NURS 233 Lecture Notes - Lecture 7: Postpartum Period, Linea Nigra, Melasma
Perinatal week 7
If the women says they have a headache we always document and tell soemoen
ebcasue it can be a major conece especially if they had an epidural
Musculoskeletal System
◦ Reversal of pregnancy adaptations
◦ Joints are completely stabilized by 6 to 8 weeks after
birth.
◦ A new mother may notice a permanent increase in shoe size.
Integumentary System
◦ Chloasma of pregnancy usually disappears in the postpartum period.
◦ It persists in about 30% of women.
◦ Hyperpigmentation of areolae and linea nigra may not regress
completely after childbirth.
◦ Some women will have permanent darker pigmentation of those areas.
◦ Stretch marks on breasts, abdomen, and thighs may fade but not disappear.-
normally its genetics if you get them
Integumentary System—cont.
◦ Vascular abnormalities, spider angiomas, palmar erythema, and epulis regress
with rapid decline in estrogens.
◦ Spider nevi persist indefinitely for some.
◦ Abundance of fine hair during pregnancy usually
disappears after birth.
◦ Coarse or bristly hair that appears during pregnancy usually remains.
Nursing Care of the Postpartum Woman
◦ Nurse provides care that focuses on transition to parenting
◦ Woman's physiological recovery
◦ Emotional adaptation
◦ Ability to care for herself and her new baby
◦ Needs of other family members include strategies in plan of care to assist the
family in adjusting to the baby.
Transfer from Recovery Area
◦ After the initial recovery period (1 to 2 hours), the woman may be moved to a
postpartum room in the same or another nursing unit. (idealy saty there for the first
4 hours
◦ Postanaesthesia recovery- they need to be able to transfer themselves ex.
weightbare
◦ Regardless of obstetrical status, no woman should be discharged from the recovery
area until she has completely recovered from anaesthesia.
Postpartum Care
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◦ Criteria for early discharge:
◦ Woman and baby are in stable condition
◦ With no complications, approximately 24 to 36 hours after birth
◦ Mother is able to and confident in care for her newborn (or at least feel
comfortable)
◦ Adequate support systems in place
◦ The nurse and health care provider are legally responsible for ensuring that the
woman is not discharged before she is stabilized within normal limits.
Nursing Care Management— Physical Needs
◦ Combined or mother–baby care
◦ Ongoing physical assessment
◦ Vital signs
◦ BUBBLLEE- breast (hass the milk come in are they fuller, suppot to latch, if not
breast feelding we need to tell them how to feel better and if they are breastfeeding
we have to make sure there isn’t a crack) , uterus fundus (firm not bogy, not
deviataed and if not make sure they have voided), bowel (voided? Make sure they
are doing pericare, if tare make sure they can void without pain, prescribe stool
softener if they ahev a tear or hemmoharge) , bladder, lochia (types of bleeding and
amounts and if there is blood to make sure there isn’t pooling) , legs (concern for
DVT and coagulation so look at everything for signs of DVT), episiotomy or
laceration or incision (look at them and make sure its healing and sutures are intact
and look fro signs of infection and healing and look at the incision and if teher are
staples count them and make sure they are intact and no dehising, no exudate or
odor or bleeding but don’t take the bandage off to do this wait for the doctor to do
that, most of the time its glued, teach the women how to care for it and make sure
they look in the mirro to see it and lok for signs or infection ) , emotions (you need
to look at all this in the physical exam
◦ Routine lab tests
◦ Hemoglobin, hematocrit
◦ Rubella and Rh status if not known
Nursing Care Management— Physical Needs—cont.
◦ Prevention of infection
◦ Proper perineal care – sits bath for example
◦ Hand hygiene
◦ Prevention of excessive bleeding
◦ Estimating blood loss
◦ A perineal pad saturated in 15 minutes or less or pooling of blood under the
buttocks is an indication of excessive blood loss.
◦ Hypovolemic shock- BP decreases, pulse is up, normal shock signs
◦ Key interventions for preventing uterine atony:
◦ Maintenance of uterine tone- can be massage or oxytocin
◦ Prevention of bladder distention
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