Describe postpartum:

Period after pregnancy and delivery (usually 6 weeks) when body returns to non-pregnant state.

1. Care in this period is focused on wellness and family integrity

2.Teaching must be initiated early to cover the physical self-care needs and emotional needs of the mother, infant, and family

PP Changes: Reproductive System

uterus/cervix/vagina/breasts

Uterus: Involution occurs (1-2cm/day). Placenta site contracts and heals without scarring

Cervix: becomes parous with a transverse slit, heals within 6 wks

Vagina: Rugae (folds) reappear within 3 wks, walls thin and dry

Breasts: If non-lactating: nodules are palpable, engorgement may occur 2-3 days PP

Breasts if lactating: lumps palpable, colostrum expressed first, the milk, may feel warm, firm, tender for 48 hrs

Normal PP VS

Temp: May rise to 100.4 *F r/t dehydration effects of labor. ANY higher may be r/t infection and should be reported

Pulse: May decrease to 50. Pulse >100 may indicate excessive blood loss or infection

BP: Should be normal; suspect hypovolemia if it decreases, preeclampsia if it increases

Resps: rarely change. If resps increase significantly, suspect pulmonary embolism, uterine atony and/or hemorrhage

1. Fill bottle with warm water, and if prescribed, an ounce of povidine/iodine solution.

2. Lavage perineum with several squirts and blot dry instead of rubbing; avoid anal area

Teaching about breastfeeding;

what to do and what to avoid

*DO: add 500 calories to pre-pregnant intake, drink 2 quarts (8 glasses) of non-caffeinated beverages daily, rest

*Avoid dieting, smoking, and intake of drugs, alcohol, or caffeine. Avoid stress as this is most common reason for decreased milk supply.

1. Encourage early ambulation

2. Encourage foot paddling and ankle rolling after general anesthesia

3. Check for positive Homan's sign

Taking in: dependency behaviors for 24-48 hrs; asking for help on simplest of tasks

Taking hold: less focus on physical discomforts, beginning confidence with infant care taking. Not uncommon for mother to feel inadequate caring for infant; the 'astute' nurse will praise efforts of parents. At this time new parents are usually most receptive to teaching about infant care.

Letting-go: total separation of newborn from self; confident in care taking activities of self and NB

PP Drugs:

*Dulcolax/Biscodyl

*Colace

Indications/Adverse reactions/Nursing implications

Indications: For constipation

Adverse reactions: abdominal cramping

Nursing implications:

What are indications to administer rhoGAM?

 Prevention of Rh isoimmunization with next pregnancy.

*Negative mom, positive fetus

*after abortion, amnio, miscarriage or procedure that increases risk of maternal/fetus blood exchange

*Negative direct Coomb's test (mom)

*@28 wks to negative mom with negative antibody titer

*IM after 27 hrs of delivery

*Must be checked by 2 nurses

PP Drugs:

Rubella Vaccine

*Rubella titer of ≤1:8 or enzyme immunoassay (EIA) of ≤0.8

*S/E: arthralgia, transient rash, hypersensitivity if allergic to duck eggs

*Nx Implications: given SQ before discharge to non-immune women, may breastfeed, don't give if woman/family member are immunocompromised, requires informed consent, teach about contraception (women should avoid pregnancy for 2-3 months after immunization)