Nursing Care of

POSTPARTal
family
ch- 17-p404
DAY-18
 Types of Lochia
• A woman can expect to have
lochia for 2 to 6 weeks
• First hour check every 15 mins
as well as the fundus
• Check the perineal pads,
evaluate lochia character,
amount, color. Odor, and
presence of clots
 Types of Lochia
• LOCHIA
– vaginal flow following delivery
consisting of blood, fragments of
decidua, white blood cells, mucus
and bacteria
– The separation of the placenta and
membranes occurs in the spongy
layer or outer portion of the
decidua basalis.
• assess its amount
– moderate or scanty
• assess for its odor
– foul smelling lochia indicates
infection
 Types of Lochia
• LOCHIA RUBRA
– a discharge consist almost
entirely of blood with only
small particles of deciduas
and mucus.
– Characterized by red color
of discharge for the 1st 3
days after birth
 Types of Lochia
• LOCHIA SEROSA
– the amount of blood
involved in the cast-off
tissue decreases and
leukocytes begin to invade
the area as they do any
healing surface, the flow
become pink or brownish
in color for 3rd-10th day
 Types of Lochia
• LOCHIA ALBA
- the amount of the flow
becomes colorless or
white, and is present in
most women until the third
week after birth.
 Signs of Abnormal Lochia
Signs Possible Cause
◼ Foul smell ◼ Infection
◼ Large clots ◼ Retained fragments

◼ Excessive amount ◼ Lacerations of birth

canal
◼ Return to rubra ◼ Retained fragment,

after serosa or alba infection

◼ Persistent bleeding ◼ Subinvolution of the

after 6 weeks uterus, infection

VAGINA
• Soft with few rugae
• diameter is considerably greater than
normal
• The hymen is permanently torn and heals
with small separate tags of tissue.

• Edematous after delivery

• May have small lacerations
• vaginal outlet will remain slightly more
distended than before
• Kegel’s exercise
– ↑ strength and tone of vagina
rapidly
CERVIX
• Soft and malleable
• flabby immediately after delivery,
closes slowly
• shape of external os changed by
delivery from round to slit-like or
stellate opening
• never returns fully to pre pregnant
state
• By the end of 7days, the external os is
narrowed to the size of a pencil
opening, and the cervix feels firm and
non-gravid again.
PERINEUM
• Edema and generalized tenderness
• Portions of the perineum may show
ecchymosis from the rupture of surface
capillaries
• Pain in perineal region may be relieved
by:
– Sim’s position
• minimizes strain on the suture
line
– Perineal heat lamp or warm sitz
baths twice a day
• vasodilation increases blood
supply and promotes healing
– Application of topical analgesics or
administration of mild oral
analgesics as ordered
 SYSTEMIC CHANGES
ABDOMINAL WALL/SKIN
• May need six weeks to
reestablish good muscle
tone
• stretch marks gradually
disappears or fade to
silvery appearance
 SYSTEMIC CHANGES
Gastrointestinal System
• Hungry and thirsty
• Hemorrhoids (often present)
• Active bowel sound
• Slow passage of stool due to
relaxin
• Difficult bowel evacuation due to
pain of episiotomy sutures or
hemorrhoids
 THE CIRCULATORY SYSTEM
• Usual blood loss is 300ml to
500ml with a vaginal birth and
500ml to 1000ml with a cesarian
birth
• Haemoglobin will fall from 11g-
10g/dl
• Plasma fibrinogen to have the
same level during the first
postpartal weeks as they did
during pregnancy
 CARDIOVASCULAR SYSTEM
• The 30% - 50% increase in total
cardiac volume during pregnancy
– reabsorbed into the general
circulation within 5 - 10 mins after
placental delivery
• ↑WBC count
– 20 000 to 30 000/mm3
 CARDIOVASCULAR SYSTEM
• The 30% - 50% increase in total
cardiac volume during pregnancy
– reabsorbed into the general
circulation within 5 - 10 mins after
placental delivery
• ↑WBC count
– 20 000 to 30 000/mm3
 CARDIOVASCULAR SYSTEM
• All blood values return to prenatal
levels
– 3rd or 4th week postpartum
• Hematocrit
– returns to prepregnant value
– 4 - 6 weeks postpartum
 CARDIOVASCULAR SYSTEM
• Extensive activation of the clotting factors
which encourages thromboembolism
– Management:
Ambulation is done early
4 - 8 hours after the normal vaginal
delivery
Recommended exercises:
Kegel and abdominal breathing
» on postpartum day one (PPD1)
Chin-to-chest
» To tighten and firm up
abdominal muscles
Knee-to-abdomen
» when perineum has healed
» to strengthen abdominal and
gluteal muscles
– Massage is contraindicated
URINARY SYSTEM
• Marked diuresis
– excess body fluid is excreted after
delivery
• Difficulty of voiding
– in immediate postpartum
• hydronephrosis or increased size of
ureters occurs during pregnancy remains
present for about 4 weeks postpartum
• Urine retention
– due to loss of elasticity tone and loss
of sensation from trauma, drugs,
anesthesia and loss of pregnancy
• Urine tends to contain more nitrogen
than normal
• Lactosuria
– may be seen in nursing mothers
• Slight proteinuria
– during first 1 - 2 days after involution
 URINARY SYSTEM
• Management:
– pouring warm and cold water
alternately over the vulva
– encouraging the client to go to
the comfort room
– let her listen to the sound of
running water
– if these measures fail,
catheterization, done gently
and aseptically, is the last
resort on doctor’s order
 HORMONAL SYSTEM
BSN-II-1
• Level of HCG(Human Chorionic
Gonadotrophin) and human
placental lactogen(hPL) are
almost negligible by 24 hours
• By week 1, progestin, estrone,
and estradiol are at pre-
pregnancy levels
• FSH(Follicle-stimulating
hormone) remains low for about
12 days, and then begins to rise
to initiate a new menstrual cycle
 INTEGUMENTARY SYSTEM
• The stretch marks still appear
reddened and may be even more
prominent than during
pregnancy.
• Excessive pigment on the face
and neck(chloasma) and on the
abdomen(linea nigra) will be
barely detectable.
• Both the abdominal wall and the
ligaments that support the uterus
require the full 6 weeks of the
puerperium to return to their
former state.
 LEGS

