SPECIFIC TIME CONTENT TEACHING AV EVALUAT

OBJECTIVES LEARNING AIDS ION

ACTIVITY

INTRODUCTION:
Introduce the topic. 2mins Student teacher
Postpartum period or postnatal period is the period beginning introduces the
topic
immediately after the birth of a child and extending for about 6
weeks. The minor ailments of puerperium are the minor
discomforts faced by the women during puerperium. There are
number of discomforts of the puerperium. While they are
considered normal, there is no reason for a woman to have to
suffer with them.

Student teacher Define

Define puerperium and 2min DEFINITION: defines puerperium
involution. puerperium and
and involution involution?
Puerperium is the period following childbirth during which the learners are
listening.
body tissues, especially the pelvic organs revert back
approximately to the prepregnant state both anatomically and
physiologically.

Involution is the process whereby the genital organs revert back

approximately to the state as they were before pregnancy. The
woman is termed as a puerpera.
Explain the duration DURATION:
puerperium. 2 mins Student teacher Explain the
Puererium begins as soon as the placenta is expelled and lasts for explains the duration of
duration puerperium
approximately 6 weeks when the uterus becomes regressed almost puerperium ?
to the nonpregnant size. and involution
learners are
listening.

The period is arbitrarily divided into —

(a) immediate – within 24 hours,

(b) early – up to 7 days and

(c) remote – up to 6 weeks.

Similar changes occur following abortion but takes a shorter

period for the involution to complete.

Fourth trimester is the time from delivery until complete

physiologic involution and psychological
Enumerate minor MANAGEMENT OF AILMENTS Student teacher Enumerate
ailments of puerperium 20min enumerate Flash minor
and its management. AFTER PAIN — minor ailments card ailments of
of puerperium puerperium
and its and its
It is infrequent, spasmodic pain felt in the lower abdomen after
management. managemen
delivery for a variable period of 2–4 days. Presence of blood clots
or bits of after births lead to hypertonic contractions of the uterus
in an attempt to expel them out. This is commonly met in
primipara. Pain may also be due to vigorous uterine contraction
especially in multipara. The mechanism of pain is similar to
cardiac anginal pain induced by ischemia. Both the types are
excited during breastfeeding.

With increased parity, there is decrease in uterine muscle tone,

which causes the uterus to relax thereby subject it to recontraction.
In the instance of breastfeeding women, the suckling of the baby
stimulates the production of oxytocin by the posterior pituitary.
The release of oxytocin not only triggers the let-down reflex in the
breasts but also causes the uterus to contract; even the well-
contracted uterus of a primipara will contract even more.
MANAGEMENT

The treatment includes massaging the uterus with expulsion of the

clot followed by administration of analgesics (Ibuprofen) and
antispasmodics.

The key to effective relief from afterbirth pains is an empty

bladder. The reason for this is the fact that a full bladder displaces
the uterus from its normal and proper position. When the uterus is
so displaced, it is unable to contract as it should and tends to relax,
thus prohibiting relief from afterpains. Some times afterbirth pains
are totally relieved just by the act of emptying the bladder.

Once the bladder is empty, the woman may lie prone with a pillow
under her lower abdomen. The prone position places constant
pressure against her uterus (the pillow creates even greater
pressure), which keeps it contracted and thus eliminates afterbirth
pains, since there is no uterine relaxation. The woman needs to be
forewarned that when she first lies on stomach, she will have
severe cramps or pain for about 5 minutes before she experiences
complete and total relief.
Analgesia can be effective for afterbirth pains, but not for very
long if the woman's bladder is not emptied. For nonbreastfeed ers,
generally analgesia is not needed because the prone position
usually alleviates the discomfort even in multipara. It is impor
tant to remember that the let-down essential to breastfeeding is
inhibited by pain. The amount of analgesic that gets into the milk
will not hurt the baby.

