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Chapter 9 The Family After Birth.

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Presentation on theme: "Chapter 9 The Family After Birth."— Presentation transcript:

1 Chapter 9 The Family After Birth

2 Objectives Describe how to individualize postpartum and newborn nursing care for different patients. Describe specific cultural beliefs that the nurse may encounter when providing postpartum and newborn care. Describe postpartum changes in maternal systems and the nursing care associated with those changes. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

3 Objectives (cont.) Identify signs and symptoms that may indicate a complication in the postpartum mother or newborn. Describe the nursing care of the normal newborn. Describe nursing interventions to promote optimal infant nutrition. Modify nursing assessments and interventions for the woman who has a cesarean birth. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

4 Objectives (cont.) Explain the emotional needs of postpartum women and their families. Recognize the needs of a grieving parent. Discuss the influences related to the choice of breastfeeding or bottle feeding the newborn. Explain the physiological characteristics of lactation. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

5 Objectives (cont.) Compare various maternal and newborn positions used during breastfeeding. Identify principles of breast pumping and milk storage. Illustrate techniques of formula feeding. Compare nutrients of human milk with those of cow’s milk. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

6 Objectives (cont.) Discuss the dietary needs of the lactating mother.
Discuss the principles of weaning the infant from the breast. Plan appropriate discharge teaching for the postpartum woman and her newborn. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

7 Puerperium Known as postpartum period Six weeks following childbirth
Sometimes referred to as the fourth trimester of pregnancy The puerperium is a time of transition for both the new mother and her family. Complete the following: Pregnancy: 40 weeks as Puerperium:______ 1. 5 weeks 2. 6 weeks 3. 2 months 4. 1 year Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

8 Adapting Care to Specific Groups and Cultures
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

9 Nursing Considerations for Specific Groups of Patients
Adolescents Single women Families at or below the poverty level Families who have twins (or more) The nurse caring for the childbearing family has a responsibility to provide culturally sensitive care. The special needs of each patient group must be incorporated into the care provided. Identify the unique concerns for adolescents, single women, families at or below the poverty level, and families who are expecting multiples. What is the best manner in which to approach each of the groups identified? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

10 Cultural Influences The nurse must adapt care to fit
Health beliefs Values Practices Use an interpreter where appropriate Should not be a family member or in cultural/religious conflict with the patient/family Dietary practices Nurses must use caution not to stereotype clients based upon outward appearances. The nurse must remain flexible when planning the care to be provided. Review the resources that might be available on the nursing unit to meet unique patient concerns relating to language barriers. What resources are available for nurses to review cultural practices? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

11 Postpartum Changes in the Mother
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

12 Reproductive System Uterus Lochia Cervix Vagina Breasts Involution
Uterine lining Descent of uterine fundus Afterpains Lochia Rubra Serosa Alba Cervix Vagina Stress importance of discussing when to resume vaginal intercourse postpartum with health care provider Breasts Engorgement Nursing care Immediately after delivery, the mother begins to experience changes in her reproductive system. The nurse must provide a comprehensive assessment of the patient’s reproductive system. What are normal and abnormal findings from the nursing assessment of the reproductive system? During post-partum discharge teaching a woman expresses that "since she is breastfeeding her newborn" she will not require birth control. The nurse will: 1. Inform the physician 2. Tell the woman she will require birth control when she is weaning the baby. 3. Inform her that breastfeeding is not a form a birth control. 4. Inform her that she must use oral contraceptives in supplement to breastfeeding. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

13 Reproductive System (cont.)
Perineum Episiotomy REEDA assessment Nursing care and patient teaching Cold packs Topical and systemic medications Nonpharmacological pain relief methods Return of ovulation and menstruation Menstrual cycle typically resumes in 6-8 weeks if not breastfeeding Return of ovulation is delayed if breastfeeding; however, it can occur at any time after birth (pregnancy is possible)

14 Cardiovascular System
Cardiac output and blood volume Coagulation Blood values Chills Orthostatic hypotension Nursing care During pregnancy, the woman experiences a 50% increase in circulating blood volume. Physiological changes during labor and delivery cause further cardiac changes. Review the pathophysiology that is responsible for the changes in blood coagulation and laboratory values. It is considered normal for a woman's blood pressure to increase during pregnancy. 1. True 2. False Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

