1. Revised Spring 2011

2.  It is the period of recovery  It is a complex state of the childbearing experience INVOLUTION  It is a period of INVOLUTION

3.  The responses of the mother to the birth of her infant are influenced by many factors such as:

4.  The uterus needs to return to its pre- pregnant state. This occurs by: Contraction of the Uterus Autolysis / Catabolism Regeneration of the Endometrium

6.  Process of lactation Suckling Hypothalamus stimulated  Anterior pituitary  Posterior pituitary  Suppression of lactation Decrease stimulation  Wear a tight fitting bra or binder  Do not express milk from the breasets  Take shower with back to warm water  Ice packs

7.  Tone -- should be firm. Assess by supporting lower portion with one hand and palpate fundus with other. If found boggy, then massage. Do not overmassage. Causes relaxation and more bleeding.

8.  Normal for loss of up to 500 cc during vaginal delivery and 1000 cc in cesarean delivery. Main assessment is for excessive bleeding. Fundus should be firm, midline, and small amt. lochia rubra, no large clots.  May be treated with Methergine. Be sure you assess the B/P prior to giving--hold the dose if elevated >140 / 90

9.  Assess Amount When did you last change your pad  Assess Odor Fleshy, not foul smelling Lochia

10.  Remains soft and flabby, appears bruised and may have some lacerations  No longer does the external os have the pre- pregnant appearance -- now appears as a jagged slit not a circle.

11.  May be edematous and bruised.  Rugae begin to appear when ovarian function returns.  May teach the mom to do Kegels exercises to increase the blood flow to the area and aid in healing

12.  May have tears, lacerations, or an episiotomy  Assessing: May need to turn patient into the Sims position to visualize.

13.  Resumption of ovulation  Lactation  Weight loss

14.  Plasma volume: body rids itself of excess by diuresis (may have 3000ml/day) and diaphoresis  Blood volume Increase for 24-48 hrs after delivery Increase blood back to heart when blood from placenta unit returns to central circulation Extravascular interstitial fluid is moved into the vascular system/intravascular Increased cardiac output mainly r/t increased stroke volume

15.  Vital Signs Temperature -- may see a SLIGHT ~100. rise in temperature because of dehydration and exertion of labor in first 24 hrs Pulse -- Bradycardia is common for 6 - 8 days postpartally. RT vagal response to increased sympathetic nervous system stimulation during labor and increase in stroke volume. Respirations –begin to fall to normal pre-birth range. B/P -- should remain steady. Not elevated or decreased

16. PREGNANCYPOSTPARTUM WBC – elevated slightly to about 12,000 RBC – increase slightly to about 10 milion. Hemoglobin – stays about normal at ~ 12 g. Below 10 g = anemia Hemotocrit – lowers 33-39% RT hemodilution. If drops below 32- 35% = anemia WBC – leukocytosis is common with values of 20,000 – 30,000 RT increassed neutrophils RBC – return to normal Hgb. – normal to see a drop of about 1 gram Hct – normal to see a drop of about 4 points and then a rise RT > loss of plasma than RBC death

17. Plasma fibrinogen (coagulation) increases Plasminogen (lysis of clots) does not rise Hypercoagulable state assess for homan’s sign

18.  Bowel sounds  Passing flatus  Bowel movement Address risks of constipation What are some of the causes?  Discuss concerns

19.  Diuresis  Overdistention Causes Signs and Symptoms  Signs of UTI

20.  Aches and pains  Decreased levels of Relaxin  Abdominal Wall

21.  Melasma (Mask of Pregnancy)  Linea Nigra  Striae gravidarum (stretch marks)  Hair loss

22.  Decreased sensation  Headaches Frontal Postpunctural Accompanied by blurred vision, photophobia  Pain

23.  Sleep  Exercise

24.  Pain Perineal Afterbirth Breast engorgement Gas distention

25.  During your shift assessment of the postpartum mom’s peri pad, you find it saturated with lochia rubra.  What would be your nursing interventions now?

26.  Most moms are hungry and eager to eat. Start off slowly to avoid nausea and vomiting.  Diet should include: High in Protein, vitamin C, and fiber Increase in fluids  Lactating moms need about 700 extra calories for milk production  Prenatal vitamins and iron supplements are often continued in the postpartum period.

27.  Taking - in Occurs during day 1 - 3 following delivery. ***Main nursing is to listen and help the mother interpret events of the delivery to make them more meaningful and clarify any misconceptions  Taking - Hold Occurs during day 3 to about 2 weeks postpartum ***Best time for teaching!  Letting Go Phase occurs after about 2 weeks

28.  Bond that endures over time. Contact should occur as early as possible and as frequently as possible.  Allow time for attachment to occur with all members of the family

29. The Claiming Process Includes the identification Of the baby’s specific Features, relating them To other family members “Those long toes are just like his Dad’s”

30. 1. 2. 3. 4.