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Discuss: Assess; cluster
data; problem list; formulate diagnosis; prioritize |
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Uterine assessment q 8 hrs
after 4th stage (1st 4 hrs PP) for: bogginess,
positioning, heavy lochia, clots. Ongoing monitoring of the lochia for amt, color, odor, etc. See Table
22-1, p 467 May need
Pitocin or Methyergonovine Maleate (Methergine) to stimulate uterine
contractions Perineal
discomfort – wear
glves, wash hands /a & /p, and always move front to back. Provide ice packs to reduce edema & provide numbing.
Prepare: glove /c ice chips, wrap in paper towel; apply 20 mins on, 10 mins
off, for 24 hrs. Sitz baths – tid, to promote comfort &
circulation; 105º max (pelvic congestions); abt 20 mins.; may faint; at home:
clean tub to prevent infecion. Topical agents – Dermoplast, Americaine, Witch Hazel compresses (Tucks
without glycerine); pt needs to WASH HANDS. Perineal
care – use
“peri-bottles” /p elimination; blot front to back/c tissue. REMEMBER: pt may
not know how to apply perineal pad (tampon user); net underwear (looks like a
dish cloth) to keep pad snug & prevent irritation to episiotomy site.
Remind client to tighten buttocks /a sitting down Refer to TEACHING ABOUT
episiotomy care. Hemorrhoidal
discomfort – sitz
baths, topical anesthetic ointments, suppositories, or Witch Hazel/Tucks.
Digital replacement; adequate fluids, fruits, & vegs; stool softeners Afterpains - > mutiparas, breastfeeding
moms; relieved by prone position, sitz, ambulation, or analgesic.
Breastfeeding: med 1 hr/a nursing. Immobility – joint & muscle pain; early
ambulation helpful; assist 1st few times: fatique, meds,blood loss,
etc. Diaphoresis – clean gown, linen ∆,
frequent fluids |
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Suppression through
mechanical inhibition: well-fitting bra within 6 hrs delivery; continuous for
5 – 7 days, remove only for showers; ice packs qid – 20 mins; teach: avoid
stimulation & heat; shower back. Don’t give meds to “dry up” breasts Rest/activity/exercises – encourage rest; sleep when baby sleeps. Relaxin
– hormone during breastfeeding; both
get sleepy. Cultural considerations: how PP is viewed: natural process vs
illness. Gradually ↑ ambulation & activity; avoid heavy lifting
(toddler at home!!), excessive stairs; light housekeeping 2nd
week; return to work 6 wks. Exercise: Figure 22-1, pp 472 – 473; may
start in hospital Pharmacologic
interventions: Rubella: titer <
1:10, give vaccine PP /a dc. Informed consent, avoid pregnancy 3 mos; contraceptive
counseling advised RH Immune Globulin: RhoGAM within 72 hrs to prevent sensitization
from fetomaternal transfusion of Rh-positive fetal RBCs. TEACHING vital!
Chapter 13:pp 280 – 283. Figure 13-3, p 281 |
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Time of
emotional stress: need to “tell her story”; feelings of inadequacy d/t “not
coping well” in L&D. Mother must
adjust to loss of fantasized child & accept child born, esp if
birth defects, wrong sex. Review the
stages: taking-in & taking-hold;
“let-down” feeling may be surprising to new mother. Parent
education: assess learning needs thru observation. Plan & implement
logically, in non-threatening manner, & respect family’s cultural values
& beliefs. Various methods: Channel 42, handouts, breastfeeding classes,
1-to-1. TIMING IS CRUCIAL! More receptive /f 1st 24hrs. Family
wellness: most facilities have mother-baby or couplet care; rooming-in.