Excessive Perspiration

Excessive perspiration is due to the body's us ing this route as well

as diuresis to rid itself of the excess interstitial fluid that resulted
from the hormonal effect during pregnancy.

MANAGEMENT:

Keeping the mother clean and dry will provide comfort. The
woman may want to change her gown frequently.
Bed sheets should be changed as necessary.
Care must be taken to assure that the woman is hydrated. Drinking
a glass of water or any fluid of her liking during each hour she is
awake, will assure this.

Correction of anemia:

Majority of the women remain in an anemic state following

delivery.

Supplementary iron therapy (ferrous sulfate 200 mg) is to be given

daily for a minimum period of 4–6 weeks.

Hypertension is to be treated until it comes to a normal limit.

Physician should be consulted if proteinuria persists.

Breast Engorgement

It is thought that engorgement of the breasts is due to a

combination of milk accumulation and stasis, and increased
vascularity and congestion. It occurs on approximately the 3rd
postpartal day in both breastfeeding and non-breastfeeding
mothers and lasts approximately 24-48 hours.
Signs and symptoms of engorgement include the following,
which are experienced to a greater or lesser degree by individual
woman:
 Sense of increasing breast heaviness or filling on the day prior
to engorgement
 Enlargement of breasts from distention
 Skin becomes tight, shining and reddened
 Breasts are warm to touch
 Veins become visible
 Breasts are tender, throbbing and painful
 Breasts feel firm, full and hard.

Because this is not an inflammatory process, there is no

temperature elevation caused by breast engorgement.

MANAGEMENT:

 Relief measures for a woman, who is nonbreastfeed is geared

toward relief of discomfort and cessation of lactation.

 Relief for a breastfeeding woman aims for relief of discomfort

and continuation of lactation.

Treatment of breast engorgement is important to the breastfeeding

mother as unrelieved breast engorgement suppresses the milk
supply.

With the current short hospital stay, many women will be home
before breast engorgement occurs and need to be instructed about
what to do when it happens.

1. Give the breasts good support. A breast binder should be used

to provide upward and inward thrust and support. If a bind er is
not available, one may be prepared using a pillowcase or towel,
which will go around the woman and two shorter strips to be used
as shoulder straps. The binder has to be secured with safety pins to
fit each woman. A tuck is to be given beneath each breast to
provide support and the ends are overlapped and fitted in front.
Applied this way a breast binder is extremely comfortable for the
woman, because it imparts support and prevents painful
movement.

2. Apply ice bags or packs to the breasts. Ice relieves discomfort,

has a certain numbing effect and does not encourage milk flow.
3. Take analgesics such as Aspirin or paracetamol to relieve pain.

4. Avoid massaging the breasts in an effort to get the milk out.

Such actions will only extend the length of time of breast
engorgement. Any emptying of the breasts by any means
stimulates the breasts to further lactation.

5. Do not apply heat to breasts, as heat dilates the blood vessels

and ductile system causing the milk to flow. This causes
partial emptying and stimulates the breasts to further lactation.

Relief Measures for Breastfeeding Mothers

Relief measures for the breastfeeding woman are designed to get

the milk flow and empty the breasts. This also alleviates the
mother's discomforts.
The following are the relief measures:

1. Carry out breast massage, manual expression and nipple

rolling.

2. Nurse the baby every 2 - 3 hours without missing any feeding or

using any of the supplements.

3. Use both breasts at each feeding. Start on the breast, which is

used last during the previous feeding. The baby should be on each
breast for 5-10 minutes to start with and then build-up to complete
empt ing of one breast, which may take about 20 minutes before
switching to the other to finish the feeding. Sucking for shorter
period initially helps to accustom the nipples to the baby's sucking
and minimizes soreness.

Many breastfeeding mothers, who had antenatal breast

preparation, begin breast feeding within an hour of delivery, feed
frequently thereafter and use both breasts to avoid undue breast
engorgement:

1. Apply warmth to the breasts, prior to each breastfeeding to

promote milk flow. This can be accomplished with warm
washcloth on breasts or warm shower.

