CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)

(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

The endometrial surface is sloughed off as lochia, in

three stages:
Module 6: Postpartum / a. LOCHIA RUBRA

Puerperium Care -
-
dark red color
days 1-3 after delivery
- consists of blood and cellular debris
POSTPARTUM PERIOD from decidua.

• 6-week period after childbirth. b. LOCHIA SEROSA

• The mother’s body experiences anatomic and - Pinkish brown
physiologic changes that reverse the body’s - 4-10 days
adaptation to pregnancy. – INVOLUTION. - Mostly serum, some blood, tissue debris.
• Begins with the delivery of the placenta and ends
when all body systems are returned to, or nearly to, c. LOCHIA ALBA
their prepregnant state. - Yellowish white
- 11-21 days
• May or may not include the return of the ovulatory / - Most leukocytes, with decidua,
menstrual cycle. epithelial cells, mucus.
• Most critical period for complications in the
postnatal mother arising from bleeding (post-partum
hemorrhage) is in the first 4-6 hours after delivery, Uterine involution may be delayed by a condition
due to excessive blood loss from the site where the such as:
placenta was attached to the mother’s uterus, or a. the birth of multiple fetuses, hydramnios
from rupture of the uterus during labor and delivery. b. exhaustion from prolonged labor
• INVOLUTION - is the process whereby the c. a difficult birth
reproductive organs return to their nonpregnant d. grand multiparity
state e. physiologic effects of excessive analgesia.

2. CERVIX
PHYSIOLOGIC CHANGES IN THE POSTPARTAL • Flabby, immediately after delivery; closes slowly.
PERIOD • Admits one fingertip by the end of one week
after delivery.
REPRODUCTIVE SYSTEM • Shape of the external os changed by the
delivery from round to slitlike or stellate (star
shaped) opening.
1. UTERUS
• A rapid reversal in size.
3. VAGINA
• Palpated after delivery below the umbilicus, the
• Edematous after delivery.
uterus regresses approximately 1 fingerbreadth
• May have small lacerations.
(1cm) per day until, by the end of the second
• Smooth-walled for 3-4 weeks, then rugae
week postpartum it is a pelvic organ and
reappear.
cannot be palpated through the abdominal
• HYPOESTROGENIC – until ovulation and
wall.
menstruation resume.
• The process is accomplished by the cell size.
• It occurs at the rate of 1 fingerbreadth / day.
4. OVULATION / MENSTRUATION
• Uterus becomes a pelvic organ again in 9 to 10
• First cycle usually ANOVULATORY.
days.
• If not lactating, menses may resume in 4-6
• Clients who breastfeed may experience a more
weeks.
rapid involution.
• If lactating, menses less predictable and may
resume in 12-24 weeks.

5. BREASTS
• NONLACTATING WOMAN
- Prolactin levels fall rapidly.
- May still secrete colostrum for 2 – 3 days.
- Engorgement of breast tissue resulting
from temporary congestion of veins
and lymphatic circulation occurs on 3rd

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

day, lasts 24-36 hours, usually resolves

spontaneously.
- Client should wear right bra to
compress ducts and use cold
applications to reduce swelling.
• LACTATING WOMAN
- High level of prolactin immediately,
after delivery of placenta continued by
frequent contact with the nursing baby.
GASTROINTESTINAL SYSTEM
• Mother is usually hungry after delivery.
• Good appetite is expected.
• May still experience constipation from lack of
muscle tone in abdomen and intestinal tract and
perineal soreness.
OTHER

