POSTPARTUM / PUERPERIUM<br />
POSTPARTUM / PUERPERIUM<br />Refers to the six-week period after delivery of the baby<br />Principles:<br />Promote healin...
Promote healing and involution of different parts of the body<br />
Vascular changes<br />The 30% - 50% increase in total cardiac volume during pregnancy will be reabsorb into the general ci...
Genital Changes<br />Uterus<br />Sealing of the placenta site<br />Reduced to its approximate pregestational size<br />Ass...
Lochia<br />
Genital Changes<br />Characteristics of Lochia<br />Pattern should not reverse<br />It should approximate menstrual flow. ...
Genital Changes<br />Vagina<br />Involution from soft and with greater diameter than normal until its approximate pregesta...
Genital Changes<br />Perineum<br />Develops edema and generalized tenderness<br />Labia majora and minora typically remain...
Sexual Activity<br />Maybe resumed by the 3rd or 4th week postpartum if bleeding has stopped and episiorrhaphy has healed<...
Menstruation<br />If not breastfeeding, return of menstrual flow is expected within 8 weeks after delivery<br />If breastf...
Urinary Changes<br />There is marked diuresis within 12 hours postpartum<br />Common complaints are frequent urination in ...
Gastrointestinal Changes<br />There is delayed bowel evacuation postpartally which maybe due to:<br />Decreased muscle ton...
Vital Signs<br />Temperature may increase<br />Bradycardia is common for the 6-8 days postpartum<br />Orthostatic hypotens...
Weight<br />There is an immediate weight loss of 10-12 pounds<br />
Provide emotional support<br />
The Psychological Phases during the Postpartum<br />Taking – In Phase<br />Taking – Hold Phase<br />Letting – Go Phase<br />
Establish a successful lactation<br />
Physiology of Breastmilk Production<br />
Physiology of Breastmilk Excretion<br />1.Crying of the baby / Thinking of the baby<br />2.Posterior Pituitary Gland<br />...
Advantages of Breastfeeding<br />For the mother:<br />Economical in terms of time, money, and effort<br />More rapid invol...
Health Teachings<br />Hygiene:<br />Wash breast daily<br />Soap or alcohol should never be used<br />Wash hands before and...
Health Teachings<br />Method:<br />Stimulate the baby to open the mouth by means of rooting reflex<br />Infant should gras...
Associated Problems and Management<br />Engorgement: tension of the breast during 3rd to 4th days. It fades after the infa...
Associated Problems and Management<br />Sore Nipples<br />Expose nipple to air<br />If normal air-drying is not effective,...
Associated Problems and Management<br />Mastitis<br />Antibiotics as ordered<br />Ice compress<br />Proper breast support<...
THE NEONATE-The first 28 days after delivery<br />
Principles of Newborn Care<br />Establish and maintain a patent airway<br />Maintain appropriate body temperature<br />Imm...
Establish and maintain a patent airway<br />
Establish and maintain a patent airway<br /><ul><li>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 </li></li></ul><li>Maintain appropriate body temperature<br />
Maintain appropriate body temperature<br />Important as it may lead to cold stress<br />Heat loss in newborn occurs in 4 w...
<ul><li>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</li></li></ul><li>Immediate assessment of the newborn<br />
<ul><li>APGAR scoring – a standardized evaluation of the newborn’s condition/stability
Done 1 minute afterbirth then 5 minutes after</li></li></ul><li>
APGAR interpretation of results:<br />0-3 (the baby is in serious danger)<br />4-6 (condition is guarded)<br />7-10 (baby ...
Assessment of gestational age<br />Naegel’s Rule<br />Mc Donald’s Rule<br />Bartholomew’s Rule<br />UTZ<br />
Proper identification of the newborn<br />
<ul><li>Must be done in the delivery room before bringing the newborn to the nursery</li></ul>Identification bands<br />Fo...
NURSERY CARE<br />
Check the identification band<br />Take anthropometric measurements:<br />Length = (Ave) 50cm / 20 inches<br />			= (Norma...
