Ch 9 - OB Introduction to Maternity and Pediatric Nursing

Ch 9 - OB Introduction to Maternity and Pediatric Nursing How long does the Puerperium last? Ans- -Known as postpartum period. -Six weeks following child birth - Sometimes referred to as the fourth trimester of pregnancy. How does nursing adapt for different cultures and OB nursing? Ans- The nursing care provided must be adapted to the circumstances of the mother and infant. What are some nursing considerations fro specific groups of patients? Ans- -Adolescents, Single women, Families at or below the poverty level, Families who have twins (or more) -Education, Support, Resources,Twins would be high stress, getting a good system/ routine down to stay sane or or both maybe in the NICU. What are some cultural influences on postpartum care? Ans- -The nurse must adapt care to fit: Health beliefs, Values, and Practices. -Use an interpreter where appropriate. -Should not use a family member or in cultural/religious conflict with the patient/family. -Use a "Language Line" (Interpreter phone) -Think of Dietary practices— Some cultures, if they believe blood loss is hot they only replace with hot liquids/foods. And nothing cold (ice water). Why is it better to use interpreters and never family members? Ans- -It is a legal purpose -Aids in the woman being able to understand and provide optimal care to her infant. -Interpreter should not be a family member or from a group that is in social or religious conflict. What should you expect with postpartum changes in the mother? Ans- -Major shifts in hormones in the first 3 days. -Immediately after delivery, the mother experiences multiple physiological changes. -It is important for the nurse to assess all body systems and not just focus on the reproductive system changes. Parts of the Reproductive System? Ans- -Uterus (Involution, Uterine lining, Descent of uterine fund us, Afterpains.) -Lochia (Rubra, Serosa, Alba) -Cervix -Vagina (Stress importance of discussing with health care provider when to resume vaginal intercourse postpartum) -Breasts (Engorgement, Nursing Care) -Perineum -Episiotomy (REEDA Assessment) (Nursing care and patient teaching- cold packs , Ice diaper, Topical and systemic medications, Non pharmacological pain relief methods) -Return of ovulation and menstruation (Menstrual cycle typically resumes in 6-8 weeks if not breastfeeding, Return of ovulation is delayed if breastfeeding; however, it can occur at any time after birth (pregnancy is possible) Mom maybe ovulation even with no period. What happens with the breasts postpartum? Ans- -First 2-3 days postpartum, breasts are full but soft. -Day 3, breasts become firm, lumpy due to increased blood flow and milk production -Engorged breasts occur in both nursing and non nursing mothers -Nipples should be assessed for redness and cracking and washed with plain water -Support bra should be worn (Don't want cracks, Nursing needs to do make sure to do good breast care, Supply and demand- maybe oral gratification if they are staying latched on longer than 10-15 mins) Changes with Cardiovascular System? Ans- -Cardiac output and blood volume -Coagulation -Blood values -Chills -Orthostatic hypotension -Nursing Care (Interventions- SCD Pumps to prevent blood clots, High BP normal but High pulse in normal) Changes with Urinary system? Ans- -A full bladder can displace the uterus and lead to postpartum hemorrhage -The woman who voids frequent, small amounts of urine may have increased residual urine because her bladder down not fully empty. (Everyone gets a hard hat for the first 24hours. About 500ml out bladder scan with an order) -Residual urine in the bladder may promote the growth of microorganisms Changes with Gastrointestinal System? Ans- -Constipation -To help alleviate this problems, encourage woman to Increase fluid and fiber intake and increase activity, such as walking. (Senna-S until the first BM, C-sec pt has gas build up.) Changes with Integumentary System? Ans- -Hyperpigmentation of the skin changes as hormone levels decreases, Linda Ingram disappears, Striae (stretch marks) fade to silver but stay forever. Changes in Musculoskeletal System? Ans- -Diastasis recti -Hypermobility of the joints -Exercises (Abdominal muscle tightening,Head light, Pelvic lift, Kegal exercises). Changes in the Immune system? Ans- -Prevent blood incompatibilities and infection -RhoGAM if woman is RH negative and baby is Rh positive. (Looking for antibodies If yes sensitized- No RhoGAM, if non-sensitized yes give RhoGAM. -Give mother immunization for rubella if she is not immune (Tiger 1:8 requires immunization) ( 