15 Urinary System A full bladder can displace the uterus and lead to postpartum hemorrhage The woman who voids frequent, small amounts of urine may have increased residual urine because her bladder does not fully empty Residual urine in the bladder may promote the growth of microorganisms During pregnancy, the bladder experiences a reduction in tone. During labor, administering intravenous fluids and anesthesia could impact urinary elimination. Review the assessment of the urinary bladder during the postpartum period. For what signs and symptoms should the nurse assess? What should be reported? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

16 Gastrointestinal System
Constipation To help alleviate this problem, encourage woman to Increase fluid and fiber intake Increase activity, such as walking After delivery, gastrointestinal function returns to normal rapidly. The patient might have concerns regarding the first bowel movement. What information concerning bowel health should be provided to the patient? When will pharmacological interventions be employed? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

17 Integumentary System Hyperpigmentation of the skin changes as hormone levels decrease Linea nigra disappears Striae fade to silver Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

18 Musculoskeletal System
Diastasis recti Hypermobility of the joints Exercises Abdominal muscle tightening Head lift Pelvic tilt Kegel exercises Many women might not be realistic concerning their appearance in the immediate postpartum period. What information should be given to the woman during the prenatal period concerning her physical appearance after delivery? At what point in the pregnancy should this information be provided? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

19 Immune System Prevent blood incompatibilities and infection
RhoGAM if woman is Rh negative and baby is Rh positive Give mother immunization for rubella if she is not immune Titer < 1:8 requires immunization Assessment of the woman’s blood type and immune status is completed during the pregnancy. If concerns are identified, they are monitored closely during the pregnancy. Review the Rh status of the father in the identified scenario. RhoGAM is a product obtained from the hospital’s blood bank. Discuss precautions that are indicated when administering this agent. Discuss the administration of the rubella vaccine. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

20 Changes After Cesarean Birth and Adaptation of Nursing Care
Same as with normal vaginal delivery except Monitoring of abdominal dressing Lochia generally less Urinary catheter Respiratory care Prevention of thrombophlebitis Interventions for pain The mother who delivers via cesarean section may experience feelings of failure because of her inability to deliver vaginally. How should the nurse address these concerns? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

21 Emotional Care The birth of an infant brings about physical changes in the mother but also causes many emotional and relationship changes in all family members Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

22 Mother Rubin’s Psychological Changes of the Puerperium
Phase 1 Phase 2 Phase 3 Postpartum blues Postpartum depression Fatigue Review each of Rubin’s phases. What is the primary focus and task for each of the phases? What are signs and symptoms the patient is not progressing normally through each of the phases? Which of the following groups of signs and symptom are the most representative of postpartum "blues"? 1. Crying, loss of appetite, constipation, abdominal pain, and anxiety. 2. Crying, loss of appetite, difficulty sleeping, and anxiety. 3. Crying, increased appetite, urinary retention, anxiety, and fear of the unknown. 4. Crying, despondency, poor concentration, diarrhea, and anxiety. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

23 Father Engrossment Four phases of adjustment
Having expectations and personal intentions Confronting reality and overcoming frustrations Creating one’s own personal father role Reaping rewards of fatherhood The relationship between the father and mother will have the greatest impact on the father’s responses to the infant. What additional factors will influence the father’s actions/reactions? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

24 Other Family Members Siblings Grandparents
Age-dependent on how older sibling will respond to new baby Preparation important Grandparents Today’s method of obstetrical care incorporates the needs and desires of the entire family into the birthing experience. What interventions can the nurse perform to promote inclusion of the siblings and grandparents into the plan of care? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

25 Grieving Parents Therapeutic communication and nursing care
Stages of the grief process Shock and disbelief Anger Guilt Sadness and depression Gradual resolution of sadness The support of the nurses is vital to the family during the grief process. What can the nurse do to offer emotional support? Discuss the types of questions and responses that should be avoided. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

26 Parenthood Can affect communication between partners
Division of responsibility can be source of conflict Fatigue increases irritability Loss of freedom and decreased socializing may cause couple to feel loneliness Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

27 Family Care Plan Studying the family as the patient can offer insight into community-based care Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

