1. POSTPARTUM / PUERPERIUM

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. Promote healing and involution of different parts of the body

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. 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. Lochia

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. 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

9. Genital Changes Perineum Develops edema and generalized tenderness Labia majora and minora typically remain softened

10. Sexual Activity Maybe resumed by the 3rd or 4th week postpartum if bleeding has stopped and episiorrhaphy has healed

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. 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. 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. Vital Signs Temperature may increase Bradycardia is common for the 6-8 days postpartum Orthostatic hypotension and dizziness is common

15. Weight There is an immediate weight loss of 10-12 pounds

16. Provide emotional support

17. The Psychological Phases during the Postpartum Taking – In Phase Taking – Hold Phase Letting – Go Phase

18. Establish a successful lactation

19. Physiology of Breastmilk Production

20. Physiology of Breastmilk Excretion 1.Crying of the baby / Thinking of the baby 2.Posterior Pituitary Gland 3.Oxytocin 4.Let-down reflex

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. 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. 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. 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

25. 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

26. Associated Problems and Management Mastitis Antibiotics as ordered Ice compress Proper breast support Discontinue breastfeeding in affected breast

27. THE NEONATE-The first 28 days after delivery

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. Establish and maintain a patent airway

31. Position the head lower than the rest of the body except if there are signs of increased ICP

32. Suction the baby properly

33. Turn the head to one side

34. Suction gently but quickly

35. Suction the mouth first before the nose

37. Maintain appropriate body temperature Important as it may lead to cold stress Heat loss in newborn occurs in 4 ways Conduction Convection Evaporation Radiation

39. he is wet at birth

40. the delivery room is cold

41. he does not have enough subcutaneous fats/adipose tissues

42. shivering mechanism is not functioning

46. 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)

47. Assessment of gestational age Naegel’s Rule Mc Donald’s Rule Bartholomew’s Rule UTZ

48. Proper identification of the newborn

52. NURSERY CARE

54. Chest circumference = 31-33 cm

56. 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

59. Gentle, quiet, rapid but shalow

60. 30-60cpm

62. Normally ruddy

63. Acrocyanosis during the first 24-48 hours of life

64. General mottling is common

65. Physiologic Jaundice from 2-7 days of life

66. Harlequin sign is normal first few days of life

67. Mongolian spots normal but disappear by school age

68. Lanugo disappears within 2 weeks

69. Desquamation normal within 24 hours of life

70. Milia disappear by 2-4weeks

75. Head Largest part of the body Fontanelles are neither sunken nor prematurely closed Craniotabes present Caput succedaneum or Cephalhematoma may be present

77. CEPHALHEMATOMA

79. Cry tearlessly during the first 2 months

80. Nose

81. There should be no septal deviation

82. Mouth

83. Should open evenly when crying

84. Palate should be intact

85. Epstein’s pearls may be present

87. Epstein pearls

88. Natal tooth

89. 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

91. Abdomen Liver, spleen, and kidneys may be palpable at birth Dome-shaped Umbilical cord breaks free at 6th – 10th day after birth

92. 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

93. Extremities Hands are clenched into fist Note for polydactyly or unusual spacing of toes

95. Change of Ductusarteriosus into Ligamentumarteriosum

96. Ductusvenosus becomes Ligamentumvenosum

99. 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

100. 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

101. Neuromuscular System Blink reflex (always present) Sucking reflex (disappears at 6 mos) Swallowing reflex (always present) Extrusion reflex (disappears by 4 months)

102. Neuromuscular System Rooting reflex (disappears by 6 weeks)

103. Neuromuscular SystemTonic neck reflex (disappears by 2-3 mos)

104. Neuromuscular SystemBabinski reflex (disappears at 3 mos)

105. Neuromuscular System Moro reflex (disappears by 4-5 mos)

106. Neuromuscular System Palmar grasp reflex (disappears at 3 mos)

107. Neuromuscular System Plantar grasp reflex

108. Neuromuscular System Step/Walk-in place reflex (disappears by 3 mos)

109. Neuromuscular System Placing reflex

111. Maybe given anytime but not within 30 minutes after feeding

112. Sponge baths are done until cord falls off

113. Cord care

114. Always maintain the cord dry

115. Dub 70% alcohol once or twice a day

117. Encourage breastfeeding

118. Should feed by demand

120. 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

121. 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

123. Starch bathSeborrhic dermatitis Apply mineral oil or petroleum jelly on scalp at night before giving shampoo in the morning

126. GOD BLESS ON YOUR FINALS! Aim to top your finals!Break a neck… Sir cj