Chapter 12 Postpartum Physiological Assessments and Nursing Care

Objectives The learner will be able to Define key terms Describe the physiological changes that occur during the postpartum period Identify the critical elements of assessment and nursing care during the postpartum period Describe the critical elements of discharge teaching

Postpartum Nursing Care Focus of postpartum nursing care Assessing for early signs of potential complications Health promotion Family education

Reproductive System Uterus Physiological changes Assessments Involution Afterpains Assessments Expected findings Nursing actions Boggy uterus Oxytocin Patient education

Chapter 12 Postpartum Physiological Assessments and Nursing Care

Objectives The learner will be able to Define key terms Describe the physiological changes that occur during the postpartum period Identify the critical elements of assessment and nursing care during the postpartum period Describe the critical elements of discharge teaching

Postpartum Nursing Care Focus of postpartum nursing care Assessing for early signs of potential complications Health promotion Family education

Reproductive System Uterus Physiological changes Assessments Involution Afterpains Assessments Expected findings Nursing actions Boggy uterus Oxytocin Patient education

Reproductive System Endometrium Physiological changes Lochia Assessments Expectant findings Nursing actions Excessive bleeding Patient education

Reproductive System Vagina and perineum Physiological changes Assessments Expectant findings Nursing actions Comfort measures Patient education

Breasts Physiological changes Assessments Expected findings Colostrum Primary engorgement Subsequent engorgement Mastitis Assessments Expected findings Nursing actions Patient education

Review Question   Only the women who are lactating will experience primary engorgement. True False

2 Answer

Cardiovascular System Physiological changes Cardiac output Orthostatic hypotension Postpartum chills Assessments Expected findings Nursing actions Patient education

Respiratory System Physiological changes Assessments Expected findings Nursing actions

Immune System Physiological changes Assessments Expected findings Temperature Rubella Rh isoimmunization Assessments Expected findings Nursing actions

Urinary System Physiological changes Assessments Expected findings Diuresis Bladder distention Cystitis Assessments Expected findings Nursing actions

Endocrine System Physiological changes Assessments Expected findings Nonlactating women Lactating women Diaphoresis Assessments Expected findings Nursing actions

Chapter 12 Postpartum Physiological Assessments and Nursing Care

Objectives The learner will be able to Define key terms Describe the physiological changes that occur during the postpartum period Identify the critical elements of assessment and nursing care during the postpartum period Describe the critical elements of discharge teaching

Postpartum Nursing Care Focus of postpartum nursing care Assessing for early signs of potential complications Health promotion Family education

Reproductive System Uterus Physiological changes Assessments Involution Afterpains Assessments Expected findings Nursing actions Boggy uterus Oxytocin Patient education

Reproductive System Endometrium Physiological changes Lochia Assessments Expectant findings Nursing actions Excessive bleeding Patient education

Reproductive System Vagina and perineum Physiological changes Assessments Expectant findings Nursing actions Comfort measures Patient education

Breasts Physiological changes Assessments Expected findings Colostrum Primary engorgement Subsequent engorgement Mastitis Assessments Expected findings Nursing actions Patient education

Review Question   Only the women who are lactating will experience primary engorgement. True False

2 Answer

Cardiovascular System Physiological changes Cardiac output Orthostatic hypotension Postpartum chills Assessments Expected findings Nursing actions Patient education

Respiratory System Physiological changes Assessments Expected findings Nursing actions

Immune System Physiological changes Assessments Expected findings Temperature Rubella Rh isoimmunization Assessments Expected findings Nursing actions

Urinary System Physiological changes Assessments Expected findings Diuresis Bladder distention Cystitis Assessments Expected findings Nursing actions

Endocrine System Physiological changes Assessments Expected findings Nonlactating women Lactating women Diaphoresis Assessments Expected findings Nursing actions

Muscular and Nervous Systems Physiological changes Diastasis recti abdominis Effects of epidural Assessments Expected findings Nursing actions Comfort measures

Gastrointestinal System Physiological changes Constipation Hemorrhoids Appetite Weight loss Assessments Expected findings Nursing actions Patient education

Discharge Teaching Signs and symptoms of possible complications Health promotion Nutrition and fluids Activity and exercise Rest and comfort Contraception Sexual activity Prescribed medications

Case Study Your postpartum patient is a 26-year-old G 2 P 1 woman who gave birth to a healthy baby boy. She is 36 hours postpartum and is breastfeeding her baby. You note that her fundus is 2/U and to the right of the umbilicus. Her lochia is moderate. Her perineum is swollen and painful. She informs you that she has a cramping sensation in her pelvic area when she breastfeeds. Her nipples are red, and she indicates they are painful.

