FOUNDATIONAL NURSING KNOWLEDGE

Normal Puerperium

OBJECTIVES
At the end of this session, student should able to

define puerperium. discuss the physiology of puerperium. discuss the management of postpartum care. briefly look at the A&P of breast.

DEFINITION

is a period of 6 weeks which begins as soon as the placenta is expelled.

PUERPERAL PERIOD the reproductive organs return to its nonpregnant state. other physiological changes which occurred during pregnancy are reversed. lactation is established. bonding between new born and parents. mother recovers from stresses of pregnancy.

PHYSIOLOGICAL CHANGES Endocrine System More oxytocin is secreted by posterior pituitary gland to act on the uterus to contract. Placental hormones: HPL, oestrogen and progesterone fall rapidly. Proloactin: remains high for milk production.

OTHER CHANGES smooth muscles of the pelvic floor, perineum, vagina, vulva and bowel are reversed due to fall in the progesterone levels. Excess fluid in these tissues are usually absorbed. Bladder, urethra and ureters regain its muscle tone.

Cardiovascular System Plasma volume reduces to normal proportions.

Breast Prolactin stimulates milk production. Breast becomes heavy and engorged.

Uterus Involution occurs- uterus returns to near non- pregnant state. Size and weight of the uterus decreases.

LOCHIA
The discharges from the uterus during puerperium. Changes occurs in 3 stages;
I.

II. III.

Red lochia (lochia rubra): first 3-4 days. lochia serosa: 5-9 days. Less blood. white lochia (lochia alba): pale, creamy brown. Contains leucocytes, cervical mucous and debris. May continue for 2-3 weeks.

POST PARTUM (PUERPERAL) PSYCHOSIS

is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following child birth. Manic symptoms: euphoria, overactivity, decreased sleep, flight of ideas, irritability, violence and delusions.

PSYCHOLOGY OF PUEPERIUM

Emotional needs provide emotional support praise encouraging attitude family support adequate rest and nutrition rooming in build confidence

IMMEDIATE POST PARTUM CARE

Mother monitor vital signs and check general well being. observe lochia observe uterine contraction ensure empty bladder establish breast feeding

Baby color, pulse, respiration. good breast attachment cord securely fastened passed urine passed meconium

COMPLICATIONS OF PUEPERIUM
1. Postpartum Hemorrhage (PPH). 2. Perineal Tears. 3. Puerperal Sepsis. 4. Fistulae. 5. Breast problems (engorgement/ infection).

DAILY OBSERVATIONS IN PNW general well being temperature, pulse and B/P breast uterus/ lochia micturation perineum/ vulva/ anus legs

ANATOMY OF THE BREAST

A. B. C. D. E. F. G.

Lactiferous duct lobule ampulla nipple subcutaneous fat pectoral muscle rib/ intercostal muscle