2. Manually express the milk if there is en gorging of the areola, to

soften the area prior to nursing the baby. This will help the baby
latch on to the nipple properly and easily.
3.Use manual expression of milk to empty the breasts after the
baby has nursed if they are still uncomfortably full and engorged.

4. Maintain good support to the breasts without any pressure

points. A nursing brassiere may be worn for this purpose.

5.Ice bags may be used between feedings to deduce swelling and

pain.

6. Analgesics may be used if needed.

Perineal (Stitch) Pain

Before any measures are instituted, it is essential to examine the

perineum to ascertain, if the woman is experiencing normal pain
or if a complication, such as hematoma or infection, is developing.

Perineal comfort measures are as following:

1. Ice pack, ice bags or rubber gloves filled with crushed ice or ice
chips can be applied. Ice bags or packs should be wrapped in
 sterile towel or any clean disposable soft material. These are most
useful in reducing the swelling and numbing the area in the
immediate postpartum period especially if the woman had a third
or fourth degree laceration.

2. Topical anesthetic spray or ointment may be used as ordered. If

an ointment is to be used the woman should be instructed to wash
her hands before applying it.

3. Sitz bath two to three times a day.

Many women consider the sitz bath most soothing of all the
measures.
A modification of the same idea is to pour warm water over the
perineum. This can be a part of routine perineal care after voiding
and defecation. The warmth of the water increases circulation and
promotes healing. The warmth and motion of the water are
Explain the care of
engorged breast & soothing.
cracked nipples

Constipation

Stool softeners or mild laxatives are usually ordered for women

with third or fourth de gree repair of perineum. Multiparas with
lax abdominal wall may also require measures to avoid
constipation.

Hemorrhoids

If the woman has hemorrhoids, they may be quite painful for a few
days. Relief measures include the following:

 Ice bags or packs

 Medicated compresses

 Analgesic or anesthetic spray or ointment

 Heat lamp

 Warm water compresses

 Stool softeners

 Rectal suppositories

 Replacement of external hemorrhoids in side the rectum.

BREASTFEEDING DIFFICULTIES AND MANAGEMENT

A mother who is breastfeeding for the first time is in a vulnerable

position and requires support, encouragement and knowledgeable
assistance. She has to make the transition from being insecure,
anxious and self-doubt to being self-assured and confident in
herself and her abilities.

Preparation for Mother

The mother should be prepared for each breastfeeding and helped

with the following measures:

1. Assume a comfortable position, which also allows proper

positioning of the baby. Side lying, reclining or sitting position
with generous use of pillows for support and comfort.

2. Her bladder should be empty and should have received comfort

measures for any afterpains or perineal discomfort prior to
breastfeeding time.

3. Assure of available help as necessary. 4. Rested and relaxed.

5. Hands should be washed and nipples cleansed by gently wiping

them off with plain water.

Preparation for Baby

1. The baby's immediate preparation includes having a clean
diaper and if absolutely necessary to be swaddle wrapped.

2. Position the baby so that he or she will not be doubled up or

have a twisted neck when sucking and the head and body are
supported.

Positioning

In bringing the baby and breast together, the following steps are
helpful:

1. Let the baby find the breast and grasp the nipple. Do not thrust
the breast in the baby's face.

2. Help the mother to hold the breast beyond the areolar area, so
her fingers will not interfere with proper positioning of the baby's
mouth and gums on the nipple.

3. Touch the baby's cheek with the nipple, so the baby will turn
toward the breast (use the rooting reflex).
4. Express few drops of colostrum, so they are on the surface of
the nipple. This pro vides the baby with instant gratification and
reinforces learning.