- Initial secretion is COLOSTRUM, with
increasing amounts of true breast milk
appearing between 48 – 96 hours.
- MILK “LET-DOWN” REFLEX – caused by
oxytocin from posterior pituitary
released by SUCKING.
- Successful interaction results from the
complex interaction of infant sucking
reflexes and the maternal production
and let-down of milk.
6. ABDOMINA WALL / SKIN
• May need 6 weeks to reestablish good muscle
tone.
• Stretch marks gradually disappear or fade to
silvery appearance.
CARDIOVASCULAR SYSTEM
• Normal blood loss in the delivery of single infant is
less than 500 cc (up to 1000 cc normal blood loss for
a c-section).
All other systems experience normal and rapid regression
to pregnancy status.
PSYCHOSOCIAL CHANGES
MOTOR SKILLS
New parents must learn new physical skills to care for
infant (e.g., feeding, holding, burping, and changing
diapers, skin care)
ATTACHMENT SKILLS
A. BONDING - the development of a caring
relationship with the baby. Behaviors include.
a. CLAIMING - identifying the ways in which
the baby looks or acts like members of the
family.
b. IDENTIFICATION - establishing the baby’s
unique nature (assigning the baby his or her
own name)
c. ATTACHMENT - is facilitated by positive
feedback between baby and caregivers.

• Hematocrit usually returns to prepregnancy value

within 44 – 6 weeks. B. SENSUAL RESPONSES - enhance adaptation to
• WBC count increases. parenthood.
• Increased clotting factors remain for several weeks
leaving woman at risk for problems with thrombi. a. TOUCH - from fingertip to open palm, to
enfolding; touch is an important
URINARY SYSTEM communication with the baby.
b. EYE-TO-EYE CONTACT - a cultural activity
• May have difficulty voiding in immediate that helps to form a trusting relationship.
postpartum period as a result of urethral edema. c. VOICE - parents await the baby’s first cry;
• Mark diuresis begins within 12 hours of delivery. babies respond to the higher pitched voice
• Increases volume of urinary output as well as that parents use in talking to the baby
perspiration loss. d. ODOR - babies quickly identify their own
mother’s breast milk by odor.
• Voiding reflex may be altered. e. ENTERTAINMENT - babies move in rhythm to
• LACTOSURIA may be seen in nursing mothers. patterns of adult speech.
• Many women will show slight PROTEINURIA f. BIORYTHM - babies respond to maternal
during the first 1 – 2 days of involution. heartbeats.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

PHASES OF THE PEUPERIUM LOCHIA

TAKING-IN PHASE • Color, amounts, clot, and odor.

• Dependent PERINEUM
• 1-2 days after delivery.
• Mother’s needs predominate, mother passive and • Healing of episiotomy
dependent. • Hematoma formation
• Mother needs to talk about labor and delivery • Development of hemorrhoids
experiences to integrate them into the fabric of her
life. BREASTS
• Mother may need help with everyday activities as
well as childcare. • firmness, condition of nipples
• Food / sleep is important.
• BY THE 3RD DAY – mother begins to reassert herself. ELIMINATION
• Identifies own needs, especially for teaching and
help with her own and baby’s needs.
• voiding, flatus, bowels

TAKING-HOLD PHASE
LEGS
• Dependent / Independent
• pain, warmth, tenderness indicating thrombosis.
• Some emotional liability may cry for no reason.
• Mother requires reassurance that she can perform
tasks of motherhood. HOOMAN’S SIGN

LETTING-GO PHASE Perform foot dorsiflexion.

• Independent PSYCHOSOCIAL ADJUSTMENT

• Usually, evident by 5th or 6th week.
• Shows pattern of life-style that includes new baby
but still focuses on entire family as a unit.
• Reestablishment of father-mother bond is seen in this
period.
• Mother may still feel tired and overwhelmed by
responsibility and conflicting demands on her time
and energies.
POSTPARTAL CHANGES (ASSESSMENT)
VITAL SIGNS
• Individual protocol until stable, then at least one
every 8 hours.
• Temperature over 100.4ºF (37.8ºC) after first 24 hours,
lasting more than 48 hours, indicative of infection.
FUNDUS
1. 1. Overall emotional status of parents
2. Parents’ knowledge of infant needs
3. Previous experience of parents
4. Physical condition of infant
5. Ethnocultural background
6. Additional family support available to parents
• BONDING – the initial step in a process in which the
mutual attractiveness and response between
parents and child develop; pave the way for the
later development of love and affiliation.
• POSTPARTUM BLUES - emotional changes or transient
period of depression (occurring during the
puerperium).
• BABY or MATERNITY BLUES – letdown feeling
accompanied by irritability, tears, and feelings of
inadequacy: related to physiological (hormonal),
psychological and social adjustments in the
immediate and postpartum period.

