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Begins with the delivery of the placenta and ends when all of the bodily systems return to their pre-pregnant state The period of involution approximately encompasses 6 weeks
MUST KNOWS:
The vagina remains smooth walled for 3-4 weeks before rugae start to reappear. The first menstrual cycle postpartum is usually ANOVULATORY Menses may resume in 4-6 weeks if the mother is not breastfeeding Levels of HCG and HPL are almost negligible by 24 hours
Puerperium 5th stage of labor, 1st 6 weeks post-partum Characterize by involution Involution - return to the normal stage of reproductive organ after pregnancy Return to Normal Healing: Physiologic Changes and Systemic Changes Cardiovascular System o plasma volume o sudden in blood volume o elevated WBCs up to 30, 000 mm3 o hyperfibrinogenemia o orthostatic hypertension can be possible o early ambulation prevents thrombos formation steps in ambulation Flat Semifowlers Fowlers with dangling Walk with assist Genital Tract o Fundus goes down 1 finger breadth a day 10th day non palpable behind the symphysis pubis Subinvolution delayed healing of uterus containing quarters or clots of blood may lead to puerperal sepsis Management : D&C o After Pains After birth pains Multiparous breastfeeding most common to develop Position = prone Cold compress Mefenamic acid o Lochia Components Blood Decidua WBC Microorganisms 3 types Rubra 1 3 days, musty, moderate amount Serosa 4 10th day, pink or brown Alba 10 21th day, crme white, amount Urinary Tract o Urinary Frequency due to urinary retention with overflow o Dysuria Damage to the bladder Urine collection for culture and sensitivity Stimulate navel to urinate
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Colon o Constipation Due to NPO Bearing down may cause pain Perenium o Pain relieved by sims position o Cold compress 1st 24 hours if there is pain at episiorraphy followed by warm compress EMOTIONAL SUPPORT 1. Taking phase 1st 3 days dependent phase passive, cant make decision tells about childbirth experience focus on: Hygiene 2. Taking Hold 4 7th day dependent to independent phase active, decides actively focus: care of newborn health teaching : Family planning 3. Letting Go Interdependent phase Redefines goals, new roles as parents May extend till the child grows Post Partum Blues 4th 5th days overwhelming feeling of depression, inability of sleep and lack of appetite 50 80% incidence rate cause by sudden hormaonal change progesterone suddenly decreases allow crying: therapeutic may lead to postpartum psychosis/ depression
POSTPARTUM BLUES 1-10 days after ONSET birth SYMPTOMS Sadness, crying spells INCIDENCE 70% of all births Support and THERAPY empathy ETIOLOGY Hormonal changes, stress
POSTPARTUM DEPRESSION 1-12 months after birth Anxiety, feeling of loss, sadness 10% of all births Counseling and drug therapy Hx of previous depression, hormonal responses and changes, lack of social support systems Refer to counseling
POSTPRTUM PSYCHOSIS Within the first month after birth Delusions and hallucinations, signs of harming infant and self 1-2% of all births Psychotherapy and drug therapy Possible activation of previous mental illness, hormonal changes, family history of bipolar disorders
NURSING ROLE
Refer to counseling and safeguard mother from injury to self and to the newborn
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Perenial Infection Same s/ sx with infection 2 3 stitches are dislodges with purulent drainage Tx resuturing Endometritis Inflammation of the endometrium Gen s/sx of infection + abdominal tenderness Management o High fowlers facilitates drainage & localize infection o Administer oxytocin
ANATOMIC AND PHYSIOLOGIC ADAPTATION OF THE NEW BORN FETUS NEWBORN Fluid filled Air filled RESPIRATORY High pressure system Low pressure system SYSTEM
causes the blood to be shunted from the lungs though the ductus arteriosus to the rest of the body encourages blood flow through the lungs for gas exchange Increased 02 content of the blood in the lungs contributes to the closing of the ductus arteriosus Lungs Pressure in the left atrium is greater than the right. This causes the foramen ovale to close
Placenta Pressure in the right atrium is greater in the left Encourages blood flow through the foramen ovale Ductus venosus bypassed Maternal liver performs filtering functions Body temperature maintained by maternal body temperature and the warmth of the intrauterine environment
Ductus venosus closes and becomes a ligament hepatic and portal circulation begins Fixed posture Brown fat- which is a specialized form of heat producing tissue found only in fetuses and in newborns
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