5. As the baby grasps the nipple, the mother must make sure that
the baby has enough of it for proper positioning in the mouth. The
baby must grasp more than just the end of the mother's nipple to
compress the lactiferous sinuses located beneath the ar eolae in
order to obtain colostrum or milk

7. Once the baby mouth is properly positioned well on to the

areola; the mother releases her grasp of her breast. As the baby
starts sucking and swallowing, she must provide breathing space
for the baby, if needed, by pressing with a finger on her breast
where the baby's nose is. This is needed only during the learning
period and when the breast is engorged. Babies usually suck a bit,
rest a bit (maintaining their hold on the nipple while they rest) and
then suck some more. The mother must be prepared for this.

7. Suction must be broken before trying to remove the baby from

 the breast by slipping a finger into the corner of the baby's mouth
and between the baby's gums. Once the suction is broken, the baby
is removed from the breast without injury to the nipple. The baby
is then burped and put to the other breast.

Establishing Lactation

Lactation is established by a combination of the following:

1. Starting breastfeeding as soon as pos sible after delivery.

2. Frequent feedings during the first few days, using both breasts.

3. No missed feedings.

4. No supplementary feedings. Rotation of breasts as the starting

State the post procedure and ending to provide for complete emptying of both breasts.
care and after care

5.Tension free, painless, rested and relaxed mother during feeding

times.

6. Baby properly positioned on the breast.

7. Supportive spouse. After first few days, the baby will settle into
his/her own pattern of feeding frequency. A self-demand
scheduling (i.e. feeding the baby when he/she is hungry) can be ad
opted rather than a rigid scheduling.

Breast Care

The final factor in successful breastfeeding is effective breast care.

Breast care and preparation for breastfeeding begin in the
antenatal period. Breast care while breastfeeding, is as follows:

1. Wash the nipples only with water. Soap, alcohol or any other
drying agent can lead to cracking of the nipples. 2. Expose the
nipples to air for 15 - 30 minutes after a feeding.

3. While exposing the nipples to air, expose them also to sunlight

and/or use dry heat from a 25-watt electric bulb or sunshine.

4. Following exposure, rub a nipple cream, vitamin A and D

ointment' or other pre scribed ointment.
4. Provide good support to the breasts.

5. If breasts become engorged, care for them..

6. If the nipple becomes tender:

a. Enhance the let-down before feeding with warmth, as discussed

for care of the breast during engorgement.

b. Nurse on the less sore nipple first until there is let-down, then
switch the baby to the sorest nipple to empty that breast, then
switch back to the less sore nipple to finish the feeding.

c. Use a pacifier to meet the baby's sucking needs rather than the
end of feedings on the nipple.

d. Breastfeed more frequently for shorter periods of time.

e. Be sure to use a combination of exposure to air and heat after

each breast feeding, followed by thorough application of nipple
cream.
8. Be sure to break the suction, before re moving the baby from
the breast

TO MAINTAIN A CHART:

A progress chart is to be maintained noting the following points:

(1) pulse, respiration and temperature recording 6 hourly or at

least twice a day,

(2) measurement of the height of the uterus above the symphysis

pubis once a day in a fixed time with prior evacuation of the
bladder and preferably the bowel too,

(3) Character of the lochia and

(4) urination and bowel movement.

POSTPARTUM EXERCISE:
The objectives of postpartum exercises are:

(1) To improve the muscle tone, which are stretched during

pregnancy and labor especially the abdominal and perineal
muscles.

(2) To educate about correct posture to be attained when the

patient is getting up from her bed. This also includes the correct
principle of lifting and working positions during day-to-day
activities.

Advantages gained thereby are:

(1) to minimize the risk of puerperal venous thrombosis by

promoting arterial circulation and preventing venous stasis,

(2) to prevent backache and

(3) to prevent genital prolapse and stress incontinence of urine.

PROCEDURE:

(1) Initially, she is taught breathing exercise and leg movements

lying in bed.

(2) Gradually, she is instructed to tone up the abdominal and

perineal muscles and to correct the postural defects. The exercise
should be continued for at least 3 months.