Case Study List the assessment data that deviate from expected and the related nursing actions. List additional data that are needed to fully assess your patient’s needs and condition. List the priority physiological needs of this patient.

Chapter 13 Transition to Parenthood

Objectives The learner will be able to Define key terms Describe the process of “becoming mother” Identify factors that influence women and men in their role transition to parent Discuss bonding and attachment Identify factors that affect the family dynamics Describe nursing actions that support the couple during their transition to parenthood

Overview Developmental process Factors that enhance or hamper transition to parenthood Previous life experiences Couple’s relationship Financial concerns Educational level Support systems Desire to be parents Age of parents

Parental Roles Role theory Expected findings Nursing actions Expectations and responsibilities of parents Intentional learning of new role Incidental learning of new role Expected findings Nursing actions

Becoming a Mother Mercer’s four stages of becoming a mother Assessment Expected findings Factor’s influencing the process of “becoming a mother” Nursing actions

Maternal Phases Overview of Rubin’s theory Taking-in Taking-hold Letting-go Factors affecting transition through phases Nursing actions Adapt teaching to reflect awareness of maternal phase

Fatherhood Preparation for fatherhood Meaning of fatherhood Factors influencing transition to fatherhood Nursing actions

Bonding and Attachment Unidirectional — parent  baby Bonding behaviors Attachment Bidirectional — parent  baby Attachment behaviors Risk factors for delayed bonding and/or attachment Nursing actions

Parent – Infant Contact Relationship of early contact and attachment Reciprocity Biorhythmic Rubin’s maternal touch Three stages Paternal – infant contact Engrossment Nursing actions

Communication Between Parent and Child Bidirectional process Forms of communication Newborn’s ability to communicate Entrainment Assessing parent – infant interactions Expected findings Nursing actions

Chapter 13 Transition to Parenthood

Objectives The learner will be able to Define key terms Describe the process of “becoming mother” Identify factors that influence women and men in their role transition to parent Discuss bonding and attachment Identify factors that affect the family dynamics Describe nursing actions that support the couple during their transition to parenthood

Overview Developmental process Factors that enhance or hamper transition to parenthood Previous life experiences Couple’s relationship Financial concerns Educational level Support systems Desire to be parents Age of parents

Parental Roles Role theory Expected findings Nursing actions Expectations and responsibilities of parents Intentional learning of new role Incidental learning of new role Expected findings Nursing actions

Becoming a Mother Mercer’s four stages of becoming a mother Assessment Expected findings Factor’s influencing the process of “becoming a mother” Nursing actions

Maternal Phases Overview of Rubin’s theory Taking-in Taking-hold Letting-go Factors affecting transition through phases Nursing actions Adapt teaching to reflect awareness of maternal phase

Fatherhood Preparation for fatherhood Meaning of fatherhood Factors influencing transition to fatherhood Nursing actions

Bonding and Attachment Unidirectional — parent  baby Bonding behaviors Attachment Bidirectional — parent  baby Attachment behaviors Risk factors for delayed bonding and/or attachment Nursing actions

Parent – Infant Contact Relationship of early contact and attachment Reciprocity Biorhythmic Rubin’s maternal touch Three stages Paternal – infant contact Engrossment Nursing actions

Communication Between Parent and Child Bidirectional process Forms of communication Newborn’s ability to communicate Entrainment Assessing parent – infant interactions Expected findings Nursing actions

Family Dynamics Definition Family compositions Effects of new member on the family unit Multiparas Concerns of multiparas when taking on a new child Sibling rivalry Sibling adjustment Nursing actions

Review Question Second-time mothers are concerned about their ability to love their new child as much as they love their first child. True False

1 Answer

Parents with Sensory or Physical Impairment Visually impaired parents Nursing actions Hearing impaired parents Physically impaired parents

Postpartum Blues Definition Possible causes Signs and symptoms Nursing actions

Case Study You are assigned to a 28-year-old G2 P1 woman who gave birth to a healthy girl. Your patient is 36 hours post birth and is breastfeeding her daughter. This was a planned pregnancy, and both parents voice they are pleased with their birthing experience and their new daughter. They indicate that their 2-year-old son wanted a baby brother.You observed that the mother holds her daughter close to her and softly sings to her baby. You also observed that the father spends a great deal of time staring at his daughter.

Case Study The woman is very interested in eating and talking about her labor and birth experience. You have had to remind her to take a shower and to change the baby’s diapers.

Case Study Discuss how you would plan your nursing care that reflects acknowledgment of the woman’s maternal phase. List parent – infant bonding behavior observed and nursing actions that will enhance bonding and/or attachment. Describe teaching you would provide on sibling rivalry.

Case Study Discuss the concerns your patient may experience based on being a mother of two children. Describe the process of “becoming a mother.”