NUR1423 chapter17 Care postpartal family

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clugger
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NUR1423 chapter17 Care postpartal family
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2014-09-07 01:13:13
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NUR1423 chapter17 Care postpartal family
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NUR1423, chapter17, Care postpartal family
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  1. postpartal period
    =puerperium= 6 week period after childbirth, also called fourth trimester of pregnancy

    • maternal changes
    • -retrogressive ( involution of uterus and vagina

    -progressive (production of milk for lactation, restoring of normal menstrual cycle, beginning of parental role)

    -> protecting women's health important, can influence her whole life (emotional and physical, can effect generations
  2. assessment puerperium
    • interview, physical examination, analysis of laboratory data
    • -> important to document/measure physical changes like uterus involution (size, consistency, lochia...)
    • -> psychological assessment: mother's emotion after birth (happy/sad), quality of interaction with child, infant and selfcare, appearance
  3. nursing diagnosis postpartal
    • -often "risk for diagnoses"
    • -concerned about family's ability to bond with newborn
    • e.g. health seeking behaviors, risk for impaired parenting related to disappointment in sex of child, ...
  4. outcome identification and planning puerperium
    • -outcomes shall be realistic
    • -outcome can also be through home care, phone calls, ...

    • -when planning consider rest for mother , time for interactin with child, prepare mother for selfcare with infant, monitor own health, brainstorming better than just giving advice, problemt solving techniques, flexibility, internet sites, teaching,
    • -Mayo clinic newborn care website,
    • -postpartum.net
  5. implementation
    • all interventions chall be family centered
    • enhance family function and bonding,
    • increasing woman's self esteem,
  6. outcome evaluation puerperium
    expected outcome could be

    • patient verbalizes at least one good comment about child...
    • clients lochial flow is no more than ...
  7. transition
    first: act of ending of old ways of thinking and believing

    2nd: neutral zone: old way is gone but new one is not yet comfortable

    3rd: new beginning, in which new ideas and consepts are put into action

    (Bridges 1994)
  8. Taking-In Phase
    • - Phase of reflection (pregnancy, childbirth...)
    • - 1-3 day period
    • - patient largely passive (discomfort, ehaustion, uncertainty regarding new role, ...)
    • - holds child with a sense of wonder
    • -wants to experience calm atmosphere

    ->encourage client to talk about the birth-> important to integrate it into life experience
  9. Taking-Hold hase
    • -beginning to initiate actions (own decisions...)
    • - could occur hours after birth
    • - stronger interest in her baby
    • - begins maternal role behaviors
    • - Rule: usually best -> short demonstration and then new mom should do this herself
    • with watchful guidance
    • -might often still feel insecure about new role -> give praise for wright actionsdo not rush a patient into this phase
    • -
  10. Letting-Go Phase
    • -woman finally redinfes her role
    • -gives up phantasized image of child and accepts real one
    • - gives up old role -> some griefwork
    • - readjustment of relationships (similar in pregnancy), continous through child growing years

    - > if woman reached this phase she is well in her new role
  11. Attachment/ Bonding
    mother is succefully linked with newborn

    • -often approach is like to a stranger, touching the blanket, start with one finger, fingertips for touch
    • -gradually she holds her child more, expresses more warmth, more palm of hand then fingertips-> kiss child, pressing to cheek-> successful bonding


    looking directly to child with direct eye contact (en face position)-> beginning effective attachment

    many fathers are known to stare at child this way (often termed engrossment)-> how actively parents bond to child


    more
  12. length of time for bonding depends on which factors?
    circumstances of pregnancy and birth

    • complication-> separation from child-> higher risk of post traumatic stress disorder/ interferes with normal bonding
    • -> helping parents sort out their feelings regarding new role + responsibilities through anticipatory guidance enhances bonding
    • supportive interactions (e.g. pointing out positive parenting and child responses-> enhance positive parent-child interaction

    helping to sort out feelings regarding the new role-> strengthens bonding
  13. Rooming in
    • the more time mother can spend with beby the better: feels more confident, sound relationship, ...
    • rooming in = space for mother and child
    • complete = 24 hours
    • partial = in room for the day but placed in nursery through the night
    • father and siblings can hold and feed the baby when they visit
    • often father can stay overnight in mother's room
  14. sibling visitation
    • siblings separated from mother
    • siblings might picture baby much older
    • visits can be helpful and can decrease feeling of separation from mother

    assess if siblings free from contagious diseases such as URI or recent exposure to chickenpox

    let them wash hands

    • assist them when holding baby
    •  give pain meds eventually to mother before visit
  15. typical issues by postpartal women
    • breast soreness
    • regaining their figure
    • regulating demands of job
    • house work
    • partner children
    • coping with emotional tension
    • combat fatigue
  16. postpartum- abandonment
    mother can feel jealous/ abandoned  when everybody or the partner is all about the baby now. ppossible : " how things have changed, it is all about the baby now and not about you...= reassuring words to make mother feel normal when experiencing thes kind of feelings

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