assisting the puerpera during initial ambulation

8/3/2019 Assisting the Puerpera During Initial Ambulation

1/37


2/37

PUERPERA the term for a woman whohas just delivered her baby

PUERPERIUM/4TH TRIMESTERpostpartum period, is approximately 6 weeksafter delivery of the placenta and 4 weeks afteran abortion or miscarriage. Immediate postpartum period 1st 24 hrs afterdelivery Early postpartum period from day 2 to day 7

after delivery


3/37

A woman who has had a normal and uneventfullabor and delivery and who has a roomed-inbabyislikelytobeupandaboutassoonasshefeels like it.

Early walking is most beneficial for thepuerpera; the earlier she walks the better for

her circulatory, respiratory, reproductive,urinary and gastrointestinal systems. Walking promotes the general strength and

well-being of the puerpera.


4/37

Decreased incidence ofthrombophlebitis----When inflammation due to a blood clot occurs in a

vein


5/37

Better uterine drainage and enhanceduterine involution

Improved tone of bladder and intestinaltract, preventing and/or alleviating

urinary retention and constipation


6/37

Less respiratory complications likepneumonia and pulmonary embolism

Early regain of maternal strength Improved well-being and self-esteemGreater confidence in providing baby care If hospitalized, shorter hospitalization days


7/37

The disease is also characterized by the slow oxygen in the

blood, rapid breathing and rapid heartbeat.


8/37


9/37

Puerperas are now advised to get out

of bed well within the first 24 hoursafter vaginal delivery and numerouswell-controlled studies have confirmed

the many advantages of earlyambulation, including the markedreduction in the frequency of venous

thromboembolic disease duringpuerperium (Cunningham et al., 1989).


10/37

Early ambulation promotes urination. Four

hours after delivery the woman should beable to urinate, at least 300 mL, withcomplete bladder emptying (AWHONN,1996).

Teach the newly delivered woman to emptyher bladder frequently, as an empty bladderpromotes comfort and uterine contraction.

A full bladder displaces the uterus to theside resulting in poor uterine contraction,poor uterine involution and more blood loss.


11/37

Six hours after normal delivery women may

have a shower bath with a mobile hand spray ora tub bath in the kneeling position (Myles,1982).


12/37

The puerpera who is out of bed for the first

timeshould not be left alone

as she maybecome dizzy and faint. Immediately afterdelivery, she should be assisted to thebathroom the first two to three times to protect

against falls due to possible orthostatichypotension and faintness (Littletle &Engebretson, 2006).


13/37

Explain the necessity and advantagesof early and frequent ambulation.

Evaluate the physical condition of thepuerpera, the state of her fundus and

the character of her lochia. A womanwith soft uterus and vaginal bleedingmuststayinbed.


14/37

Check her vital signs. Pulse Rate Respiratory RateBlood Pressure

Temperature


15/37

Immediately after delivery, the PR may beslightly because of the effect of epinephrine

from stress of labor. Rates greater than 100 bpm may mean

bleeding and hypovolemia, dehydration, fever,

infection or pain. There is usually slight bradycardia during earlypostpartum, with the average PR at 60 bpm.


16/37

16-24 breaths per minute normal range ofRR

For women who received epidural narcoticssuch as morphine, their RR should be closelymonitored because these drugs have thepotential to depress the RR to < 12 bpm

CAUTION: always have a narcoticantagonist ( Naloxone (NARCAN)) on handwhenever narcotics like fentanyl and morphineare administered to a woman in labor.


17/37

During postpartum, the clients BP changesminimally and is usually stabilized within the first

6 hours. Hypotension may be due to the effects ofepidural analgesia or anesthesia or bleeding.

Hemorrhage may be difficult to identify in the

postpartum woman if BP is used as aparameter. The womansBP may still be withinnormal limits even if she is bleeding due to theincreased circulating volume during pregnancy.


18/37

Hypotension from hemorrhage , therefore, maybe a late sign of hemorrhage in the puerpera.

Orthostatic hypotension is common and maycause dizziness and faintness. Instruct theclient to avoid sudden positional changes such

as rising.


19/37

Blood pressure elevation in the postpartummay be related to oxytocin use, excessive use

of medication, pregnancy-inducedhypertension, essential hypertension or anxiety(AWHONN, 1996).


20/37

It is common for the postpartum womanto have slight elevation of temp afterdelivery.

Normal postpartum oral temperature

should range from 36.2C (97.1F) to38C (100.4F)


21/37

In the first 24 hours after delivery, atemp reading > 38C (100.4F) may

indicate dehydration from loss of fluidsduring delivery, but may also be due tothe excitement and stress of labor. Butafter 24 hours, temp readings > 38C(100.4F) six hours apart for twoconsecutive days indicate a postpartuminfection (AWHONN, 1996).


22/37

Explain that there is the possibility of asudden temporary gush of vaginaldischarge the first time the client getsup and that it reflects the effect of thechange in her posture from beingrecumbent for several hours to suddenupright, favoring effective uterinedrainage.


23/37

Assist the puerpera in getting up andout of bed. Instruct her to dangle herlegs for a few minutes. If the puerperabecomes dizzy or faints, help her getonto a chair. Instruct her to lower herhead to her knees to improve bloodflow to the brain. Ask if she feelsbetter.


24/37

Accompany the puerpera throughout theinitial ambulation. The initial ambulation

may be to the bathroom.D

o not leave thepuerpera alone! From the bathroom,instruct the client to walk back to her roomslowly and sit on the bedside chair. The

health care giver may take this opportunityto promote bonding between the motherand her baby: hand to the mother herroomed-in baby to hold or to feed.


25/37

Assist the puerpera to her bed afterthe first to second ambulations.

Evaluate the clients condition. Ask howshe feels.

Praise the client for her

effort/behavior/cooperation.Do proper recording.


26/37


27/37

___________________ the term fora woman who has just delivered herbaby


28/37

_____________________ denotespostpartum period, is approximately 6weeks after delivery of the placentaand 4 weeks after an abortion ormiscarriage


29/37

_____________________ this

period is the1st

24 hrs afterdelivery


30/37

______________________ thisperiod is from day 2 to day 7 afterdelivery


31/37

Give 3 advantages of early ambulation


32/37

According to AWHONN, four hoursafter delivery the woman should be able to

urinate, at least ________ mL, withcomplete bladder emptying


33/37

_____________hours after normal deliverywomen may have a shower bath with a mobile

hand spray or a tub bath in the kneelingposition.


34/37

TRUEORFALSE.The puerpera who is out of bed for the first

time can be left alone.


35/37

Rates greater than 100 bpm may mean_____________, _____________,_____________.


36/37

__________________is common and maycause dizziness and faintness. Instruct the

client to avoid sudden positional changes suchas rising.


37/37

after 24 hours, temp readings >

38C (100.4F) six hours apartfortwo consecutive days indicate a__________________________

(AWHONN, 1996).

assisting the puerpera during initial ambulation

Documents