The common exercises prescribed are:

(a) To tone up the pelvic floor muscles: The patient is asked to

contract the pelvic muscles in a manner to withhold the act of
defecation or urination and then to relax. The process is to be
repeated as often as possible each day.

(b) To tone up the abdominal muscles: The patient is to lie in

dorsal position with the knees bent and the feet flat on the bed.
The abdominal muscles are contracted and relaxed alternately and
the process is to be repeated several times a day.

(c) To tone up the back muscles: The patient is to lie on her face
with the arms by her side. The head and the shoulders are slowly
moved up and down. The procedure is to be repeated 3–4 times a
day and gradually increased each day. Physical activity should be
resumed without delay.

(d) Sexual activity may be resumed (after 6 weeks) when the

perineum is comfortable and bleeding has stopped.

CHECK-UP AND ADVICE ON DISCHARGE:

A thorough check-up of the mother and the baby is mandatory

prior to discharge of the patient from the hospital. Discharge
certificate should have all the important informations regarding
mother and baby.

Advice includes:

(1) Measures to improve her general health. Continuance of

supplementary iron therapy,

(2) postnatal exercises,

(3) procedures for a gradual return to day-to-day activities,

(4) breastfeeding and care of the newborn,

(5) avoidance of intercourse for a reasonable period of 4–6 weeks

until lacerations or episiotomy wound are well healed,

(6) family planning advice and guidance — Nonlactating women

should practice some form of contraceptive measures after 3
weeks and the lactating women should start 3 months after
delivery .

(7) To have postnatal check up after 6 weeks.

The method of contraception will depend upon breastfeeding

status, state of health and number of children .

Natural methods cannot be used until menstrual cycles are regular.

Exclusive breastfeeding provides 98% contraceptive protection for

6 months. Barrier methods may be used.

SUMMARY:
 Define puerperium and involution.
 Explain the duration of purperium.
 Enumerate minor ailments of puerperium and its management
CONCLUSION:
majority of postnatal mothers experienced the postnatal minor
ailments such as afterpain, perineal discomfort, constipation, and
fatigue. Health education should be provided to all the postnatal
mothers regarding minor ailments of puerperium and its
management. Providing empathetic and sound advice about
measures relive these discomforts helps promote overall health
and well-being.
EVALUATION:

1. Enlist minor ailments of puerperium.

2.Explain breast engorgement and relief measures to be provided for breastfeed ing and non-breastfeeding mothers.

BIBLIOGRAPHY:

 Annamma J.A. Comprehensive textbook of Midwifery.2nd edition. Jaypee Brothers Medical Publishers. Pg.:120-121.

 Dutta DC. Textbook of Obstetrics. 8th edition. 2015. Jaypee Brothers Medical Publishers. Pg.:172-173.

 Myles. Textbook for Midwives. 16th edition. 2016. Elsevier Publishers. Pg.:515,709.

 Swan D. Obstetrics Nursing procedures Manual. The health science Publishers. 2019. Pg.:158.

 NINE clinical nursing procedures. 1st edition. 2018. CBS Publishers & Distributors Pvt.Ltd. pg.:663-665.
 CLINICAL TEACHING
Subject : Obstetrics and gynaecological nursing

Topic : Management of minor ailments of puerperium

Date : 20.05.2022

Time :

Place : Clinicals

Duration :

Method of teaching : Clinical teaching

AV AIDS : flash card

Group : B.Sc.Nursing IV year

Name of the student : Varna mohan

M.Sc.Nursing I year

CON, JIPMER.

Name of the Evaluator : Mrs. Kanimozhi K

tutor,

CON,JIPMER.
GENERAL OBJECTIVE:

At the end of clinical teaching, The students will gain adequate knowledge regarding,”Management of minor ailments of

puerperium ” and develop positive attitude towards it and apply this knowledge in their future practice.

SPECIFIC OBJECTIVES:

 Define puerperium and involution.

 Explain the duration of purperium.

 Enumerate minor ailments of puerperium and its management