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Postpartum slides finals for the students
 

Postpartum slides finals for the students

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    Postpartum slides finals for the students Postpartum slides finals for the students Presentation Transcript

    • POSTPARTUM / PUERPERIUM
    • 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
    • Promote healing and involution of different parts of the body
    • 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
    • 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
    • Lochia
    • 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
    • Genital Changes
      Vagina
      Involution from soft and with greater diameter than normal until its approximate pregestational state takes the entire postpartal period
      Nursing Management:
      Encourage Kegel Exercise
    • Genital Changes
      Perineum
      Develops edema and generalized tenderness
      Labia majora and minora typically remain softened
    • Sexual Activity
      Maybe resumed by the 3rd or 4th week postpartum if bleeding has stopped and episiorrhaphy has healed
    • 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.
    • 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.
    • 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.
    • Vital Signs
      Temperature may increase
      Bradycardia is common for the 6-8 days postpartum
      Orthostatic hypotension and dizziness is common
    • Weight
      There is an immediate weight loss of 10-12 pounds
    • Provide emotional support
    • The Psychological Phases during the Postpartum
      Taking – In Phase
      Taking – Hold Phase
      Letting – Go Phase
    • Establish a successful lactation
    • Physiology of Breastmilk Production
    • Physiology of Breastmilk Excretion
      1.Crying of the baby / Thinking of the baby
      2.Posterior Pituitary Gland
      3.Oxytocin
      4.Let-down reflex
    • 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
    • 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
    • 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
    • Associated Problems and Management
      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
    • Associated Problems and Management
      Sore Nipples
      Expose nipple to air
      If normal air-drying is not effective, exposure to a 20-watt bulb placed 12-18inches away
    • Associated Problems and Management
      Mastitis
      Antibiotics as ordered
      Ice compress
      Proper breast support
      Discontinue breastfeeding in affected breast
    • THE NEONATE-The first 28 days after delivery
    • 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
    • Establish and maintain a patent airway
    • Establish and maintain a patent airway
      • 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
    • Maintain appropriate body temperature
    • Maintain appropriate body temperature
      Important as it may lead to cold stress
      Heat loss in newborn occurs in 4 ways
      Conduction
      Convection
      Evaporation
      Radiation
      • 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
    • Immediate assessment of the newborn
      • APGAR scoring – a standardized evaluation of the newborn’s condition/stability
      • Done 1 minute afterbirth then 5 minutes after
    • 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)
    • Assessment of gestational age
      Naegel’s Rule
      Mc Donald’s Rule
      Bartholomew’s Rule
      UTZ
    • Proper identification of the newborn
      • 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
      = (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
    • 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
    • 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
    • Nursery CarePhysical Assessment
      • Vital Signs
      • Pulse - Apical pulse recommended
      - 120-140 bpm, irregular
      • Respirations – largely abdominal
      • Gentle, quiet, rapid but shalow
      • 30-60cpm
      • Blood pressure – not routinely measured unless Coartation of the Aorta is suspected
      • 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
    • Head
      Largest part of the body
      Fontanelles are neither sunken nor prematurely closed
      Craniotabes present
      Caput succedaneum or Cephalhematoma may be present
    • CEPHALHEMATOMA
      • 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
    • Cleft palate
    • Epstein pearls
    • Natal tooth
    • Neck
      Head rotate 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
    • Abdomen
      Liver, spleen, and kidneys may be palpable at birth
      Dome-shaped
      Umbilical cord breaks free at 6th – 10th day after birth
    • 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
    • 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
      Increased pressure on the left side of the heart results in:
      • Closure of the foramen ovale
      • Change of Ductusarteriosus into Ligamentumarteriosum
      • Ductusvenosus becomes Ligamentumvenosum
      • Blood volume: Ave = 300ml or 80-100ml/kg BW
    • 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
    • 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
    • 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
    • Neuromuscular System
      Blink reflex (always present)
      Sucking reflex (disappears at 6 mos)
      Swallowing reflex (always present)
      Extrusion reflex (disappears by 4 months)
    • Neuromuscular System
      Rooting reflex (disappears by 6 weeks)
    • Neuromuscular SystemTonic neck reflex (disappears by 2-3 mos)
    • Neuromuscular SystemBabinski reflex (disappears at 3 mos)
    • Neuromuscular System
      Moro reflex (disappears by 4-5 mos)
    • Neuromuscular System
      Palmar grasp reflex (disappears at 3 mos)
    • Neuromuscular System
      Plantar grasp reflex
    • Neuromuscular System
      Step/Walk-in place reflex (disappears by 3 mos)
    • Neuromuscular System
      Placing reflex
    • 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
      • Nutrition
      • Encourage breastfeeding
      • Should feed by demand
      • Should be burp at least twice during feeding
    • Discharge Instructions
      Clothing the newborn
      Rule of thumb
      Sleep pattern
      Usually sleeps 16-20 hours a day
    • Management for the Common Health 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
    • Management for the Common Health 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
      • Miliaria
      • Starch bath
      Seborrhic dermatitis
      Apply mineral oil or petroleum jelly on scalp at night before giving shampoo in the morning
    • GOD BLESS ON YOUR FINALS!
      Aim to top your finals!Break a neck…
      Sir cj