Learning in a supportive environment; allows father, siblings, friends to
help. Flexibility: mother needs respite & can return baby to nursery. Reactions
of siblings: visit to mother-baby unit assures sibling that mother is well
& still loves them. Arriving home: requires adjustment; have father carry
newborn so Mom can hug older children. Use of doll. Expect anger & need
for regression. Let child help. Parent-Infant
attachment: support parents in childbirth & childrearing goals; postpone
eye prophylaxis 1 hr – promote eye contact; provide privacy; enc integration
of siblings; help identify & understand negative feelings; support,
support, support! Table
22-4: Parent Attachement Behaviors, p
476 Cultural
considerations: developing cultural competence: enc class stories |
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Chances of pulmonary
infections greater. Assess pain: incisional, gas pains, referred shoulder
pain, uterine contractions, pain from elimination Administer pain meds 1st
24 – 72 hrs; promote comfort; TC&DB. Duromorph or PCA. General anesthesia:
abdominal distension: ambulation, liquid diet 1st 24- 48 hrs or
return of BS; avoid straws, carbonated drinks; rectal suppositories;
lying on Left die → passage of flatus. Mother/baby separated /p
C-sec → anger, withdrawal, depression indicates grief response to loss
of fantasized birth experience; by 2nd or 3rd day
→ “taking-hold” period. Reactions to C-sec: depends on woman’s
perception & definition of experience. PP Adolescent: assess
support; Social Services referral; benefits from Beta or similar group classes. contraception essential
part of teaching Woman relinquishing
infant: potential for emotional crises in decision-making; ambivalence;
seeing the newborn aids the grieving process; relinquishing is a painful act
of love. Anticipate potential for problems if decision is made to parent an
unwanted child. |
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Previously,
couples were discouraged from sexual intercourse until after 6 wks chek-up.
Now couples resume once episiotomy heals & lochia flow stops, usually end
of 3rd week. Advise: vaginal dryness, KY-Y jelly needed as
lubricant. Change in position may ease discomfort. Nursing mothers should
nurse prior to lovemaking.
Interference such as baby crying, poor self-image with PP body, etc.
Return to prepregnant levels of sexual varies by couple and may take a few
monts to year. Patient
Teaching: Clients will ask questions. If patient receives Rubella vaccine,
teach avoid pregnancy for 3 months. Vaccine can be teratogenic. Methods:
Any method of birth control is safer statistically than pregnancy &
giving birth Fertility
Awareness:
natural family planning;
periodic abstinence & recording of certain events during cycle; cooperation of partner important.
Only method approved by Roman catholic Church. Failure rate: 25%; no
protection against HIV, STDs. BBT or
Basal body temperature: upon awakening, prior to any activity, take temp; based on temp
drops before ovulation & rises & remains up. Couples avoid
intercourse that day + 3 days. Record keeping. Calendar
0r rhythm method: ovulation
14 days (+ or – 2 days) before start of next menstrual period. Sperm are viable
48 – 72 hrs, ovum 24 hrs. Record cycles 6 – 8 mos. Fertile period is 18 days
from END of shortest recorded cycle . EX: cycle is 24 – 28 days; fertile time
is day 6 – 17, abstinence necessary. Least reliable of fertility awareness
method. Cervical
mucus or ovulation method or Billings
method. At ovulation, cervical mucus (estrogen-dominant) is clearer, more
stretchable , called spinnbarkeit. Mucus assessed daily; abstain from
intercourse 1st sign of slippery, clear to 4 days after last wet
mucus. Can be used by women with irregular cycles: based on hormonal changes. Coitus
interruptus –
withdrawal; doesn’t protect against STIs or HIV; failure rate 19%; requires self-control & preejaculatory
fluid contains sperm. Better than
nothing! Douching
- facilitates conception ↑ sperm into
birth canal Barrier
methods: male
& female condoms, spermicides, diaphragms, cervical caps. Can protect
against spread of STIs; spermicides failure rate is 26%, messy; condoms
failure rate 14%, latex allergies, lack of knowledge on correct usage; diaphragm protects, allergy , objection to
insertion of a device, toxic shock, need to refit q 2 years or with weight
change Intrauterine
devices – small
T-shaped devices loaded with either copper or a progestational agent; Failure
rate 0.1% to 2.0%, risk for PID, uterine perforation, infection Hormonal
methods - over 30 kinds including combined
estrogen-progestin steroidal medications or progestin-only agents which are
administered orally, subdermally, patch, or by implantation; emergency
contraception using high doses of OCPs;r no protection against STIs, most
effective form, not suitable for heavy smokers, 35+ women with HTN, hx of
vascular disease, familial DM Emergency
contraception: 2 kits: Preven & Plan B, “morning after” pill Sterilization,
male & female:
permanent; Nurses must be aware of informed consent for voluntary
sterilization Clinical
interruption –
abortion - purposeful interruption of
a pregnancy before 20 wks gestation; legal in US since 1973. 1st
trimester: D&C, minisuction, or vacuum curettage. 2nd
trimester: D & E (dilatation & extraction), hypertonic saline,
prostaglandins; Complications of
bleeding or infection, religious & moral considerations mifepristone
(RU 486): may be used medically to induce abortion during 1st 7
wks, up to 49 days/p conception; returns in 2 days for misoprostol to induce
contractions to expel embryo/fetus; returns to MD 12 days to confirm successful abortion. |
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B |
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A |