handout 8.doc

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NCM 101 Lecture Notes FINALS Handout 8 _____________________

THE POSTPARTUM PERIOD:- Begins with the delivery of the pl!ent nd ends

when ll of the "odily syste#s ret$rn to their pre%pregnnt stte

- The period of invol$tion ppro&i#tely en!o#psses ' wee(s

MUST )*O+S: The vgin re#ins s#ooth wlled for ,%- wee(s "efore r$ge strt to

repper.

The first #enstr$l !y!le postprt$# is $s$lly A*O/U0ATOR1

Menses #y res$#e in -%' wee(s if the #other is not "restfeeding

0evels of H23 nd HP0 re l#ost negligi"le "y 4- ho$rs

Puerperium 5thstage of labor, 1st6 weeks post-partumCharacterize by involution

Involution- return to the normal stage of reproductive organ after pregnancy

Return to Normal Healing: Physiologic Changes and Systemic Changes

Cardiovascular System

o plasma volume

o sudden in blood volume

o elevated !C"s up to #$, $$$ mm#

o hyperfibrinogenemia

o orthostatic hypertension can be possible

o early ambulation prevents thrombos formation steps in ambulation

%lat

&emifowlers

%owlers with dangling

alk with assist

Genital Tracto Fundus

goes down 1 finger breadth a day

1$thday non palpable behind the symphysis pubis

Subinvolution delayed healing of uterus containing 'uarters or clots of blood

may lead to puerperal sepsis

anagement :()C

o !"ter Pains

*fter birth pains

+ultiparous breastfeeding most common to develop

osition prone

Cold compress

+efenamic acido #ochia

Components !lood

(ecidua

!C

+icroorganisms

# types

1 3reywolfRedMs. April Anne D. Blnon


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NCM 101 Lecture Notes FINALS Handout 8 _____________________ Rubra 1 # days, musty, moderate amount

Serosa . 1$thday, pink or brown

!lba 1$ /1th day, cr0me white, amount

$rinary Tracto $rinary Fre%uency due to urinary retention with overflow

o &ysuria

(amage to the bladder rine collection for culture and sensitivity

&timulate navel to urinate

alpate bladder

2istening to 3unning water

ull pubic hair - stimulate cremasteric refle4

Colono Constipation

(ue to

!earing down may cause pain

Pereniumo ain relieved by sim"s position

o Cold compress 1st/. hours if there is pain at episiorraphy followed by warm compress

'(TI(N!# S$PP(RT

)* Ta+ing phase

1st# days

dependent phase

passive, can"t make decision

tells about childbirth e4perience

focus on7 8ygiene,* Ta+ing Hold

. 9thday

dependent to independent phase

active, decides actively

focus7 care of newborn

health teaching 7 %amily planning

-* #etting Go

:nterdependent phase

3edefines goals, new roles as parents

+ay e4tend till the child grows

Post Partum .lues

.th 5thdays

overwhelming feeling of depression, inability of sleep and lack of appetite

5$ ;$< incidence rate

cause by sudden hormaonal change progesterone suddenly decreases

allow crying7 therapeutic

may lead to postpartum psychosis= depression

POSTPARTUM

BLUES

POSTPARTUM

EPRESSION

POSTPRTUM PS!CHOSIS

ONSET 1-10 days afterbirth

1-12 months after birth Within the first month after birth

S!MPTOMS Sadness, crying

spells

Anxiety, feeling of loss,

sadness

Delusions and hallucinations, signs of

harming infant and self

INCIENCE 70 of all births 10 of all births 1-2 of all births

THERAP! Support andempathy

!ounseling and drugtherapy

"sychotherapy and drug therapy

2 3reywolfRedMs. April Anne D. Blnon


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NCM 101 Lecture Notes FINALS Handout 8 _____________________ETIOLO"! #ormonal changes,

stress

#x of pre$ious

depression, hormonal

responses and changes,lac% of social support

systems

"ossible acti$ation of

pre$ious mental illness,

hormonal changes,family history of

bipolar disorders

NURSIN"

