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
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
TYPE COLOR DURATION COMPOSITI
ON
Rubra Red 1-3 days Blood,
fragments of
decidua, and
mucus
Serosa Pink 3-10 days Blood,
mucus, and
invading
leukocytes
Alba White 10-14 days Largely
mucus;
Leukocyte
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
Involutionfrom 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
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
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
30. Establish and maintain a patent
airway
• Never stimulate crying unless secretions have
been drained out
• Position the head lower than the rest of the
body except if there are signs of increased ICP
• Suction the baby properly
– Turn the head to one side
– Suction gently but quickly
– Suction the mouth first before the nose
– Test the patency of airway
32. Maintain appropriate body
temperature
Important as it may lead to cold stress
Heat loss in newborn occurs in 4 ways
Conduction
Convection
Evaporation
Radiation
33. • The newborn suffers large losses of body
heat (cold stress) because:
– he is wet at birth
– the delivery room is cold
– he does not have enough
subcutaneous fats/adipose tissues
– shivering mechanism is not
functioning
– thermoregulatory center is
underdeveloped
44. Check the identification band
Take anthropometric measurements:
Length = (Ave) 50cm / 20 inches
= (Normal range) 47.5 – 53.75 cm /
19-21 ½ in
- Head circumference = 33-35 cm
- Chest circumference = 31-33 cm
- Abdominal circumference = 31-33cm
45. Take the temperature
At birth 37.2 degrees Celsius but will stabilize in 8
hrs.
(Before) rectal route is preferred
Give initial oil bath
Dress the umbilical cord
Crede’s prophylaxis
Vitamin K administration
46. 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
47. Nursery Care
Physical Assessment
• Vital Signs
o Pulse - Apical pulse recommended
- 120-140 bpm, irregular
o Respirations – largely abdominal
- Gentle, quiet, rapid but shalow
- 30-60cpm
o Blood pressure – not routinely measured unless
Coartation of the Aorta is suspected
48. • Skin
– Normally ruddy
– Acrocyanosis during the first 24-48 hours of life
– General mottling is common
– Physiologic Jaundice from 2-7 days of life
– Harlequin sign is normal first few days of life
– Mongolian spots normal but disappear by school age
– Lanugo disappears within 2 weeks
– Desquamation normal within 24 hours of life
– Milia disappear by 2-4weeks
– Deviation from normal: Pallor , Gray color
49.
50.
51.
52.
53. Head
Largest part of the body
Fontanelles are neither sunken nor
prematurely closed
Craniotabes present
Caput succedaneum or
Cephalhematoma may be present
56. • Eyes
– Cry tearlessly during the first 2 months
• Nose
– There should be no septal deviation
• Mouth
– Should open evenly when crying
– Palate should be intact
– Epstein’s pearls may be present
– Natal teeth may be seen
60. Neck
Headrotate 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
61.
62. Abdomen
Liver, spleen, and kidneys may be
palpable at birth
Dome-shaped
Umbilical cord breaks free at 6th –
10th day after birth
63. 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
64. Extremities
Hands are clenched into fist
Note for polydactyly or unusual spacing of toes
65. Cardiovascular System
As soon as breathing has been initiated,
oxygenation takes place in lungs
Increased pressure on the left side of
the heart results in:
Closure of the foramen ovale
Change of Ductus arteriosus into
Ligamentum arteriosum
Ductus venosus becomes
Ligamentum venosum
- Blood volume: Ave = 300ml or 80-
66. Gastrointestinal Tract
Meconium should be present within
24-48 hours after birth
Transitional stool present on the 2nd
– 10th day of life
Milk stool (Breastfed / Bottlefed)
Deviation from normal: Clay-
colored, blood-flecked, black tarry
stool
67.
68. 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
69. 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
70. Neuromuscular System
Blink reflex (always present)
Sucking reflex (disappears at 6 mos)
Swallowing reflex (always present)
Extrusion reflex (disappears by 4 months)
71. Neuromuscular System
Rooting reflex (disappears by 6 weeks)
79. Discharge Instructions
• Bathing
– Maybe given anytime but not within 30 minutes
after feeding
– Sponge baths are done until cord falls off
• Cord care
– Always maintain the cord dry
– Dub 70% alcohol once or twice a day
– If it remains moist for a week, advise to see the
doctor
80. • Nutrition
– Encourage breastfeeding
NUTRIENTS HUMAN MILK COW’S MILK
Proteins 8% 20%
Fats 50% 50%
Carbohydrates 42% 30%
Minerals Lesser Greater
– Should feed by demand
– Should be burp at least twice during feeding
81. Discharge Instructions
Clothing the newborn
Rule of thumb
Sleep pattern
Usually sleeps 16-20 hours a day
82. 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
83. 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
84. Miliaria
Starch bath
Seborrhic dermatitis
Apply mineral oil or petroleum jelly on scalp at
night before giving shampoo in the morning
85.
86.
87. GOD BLESS ON YOUR FINALS!
Aim to top your finals! Break a neck…
Sir cj