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What is the Nurse practice act/Standards of care?
“What would any other reasonable prudent nurse do?
- -Postpartum, may be referred to as 4th trimester
- -6 week period following childbirth and expulsion of placenta
- -All organs go back to where they normally are- Period comes back, breast feeding begins
Regeneration of uterine epithelium
- -Involution begins directly after delivery of the placenta
- -Contraction controls bleeding from area where placenta separates from uterus
- -Uterus becomes smaller as muscles contract & gradually return to original size
Episiotomy (types, vs tear)
- -Midline or Medial lateral
- - Reduces pressure on fetal head and shortens second stage of labor
- - Tear may heal more quickly and may have less scarring
Midline Episiotomy (pro/con)
- -Minimal blood loss, neat, little scaring, less post-partum pain, shortens 2nd stage of labor
- -Higher risk to extend into rectal sphincter & urethra
Medial-lateral Episiotomy (pro/con)
- -More opening, if tearing occurs it’s away from rectum
- -More blood loss, increased post-partum pain, goes through muscle, have to sit on one side, longer healing, prolonged painful intercourse
3 stages of labor
- 1) Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm.
- 2) After the cervix is dilated to 10 cm until the delivery of the baby.
- 3) Delivery of placenta
How to promote involution of uterus
- -Ambulation ASAP post-delivery
- -Massage fundus
- -Breast feeding (releases oxytocin)
- -3 drugs,
- Methergine- potent vasoconstrictor, contraindicated if mother has chronic HTN or PIH
- Hemobate- cost > oxytocin & Methergine
Changes in vascular system postpartum
- -Bradycardin d/t large amounts of blood returning to central circulation. Increases stroke volume decreasing HR.
- -Tachycardina- excitement, fear, fatigue, pain, dehydration, hypovolemia, anemia, infection. Rule out excessive bleeding/intervene STAT if hemorrhage is suspected.
- -Rubra (1-3 days) mod-heavy, red, some clots
- -Serosa (4-10 days) mod-scant, pink
- -Alba (11-21 days) scant, white-tan,
Gastrointestinal system postpartum
- - Delayed bowel evacuation
- -Hemorrhoids- tucks pads, epifoam, sitz-bath, dermafoam
- -Constipation- increase fiber & fluids, diet, ambulate asap
Rubin’s 3 stages postpartum
- -Taking in- mother focus on self (sleep, her needs, food), content 4 others to make decisions, mom tries to integrate birth experience into reality.
- -Taking hold- High-fatigue, mother more independent, verbalize anxiety of competence as mom, “teachable reachable referable”, let mom do as much care as possible.
- -Letting go- relinquish old life, see themselves as a parent, disappointment/grief, fantasize baby’s future, let go of expectations.
- -insomnia, irritability, fatigue, tearful, mood instability
- -Symptoms usually unrelated to events -begins first week and no longer then 2 weeks
- -Common and effects 70% of women
- -Do not confuse with postpartum depression/psychosis
Maternal behaviors indicating positive attachment to infant
- -Holds baby close. “en face” position, kiss/touch cheek to hers
- -Speaks to baby in soft voice
- -Notes desirable traits
- -Attentive to baby’s reflex actions
Reciprocal infant behaviors to mom’s positive attachment behavior
- - Eye contact with mom
- - Roots, sucks, licks
- - Vocalizes/stretches to mom’s voice
- - Mimics mom’s facial expressions
Best time to encourage bonding between mom and baby
- -Early, prolonged contact during the 1st few hours
- - Rooming in allows for better contact, helps mom feel more confident in her role and ability to care for baby
Negative mothering behavior
- - Holds baby at far distance
- - calls baby “it”
- - Quickly hands baby off
- - Doesn’t talk to baby, ignores baby’s communication
- - May express demand for attention in competition w/ infant
- - These behaviors more common in drug addicts, rape victims
Baby bonding behaviors by fathers
- -Engrossment- intense fascination & close face-to-face observation
- - En Face position
- - Desires to hold, touch, & chuck in the air
- Post partum assessment
- B- breast
- U- Uterus
- B- Bladder
- B- Bowel function
- L- Lochia
- E- Episiotomy
- H- Homan’s sign
- E- Emotional Status
- R- Relationship
ACS guidelines for first pap smear and how often thereafter?
- First pap should be within 3 years of beginning sexual activity and yearly after that