ROLE

&ffering

compassion and

understandi

ng

'efer to counseling 'efer to counseling and safeguard

mother from in(ury to self and to the

ne)born

Postpartal Complications

Hemorrhage

bleeding within /. hours postpartum

'arly Pospartal Hemorrhage

)* $terine !tony

boggy fundus

profuse bleeding interventions

o massage the uterus

o cold compress

o modified trendelenburg

o fast drip :>

o breastfeeding to release o4ytocin

,* #aceration

well contracted uterus with profuse bleeding

assess perenium for laceration

degrees o" lacerationo 1stdegree vaginal skin and mucus membraneo /nddegree 1stdegree ? muscles

o #rddegree /nddegree ? e4ternal sphincter of rectum

o .thdegree #rddegree ? mucus membrane of rectum

-* Hematoma

bluish discoloration of sub@ tissues of vagina or perenium

candidateso delivery of very large babies

o pudendal block

o e4cessive manipulation due to e4cessive :A

interventiono cold compress 1$ /$ min then allow #$ minutes rest period for /. h

/* &IC 0 disseminated intravascular coagulation

Consumption of pregnancy Botherterm

%ailure to coagulate

!leeding in the eyes, ears, nose

ozing blood

&een in cases witho *bruptio placenta

o &till birth = :%(

anagemento !lood transfusion of cryoprecipitate or fresh frozen plasma

o hysterectomy

#ate Postpartum Hemorrhage

Retained placental "ragments

* 3reywolfRedMs. April Anne D. Blnon


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NCM 101 Lecture Notes FINALS Handout 8 _____________________ manual e4traction of fragments is done

uterine massage

&1C e2cept "or cases o"o Placenta !creta umusual attachment of the placenta to the myometrium

o Placenta Increta deeper attachment of placemat to the myometrium

o Placenta Percreta invasion of placenta to the perimetrium

Candidates of these disorders are

Drand multiparous ost C&

*ll these re'uires hysterectomy

In"ection

Sourceso Andogenous from normal flora of the body

o A4ogenous from the health care team

+ost common *naerobic &treptococci

anagemento &upportive care

o %luid intake

o E&! if there is fever= cold compress ? paracetamol may also be given

o *nalgesics

Diven on time to achieve ma4imum effecto Culture and sensitivity

Perenial In"ection

&ame s= s4 with infection

/ # stitches are dislodges

with purulent drainage

E4 resuturing

'ndometritis

:nflammation of the endometrium

Den s=s4 of infection ? abdominal tenderness

anagemento 8igh fowler"s facilitates drainage ) localize infection

o *dminister o4ytocin

ANATOMIC AN PH!SIOLO"IC AAPTATION OF THE NE# BORN

FETUS NE#BORN

RESPIRATOR!

S!STEM

5l$id filled

High press$resyste# !$ses the"lood to "esh$nted fro# thel$ngs tho$gh thed$!t$s rterios$sto the rest of the"ody

Air filled

0ow press$resyste# en!o$rges"lood flow thro$ghthe l$ngs for gse&!hnge

In!resed 64!ontent of the "loodin the l$ngs!ontri"$tes to the!losing of the d$!t$srterios$s

SITE OF "AS

E$CHAN"E

Pl!ent 0$ngs

CIRCULATION

THROU"H THE HEART

Press$re in theright tri$# isgreter in the left

En!o$rges "loodflow thro$gh thefor#en ovle

Press$re in the lefttri$# is greterthn the right.

This !$ses thefor#en ovle to!lose

+ 3reywolfRedMs. April Anne D. Blnon


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NCM 101 Lecture Notes FINALS Handout 8 _____________________HEPATIC AN PORTAL

CIRCULATION

D$!t$s venos$s"ypssed

Mternl liverperfor#s filteringf$n!tions

D$!t$svenos$s!losesnd"e!o#es lig#ent

hepti! nd portl!ir!$ltion "egins

THERMORE"ULATION Body te#pert$re#intined "y#ternl "odyte#pert$re ndthe wr#th of theintr$terineenviron#ent

5i&ed post$re Brown ft% whi!h is

spe!ili7ed for# ofhet prod$!ingtiss$e fo$nd only infet$ses nd innew"orns

ASSESSME*T O5 THE HEAD:

Breg#:

8DIAMO*D SHAPED8!loses t 94%9 #onths of ge

0#"d: "egins to !lose t "o$t 4 #onths of ge

B$lging fontnels #y indi!te in!resed I2P

S$n(en fontnels #y indi!te ;;;;;;;;;;;;;;;;;;;;;

