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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 • • • • 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 • • • • Promotion of comfort Promotion of rest Promotion of ambulation Promotion of exercise Nursing Care Management— Physical Needs—cont’d • • • • 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