Chest circumference = 31-33 cm
Abdominal circumference = 31-33cm</li></li></ul><li>Take the temperature <br />At birth 37.2 degrees Celsius but will stab...
Weight taking <br />5.5 – 6.5 lbs. (2.5 – 3.5 kg)<br />Feeding<br />Initial feeding with an ounce of sterile water<br />Su...
Nursery CarePhysical Assessment<br /><ul><li>Vital Signs
Pulse  -  Apical pulse recommended</li></ul>			- 120-140 bpm, irregular<br /><ul><li>Respirations – largely abdominal
Gentle, quiet, rapid but shalow
30-60cpm
Blood pressure – not routinely measured unless Coartation of the Aorta is suspected</li></li></ul><li><ul><li>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</li></li></ul><li>
Head<br />Largest part of the body<br />Fontanelles are neither sunken nor prematurely closed<br />Craniotabes present<br ...
CEPHALHEMATOMA<br />
<ul><li>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</li></li></ul><li>Cleft palate<br />
Epstein pearls<br />
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Postpartum slides finals for the students

  1. 1. POSTPARTUM / PUERPERIUM<br />
  2. 2. POSTPARTUM / PUERPERIUM<br />Refers to the six-week period after delivery of the baby<br />Principles:<br />Promote healing and involution of different parts of the body<br />Provide emotional support<br />Establish a successful lactation<br />Prevent postpartum complications<br />
  3. 3. Promote healing and involution of different parts of the body<br />
  4. 4. Vascular changes<br />The 30% - 50% increase in total cardiac volume during pregnancy will be reabsorb into the general circulation<br />WBC count increases to 20,000 – 30,000/mm3<br />There is extensive activation of clotting factors, which encourages thromboembolization.<br />All blood values are back to prenatal levels by the 3rd and 4th week postpartum<br />
  5. 5. Genital Changes<br />Uterus<br />Sealing of the placenta site<br />Reduced to its approximate pregestational size<br />Assessed by measuring the fundus by fingerbreadth<br />In some women, causes afterpains<br />Nursing Management:<br />Never apply heat on abdomen<br />Give analgesics as ordered<br />Advise knee-chest position when perineum has healed<br />
  6. 6. Lochia<br />
  7. 7. Genital Changes<br />Characteristics of Lochia<br />Pattern should not reverse<br />It should approximate menstrual flow. However, it increases with activity and decreases with breastfeeding<br />It should not have any offensive odor<br />It should not contain large clots<br />It should never be absent, regardless of the method of delivery<br />
  8. 8. Genital Changes<br />Vagina<br />Involution from soft and with greater diameter than normal until its approximate pregestational state takes the entire postpartal period<br />Nursing Management:<br />Encourage Kegel Exercise<br />
  9. 9. Genital Changes<br />Perineum<br />Develops edema and generalized tenderness<br />Labia majora and minora typically remain softened<br />
  10. 10. Sexual Activity<br />Maybe resumed by the 3rd or 4th week postpartum if bleeding has stopped and episiorrhaphy has healed<br />
  11. 11. Menstruation<br />If not breastfeeding, return of menstrual flow is expected within 8 weeks after delivery<br />If breastfeeding, menstrual return is expected in 3-4 months. In some women, no menstruation occurs during the entire lactation period.<br />
  12. 12. Urinary Changes<br />There is marked diuresis within 12 hours postpartum<br />Common complaints are frequent urination in small amounts and difficulty voiding<br />Nursing management:<br />Initiate voiding<br />If measures fail, catheterization as ordered.<br />
  13. 13. Gastrointestinal Changes<br />There is delayed bowel evacuation postpartally which maybe due to:<br />Decreased muscle tone <br />Lack of food and enema during labor<br />Dehydration<br />Perineal tenderness<br />Almost immediately, the woman feels hungry and thirsty. She can eat unless she has the after effects of general anesthesia.<br />
  14. 14. Vital Signs<br />Temperature may increase<br />Bradycardia is common for the 6-8 days postpartum<br />Orthostatic hypotension and dizziness is common<br />
  15. 15. Weight<br />There is an immediate weight loss of 10-12 pounds<br />