• Homan’s sign
– should be negative
– Venous thrombosis in the legs
 VITAL SIGNS CHANGES
• ↑temperature
– 1st 24 hours
– dehydration effects of labor
– A rise of about 38 degree Celsius is
considered as febrile, and suspected as having
infection
– On the 3rd-4th day postpartum, the breasts fill
with milk and the temperature rises
• Bradycardia
– common for 6 to 8 days postpartum
– After birth, stroke volume increases to
accommodate the increased blood volume
returning to the heart.
– The increased stroke volume reduces the pulse
rate between 60-70bpm
 VITAL SIGNS CHANGES
• No change in the RR
• Blood Pressure
– It should be monitored because it
can indicate bleeding.
– A reading above 140mmHg systolic
or 90mmHg diastolic may indicate
the development of postpartal
pregnancy-induced hypertension
 VITAL SIGNS CHANGES
• No change in the RR
• Blood Pressure
– It should be monitored because it
can indicate bleeding.
– A reading above 140mmHg systolic
or 90mmHg diastolic may indicate
the development of postpartal
pregnancy-induced hypertension
 LACTATION
• the mother secreting the
colostrums
• breast tends to become full and
feel tense or tender as milk
forms within breast ducts
• primary engorgement
 RETURN OF MENSTRUAL
FLOW
• If the women is not
breastfeeding, menstrual flow
return in 6-10 weeks after birth.
• If the women is breastfeeding,
menstrual flow may not return for
3-4 months or for the entire
lactation period, and does not
guarantee that the mother will
not conceive
 Nursing Care of Woman During
First 24 Hours
Nursing Management:
Reassure a woman that sudden
crying episodes are normal
Encourage to verbalized her
feelings
Allow her to make as many
decisions as possible
 Nursing Care of Woman During
First 24 Hours
Provide Pain Relief for Afterpains:
Analgesics is effective for relief
Heat to the abdomen should be
avoided
Relieve Muscular Aches
Back rub
Give Episiotomy care
Apply soothing cream or anesthetic
spray
Sitz bath
Promote perineal exercises
Kegel’s exercise
Improves circulation and
decreses edema
Heps regain prepregnant
muscle tone and form
 Nursing Care of Woman During
First 24 Hours
Administer Cold and Hot therapy
Apply an ice or cold pack to the
perineum during the first 24 hours
After 24 hours sitz bath or perineal
hot pack is effective
Administer sitz bath
Use water that is maintained at at 38C
to 41C
Use 3 to 4 times a day for a maximum
of 20 minutes each time
 Nursing Care of Woman During
First 24 Hours
Provide Pain Management
Provide Perineal Care
Teach a woman to include perineal
care as part of daily bath
Promote Perineal Self-Care
Promote rest in the early and
thorughout the pueperium
Promote adequate Fluid intake
Encourage to drink at least 3 to 4,
8 oz of glasses of fluid each day
 Nursing Care of Woman During
First 24 Hours
Promote Urinary Elimination
Prevent constipation
Prevent development of
Hemorrhoids
Assess peripheral circulation
Assess for skin turgor
Assess for edema at the ankle
Homan’s sign
Promote Breast Hygiene
Breast care
 Nursing Care of Woman During
First 24 Hours
Promote Urinary Elimination
Prevent constipation
Prevent development of
Hemorrhoids
Assess peripheral circulation
Assess for skin turgor
Assess for edema at the ankle
Homan’s sign
Promote Breast Hygiene
Breast care
 Nursing Care of Woman During
First 24 Hours
Teach Methods to promote uterine
involution
Lie on the abdomen
It is dangerous to assume a knee
chest position until at least the 3rd
week after birth
 SEXUAL ACTIVITY
• 3rd or 4th week postpartum
– if bleeding has stopped and
episiorrhaphy has healed.
• Decrease physiologic reactions to
sexual stimulation
– expected for the first 3 months
postpartum because of hormonal
changes and emotional factors
 Check the site
1. https://www.youtube.com/watch?v
=ZDP_ewMDxCo
2. https://www.youtube.com/watch?v
=lWAGAu1o4lY