• Should be firm, in midline, slightly below the ANALYSIS

umbilicus immediately after delivery.
• After 12 hours should rise to the level of the umbilicus
or 1 cm above.
NURSING DIAGNOSIS
• Should regress 1 cm/day thereafter until end of
second week. 1. Alteration in Bowel Elimination: constipation
• Assessment should always be done with the client’s 2. Knowledge deficit
bladder empty. 3. Self-care deficit
4. Alteration in pattern of urinary elimination

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
5. Alteration in family process
6. High risk for alteration in parenting
7. Disturbance in self-concept: role performance
8. Pain
PLANNING AND IMPLEMENTATION
GOALS
1. 1. Involution and return to prepregnancy state will
be accomplished without complication
2. Parental role(s) will be successfully assumed.
3. New baby will be successfully integrated into family
structure.
4. Successful infant feeding patterns (bottle- or breast
feeding) will be established.
INTERVENTIONS (physical care)
1. Assess mother according to individual needs during
first critical hours after delivery; implement nursing
interventions as needed.
2. Implement routine postpartum care after first hour 1
a. Administer medication as ordered (e.g.,
antilactational, oxytocin, and analgesics).
b. Teach perineal care.
c. Perform other care as needed (e.g., heat,
cold applications)
d. Measure first voiding for sufficiency, observe
I&O for first 24 hours.
e. Assist with breast-feeding as needed.
3. Encourage measures to promote bowel function:
roughage in diet, ambulation, sufficient fluids,
attention to urge to defecate. Reassure about
integrity of episiotomy.
ADJUSTMENT TO PARENTHOOD
1. Provide time for parents to be alone with their baby
in crucial early time after delivery.
2. Identify learning needs of parents.
3. Plan teaching to include parents where possible.
4. Help parents realize that fatigue is normal at this
time.
5. Help parents identify and strengthen their own
coping mechanisms.
6. Help parents identify resources available to them.
7. Promote positive self-esteem on part of parents as
they learn new role(s)
8. Provide anticipatory guidance after discharge.
9. Provide information about contraception if
requested.
10. Prepare for discharge: reinforce physician’s
instructions about activities, rest, diet, drugs,
DUQUE, CHRISTINE D.
exercise, resumption of sexual intercourse, return for
postpartum examination.
INFANT FEEDING
The first year of life is a time of rapid growth and
development, necessitating sufficient and appropriate
intake of nutrients. The goals of infant nutrition are to
provide these nutrients without subjecting the new born
to undue stress.
A. CHOICES IN NEWBORN NUTRITION
1. BREAST-FEEDING - also called lactation; provide
exact type and distribution of nutrients needed by
human newborn in amounts needed.
a. Initiated by prolactin, which stimulates milk
production.
b. Also affected by oxytocin, which causes
“let-down” or delivery of milk to nursing
baby.
2. FORMULA FEEDING (BOTTLE-FEEDING) - utilizes
modified cow’s milk, goat’s milk or soy formulas as
basis for provision of 20kcal/oz.
a. Formulas are widely available in ready-to-
feed, concentrated or powdered forms.
b. They have supplemental vitamins; may also
contain added iron.
c. Concentrated and powdered forms require
addition of prescribed amounts of water for
appropriate reconstitution
d. Sterilization of prepared formulas may be
recommended; methods are
- TERMINAL HEATING METHOD - formula
and bottles prepared using clean
technique; entire batch sterilized at end
of preparation.
- ASEPTIC METHOD - sterile technique
and sterile water used to prepare
individual bottles and formula.
B.) NURSING MEASURES TO PROMOTE
SUCCESSFUL INFANT FEEDING
1. Assess previous experience and knowledge of the
process of infant feeding.
2. Demonstrate how to hold baby for breast feeding
and for feeding with formula
3. Show how to burp baby.
