chapter 15 caring for the postpartal woman and her family
DESCRIPTION
Chapter 15 Caring for the Postpartal Woman and Her Family. Gloria Nwagwu MSN, FNP-BC, RN. Question?. The most effective and least expensive treatment of puerperal infection is prevention. What is important in this strategy? a. Large doses of vitamin C during pregnancy - PowerPoint PPT PresentationTRANSCRIPT
Gloria Nwagwu MSN, FNP-BC, RN
Chapter 15Caring for the Postpartal Woman and Her
Family
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Question?The most effective and least expensive
treatment of puerperal infection is prevention. What is important in this strategy?
a. Large doses of vitamin C during pregnancy
b. Prophylactic antibioticsc. Strict aseptic technique, including
handwashing, by all health care personnel
d. Limited protein
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Fourth TrimesterBegins immediately after childbirthPuerperium—first 6 weeks after birthClose observation—identify hemorrhage
and complications during first critical hour
Ongoing education and support
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Safety for Mother and InfantPrevent infant abductions
Check ID bands
Educate mother about safety measures
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Early Maternal AssessmentVital signs
Temperature—below 100.4oF (38oC)Pulse—bradycardiaBlood pressureRespirations
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
FundusImmediate postpartum—halfway between
the symphysis pubis and the umbilicus1 hour postpartum—level of the umbilicus
or one fingerbreadth aboveThen, descends one fingerbreadth each
dayAssess lochia
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Perineal AssessmentSim’s positionREEDAHemorrhoids
Teach regarding comfort measuresIf severe, teach how to manually reposition
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Postpartum Assessment Guide
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Bubble-HeBreastsUterusBladderBowelLochiaEpisiotomy
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Other Important ComponentsMaternal painHomans’ signMother’s emotional statusInfant bonding
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Breast Assessment
Firmness, fillingNodulesFissures, cracksBloodDried milk Erect or inverted nipples
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Assessment of UterusPlacental expulsion usually occurs within 15
minutes after birthUterine contractions control bleedingTechnique for uterine palpationInvolutionSubinvolution
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Fundal AssessmentLocation immediately after birthDescends 1 cm/dayConsistencyLocationHeight
Measured in fingerbreadths
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
AfterpainsOccur during process of involutionMore pronounced in multiparaNursing care
Explain causeProne position with abdominal pillowSitz bathsEncourage ambulationAdminister mild analgesics
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
BladderSpontaneous void within 6 to 8 hours ppMonitor first voidingAnticipate maternal diuresisUrinary output may reach 3000 mL/dayUrine volume, flow returns to pre-pregnant
levels within 2 to 3 days pp
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Assessment Findings: BladderIncomplete emptying OverdistentionUrinary retentionNursing interventions
Support and enhance attempts to void
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
BowelHunger and thirst after childbirthRelaxin—depresses bowel motilityStrategies to prevent constipation
Early ambulationAbundant fluidsHigh-fiber diet
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
LochiaCharacteristic indicative of status in
process of involutionLochia rubraLochia serosaLochia albaDocument amount
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Episiotomy1 to 2 inch surgical incisionAssess REEDAIce for first 24 hoursMoist heat—Sitz bathDry heat—hot packs
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Pain AssessmentDetermine sourceDocument location, type, and durationAdminister Tylenol or IbuprofenSitz bathEducate regarding nonpharmacological
measures
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Assess for DVTHomans’ sign
Dorsiflex foot and ask about painClinical assessment
Erythema, unequal calf circumference, heatClinical signs are NOT reliable
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Emotional StatusWide range of emotionsMay be sad during first 1 to 2 weeks ppOngoing assessment and educationEducate regarding “baby blues”
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyMaternal Physiological
AdaptationsContinued Assessment of the Patient
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Hematological SystemDecrease in blood volume
Blood lossDiuresis
White blood count increased x 5 to 6 daysFibrinogen increased
Returns to normal by third to fourth week
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Hormonal LevelsEstrogen and progesterone decrease
Anterior pituitary—prolactin
Placental lactogen, cortisol, growth hormone, and insulinase levels decreaseInsulin needs decrease—“Honeymoon phase”
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Neurological SystemAltered sleep patterns—maternal fatigueNumbness in legs, dizziness
Safety for infant and motherHeadaches
Assess quality and location, and carefully monitor vital signs
Implement environmental interventions
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Renal System, Fluid and ElectrolytesGFR, Creatinine, and BUN return to pre-
pregnant levels within 2 to 3 monthsUrinary glucoseProteinuriaRapid, sustained natriuresis and diuresisOutput may reach 3000 mL/day
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Respiratory SystemRespiratory alkalosis and compensated
metabolic acidosis may persist
Decrease in intra-abdominal pressureRelief from dyspnea