28 Data Collection for the Family Care Plan
Demographic information Family composition Occupation Cultural group Religious/spiritual affiliation Developmental tasks Health concerns Communication patterns Decision making Family values Socialization Coping patterns Housing Cognitive abilities Support system Response to care The development of a successful plan of care requires the nurse to be comprehensive in scope. In addition to the patient interview, what are other sources of data? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

29 Phase 2 Nursing Care of the Newborn
Supporting thermoregulation Evaporation Conduction Convection Radiation Observing bowel and urinary function Identifying the infant Security measures Umbilical cord care Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

30 Phase 2 Nursing Care of the Newborn (cont.)
Observing for anomalies Obtaining vital signs Weighing and measuring Gestational age evaluation Skin Vernix Hair Ears Breast tissue Genitalia Sole creases After delivery, the infant must have a complete assessment. Abnormal findings must be reported. Discuss normal findings for each category. What other security measures may need to be implemented? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

31 Hypoglycemia A blood glucose below 40 mg/dL in the term infant indicates hypoglycemia The infant must have a source of energy to successfully adapt to life outside of the uterus. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

32 Risk for Neonatal Hypoglycemia
Preterm/postterm Diabetic mother LGA/SGA IUGR Asphyxiated Cold stress Mother had tocolytics during labor process Review the underlying pathophysiology responsible for the increased potential for hypoglycemia in infants with these scenarios. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

33 Signs and Symptoms of Hypoglycemia in the Newborn
Jitteriness Poor muscle tone Sweating Respiratory difficulty Low temperature Poor sucking High-pitched cry Lethargy Seizure The key to successful management of hypoglycemia requires early intervention. Review the actions that should be taken by the nurse to provide care to the hypoglycemic infant. Discuss charting for this occurrence. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

34 Screening Tests Heel stick performed on day of discharge PKU
Hypothyroidism Galactosemia Thalassemia Sickle cell Maple syrup urine disease Homocystinuria Screening tests are routinely performed to assess for abnormalities which are known to cause physical or mental disabilities. The tests required will vary by state. What screening tests are required by your state? After birth, nurses are reminded to wear gloves until the initial bath has been completed. Generally, the newborn spends most of its time in the mother’s room. This provides an ideal time for teaching the parents infant care. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

35 Recognizing Hunger in the Newborn
Hand-to-mouth movements Mouth and tongue movement Sucking motions Rooting movements Clenched fists Kicking of legs Crying (a late sign) One of the primary needs of the newborn involves providing nutrition. It is important for parents and nurses to be aware of the signs of hunger manifested by the newborn. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

36 Breastfeeding Choosing whether to breastfeed Physiology of lactation
Hormonal stimulation Prolactin Oxytocin Composition of milk Foremilk Hindmilk Phases of milk production Colostrum Transitional Mature Selection of a method of feeding is often an area of concern for new mothers. It is helpful to provide as much information as possible to assist in the decision-making process. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

37 Assisting the Mother to Breastfeed
Advantages of breastfeeding are Promotes mother-infant bonding Maintains infant temperature Suckling stimulates oxytocin release to contract mother’s uterus Cultural use of galactogogues As a point of class discussion, inquire about why some women might choose not to breastfeed. The cultural use of galactogogues refers to the use of “breast milk stimulators.” These are interventions taken by the mother to facilitate lactation. Nurses must be culturally respectful of these practices. What are commonly used breast milk stimulators? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

38 Positions for Breastfeeding
Positions for nursing. Cradle hold. Football hold. Side-lying position. Which of the positions would be most comfortable for a mother after a cesarean section? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

39 Breastfeeding Techniques
Positions of the mother’s hands Latch-on Suckling patterns Removing the infant from the breast Essential factors in breastfeeding involve: 1. Proper body alignment 2. Correct grasp of the areola 3. Proper hand positions of the mother on the breast The mother should wash her hands before breastfeeding. Attempting to express some colostrum on the nipple prior to breastfeeding will increase the erectness of the nipples. Which breast should the mother use to initiate breastfeeding? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

40 Latch-on What actions can the mother take to cause the infant to open the mouth and turn toward the breast? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

41 Removing Infant From Breast
Correctly removing the infant from the breast requires the mother to “break suction.” The mother should break the suction before removing the infant from the breast. She can break the suction by inserting a finger in the corner of the infant’s mouth. The infant should never be pulled away from the breast without first breaking suction. What problems can result if the mother does not break suction? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