  16. 16. Provide emotional support<br />
  17. 17. The Psychological Phases during the Postpartum<br />Taking – In Phase<br />Taking – Hold Phase<br />Letting – Go Phase<br />
  18. 18. Establish a successful lactation<br />
  19. 19. Physiology of Breastmilk Production<br />
  20. 20. Physiology of Breastmilk Excretion<br />1.Crying of the baby / Thinking of the baby<br />2.Posterior Pituitary Gland<br />3.Oxytocin<br />4.Let-down reflex<br />
  21. 21. Advantages of Breastfeeding<br />For the mother:<br />Economical in terms of time, money, and effort<br />More rapid involution<br />Less incidence of cancer of the breast<br />For the baby:<br />Closer mother-infant relationship<br />Contains antibodies<br />Fewer incidence of GI diseases<br />Always available at the right temperature<br />
  22. 22. Health Teachings<br />Hygiene:<br />Wash breast daily<br />Soap or alcohol should never be used<br />Wash hands before and after feeding<br />Insert clean OS squares or piece of cloth in the brassiere to absorb moisture<br />
  23. 23. Health Teachings<br />Method:<br />Stimulate the baby to open the mouth by means of rooting reflex<br />Infant should grasp not only the nipple but also the areola<br />Infant should be introduced to breast gradually<br />Infant should be placed first on the breast he fed last in the previous feeding<br />Feed by demand<br />Advise the mother how to relax during feedings<br />
  24. 24. Associated Problems and Management<br />Engorgement: tension of the breast during 3rd to 4th days. It fades after the infant begins sucking<br />Advise use of firm-fitting brassiere for good support<br />Cold compress / warm compress depending if the mother will breastfeed or not<br />
  25. 25. Associated Problems and Management<br />Sore Nipples<br />Expose nipple to air<br />If normal air-drying is not effective, exposure to a 20-watt bulb placed 12-18inches away<br />
  26. 26. Associated Problems and Management<br />Mastitis<br />Antibiotics as ordered<br />Ice compress<br />Proper breast support<br />Discontinue breastfeeding in affected breast<br />
  27. 27. THE NEONATE-The first 28 days after delivery<br />
  28. 28. Principles of Newborn Care<br />Establish and maintain a patent airway<br />Maintain appropriate body temperature<br />Immediate assessment of the newborn<br />Proper identification of the newborn<br />Nursery care<br />
  29. 29. Establish and maintain a patent airway<br />
  30. 30. Establish and maintain a patent airway<br /><ul><li>Never stimulate crying unless secretions have been drained out
  31. 31. Position the head lower than the rest of the body except if there are signs of increased ICP
  32. 32. Suction the baby properly
  33. 33. Turn the head to one side
  34. 34. Suction gently but quickly
  35. 35. Suction the mouth first before the nose
  36. 36. Test the patency of airway </li></li></ul><li>Maintain appropriate body temperature<br />
  37. 37. Maintain appropriate body temperature<br />Important as it may lead to cold stress<br />Heat loss in newborn occurs in 4 ways<br />Conduction<br />Convection<br />Evaporation<br />Radiation<br />
  38. 38. <ul><li>The newborn suffers large losses of body heat (cold stress) because:
  39. 39. he is wet at birth
  40. 40. the delivery room is cold
  41. 41. he does not have enough subcutaneous fats/adipose tissues
  42. 42. shivering mechanism is not functioning
  43. 43. thermoregulatory center is underdeveloped</li></li></ul><li>Immediate assessment of the newborn<br />
  44. 44. <ul><li>APGAR scoring – a standardized evaluation of the newborn’s condition/stability
  45. 45. Done 1 minute afterbirth then 5 minutes after</li></li></ul><li>
  46. 46. APGAR interpretation of results:<br />0-3 (the baby is in serious danger)<br />4-6 (condition is guarded)<br />7-10 (baby is in the best possible health)<br />
  47. 47. Assessment of gestational age<br />Naegel’s Rule<br />Mc Donald’s Rule<br />Bartholomew’s Rule<br />UTZ<br />
  48. 48. Proper identification of the newborn<br />
  49. 49. <ul><li>Must be done in the delivery room before bringing the newborn to the nursery</li></ul>Identification bands<br />Footprints<br />
  50. 50.