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Integumentary System
Hormonal changes cause skin alterationsMost disappearStriae gravidarum
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Cardiovascular System
Delivery of the baby, expulsion of the placenta, and loss of amniotic fluid can create cardiovascular instability
Cardiac output remains elevatedPhysiological diuresis
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Immune SystemRho (D) immune globulin (RhoGAM)Rubella vaccination
Nonimmune statusSigned consent formAvoid pregnancy for 1 monthFlu-type symptoms may occur
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Reproductive SystemInvolution of uterusHealing of placental siteVaginal changesLabia majora and labia minora flaccid
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Menstruation and OvulationNonlactating women
Menstruation returns in 6 to 8 weeksFirst cycle may be anovulatory
Lactating womenDelayed ovulation and menstruationEducate—ovulation can precede
menstruation, need contraception
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Gastrointestinal System Decreased gastric motilityDecreased muscle tone in abdominal wallConstipation
Stool softeners
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Musculoskeletal SystemLaxity of pelvic joints and ligaments Relaxation of soft tissuesMuscle fatigueBody achesRectus abdominis diastasis
Correct posture Modified sit-ups
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyEnhancing Cultural
SensitivityConduct cultural assessmentsExpand knowledge and understanding
Culturally influenced beliefs Common health care practices Customs and rituals
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Question?To provide optimum care for the postpartum
woman, the nurse understands that the most common causes of subinvolution are:
a. Postpartum hemorrhage and infection.b. Multiple gestation and postpartum
hemorrhage.c. Uterine tetany and overproduction of
oxytocin.d. Retained placental fragments and infection.
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Promoting Recovery and Self-Care
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Activity and RestEarly postpartum ambulationMild exercises
KegelIncrease gradually
Encourage frequent rest periodsObtain adequate sleep
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
NourishmentWeight lossAppetiteBalanced dietMultivitamin supplementIron if hemoglobin low
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
EliminationVoid every 4 to 6 hoursMonitor intake and output x 24 hoursIncreased risk of infectionUrinary retentionConstipation
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Perineal CareRisk of infectionTeach perineal hygieneHand washingTampons contraindicatedCesarean births
Nurse provides perineal care until ambulatory
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Ice PacksReduce edema and painVasoconstriction and numbingApply for 20 minutes every 2 to 4 hoursFirst 24 hours
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Afterbirth PainIntermittent uterine contractions during
involutionBreastfeeding (release of oxytocin)Duration: 2 to 3 daysMild analgesics
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Special Considerations
Women with HIV/AIDS Gloves, safety glasses Discourage breastfeeding Patient teaching for infant safety
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Postpartal Surgical PatientTubal ligationCesarean birthIncisional woundRecovery from anesthesiaRespiratory care
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Infant Feeding ChoicesBreastfeedingBottle feedingEducateSupport
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Physiology of LactationBreast structure
Lactogenesis
Milk ejection reflex—“let down” reflex
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyAssisting the
Breastfeeding MotherStrategies for Success
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
BreastfeedingInitiating the feedingAchieving proper latch-onAssessing for milk let-downAssuming a position of comfortAssessing for infant weight gain
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Ineffective BreastfeedingIncorrect latch-on (nipple trauma)Breast engorgement
Complementary careEthnocultural considerations
Collecting and storing breast milk
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Expressing Breast MilkManual—handElectric pumpTypes of breast pumpsStorage of breast milkWeaning
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Formula FeedingSafe Practices
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Family and Infant BondingTransition to parenthoodAssuming the mothering role
Rubin’s phasesPaternal bondingFactors that interrupt bonding
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyAdjustment of
Other Family Members
SiblingsTips for parents
Grandparents
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyEmotional Events
During the Puerperium
First 3 months most vulnerable periodBaby bluesPostpartum depressionPostpartum psychosis
Physiological response—tiredness, fatigue
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Discharge Planning and TeachingMaternal Self-Care
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Maternal Self-AssessmentFundus and lochiaHygieneAbdominal incisionBody temperatureElimination Nutrition
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Maternal Self-AssessmentFatigueWeight lossExercisePain managementMoodSexual activity and contraception
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Special Needs PopulationsAdolescent mothers
Woman placing infant for adoption
Older mothers
Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families
Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley
Community ResourcesSupport groupsHome visitsTelephone follow-upOutpatient clinics