42 Evaluating Intake of Infant
Let-down reflex occurs A tingling sensation with milk dripping from nipple Infant nurses for 15 minutes per breast 8 to 10 times per day An audible swallow is heard Infant appears relaxed after feeding Infant has 6-8 wet diapers per day Infant passes several stools per day Breast feels soft after feeding Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

43 Preventing Problems Frequency and duration of feedings
The sleepy infant The fussy infant Flat or inverted nipples Supplemental feedings Nipple confusion of the infant Breast engorgement Nipple trauma Breast hygiene Breastfeeding problems can cause emotional distress for the new mother. It is vital for the nurse to assess for complications/concerns related to breastfeeding. Discuss the manifestations for each of the identified problems. What nursing interventions could help the mother work through the problems listed? Audience Response Question #1 A woman with flat nipples will not be able to breastfeed. 1. True 2. False Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

44 Special Breastfeeding Situations
Multiple births Premature birth Delayed feedings Special breastfeeding challenges can be overcome with nursing assistance. Identify potential problems/concerns with each of the situations presented. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

45 Storing and Freezing Breast Milk
Milk at room temperature for more than 4 hours increases potential for bacterial contamination Container size should hold no more than one feeding Safely stored or frozen in glass or hard plastic containers Milk can be stored in refrigerator at 4° C (390F) for 24 hours or in the freezer at –4° C (-200F) for up to 3 months (although freezing breast milk can destroy some antimicrobial factors) Can be thawed in refrigerator for 24 hours prior to using Microwaving of breast milk is not advised because it destroys immune factors in the milk Important points to stress with class and when teaching mother/caregiver. Milk stored in the refrigerator compartment should be stored toward the back of the refrigerator. Milk stored in the freezer should also be stored toward the back as the temperature is more constant in this area. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

46 Maternal Nutrition Mother needs an additional 500 calories over the nonpregnant diet 8-10 glasses of fluids per day Some foods eaten by mother may cause a change in the taste of the milk or cause the infant to develop gas (flatus) Medications taken by the mother may be secreted in the breast milk Dietary changes might be required if certain substances are found to cause distress in the infant. Discuss common foods that can be a source of problems when eaten by the breastfeeding mother. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

47 Weaning Gradual weaning is preferred There is no “best time” to wean
Technique of weaning Eliminate one feeding at a time Omit daytime feedings first Eliminate the favorite feeding last Infant will need “comfort nursing” if tired or ill Breast pumping not advised in order to decrease the milk supply cycle Abrupt weaning can cause engorgement, mastitis, and discomfort in the mother, and the infant could become distressed. As solid foods are gradually introduced into the diet, the infant will gradually lose interest in breastfeeding. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

48 Formula Feeding Types of formulas
Ready to feed Concentrated liquid Powdered Regardless of type, it is important to follow manufacturer’s instruction on preparation and storage of formula products The mother who decides to formula feed her infant will require education from the nurse concerning this method. Formulas are available in a variety of stages of preparation. What are the necessary steps to prepare each type of commercial formula? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

49 Safety Alert Overdilution or underdilution of concentrated liquid or powdered formulas can result in serious illness Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

50 Feeding the Infant with Formula
Feed every 3 to 4 hours because formula is digested more slowly than breast milk Do not microwave formula Do not prop bottle Involve partner and family in bottle feeding of infant Many women desire to warm their infant’s formula. This is not necessary. Why should the use of the microwave be avoided? Although bottle propping may seem like a timesaver for the mother, it must be avoided. Why? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

51 Discharge Planning Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

52 Postpartum Self-Care Teaching
Ample written materials regarding mother and newborn care should be provided and reviewed Follow-up appointments Hygiene Sexual intercourse Diet and exercise Danger signs to watch for and report Newborn follow-up care Infant safety seats Reassure mother that hospital staff is available by telephone should any questions arise Childbirth and the addition of a new family member will require education for both the mother and father. What is the best time to begin discharge teaching? Discuss ideal times for providing discharge education. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

53 Question for Review What are the essential nursing assessments of the new postpartum mother? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

54 Review Objectives Key Terms Key Points Online Resources
Critical Thinking Question Review Questions Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.


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