Download Nursing Care During the 4 th Trimester

Chapter 21
Nursing Care During the
Fourth Trimester
Nursing Care of the Postpartum
Woman
• Nurse provides care that focuses on
transition to parenting
– Woman’s physiologic recovery
– Psychologic well-being
– Ability to care for herself and her new baby
– Needs of other family members include
strategies in plan of care to assist family in
adjusting to baby
Transfer from Recovery Area
• In traditional setting woman is moved to
postpartum room after recovery
• In LDRP setting woman and infant remain
together in room where birth occurred
• Postanesthesia recovery
– Regardless of obstetric status, no woman
should be discharged from recovery area until
completely recovered from anesthesia
– Transfer from recovery area
Discharge—Before 24 Hours
and After 48 Hours
• Terms for decreasing length of stay of
mothers and newborns after low risk birth
– Early postpartum discharge
– Shortened hospital stay
– 1-day maternity stay
• Laws relating to discharge
– Newborns’ and mothers’ Health Protection
Act
of 1996
– Advantages and disadvantages to early
Discharge—Before 24 Hours
and After 48 Hours—cont’d
• Criteria for early discharge
– Woman recovered and able to care
for self and baby
– Provider and nurse are still
responsible if the woman is
discharged before her condition is
stable
Nursing Care Management—
Physical Needs
• Couplet or mother-baby care
– Infant security
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Prevention of infection
Prevention of excessive bleeding
Maintenance of uterine tone
Prevention of bladder distention
Nursing Care Management—
Physical Needs—cont’d
• Promotion of comfort
– Nonpharmacologic interventions
– Pharmacologic interventions
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Promotion of comfort
Promotion of rest
Promotion of ambulation
Promotion of exercise
Nursing Care Management—
Physical Needs—cont’d
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Promotion of nutrition
Promotion of normal bladder function
Promotion of normal bowel function
Promotion of lactation
– Suppression of lactation
Planning Future Pregnancies
• Rubella vaccination
– If woman is not immune, vaccination is
recommended
– Must use contraception for 1 month
• Rh Isoimmunization
– Rh immune globulin should be given within 72
hours for R-negative women who deliver an
Rh-positive infant
Nursing Care Management—
Psychosocial Needs
• Impact of birth experience
• Maternal self-image
• Adaptation to parenthood and parentinfant interactions
• Family structure and functioning
• Impact of cultural diversity
Discharge Teaching
• Self-management and signs of
complications
• Sexual activity/contraception
• Prescribed medications
• Routine mother and baby checkups
• Dealing with activities of daily living at
home
• Dealing with visitors
Discharge Teaching—cont’d
• Follow-up after discharge
– Home visits
– Telephone follow-up
– Warm lines
– Support groups
– Referral to community resources
Key Points
• Postpartum care modeled on concept of
health
• Cultural beliefs and practices affect
patient’s response to puerperium
• Nursing plan of care includes:
– Assessment to detect deviations from
normal
– Comfort measures to relieve discomfort or
pain
– Safety measures to prevent injury or
infection
Key Points—cont’d
• Teaching/counseling to promote woman’s
feelings of competence in self- and baby
care
• Common nursing interventions include:
– Evaluating and treating boggy uterus and the
full urinary bladder
– Pharmacologic and nonpharmacologic relief
of pain and discomfort associated with
episiotomy or lacerations
– Measures to promote or suppress lactation
Key Points—cont’d
• Meeting psychosocial needs of new
mothers involves planning care that
considers composition and functioning of
entire family
• Early postpartum discharge will continue
to be trend as result of:
– Consumer demand
– Medical necessity
– Discharge criteria for low risk childbirth
– Cost-containment measures
Key Points—cont’d
• Effective means to prevent crisis and
facilitate physiologic and psychologic
adjustments in combination include:
– Early discharge classes
– Telephone follow-up
– Home visits
– Warm lines
– Support groups