;;;;;;;;;;;;;;;;;;;;;;;;; res$lts fro# press$re of the presenting prt

ginst the !ervi& whi!h delys veno$s ret$rn res$lting to !!$#$ltion

of fl$ids within the s!lp < disppers witho$t tret#ent in ,%- dys =

5or!eps delivery nd too #$!h press$re ginst the pelvis #y led to

r$pt$re of severl !pillries of the perioste$# of the fetl s($ll

res$lting to !!$#$ltion of "lood "etween the s($ll "one nd the

perioste$# res$lting to this finding:

;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;< resolves within ,%' wee(s fter "irth

witho$t tret#ent =

ASSESSME*T O5 THE EARS:

The level of the top prt of the er sho$ld "e in line with the o$ter

!nt$s of the eye

2hildren with Ers "elow this line re (nown to hve down>s syndro#e

ASSESSME*T O5 THE E1ES

Tr$e eye !olor "egins to show t ,%- #onths fter "irth

Ters pper fter ,%- #onths

ASSESSME*T O5 THE MOUTH Rooting? s$!(ing? nd e&tr$sion refle& sho$ld "e present t "irth

*ew "orn ""ies hve s!nty sliv "e!$se of i##t$re slivry glnds

;;;;;;;;;;;;;;;;;;;;;;;;; Teeth fo$nd in new"orns. Sho$ld "e $prooted to

prevent spirtion

3reywolfRedMs. April Anne D. Blnon


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NCM 101 Lecture Notes FINALS Handout 8 _____________________ ;;;;;;;;;;;;;;;;;;;;;;;;; S#ll white !ysts seen t the plte

whi!h re !!$#$ltion of epithelil !ells. These dispper

within 4 wee(s

ASSESSME*T O5 THE 2HEST

2hest retr!tions8 RDS

B$lging of the !hest8 pne$#othor&

ASSESSME*T O5 THE BREAST:

;;;;;;;;;;;;;;;;;;;;;;;;% Is thin wtery fl$id se!reted "y the new"orn>s

nipple whi!h disppers within the first wee( of life. It is !$sed "y the

infl$en!e of #ternl hor#ones.

ASSESSME*T O5 THE S)I*:

;;;;;;;;;;;;;;;;;;;;;;;;;: irreg$lr dis!olortion of the s(in res$lting fro#

vso!onstri!tion? l!( of ft nd hypo&i

*ew"orns do not swet "e!$se of i##t$re swet glnds. Sweting

will "egin fter #onth

;;;;;;;;;;;;;;;;;;;;;;;;;: white !heese li(e s$"stn!es in s(in !reses

whi!h re !!$#$ltion of old !$tneo$s !ells nd se!retions of the

se"!eo$s glnds while in the $tero. Se"!eo$s glnds f$n!tion

intr$tero "e!$se of@ in response to hor#ones of the #other.

;;;;;;;;;;;;;;;;;;;;;;;;;: !logged nd distended se"!eo$s glnds seen on

the new"orn>s f!e? prti!$lrly on the nose. These dispper witho$t

tret#ent within 4%- wee(s fter "irth when the glnds #t$re nd

drin

;;;;;;;;;;;;;;;;;;;;;;;;;: fine downy hirs fo$nd on the infnt>s sho$lders?

"!(? !hee(? forehed? nd $pper r#

;;;;;;;;;;;;;;;;;;;;;;;;;: "l$ish dis!olortion of the lower "!( nd

"$tto!(s seen #ostly in !hildren of Asin nd Afri!n n!estry

;;;;;;;;;;;;;;;;;;;;;;;;;: hr#less rsh fo$nd in #ny new"orns? res$lts

fro# re!tion to !lothes nd sheets. S$"sides in 4 wee(s witho$t

tret#ent

;;;;;;;;;;;;;;;;;;;;;;;;;: "l$ish dis!olortion of the s(in

;;;;;;;;;;;;;;;;;;;;;;;;;: "l$ish dis!olortion of the hnds nd feet d$e to

poor peripherl !ir!$ltion

;;;;;;;;;;;;;;;;;;;;;;;;;: t$rning ple of the $pper hlf of the "ody while

the lower portion develops deep red !olor when the infnt is p$t on

side lying

3reywolfRedMs. April Anne D. Blnon

handout 8.doc

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