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Chapter 21.docx

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NUR1 233
Sonia Elizabeth Semenic

Chapter 21: Nursing Care During the 4 Trimester Laws relating to discharge  Newborns’ and Mothers’ Health Protection Act 1996 provided minimum federal standards for health plan coverage for mothers and their newborns  All health plans required to allow the new mother and newborn to remain in hospital for minimum of 48 hrs for vaginal birth and for 96 hours after cesarean birth Assessment  Interview: emotional status, energy level, physical discomfort, hunger, knowedge of self care and baby care  Physical examination o Breasts: firmness o Uterine fundus: location, consistency o Bladder: amount, frequency o Bowel: amount, frequency o Lochia: amount, color, odour o Episiotomy  Review of lab results: hemoglobin, hematocrit, rubella, Rh Diagnoses  Risk for deficient fluid volume (hemorrage) related to uterine atony after birth  Urinary retention or constipation related to postchildbirth discomfort, childbirth trauma to tissues  Acute pain related to uterine involution (contractions), episiotomy or lacerations, hemorrhoids, engorged breasts  Disturbed sleep pattern related to discomforts of postpartum period, long labor, infact care and hospital routine  Ineffective breastfeeding related to maternal discomfort and infant positioning Signs of potential physiological complications  Temperature: more than 38 degrees celcius after first 24 hours  Pulse: tachycardia or bradycardia  BP: hypo or hypertension  Energy level: lethargy or extreme fatigue  Uterus: deviated from midline, boggy consistency, above umbilicus for 24 hours  Lochia: heavy, foul odour, bright red bleeding that is not lochia  Perineum: pronounced edema, not intact, infection, discomfort  Legs: Homa’s sign positive, painful, reddened area, warmth on posterior aspect of calf  Breasts: redness, heat, pain, cracked and fissured nipples, inverted nipples, palpable mass  Appetite: lack of appetite  Elimination: urine – not able to void, urgency, frequency, dysuria, bowel – constipation, diarrhea  Rest: inability to rest or sleep Plan of care and implementation  Periodic assessments to detect deviations from normal physiological changes, measures to relieve discomfort or pain, safety measures to prevent injury or infection, and teaching and couseling measures designed to promote the woman’s fstlings of competence in self-management and baby care  1 step: check wristband ID and matching infants ID number Prevention of infection  Wipe genital area front to back after voiding or defecating  Change perineal pad from front to back each time voids or defecates and wash hands thoroughly Prevention of excessive bleeding  Most frequent cause: uterine atony – uterine can’t contract o Caused by: placenta piece left inside, bladder distention, vaginal or vulvar hematomas, unrepaired lacerations o Maintain good uterine tone and prevent bladder distention  If pad filled with blood in less than an hour – PROBLEM Maintainence of uterine tone  Stimulation by gently massaging uterine fundus until firm  Can cause temporary increase in amount of vaginal bleeding seen as pooled blood leaves the uterus – can be uncomfortable for mothers but explain causes and dangers of uterine atony Prevention of bladder distention  Prevents uterus from contracting normally  Help mother to bathroom – hands in warm water or water over perineum or listen to running water Promotion of comfort  Afterbirth pains, episiotomy or perineal lacerations, hemorrhoids, and breast engorgement  Inspect and palpate areas of pain for redness, swelling, discharge, and heat and observe for body tension, guarded movements, facial tension  Nonpharmacologic interventions o Afterbirth pains: Warmth, distraction, deep breathing, imagery, therapeutic touch, relaxation, interaction with infact o Episiotomy: Encourage woman to lie on side whenever possible and use a pillow pack, topical application, dry heat, cleansing with squeeze bottle o Engorged breasts: applying ice, heat, or cold cabbage leaves, wearing well-fitted support bra  Pharmacological interventions o Nearly all medications present in maternal circulation are also found in breast milk, many analgesics commonly used during postpartum period are considered relatively safe for breastfeeding mothers Promotion of rest  Fatigue common in postpartum and involves o physiological component: long labors, cesarean birth, anemia, and breastfeeding o psychological component: depression and anxiety o neuroendocrine and immune components  Lower serum prolactin levels associated with depression and fatigue  Can be association with milk prolactin and melatonin and stress and fatigue in mothers who breastfeeds  Side-lying position for breastfeeding minimizes fatigue in nursing mothers  Milk: contains high levels of melatonin which induces sleep at night and is not detectable during the day, fati
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