  51. 51.
  52. 52. NURSERY CARE<br />
  53. 53. Check the identification band<br />Take anthropometric measurements:<br />Length = (Ave) 50cm / 20 inches<br /> = (Normal range) 47.5 – 53.75 cm /<br /> 19-21 ½ in<br /><ul><li>Head circumference = 33-35 cm
  54. 54. Chest circumference = 31-33 cm
  55. 55. Abdominal circumference = 31-33cm</li></li></ul><li>Take the temperature <br />At birth 37.2 degrees Celsius but will stabilize in 8 hrs.<br />(Before) rectal route is preferred<br />Give initial oil bath<br />Dress the umbilical cord<br />Crede’s prophylaxis<br />Vitamin K administration<br />
  56. 56. Weight taking <br />5.5 – 6.5 lbs. (2.5 – 3.5 kg)<br />Feeding<br />Initial feeding with an ounce of sterile water<br />Subsequent feedings given by demand<br />
  57. 57. Nursery CarePhysical Assessment<br /><ul><li>Vital Signs
  58. 58. Pulse - Apical pulse recommended</li></ul> - 120-140 bpm, irregular<br /><ul><li>Respirations – largely abdominal
  59. 59. Gentle, quiet, rapid but shalow
  60. 60. 30-60cpm
  61. 61. Blood pressure – not routinely measured unless Coartation of the Aorta is suspected</li></li></ul><li><ul><li>Skin
  62. 62. Normally ruddy
  63. 63. Acrocyanosis during the first 24-48 hours of life
  64. 64. General mottling is common
  65. 65. Physiologic Jaundice from 2-7 days of life
  66. 66. Harlequin sign is normal first few days of life
  67. 67. Mongolian spots normal but disappear by school age
  68. 68. Lanugo disappears within 2 weeks
  69. 69. Desquamation normal within 24 hours of life
  70. 70. Milia disappear by 2-4weeks
  71. 71. Deviation from normal: Pallor , Gray color</li></li></ul><li>
  72. 72.
  73. 73.
  74. 74.
  75. 75. Head<br />Largest part of the body<br />Fontanelles are neither sunken nor prematurely closed<br />Craniotabes present<br />Caput succedaneum or Cephalhematoma may be present<br />
  76. 76.
  77. 77. CEPHALHEMATOMA<br />
  78. 78. <ul><li>Eyes
  79. 79. Cry tearlessly during the first 2 months
  80. 80. Nose
  81. 81. There should be no septal deviation
  82. 82. Mouth
  83. 83. Should open evenly when crying
  84. 84. Palate should be intact
  85. 85. Epstein’s pearls may be present
  86. 86. Natal teeth may be seen</li></li></ul><li>Cleft palate<br />
  87. 87. Epstein pearls<br />
  88. 88. Natal tooth<br />
  89. 89. Neck<br />Head rotate freely on the neck and flex forward and back<br />Chest<br />Smaller or as large as the head<br />Breast may be engorged<br />Witch’s milk may be present<br />
  90. 90.
