensure presence and patency  Female genitalia: may have swollen labia and pseudomenstruation  Male genitalia: Scrotum may be edematous Testes should be present Cremasteric reflex should be elicited
  56. 56.  Extremities  Hands are clenched into fist  Note for polydactyly or unusual spacing of toes
  57. 57.  Cardiovascular System  As soon as breathing has been initiated, oxygenation takes place in lungs  Increased pressure on the left side of the heart results in: Closure of the foramen ovale Change of Ductus arteriosus into Ligamentum arteriosum Ductus venosus becomes Ligamentum venosum - Blood volume: Ave = 300ml or 80-
  58. 58.  Gastrointestinal Tract Meconium should be present within 24-48 hours after birth Transitional stool present on the 2nd – 10th day of life Milk stool (Breastfed / Bottlefed) Deviation from normal: Clay- colored, blood-flecked, black tarry stool
  59. 59.  Urinary system  Urine is less concentrated  Female: strong stream voiding  Male: projected arc voiding Autoimmune system  Have difficulty forming antibodies until 2 months  Passive natural immunity
  60. 60.  Senses  Sight:Can only see within 9 inches away from the eyes on the first 6-8weeks  Hearing: As soon as amniotic fluid has been absorbed  Taste and Smell: As soon as mucus and fluid have been cleared  Touch: Most develop of all senses
  61. 61.  Neuromuscular System Blink reflex (always present) Sucking reflex (disappears at 6 mos) Swallowing reflex (always present) Extrusion reflex (disappears by 4 months)
  62. 62.  Neuromuscular System Rooting reflex (disappears by 6 weeks)
  63. 63. Neuromuscular SystemTonic neck reflex (disappears by 2-3 mos)
  64. 64. Neuromuscular SystemBabinski reflex (disappears at 3mos)
  65. 65.  Neuromuscular System Moro reflex (disappears by 4-5 mos)
  66. 66.  Neuromuscular System Palmar grasp reflex (disappears at 3 mos)
  67. 67.  Neuromuscular System Plantar grasp reflex
  68. 68. Neuromuscular SystemStep/Walk-in place reflex (disappears by 3 mos)
  69. 69.  Neuromuscular SystemPlacing reflex
  70. 70. Discharge Instructions• Bathing – Maybe given anytime but not within 30 minutes after feeding – Sponge baths are done until cord falls off• Cord care – Always maintain the cord dry – Dub 70% alcohol once or twice a day – If it remains moist for a week, advise to see the doctor
  71. 71. • Nutrition – Encourage breastfeeding NUTRIENTS HUMAN MILK COW’S MILK Proteins 8% 20% Fats 50% 50% Carbohydrates 42% 30% Minerals Lesser Greater – Should feed by demand – Should be burp at least twice during feeding
  72. 72. Discharge Instructions Clothing the newborn  Rule of thumb Sleep pattern  Usually sleeps 16-20 hours a day
  73. 73. Management for the CommonHealth Problems Constipation  Encourage breastfeeding  Add more fluids, carbohydrates, sugar Colic  Feed by demand  Burp at least twice during feeding  May need to change formula as per doctor’s order
  74. 74. Management for the CommonHealth Problems Spitting up  Feed in upright position  Position on right side after feeding  Burp more frequently Diaper rash  Expose to air  Careful washing and rinsing
  75. 75.  Miliaria Starch bath Seborrhic dermatitis Apply mineral oil or petroleum jelly on scalp at night before giving shampoo in the morning
  76. 76.  GOD BLESS ON YOUR FINALS! Aim to top your finals! Break a neck… Sir cj

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