4. Allow time for practice with selected feeding
method
5. Provide positive reinforcement for successful
actions.
6. Give written instruction for at-home reference
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
7. Help parents identify progress and pleasure in
feeding infants.
8. If bottle-feeding, demonstrate how to prepare
formula using appropriate method.
9. If breast-feeding, assessed breasts for tenderness or
discomfort and examine nipples for cracks,
bleeding, soreness, and erectility
10. Assist mother with preparation: clean hands,
comfortable position, support as needed (extra
pillows). Demonstrate alternate infant positioning,
e.g., “football hold.”
11. Bring infant to nurse as soon as possible after
delivery.
12. Demonstrate positioning of baby at breast, initiate
rooting reflex, place entire nipple and as much of
areola as possible into the baby’s mouth, depress
fleshy part of breast away from baby’s nose if
needed
13. Allow baby to nurse in short frequent periods,
lengthening gradually in later days. Alternate breast
offered first.
14. Help mother release baby from nipple by breaking
suction of baby on nipple. Check for nipple trauma.
15. Help mother move baby to alternate breast if
needed.
16. Remain with mother at each feeding until she feels
confident.
17. Assist bottle feeding mother with suppression of
lactation, accomplished primarily by mechanical
inhibition.
1. Mechanical inhibition: usually takes 48-72
hours.
- snug breast binder for 2-3 days post
delivery
- applications of cold (ice packs) and
analgesia to relieve discomfort.
- avoidance of heat or other stimuli to
breasts that increase milk production
(including breasts pumps)
- a well-fitting bra until lactation is
suppressed.
2. No approved medications to suppress
lactation.
TIPS FOR SUCCESSFUL BREAST FEEDING
• Breast care
- Do not use soap on nipple or areola
- Expose nipples to air to toughen them.
- Know how to pump breast milk if necessary and
how to store expressed breast milk.
• Nutrition
- Need for good maternal nutrition while nursing.
- additional 500 kcal/day
- 2-3 liters fluid/day
DUQUE, CHRISTINE D.
- Know that certain foods may make the baby
fussy and will need to be avoided.
• Comfort
- Wear a well-fitting bra, use absorbent packs
without plastic coating if leaking occurs.
- Mild uterine cramping during nursing normal at
first
• Medications
- Avoid medications excreted in breast milk
(mother should check with physician before
taking any drugs while nursing). Birth control pills
should not be taken while nursing (decreases
milk production)
• Sources of help
- Inform mother of community support system
available for nursing mother
EVALUATION
1. Involution successfully initiated and progressing
without complication
2. Parents begin to assume new role behaviors and
identities.
3. Beginning integration of newborn into family
structure; bonding established
4. Infant feeding techniques mastered; infant growing
and developing appropriately.
5. Parents are comfortable with infant care techniques
and can demonstrate knowledge.
TEACHINGS: POSTPARTUM / DISCHARGE
A. POSTPARTUM
• Normal events of postpartum period:
physical, psychological
• Information about feeding her infant.
• Basic infant care, including cord care,
bathing, circumcision care, dressing,
handling, signs of illness.
• Safety needs of infants.
• Recommendations concerning activities.
• Specific teaching about any medications
B. DISCHARGE
• Reinforcement of all postpartum teaching
allowing parent(s) time to ask questions.
• Referrals to professional assistance (MD,
CNM, hospital’s maternity unit etc.)
• Referrals to appropriate community
assistance groups (Nursing Mothers, Mothers
of twins, etc.) that meet individual needs.
• Scheduled appointments for postpartal
examination/newborn’s first well-baby
examination.
• Literature to reinforce all teaching.
Excitement and anxiety of discharge may
interfere with learning.