Care of Mother and Neonate During the Postpartum Period NURSING CARE OF THE MOTHER The Puerperium The puerperium is the period beginning after delivery and ending when the woman’s body has returned as closely as possible to its prepregnant state. The period lasts approximately 6 weeks. (See
Standards of Care Guidelines 38-1, page 1296.) Physiologic Changes of the Puerperium Uterine changes. Immediately after delivery, the fundus is palpable halfway between the umbilicus and symphysis pubis. At 1 hour
postpartum, the fundus is usually level with or slightly below the level of the umbilicus. The fundus is usually midline. Within 12 hours of delivery, the fundus may be ½ inch (1.3 cm) above the umbilicus and by 24 hours, ¼ inch (1 cm) below the umbilicus. After this, the level of the fundus descends approximately 1 fingerbreadth (or ½ inch) each day, until by the 10th to the 14th day, it has descended into the pelvic cavity and can no longer be palpated (see
Figure 38-1). After delivery, lochia—a vaginal discharge that consists of fatty epithelial cells, shreds of membrane, decidua, and blood—is red or dark brown with clots (lochia rubra) for approximately 1 to 3 days. It then progresses to a paler pink or more brown-tinged color of serosanguineous consistency (lochia
serosa) for 3 to 10 days, followed by a whitish or yellowish color (lochia alba) in the 10th to 14th day. Lochia usually ceases by 3 weeks and the placental site is completely healed by the 6th week. The amount of lochial flow can be scant (less than 2.5 cm stain [1 inch]/hour), light (less than 10 cm stain [4 inches]/hour), moderate (less than 15.2 cm stain [6 inches]/hour), or heavy (one pad saturated within 1 hour). Lochial flow is considered to be “excessive” if the
perineal pad becomes saturated in less than 15 minutes (see Figure 38-2). Immediately after delivery of the placenta, the cervix has little tone or resemblance to the prepregnant state. In approximately 2 to 3 days, it appears more like the prepregnant state and is dilated to 2 to 3 cm. By the end Figure 38-1. Changes in uterine size and shape following delivery. (A) Uterus after delivery. (B) Uterus at 6th day. (C) Nongravid uterus. The vaginal walls, uterine ligaments, and muscles of the pelvic floor and abdominal wall regain most of their tone during the puerperium. Immediately after delivery, the vaginal walls are smooth and swollen because the vaginal rugae are absent. Rugae reappears approximately 3 weeks postpartum. At approximately 6 weeks postpartum, involution of the vagina is complete. Postpartum diuresis begins within 12 hours after birth and continues for 2 to 5 days postpartum, as extracellular water accumulated during pregnancy is excreted. Diuresis may also occur shortly after delivery if urine output was obstructed because of the pressure of the presenting part, or if IV fluids were given during labor. Breasts.
Endocrine/metabolic function.
Ovarian function.
Kidneys and bladder function.
Neurologic function.
Cardiovascular function.
Respiratory function.
GI/hepatic function.
Musculoskeletal function.
Integumentary function.
A good method to remember how to check the postpartum changes is the use of the acronym BUBBLERS:
Emotional and Behavioral (Psychosocial) Status
Nursing Assessment Immediate Postpartum Assessment The first hour after delivery of the placenta (fourth stage of labor) is a critical period; postpartum hemorrhage is most likely to occur at this time (see page 1364). Subsequent Postpartum Assessment
Nursing Management Nursing Diagnoses
Nursing Interventions Monitoring for Hypotension and Bleeding
Promoting Urinary Elimination
Promoting Proper Bowel Function
Preventing Infection
Reducing Fatigue
Minimizing Pain
Promoting Postpartum Health Maintenance
Promoting Health Maintenance of the Neonate
Promoting Breastfeeding
Evaluation: Expected Outcomes
Postpartum Patient Education
NURSING CARE OF THE NEONATE Physiology of the Neonate The first 24 hours of life constitute a highly vulnerable time, during which the infant must make major physiologic adjustments to extrauterine life. Most neonates transition without difficulty during the first 6 to 10 hours of life. Transitional Stages During the period of postnatal transition, six overlapping stages have been identified:
Respiratory Changes Factors Initiating Respiration
Character of Normal Respirations
Circulatory Changes
Temperature Regulation
Basal Metabolism
Renal Function Neonatal kidneys have functional deficiency in concentrating urine and coping with fluid and electrolyte fluctuations. Low
Only gold members can continue reading. Log In or Register to continue Jun 14, 2016 | Posted by in NURSING | Comments Off on Care of Mother and Neonate During the Postpartum Period Where should the nurse locate the fundus at day 2 postpartum?The fundus is usually midway between the umbilicus and symphysis 1 to 2 hours after delivery, 1 cm above or at the level of the umbilicus 12 hours after delivery, and about 3 cm below the umbilicus by the third day after delivery.
How do you check fundus after delivery?At about an hour after childbirth, your fundus should be around your belly button (where it was at 20 weeks). After that, it should steadily decrease 1 centimeter every 24 hours. At about one week postpartum, your fundus should be at your pubic bone (where it was at 12 weeks).
Where should I expect to find a woman's fundus at 24 hours postpartum?Immediately postpartum, the uterine fundus is palpable at or near the level of the maternal umbilicus.
What would the nurse expect to find when assessing the fundus of the uterus immediately after delivery?What would the nurse expect to find when assessing the fundus of the uterus immediately after delivery? Immediately after the placenta is expelled, the uterine fundus can be felt as a firm mass, about the size of a grapefruit, at the level of the umbilicus. 3.
|