  91. 91. Abdomen<br />Liver, spleen, and kidneys may be palpable at birth<br />Dome-shaped<br />Umbilical cord breaks free at 6th – 10th day after birth<br />
  92. 92. Anogenital area<br />Inspect anus to ensure presence and patency<br />Female genitalia: may have swollen labia and pseudomenstruation<br />Male genitalia: Scrotum may be edematous<br /> Testes should be present<br />Cremasteric reflex should be elicited<br />
  93. 93. Extremities<br />Hands are clenched into fist<br />Note for polydactyly or unusual spacing of toes<br />
  94. 94. Cardiovascular System<br />As soon as breathing has been initiated, oxygenation takes place in lungs<br />Increased pressure on the left side of the heart results in:<br /><ul><li>Closure of the foramen ovale
  95. 95. Change of Ductusarteriosus into Ligamentumarteriosum
  96. 96. Ductusvenosus becomes Ligamentumvenosum
  97. 97. Blood volume: Ave = 300ml or 80-100ml/kg BW</li></li></ul><li>Gastrointestinal Tract<br />Meconium should be present within 24-48 hours after birth<br />Transitional stool present on the 2nd – 10th day of life<br />Milk stool (Breastfed / Bottlefed)<br />Deviation from normal: Clay-colored, blood-flecked, black tarry stool<br />
  98. 98.
  99. 99. Urinary system<br />Urine is less concentrated<br />Female: strong stream voiding<br />Male: projected arc voiding<br />Autoimmune system<br />Have difficulty forming antibodies until 2 months<br />Passive natural immunity<br />
  100. 100. Senses<br />Sight: Can only see within 9 inches away from the eyes on the first 6-8weeks<br />Hearing: As soon as amniotic fluid has been absorbed<br />Taste and Smell: As soon as mucus and fluid have been cleared<br />Touch: Most develop of all senses<br />
  101. 101. Neuromuscular System<br />Blink reflex (always present)<br />Sucking reflex (disappears at 6 mos)<br />Swallowing reflex (always present)<br />Extrusion reflex (disappears by 4 months)<br />
  102. 102. Neuromuscular System<br />Rooting reflex (disappears by 6 weeks)<br />
  103. 103. Neuromuscular SystemTonic neck reflex (disappears by 2-3 mos)<br />
  104. 104. Neuromuscular SystemBabinski reflex (disappears at 3 mos)<br />
  105. 105. Neuromuscular System<br />Moro reflex (disappears by 4-5 mos)<br />
  106. 106. Neuromuscular System<br />Palmar grasp reflex (disappears at 3 mos)<br />
  107. 107. Neuromuscular System<br />Plantar grasp reflex<br />
  108. 108. Neuromuscular System<br />Step/Walk-in place reflex (disappears by 3 mos)<br />
  109. 109. Neuromuscular System<br />Placing reflex<br />
  110. 110. Discharge Instructions<br /><ul><li>Bathing
  111. 111. Maybe given anytime but not within 30 minutes after feeding
  112. 112. Sponge baths are done until cord falls off
  113. 113. Cord care
  114. 114. Always maintain the cord dry
  115. 115. Dub 70% alcohol once or twice a day
  116. 116. If it remains moist for a week, advise to see the doctor</li></li></ul><li><ul><li>Nutrition
  117. 117. Encourage breastfeeding
  118. 118. Should feed by demand
  119. 119. Should be burp at least twice during feeding</li></li></ul><li>Discharge Instructions<br />Clothing the newborn<br />Rule of thumb<br />Sleep pattern<br />Usually sleeps 16-20 hours a day<br />
  120. 120. Management for the Common Health Problems<br />Constipation<br />Encourage breastfeeding<br />Add more fluids, carbohydrates, sugar<br />Colic<br />Feed by demand<br />Burp at least twice during feeding<br />May need to change formula as per doctor’s order<br />
  121. 121. Management for the Common Health Problems<br />Spitting up<br />Feed in upright position<br />Position on right side after feeding<br />Burp more frequently<br />Diaper rash<br />Expose to air<br />Careful washing and rinsing<br />
  122. 122. <ul><li>Miliaria
  123. 123. Starch bath</li></ul>Seborrhic dermatitis<br />Apply mineral oil or petroleum jelly on scalp at night before giving shampoo in the morning<br />
  124. 124.
  125. 125.
  126. 126. GOD BLESS ON YOUR FINALS! <br />Aim to top your finals!Break a neck…<br />Sir cj<br />
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