1st RhoGAM shot at 28 weeks gestation, and 72 hours after delivery). Adaptation of nursing care following a cesarean birth? Ans- -Same as with normal vaginal delivery except: Monitoring of abdominal dressing, Lochia generally less, Urinary catheter, respiratory care, Prevention of thrombophlebitis, Pain management. Being aware of Emotional Care. Ans- -The birth of an infant brings about physical changes in the mother but also causes many emotional and relationship changes in all family members. Rubin's Psychological Changes of the Puerperium— What is Phase 1 ? Ans- Taking- In Phase -Mother is passive and willing to let others do things for her. Conversation centers on her birth experience. Has interest in infant but prefers that others care for infant. Has Interest in learning. Focus is on need for food, fluids, and restorative sleep. Nursing Responses- Provide opportunity for rest and appropriate nutrition. Provide opportunity to discuss birth experience and vent disappointments and share joys. Rubin's Psychological Changes of the Puerperium — What is Phase 2 ? Ans- Taking-Hold Phase -Mother begins to initiate action and becomes interested in caring for infant. May be critical about her abilities. Has increased concern about her body functions and assumes self-care needs. Is interested in learning how to care for self and baby. Nursing Responses- Provide supportive atmosphere. Identify support system of mother. Use teaching moments. Reinforce self-care and infant care taking abilities. Rubin's Psychological Changes of the Puerperium — What is Phase 3 ? Ans- Letting-Go Phase -Mothers and partners work through giving up their previous lifestyle to incorporate new infant. Many mothers must give up their ideal of the birth experience and reconcile it with what really occurred. They give up the fantasy child and accept the real child. Nursing Responses- Provide supportive atmosphere. Provide referrals to community agencies as appropriate for assistance needed. Reinforce infant caregiving abilities. What are Postpartum Blues? Ans- New mothers often experience conflicting feelings of joy and emotional letdown during the first few weeks after birth. The nurse should prepare the woman for these feelings and reassure her that they are normal and temporary. What is Postpartum Depression? Ans- A persistent mood of unhappiness.The nurse should explain that persistent depression is not expected and should be reported to her health care provider. What is Fatigue? Ans- Today's modern lifestyle often includes the woman working through most of her pregnancy, rooming-in after delivery with responsibility for newborn care, and then returning home after delivery in 48 hours or less to accept complete home responsibilities. Women do not have the opportunity to rest and adapt in the postpartum phase. What are the changes for Fathers postpartum? Ans- -New fathers typically display intense interest in their new child (engrossment). Four phases of adjustment: 1. Having expectations and personal intentions 2. Confronting reality and overcoming frustrations 3. Creating one's own personal faith role 4. Reaping rewards of fatherhood What changes do the siblings go through? Ans- May respond with regression and anger when the mother's attention turns to the infant. -No longer potty trained -wanting bottle or pacifier What are nurses likely to encounter with grieving parents? Ans- Therapeutic communication and nursing care. Stages of the grief process: Shock and disbelief, Anger, Guilt, Sadness and Depression, Gradual resolution of sadness. What changes when you enter Parenthood? Ans- -Can affect communication between partners -Division of responsibility can be source of conflict -Fatigue increases irritability -Loss of freedom and decreased socializing may cause couple to feel lonely What do you do for Family Care Plan? Ans- Studying the family as well as the patient care offer insight into community-based care. What data do you collect for the family care plan? Ans- -Demographic information -Family composition -Occupation -Cultural group -Religious/ Spiritual affiliation -Developmental tasks -Health concerns -Communication patterns -Decision making -Family values -Socialization -Coping patterns -Housing -Cognitive abilities -Support system -Response to care Neonatal Transition to extrauterine life what are the 3 phases? Ans- Phase 1 : Period of reactivity, 0-30 minutes after birth (Focus of breast feeding and skin to skin) Phase 2 : Decreased responsiveness, 30 mins- to 2 hours after birth. Phase 3 : Second period of reactivity, 2 to 8 hours after birth. (Back to skin to skin